Then I was going to relate the story about how, in the summer of 2002, I chose to stop taking my medicine the way my doctor directed me to take it, and then I stopped taking my medicine at all.

This was a bad choice. As a result, my illness became an emergency.

Nine hours in the ICU, four days in a private room, and two more weeks of hospital care brought a bill that topped $95,000.

The cost of nine years of care was eaten up by just a few weeks of my irresponsibility. That was cost that the health care industry, including my insurance company, would not have had to bear if I had only taken my medicine as directed.

It then seemed easy for me to extend this argument to all patients with any chronic disease. Do what your doctor tells you and your condition should improve, or, at least, be far less likely to worsen. By patients only complying with their prescribed treatment regimens the cost of health care in the United States would go down.

How much? A lot. As a matter of fact, a New England Healthcare Institute study of health care costs in the United States pegged the added cost of care due to patient noncompliance at $290 billion. That’s 15 percent of the country’s total annual health care cost. And a Medco study found that only 50 to 65 percent of patients with chronic conditions adhere to the medication therapy prescribed for them.

It seemed clear. I am, for my lost summer, and everyone else who does not take responsibility for their own treatment, everyone who does not comply with their doctor’s orders, are responsible for the high cost of health care in the United States.

When noncompliant, a person does not take his or her medicine as directed. This often leads to their condition worsening and results in higher costs of doctor visits, emergency room visits, and hospitalizations. On the other hand, medication compliance can significantly reduce these costs.

According to Medco, for every dollar spent on diabetes medication medical cost savings are $7.00, for every dollar spent on high cholesterol medication medical cost savings are $5.10, and savings of $3.98 are found for every dollar spent on prescription medication for high blood pressure. Mental illness costs are surely similar.

So if simply taking one’s medicine can lead to lower total health care costs, why are so many patients not taking their medication as prescribed?

Reasons for noncompliance include side effects, lack of continuing symptoms, and, yes, irresponsibility. But cost may loom largest.

I have always had health insurance. The co-payment for my medicine is $49 per month when I’m stable (it was higher, but one drug went generic). It goes up during rough patches. I’m responsible. I pay it. I’m well. I thought, perhaps I adhere to my treatment regimen because I am so heavily invested in it.

Maybe if everyone paid a larger share of his own health care bill, compliance with treatment would increase. Maybe personal responsibility, sacrifice when necessary, and more participation by each individual in the cost of his or her care would improve compliance rates and reduce the overall cost of health care.

But the cost of medication to the individual must be considered. As costs increase, fewer can afford to pay them. A study from the National Bureau of Economic Research finds that an increase in medication co-payments from only $6 to $10 results in a 6.2 percent increase in noncompliance and a 9 percent reduction in the share of fully compliant persons. The same study finds that increases in coinsurance lead to even larger increases in noncompliance. As for the uninsured, the American Public Health Association has found that 89 percent have not filled a prescription due to cost.

What was lost on me was some very simple economics. If each individual pays less for his or her prescriptions, compliance increases and the nation and insurance companies pay less of a total health care bill. Unfortunately, the trend in health insurance is for each individual to pay higher co-pays or coinsurance. As these costs go up out-of-pocket expenses may exceed one’s ability to pay. The choice? Noncompliance or increased debt and possible bankruptcy.

So yes, compliance is a choice. And noncompliance greatly increases the nation’s health care bill. Every proposal on the table that makes an individual pay more for his medicine will increase noncompliance and add even more to the nation’s health care bill. High deductibles and higher co-payments charged by insurance companies against each individual will only make the problem worse. Paradoxically, as cost-driven noncompliance pushes total health care costs higher, these same insurance companies may find themselves less profitable over the long run as they face the higher cost of complications caused by medication noncompliance.

Perhaps if insurance companies lowered prescription co-payments more patients would take their medicine as directed and the insurance companies, with fewer complication-related charges against premiums, could actually increase profits. Pharmaceutical companies would benefit as well as more prescriptions would be filled. We should have no problem with health insurance and pharmaceutical companies making more money if the profits they earn come from lower total health care costs and healthier individuals.

As for my, and others’, idea that if people pay a larger percentage of their health care costs they will live healthier, more compliant, lives, the truth is that health and compliance can be expensive. Low-cost prescription benefits must be considered as we approach ideas to lower total healthcare costs. Higher costs to individuals for medication lead to higher rates of noncompliance, which lead to a higher national health care bill that, one way or another, we all must share.

References

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326767/

http://www.hreonline.com/HRE/view/story.jhtml?id=5059249

http://www.nber.org/digest/apr05/w10738.html

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2010/Jun/1408_Morgan_Prescription_drug_accessibility_US_intl_ib.pdf

How then later did I come to embrace cognitive behavioral and related therapies that spell out that we are, essentially, just a mess of behaviors (good and bad)?

If you dig into your family dynamic, and maybe establishing relationships with others from equally dysfunctional backgrounds, you are bound to have a change of heart about old Skinner. Maybe there is something to behaviorism after all, and it can jibe with the deeper therapies that ask you to reflect on early places of pain and identity-molding.

Dialectical Behavior Therapy (DBT) is particularly of interest not just to me, but folks trying to come to grasp with certain subsets of mental illness — borderline personality disorder, bipolar and other depressive disorders. But its principles can be significantly farther-reaching than mental illness circles alone.

