Addressing the more difficult and less discussed aspects of bipolar disorder, such as the high suicide rates associated with the condition, the severe impacts of depressive episodes, and societal stigma & discrimination is never easy. However, in today’s episode, we ask ourselves, candidly, do podcasts like this one ignore the “ugly” side of bipolar disorder? What about mental health speakers, writers, and influencers? Has the desire to put a positive spin on the harsh reality of mental illness gone too far?

Our hosts want to acknowledge the complexity of addressing bipolar disorder and its consequences while still providing hope and encouragement to those affected. This episode was inspired by a listener’s email. As always, we encourage feedback and topic suggestions. Send them to

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website,

Dr. Nicole Washington
Dr. Nicole Washington

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe: Hey everybody. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: And today we’re going to be talking about the ugly side of bipolar disorder. And I want to give everybody a little set up. We get your emails, we get your topic suggestions, and we want you to keep them coming. If you’ve got a question, a topic idea, just any feedback for the show, hit us up at We absolutely get them and they inform the direction of the show. So don’t be shy. But this email that we got and it’s sort of I don’t want to say it confused us, Dr. Nicole. Like it’s confused the right word. It struck us as odd.

Dr. Nicole: Yeah. It was. I think it made us think. It caused us to think about our previous episodes. And how have we approached the topic around bipolar disorder? Have we been too positive in our, in our approach? Have we left people with too much hope? It felt like the person was asking.

Gabe: The person literally said, we want you to cover the ugly side of bipolar disorder. And my kneejerk reaction was, isn’t that all we’re covering? Like, I don’t I don’t really think there’s a pretty side of bipolar disorder. So therefore every episode is covering the ugly side of bipolar disorder. Uh, but through a little bit of an email exchange, the person said, look, you always make it sound like if you try harder, if you work harder, you will be just fine. And it’s creating this idea, at least in this listener’s head, that if she’s not doing well, it’s her own fault, and that everything that happens with bipolar disorder can just be easily maneuvered around if you find your own Dr. Nicole. And that is absolutely not what we’re trying to say.

Dr. Nicole: Not at all. Not at all. I think we both realized that bipolar disorder is a very complex illness. There are mild versions where people hardly have any disruption to their lives from their illness. And then there are people like this particular listener who sent this email, who have had lots of social relationship stress as a result of their bipolar disorder.

Gabe: I want to rip the band aid off right away and talk about suicidality in bipolar disorder, specifically completed suicides because bipolar disorder it. And you can hear my voice cracking a little bit because it just the 