There are 4 critical components to the DBT methodology. The categorical names alone should conjure hope for those suffering from mental illness symptoms and individuals afflicted with interpersonal issues at home and in workplace: mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation.

Any reader of Daniel Goleman’s Emotional Intelligence, with an introduction by the Dalai Lama, knows that mindfulness is at the core of human attempts to find balance and centeredness in our own body, as well as connection to others. Nothing is more key for individuals with beginner-level trust in family or therapists or slowly-developing insight into dysfunctional ways of relating to colleagues.

Interpersonal effectiveness involves “strategies” — practical, effective means of dealing with thought, mood and behavioral maladjustments. Yes, actual skills are taught, driven by goals for different situations. (Sound like business counsel?) This is invaluable to those with borderline personality disorder, who “possess good interpersonal skills in a general sense” but are unable to have self-insight to get past “problematic situations” when stress hits.

Now, what better need do we have as humans than to develop distress tolerance? It can help us in our workplace, for ill loved ones, and for ourselves when debilitated by depression, addictive thoughts, or the surfacing of manic traits. This is integral to DBT’s beauty. As in Alcoholics Anonymous, where people are encouraged to discern between what can be changed and what can not, distress tolerance skills involve “the ability to accept, in a non-evaluative and non-judgmental fashion, both oneself and the current situation.”

The heart of helping ill individuals and ourselves lies, I believe, in letting this mindset seep in, allowing for gentle, passive strength. (Not to mention that this simple maxim is a behavioral powerhouse when artfully practiced and applied, and can profoundly affect our professional, family and social life.) “Self-soothing” and “pros and cons” work are two tactics in the distress tolerance strategy, one whose benefits to mentally ill family systems can certainly be equally applied to the needy masses of a larger society.

The last outlined DBT component is emotion regulation, so critical to disorders such as bipolar, where emotional intensity and stress make for frequent anxiety. But we all have encountered situations with bosses and friends that contain these elements. How do we identify obstacles and triggers, and then work on changing emotional patterns? And can we increase positive emotional experiences? Like the mouse after his cheese, is it not possible to stack the deck a certain way in families, in the workplace and within the mental health system so that the satisfaction of getting a little more of that nibble — stability, harmony, collaboration — can happen more effectively and more often?

Want to learn more about dialectical behavior therapy?
Follow our blog, Dialectical Behavior Therapy Understood or read the article, An Overview of Dialectical Behavior Therapy.

The focus for most treatment professionals is on a patient’s symptoms and the alleviation of symptoms. Few professionals delve into how a disorder — like bipolar disorder or clinical depression — changes our identity. Everything we know about ourselves.

Everything we thought we knew about ourselves.

That’s why this recent piece in the NYT Magazine by Linda Logan exploring this issue is so interesting and timely.

Our identities as unique individuals with well-worn and familiar roles in life — mother, confidante, partner, employee — are quickly stripped away when a new label takes over: patient. Inpatient. Psychiatric inpatient. In all of society, there is almost no worse label that could be applied.

The illness then takes precedent. Everything about you fades away. It’s all about treating the symptoms, bringing them “under control” — usually through a combination of medication and structured activities in an inpatient setting. It’s an unsettling and uniquely dehumanizing experience. In our society, I suspect only prisoners experience worse.

Linda tells the long and sad story of her grappling with her disorder — bipolar disorder — while a mother to three children and struggling to complete her doctoral studies in geography:

The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open.

Linda writes, “I would try to talk to my doctors about my vanishing self, but they didn’t have much to say on the subject.”

While some medications affected my mood, others — especially mood stabilizers — turned my formerly agile mind into mush, leaving me so stupefied that if my brain could have drooled, it would have. Word retrieval was difficult and slow. It was as if the door to whatever part of the brain that housed creativity had locked. Clarity of thought, memory and concentration had all left me. I was slowly fading away.

Going back again and trying to regain your identity as a unique person with a number of roles in life can be just as hard.

Philip Yanos, an associate professor of psychology at John Jay College of Criminal Justice, in New York, studies the ways that a sense of self is affected by mental illness. [...] Yanos told me that reshaping your identity from “patient” to “person” takes time. For me, going from patient to person wasn’t so arduous. Once I understood I was not vermicelli, part of my personhood was restored. But reconstructing my self took longer.

Mental health professionals across all professions — psychiatry, psychology, social work, etc. — should be more aware that this loss of self identity is a very real component of some people’s mental illness and subsequent treatment. It should be addressed as a regular component of mental health treatment, especially when the loss is acutely felt.

Because across all of healthcare, we are quick to dehumanize patients and focus only on the treatment of symptoms. Maybe it’s a way some professionals seek to keep their patients at arm’s length — not to become too emotionally connected to them. But in doing so, it also sends a (perhaps unintentional) message to the patient — you are only a constellation of symptoms to me. That’s all we’ll focus on, that’s all we’ll treat.

As professionals and clinicians, we can do better. We should do better to not turn someone in emotional pain into a simple diagnosis or label. If we think of Linda as simply “Oh, the bipolar woman in room 213,” we’ve lost our humanity and our focus.

Linda is now 60, and has lived a life full of color and heartbreak. Her story is worth checking out below.

Read the full article: The Problem With How We Treat Bipolar Disorder

Mindfulness meditation is currently all the rage, and it works. But I am wary of its proponents who claim it can treat (or even cure) mental illness by itself.

Meditation is a powerful tool when used to decrease stress and increase well-being. But if we are to maintain that mental illnesses are biochemical malfunctions of the brain and nervous system, then we must allow room in treatment for medicine. Therapy also has a long history of positive impact on the lives of those challenged by psychiatric disease. Meditation, when added to more traditional and well-tested methods of treatment, can help a patient successfully manage a challenging life. I, and so many others like me, am proof of that.

I am sure that there are people who face serious mental illness well using only meditation. Dan Siegel writes of one teenager who manages bipolar disorder with meditation alone in his excellent book Mindsight.

But the popularization of such case studies may lead people to stop taking medication and pick up meditation in a hope to finally be done with meds. Anyone who hopes for this and changes his own medication regimen without proper medical oversight is asking for relapse and worse.

Another book on the benefits of meditation, Transcendence, by Norman E. Rosenthal, clearly states that meditation for mental illnesses such as bipolar disorder and schizophrenia should only be administered in conjunction with medication and therapy and should be monitored by a physician. I believe this more balanced view will help more people manage the symptoms of mental illness successfully.

Since I have become a disciplined meditator I have had little difficulty with my bipolar disorder. It is only natural to wonder if I could manage as well if I continued to meditate and came off the drugs. In fact, it is very tempting.

But my doctor advises me not to and, after much reflection and concern for my family, I agree. Just as I couldn’t manage this well without the meditation, much research evidence supports the idea that I couldn’t manage without the medication either. I’m not willing to take the chance.

Every person with mental illness to whom I have taught meditation has asked me if I think serious mental illness can be cured. At this point, with what science has discovered, I don’t. But it can be managed, and managed well, if meditation is added to the medical model of drugs and therapy.

Just as the person with diabetes will take insulin indefinitely, I must continue to take my medicine. And just as one with diabetes must adopt a healthy lifestyle to best complement her medication, the person with mental illness must as well. What I am sure of is that meditation is one of the best complements available.

Even the word “survivor” uncovers stigma in the world of suicide prevention. Traditionally it’s been used by those bereaved by the suicide death of someone else, and does not refer to those who have survived suicide attempts.

A few savvy agencies, including the AAS and the American Foundation for Suicide Prevention, are careful to distinguish between “loss survivors” and “attempt survivors,” but more often organizations will simply refer to “survivors,” and they always mean the bereaved when they do.

This might seem like a quibble with language, but in fact illustrates structural stigma among suicide prevention agencies. Attempt survivors simply don’t exist in their language, or in their activities.

For many reasons suicide attempt survivors have been left out of suicide prevention efforts, beginning with stigma, but there are also clashes with the bereaved who can be angry at attempt survivors. This unfortunate situation means that those who have literally survived suicide are rarely able to contribute knowledge from lived experience to the field. Channels are closed.

In my hometown of Vancouver, BC, for example, not only are suicide attempt survivors explicitly banned from volunteering (for two years post-attempt), those with active mental illness are excluded from Crisis Centre BC. (As of the publication date, Crisis Centre BC hadn’t responded to a request to explain their rationale for this policy. I received an email later explaining that people with mental illness are welcome once they have a year of recovery, and the reason for not having attempt survivors volunteer for two years is to avoid triggering and give time for healing.)

As a suicide attempt survivor, I’ve used the knowledge I gained from my lived experience of pain and recovery to help others, through blogging, by creating the Unsuicide Online Suicide Help Wiki, and sharing links to resources and supports on @unsuicide. I have bipolar disorder, which is cyclical in nature, so I’ve fought many battles with suicidal thoughts. I’ve learned what works and what doesn’t, not only for me, but by talking with peers I’ve learned what works for them as well. Books (and apps) like Kate Bornstein’s “Hello Cruel World: 101 Alternatives to Suicide for Teens, Freaks, and Other Outlaws” and Susan Blauner’s “How I Stayed Alive When My Brain Was Trying To Kill Me” are two examples of peer knowledge that have helped many people.

Peers know that bombarding us with trite “inspirational” aphorisms doesn’t help, and can have the opposite effect because it demonstrates a profound lack of understanding and empathy. We know that intentionally guilting us about loved ones makes us feel worse about ourselves (this is one example of how loss survivors and attempt survivors can be at odds). We know all the clichés and why they’re unhelpful. And we know what does help. Not every tip helps every person, but by compiling knowledge we have a lot of powerful wisdom to share.

Why don’t suicide prevention professionals want this knowledge, then? Wouldn’t it provide a tremendous amount of insight, and useful feedback on services? Couldn’t it help save lives? Why are we being overlooked? Are we considered incompetent? Failures? Traitors to life? Contagious?

What Happens Now is a groundbreaking work that explores these themes and more. If you want to keep up with the cutting edge of suicide prevention, this is truly it.

If you are experiencing suicidal thoughts, read this first. Find help near you through the International Suicide Prevention Wiki, or the Unsuicide Online Suicide Help Wiki if you’re not comfortable using a phone. Also check out the Suicide Project, a place to share your suicide story with others.

It’s been hard to sit at all, let alone for the 30 minutes I meditate each day. I find myself agitated and fidgety. My thoughts are all over the place.

This is not unusual during meditation, but in taking note of the subjects of my thoughts, I can see hypomania creeping in. I’m thinking of buying stuff. I’m thinking of trading stocks. I’m thinking of another career change, discarding good ideas for more exciting, if undoable, ones.

All of my thoughts are about getting and doing. Anything. Right now I feel smarter, more creative, and more energetic than I usually do. That might be dangerous, but that’s what I’m feeling, and that’s what I encounter during meditation.

And here’s where mindfulness meditation really helps.

I’ve picked up these early signs of hypomania, so I can work to avoid myself going full-blown manic. During meditation, which I now have to force myself to do, I become calm for a time and clearly see the maelstrom I’ve entered. I give my wife my credit cards. I walk past the corner pub without going inside.

I also implement the two-week rule for purchases, investments, changing my LinkedIn profile, and publicly flouting new ideas. The two-week rule allows me to note what I want, or want to do, and set it aside. If, two weeks later, it still seems like a good idea, I can act on it. Meditation sessions keep me honest. I note if I’m breaking the rules, or planning anything big and stupid.

This is when meditation becomes a little different. In quieter times, while focusing on the breath I note thoughts and release them, always returning to the present moment.

But when I recognize the signs of creeping mania (or depression), I incrementally change my relationship to my thoughts. As they arise, I pay a little more attention to them as I note them. I investigate what my thoughts are about.

Are they fantasies? Is there anger? Am I subconsciously planning? What thoughts keep returning? Are there consistencies, or even deep inconsistencies? As I note repeating and defeating thoughts, I can see how they are affecting my behavior when I’m not meditating. Then I can make what changes I need to make in my day, my plans, and my expectations, and avoid trouble.

So here’s hypomania. Although it can lead to very bad things, it has its benefits. As I stated, I think it does make me more creative and energetic. By meditating, staying present and responsible, and noting my thoughts, I can both stay focused and harness some of that energy and creativity. Meditation helps me hold on to the good ideas and keeps me away from acting out the bad ones.

Anyone who’s experienced hypomania and felt the energy, charisma, and flush of ideas it often brings, knows that if we could bottle this stuff we’d make millions. But we can’t bottle it. If left to ramble it often becomes grandiosity, poor judgment, and hurtfulness.

Through the focused attention of mindfulness meditation, I can harness the positive and avoid the negative. This episode will pass, and I hope to leave it with my life intact — and a few good ideas.

When a person hears the word “bipolar,” his or her mind usually immediately jumps to the depiction of roller-coaster mood swings and lashing out.

Yet, this is not always the case with bipolar disorder. Bipolar can also affect your thoughts. Some people — like myself — experience a different version of the mental illness where many of your symptoms are internalized.

My illness varies from depressive apathy to euphoric mania which can be accompanied by a delusion or hallucination. I have not had the more severe experiences in about five years, thanks to therapy and medication. Though my journey to recovery was a difficult one, it is not an impossible feat.

It was two days after my fifteenth birthday that I had a full-on episode. I can remember it as clear as day.

First there was the fever, then a slow numbing to the core with sounds around me heightening, and nonexistent pain causing me such unbearable agony. Light burned, sounds screamed, and the depression was unbearable — it left me nearly incapacitated. My mood was so flat that people who hadn’t seen me prior had quickly judged it as something more severe.

Prior to this episode I was living at a boarding school for high school students. My behavior was erratic for several weeks prior to my episode, and had also instigated feelings of neglect from other students, who either felt sympathy or who bullied and harassed me.

I could not be talked down from the mania. Eventually I had climbed so high that I crashed into a severe depressive episode. My dad consulted a doctor, who immediately jumped the gun by telling me I might be smelling things that weren’t there or tasting or sensing things that weren’t real. That didn’t happen, though.

What did happen was I listened to Sarah McLaughlin on repeat for hours on end, trying to divine any emotional contact from her words. Nothing I did was bringing me back to myself. I was trying, in my own way, but it was painful.

Then came the hospitalization — I had been betrayed by my parents. I was put on Risperdal, and thus began the catatonia and shortly thereafter a suicide attempt after missing a dose: I walked into a field of icy water and nearly froze to death.

The second hospital, which my dad had to fight the insurance to pay for, was a disaster. After the psychiatrist there finally told my parents that they could not keep me any longer for fear of making me worse — and several abuses which I reported in writing — I had post-traumatic stress disorder. At age 16, I left a meeting with my psychiatrist to find “paranoid schizophrenia” circled on a sheet of yellow paper.

This label continued to define me for several years, and caused me a very confusing internal dilemma. I began to mimic the behaviors of schizophrenics on forums, and applied the label to myself to understand what was wrong. My dad was utterly convinced of it, as it was something to explain the catastrophe.

But, I really do have bipolar disorder, which my doctor realized when I was 17. Trauma caused my condition to worsen. This was clear only after fighting with doctors who too quickly labeled my behavior as erratic, not eccentric. I actually began to hear voices for the first time when I was 17, inside a hospital before they sent me home.

So does it matter what you call it? Yeah, it does. If I had actually had someone to talk to those times in the hospital, instead of being ridiculed for my behavior from staff more than patients, I would have recovered more quickly. I’d not been so plagued if they hadn’t tried to diagnose what they saw, not the actual chemistry behind it.

At 24, I am still the same as ever, but there is definitely a wound. I endured severe trauma in an understaffed hospital. I wonder exactly what was going through their minds when they verbally harassed me. Did they not understand that I had just attempted suicide and was traumatized?

If it weren’t for my voice — the same one which spoke out against treatment in the beginning — I wouldn’t have recovered. The same stubbornness that told me to say I didn’t want a certain medication was the same stubbornness that said I wanted to heal and recover. You don’t break someone to get them to comply, you try to put yourself in their shoes and understand where they’re coming from. If you’re trying to break people who are sick, you are coercing them, not helping them. I feel that this point needs to be heard.

I am on medication now, and have been on just one for about six or seven years. It works to help with depression and mania. I would not be better had it not been for my family, though stubborn themselves, who have loved me unconditionally and were always there for me when they could be. We have all learned from this mental illness, so implore people everywhere to learn what they can about bipolar and other disorders. If people were more open to reaching out to those who need help, more people will recover. Insight is the key.

Yes, I have been scattered, unkempt, flighty, undependable, and absent. But I have also, at times, been able to carry out with incredible focus to minute detail tasks that I could never stick with if not at least mildly manic.

While the energy to work and the attention to detail did not always congeal on a reasonable or desirable task, the results were often impressive.

But then, I’ve also spent an awful amount of time lying around doing nothing. Not contemplating, not planning, not even daydreaming. Just depressed. Could there be a way to predict moods? A way to harness and apply a disciplined approach to managing symptoms?

Too often we equate discipline with punishment or control. But The American Heritage Dictionary offers the first definition of discipline as training expected to produce a specific character or pattern of behavior, especially training that produces moral or mental improvement.

Viewed in this way, discipline can be very positive. Self-discipline can lead to self-improvement. A regular meditation practice is a tremendous exercise in self-discipline. And this self-discipline can help one to manage and even predict difficult times with mental illness.

Mindfulness meditation, for most practitioners, is about cultivating an ability to stay aware of the present moment in order to manage stress. But for those suffering from a chronic illness, it can also be diagnostic.

Prior to becoming a meditator, I all too often found myself in the midst of a hypomanic or manic episode, unaware how things had gotten so carried away. While meditating, however, I can sense the very small changes in mood that signal an oncoming episode.

Thoughts, emotions, and behavior patterns often become clear during meditation sessions. Fleeting, disorganized thoughts, looming grandiosity, and kinks in self-control can all pass unnoticed in a busy schedule. Soon, the negative symptoms have grown so large that positive behavior is buried by irresponsibility and self-destruction.

But if I take time to stay present each day, and to remove myself for a time from the onslaught of distractions in life, early clues of changing behavior become apparent.

Once a pending episode is revealed, adapting to and preventing further behavior changes can be handled by avoiding stressful situations, getting enough sleep, rallying friends and family, and calling the doctor (if necessary). A plan previously put in place to best handle oncoming episodes can be carried out, and a major episode can be avoided.

Used this way, meditation not only affords a way to manage stress, but it provides a tool to manage changes in mood and breaks in rational thinking. Meditation can help both diagnose and manage the symptoms of chronic illness.

Plummeting into darkness on occasion made me a burden. When insomnia attacks, I get frustrated and the anxiety builds up — that deep gut feeling where everything is my fault. It’s 3 A.M. and I think about all the times people have promised me that things will get better. But they don’t.

I’m in the office with the psychiatrist and he diagnoses me with the “bad medicine.” He tells me it works for manic-depressive symptoms in children. It was the dark purple kind. In other words — bipolar. But my mood disorder is not that heavily diagnosed yet.

I turn to my laptop in my room. I take a sip of coffee or tea and close my eyes. I look at the blue capsules that hold my pills. I can’t forget to take my medicine or dangerous things happen. Terrible things. It’s never simple to live with but it keeps me stable most of the time.

I keep a list of the times I’ve changed myself. It’s located in the back of my closet, concealed beneath old sweatshirts that I don’t wear anymore. The pushpin binds itself to the wall from the cracking plaster; it reveals the times I’ve become a different person.

I track the months and color-code for whenever my mood changes, I switch crowds, or flip my attitude around. Sometimes, I think it’s getting better since I don’t let it interfere with my life or change who I really am.

It’s strange. I delved into emptiness because I focused on the absence of living. If I were really better off alone, I would not feel the need to connect with others. I would isolate myself and never need anyone. I had my illness to overcome.

With neglected makeup and last night’s eyeliner smeared over my face, it looks as if they’re tire marks. The sky is obnoxiously blue. If it rains it would match my mood.

It’s different with friendships. If I can’t fix problems between my parents, or my inner voice, at least I can talk to Linda. I grab the phone off the bedside table and talk to my middle-school best friend before she moved to California.

She listens while I turn on my crying-and-talking fast mixture. At the end of our conversation, she sings me a song (vanilla twilight), which makes everything okay again.

In a mid-second of a blink, I found out things get much worse later in life. If you are blessed enough that God doesn’t give you a crippling illness and anxiety to count the days until your life ends, consider yourself lucky.

I remember my psychiatrist telling me to be myself. That’s the only way.

It was a long struggle back to reality. After, I decided to keep a journal. I began getting my poems published by various magazines and journals. I also worked for The Student Review. Things started to change again.

Being diagnosed at an early age has helped my recovery since then. There was a time where all my social interactions were unethical because I couldn’t find stability. It’s like a virus, it takes all of my strength to fight it.

And the memories. My inspiration has always reached out to show me a different path. I believe there is faith in even the littlest parts of life.

I have hurt those who love me, squandered my savings, lost jobs, behaved very poorly, and even attempted suicide.

As episodes ended, the knowledge of what I had done made me feel so alone, so separate from those close to me. Isolated even from strangers. The worse I felt I behaved, the more I felt undesirable. Immoral acts left me feeling as if I had no one.

Mental illness and its associated behaviors can make one feel wrong without equal. A sense that only a very sick person would commit such transgressions can drive one inward and away from those who can help. We often push those who want to help away. Fear of hurting or disappointing others leads to strained and severed relationships.

But who hasn’t hurt someone? Who hasn’t lost money, stayed in bed, embarrassed himself in public or acted cruelly? No one is infallible — we all have flaws.

Could it be possible that our egregious behavior actually joins us to others? Love, grace, and honesty support humanity. But humanity screws up. Why should our failures leave us feeling so apart when everyone has failed?

Perhaps the very things that make us feel alone are the things we have most in common with others. Perhaps the acknowledgement that we share failure can make us more able to share success.

This does not give us license to continue to hurt others and ourselves. But it does allow us to forgive ourselves.

Just as we can forgive others for transgressions against us, we must forgive ourselves for our failings, rejoin humanity, and move on. We must see the behavior that most embarrasses us as an opportunity to practice self-compassion. We should hold ourselves gently and let guilt and regret go. Then, and only then, can we seek forgiveness from others. For how can we ask to be forgiven if we haven’t first forgiven ourselves?

Everyone who hurts, and everyone who has hurt someone else, has something very deep in common. This hurt is independent of any diagnosis. Hurt is not a symptom. It’s part of being human, something we all share.

With something so profound in common with everyone, why should we feel so alone?

So that’s why I’m pleased to introduce Her Bipolar Life, with Kat Dawkins. I’ll let her explain the purpose of the blog in her own words…

This is the chronicling of Kat — and all young Bipolar women — navigating through life a little more creatively than most of the female population. It makes us stronger, it makes us more interesting, it makes us who we are.

How, as Bipolar women, do we blend the inevitable difficulties of Bipolar with the necessary demands of life — work, education, dating and marriage, relationships, children, self-care, body image? We will explore these issues and then some. I will provide young Bipolar women with something to relate to and something to learn from.

A new bipolar blog from a woman’s perspective focused on women’s issues?

Sounds like a valuable addition to the Psych Central family (as well as for the Internet as a whole!). Please give her a warm Psych Central welcome over on her blog today, Her Bipolar Life.

With so many apps on the market, it’s hard to know which are useful.

Many are designed by software developers instead of psychologists, without scientific testing. They range from beneficial, to harmless but useless, to bordering on fraudulent.

The apps selected for this list make no hucksterish claims and are based on established treatments. Progressive Muscle Relaxation, for example, has been used for a century and is likely just as effective in this new medium. Knowledge from Cognitive Behavioral Therapy and Dialectical Behavior Therapy enrich two apps on this list. Others mix solid information with ingenuity.

Don’t forget to download the free PsychCentral app to keep up with the latest mental health information.

1. BellyBio

Free app that teaches a deep breathing technique useful in fighting anxiety and stress. A simple interface uses biofeedback to monitor your breathing. Sounds cascade with the movements of your belly, in rhythms reminiscent of waves on a beach. Charts also let you know how you’re doing. A great tool when you need to slow down and breathe.

2. Operation Reach Out

Literally a lifesaving app, this free intervention tool helps people who are having suicidal thoughts to reassess their thinking and get help. Recommended by followers of @unsuicide, who report that this app has helped in suicidal crises. Developed by the military, but useful to all. Worth a download even if you’re not suicidal. You never know if you might need it.

3. eCBT Calm

Provides a set of tools to help you evaluate personal stress and anxiety, challenge distorted thoughts, and learn relaxation skills that have been scientifically validated in research on Cognitive Behavioral Therapy (CBT). Lots of background and useful information along with step-by-step guides.

4. Deep Sleep with Andrew Johnson

Getting enough sleep is one of the foundations of mental health. A personal favorite I listen to all the time, this straightforward app features a warm, gentle voice guiding listeners through a Progressive Muscle Relaxation (PMR) session and into sleep. Features long or short induction options, and an alarm.

5. WhatsMyM3

A three minute depression and anxiety screen. Validated questionnaires assess symptoms of depression, anxiety, bipolar disorder, and PTSD, and combine into a score that indicates whether or not your life is impacted significantly by a mood disorder, recommending a course of action. The app keeps a history of test results, to help you track your progress.

6. DBT Diary Card and Skills Coach

Based on Dialectical Behavior Therapy (DBT) developed by psychologist Marsha Linehan, this app is a rich resource of self-help skills, reminders of the therapy principles, and coaching tools for coping. Created by a therapist with years of experience in the practice, this app is not intended to replace a professional but helps people reinforce their treatment.

7. Optimism

Track your moods, keep a journal, and chart your recovery progress with this comprehensive tool for depression, bipolar disorder, and anxiety disorders. One of the most popular mood tracking apps available, with plenty of features. Free.

8. iSleepEasy

A calm female voice helps you quell anxieties and take the time to relax and sleep, in an array of guided meditations. Separately controlled voice and music tracks, flexible lengths, and an alarm. Includes a special wee hours rescue track, and tips for falling asleep. Developed by Meditation Oasis, who offer an great line of relaxation apps.

9. Magic Window – Living Pictures

Not technically a mental health app, it makes no miraculous claims about curbing anxiety. However, there is independent research indicating that taking breaks and getting exposure to nature, even in videos, can reduce stress. This app offers an assortment of peaceful, ambient nature scenes from beautiful spots around the world.

10. Relax Melodies

A popular free relaxation sound and music app. Mix and match nature sounds with new age music; it’s lovely to listen to birds in the rain while a piano softly plays.

Do you have a favorite app not on the list?
Please share links in the comments.

This time I was left waiting. Children screamed and people who may be as impatient as I am moved their legs up and down rapidly. Everyone made a socially concerted effort not to look at each other.

I decided to settle in and read. At the rate the room was moving — sort of like a turnover rate at a bad job — it was clear I had at least 30 minutes longer to wait.

I have always found ‘literature’ in doctors’ offices disconcerting, though equally fascinating. After all, where can you find a magazine on parenting (a beautiful woman is holding a golden-haired toddler) and a celebrity magazine (apparently, Angelina Jolie has adopted five children from Nigeria) sitting side by side?

I noticed a brochure rack across the room, near the receptionist station, full of white and blue pamphlets. It always feels sort of weird getting up in a room full of people sitting down, but I made my way across the room with intent, avoiding people’s shoes and a toddler who had planted himself nearby. It contained the usual assortment of literature: six tips to live a healthy life, fascinating tips on how to get 30 minutes of exercise in each day and a guide to drinking more water.

Arranged in the same area, I found pamphlets on recognizing the symptoms of depression, bipolar disorder and schizophrenia and, to my complete surprise, a bleach-white brochure with the words “Understanding Psychosis” in bold and black text. Last time I was stuck in the office I read the pamphlets on getting enough calcium and the increase in cervical cancer among women under 30 years old.

I grabbed the brochure and walked slowly — the toddler had yet to move — back to my seat. It contained a first-person account written by a man who had lived with periodic psychosis and was now recovered. The symptoms of psychosis and their connection to other serious mental illness such as bipolar disorder and schizophrenia was included. But I wondered, did it make sense to have it in the waiting room, sitting beside the pamphlets on arthritis and increasing your fiber intake?

I decided to ask my doctor how he felt about mental illness creeping through societal cracks and into his sterile office. As a woman living with bipolar disorder, I feel it is long overdue. But what might he think, as a practicing physician who may not be familiar with psychosis? After all, it is usually a term, a diagnosis, associated with psychiatry.

My name was finally called and I soon found myself in his office. I will spare you the details of my appointment. I did not walk out with a prescription to cure me, no, I had a cold. Just like half of those sitting in the waiting room. He stood up, a signal for me to do the same, but I remained in my chair and pulled the brochure out my purse.

I asked him, point blank, how he felt about mental illness becoming more mainstream and handed him the brochure on psychosis.

He looked at it, and then back at me, and said simply: “Natalie, it’s about time people become educated on mental illness. I was not aware we had these in the clinic, but I’m damn happy we do.”

And so am I.

I have a question. I have bipolar and depression and things like special family events, birthdays, and the holidays are always hard for me as well as all most everyday of my life. My husband has a hard time dealing with it as well as the rest of my family. How can I make it easier on them and get through the holidays and most important save my marriage from my mental illness?

My husband wants to fix it and instead he makes it worse.

A great question deserving of a great answer.

Ironically, two days later, a friend sent me information on a new podcast distributed by Families for Depression Awareness, a wonderful site offering many resources to tackle the very problem you mentioned. One of their latest podcasts is entitled “Family Communication” and features Laura Rosen, Ph.D., author of When Someone You Love Is Depressed and Trina Mallet, who talks about the support her family provided during her struggle with major depression.

Ultimately your best ally is going to be better education and better communication. One of the best bloggers on this topic is James Bishop at Finding Optimism. He has a great post called “Ways to insult someone with depression.”

I would print this out and give it to your husband so he can be aware of the hurtful sting in some of his comments because people speak them with no intention of being mean (usually). Here are some of the statements James lists:

“This is what life is like. Get used to it.”

“Life isn’t meant to be easy.”

“Just snap out of it!”

“Pull yourself together.”

“Who said that life is fair?”

“You just have to get on with things.”

“At least it’s not that bad.”

“Stop feeling sorry for yourself.”

“You have so many things. What do you have to feel down about?”

“You just need to cheer up.”

“Quit trying to be a martyr.”

“Stop taking all those medicines.”

“I know how you feel. I’ve been depressed for whole days at a time.”

“You don’t like feeling that way? So change it!”

Next, I would print out for your husband James’s post on “Ways to build up someone with depression” because chances are good that your husband is clueless as to what you’d like to hear, what you need to hear. Here are three of James’s suggestions.

1. Be On Their Side

The depressed person will often be defensive, so an accusatory tone is not helpful. Try to convey a sense of understanding. It isn’t helpful to say “Why can’t you just get out of bed?” Instead try “You seem to have trouble getting out of bed in the mornings. What can I do to help you in this area?”

The person may have lost perspective on how big a problem actually is. They will find it hard to hear that what is insurmountable for them is actually not such a big deal. It is unhelpful to say “What’s your problem? You’re upset about nothing.” Instead try “You seem to be finding this issue a big deal at the moment. Can we solve it together?”

When I was very sick, I often thought that my wife was trying to ruin my life. To counter that kind of thinking she would often say “We are a team. I am on your side.”

Depression is an awful illness, a whole world away from pure sympathy-seeking. So you should treat it as such. “I trust you. If you had a choice in the matter you wouldn’t choose to have depression. How about we search for some solutions together?”

2. Give Plenty of Reassurance

Many people suffering with depression feel unworthy of being loved. You need to reassure them frequently. For example “I love you for who you are. I am not going to leave you.”

In a similar vein, they may have lost the ability to recognize their positive attributes. You might reaffirm them with “You are a sensitive person who cares for others” or “People really love you a lot. They think you’re a great person.”

If said repeatedly and with absolute sincerity then it is helpful to say “If you ever need a friend, I am here.”

3. Give Understanding and Sympathy

People with depression can spend a lot of time ruminating on their situation and feeling sorry for themselves. Pointing it out to them is not helpful. Instead, try to sympathize.
“I can’t imagine how hard it is for you, but you have all my sympathy.”

“All I want to do is give you a hug and a shoulder to cry on.”

“I can’t honestly say that I know how you feel, but I want to help in any way I can.”

This is, perhaps, the hardest thing about our illness: we have cast, no physical evidence of our disease, to tell people to go gentle. But with enough education and better communication, many loved ones will come to appreciate our battle.

Fast was diagnosed with rapid-cycling bipolar disorder II at 31 years old in 1995, a time when very little was discussed regarding the diagnosis. Fortunately, knowledge and media coverage of bipolar disorder have improved dramatically over the years. “I’m astonished at how much more people know about the illness,” she said.

Even TV shows are featuring more accurate portrayals of bipolar disorder. “In the past, people with bipolar disorder were practically frothing at the mouth,” Fast said. Today, writers and producers make it a point to get it right. Recently, Fast served as one of the advisors on the hit Showtime series “Homeland” and talked with Claire Danes about her character’s bipolar disorder.

While information has gotten much better, many misconceptions still exist and endure.

Below, you’ll find five persistent myths about bipolar disorder

1. Myth: Bipolar disorder and depression are completely different diagnoses.

Fact: Bipolar disorder and depression — also known as unipolar depression — are not completely different illnesses, according to Francis Mondimore, MD, associate clinical director of the Department of Psychiatry at Johns Hopkins. In fact, he believes this is one of the most misunderstood ideas about bipolar disorder. (He blames psychiatrists for the misconception.)

Patients who believe this myth may oppose the diagnosis “if they don’t have the full-blown ‘manic-depressive’ picture and also resist taking “bipolar” medications like lithium,” said Dr. Mondimore, also author of Bipolar Disorder: A Guide for Patients and Families.

It’s more accurate to think of bipolar disorder and depression as “probably represent[ing] two ends of a spectrum of illnesses,” he said. “The designation ‘bipolar II’ has helped crack this a bit, but this is why the term ‘bipolar spectrum disorder’ continues to gain ground,” he said.

2. Myth: People with bipolar disorder experience dramatic mood swings followed by complete remission of symptoms.

Fact: Some people with bipolar disorder experience this pattern, Mondimore said. (Lithium is typically very effective for these individuals, he said.) However, “Many patients have periods of residual symptoms and less severe but still significant mood fluctuations between episodes of more severe symptoms,” he said. This is especially common if people don’t engage in healthy habits to manage the illness.

3. Myth: Medication is the only treatment for bipolar disorder.

Fact: Medication is an important part of managing bipolar disorder. But it’s not the only answer. Viewing medication as your only treatment option “can lead to fruitless reaches for the ‘right’ medication,” Mondimore said. And it can lead you to avoid making valuable lifestyle changes and seeking therapy, he said.

As Fast writes on her website, “Medications take care of half of the illness, the other half is management.”

Both Fast and Mondimore stressed the importance of leading a healthy lifestyle, including avoiding alcohol and drugs, cultivating good sleep habits, exercising and effectively coping with stress.

Fast includes medication and alternative therapies as part of her treatment plan. Still, she cautioned against thinking “that we can exercise, diet, meditate, walk and rethink our way out of this illness.” (In fact, this is another big myth that persists, Fast said.)

Think of bipolar disorder like any other long-term illness, such as diabetes and high blood pressure, Mondimore said: It requires commitment and comprehensive management.

4. Myth: After having a severe episode, people with bipolar disorder should be able to bounce back.

Fact: If a person with bipolar disorder experiences a severe episode — one that requires hospitalization, for instance — there’s an expectation that afterward they’ll be able to get back to their work and life, Fast said. However, she equated this scenario to people who’ve been in a car crash. You wouldn’t expect someone with broken bones simply to get up and start sprinting.

5. Myth: People with bipolar disorder aren’t trying hard enough.

Fact: People wonder why someone with bipolar disorder just doesn’t try harder. They think that if they exert more effort, they’d have the life they want. They wonder why everyone else who experiences mood swings can cope with them but someone with bipolar disorder can’t. Sometimes Fast has even wondered the same thing about herself.

But this implies that bipolar disorder is a choice, she said. “Would you ever say that to someone with diabetes or pneumonia?” she said.

People just don’t realize how serious bipolar disorder is, Fast said. Thankfully, though serious, it’s highly treatable. Managing the illness is hard work, and finding the right medication takes time. But as Fast said, “Keep trying. Never give up.”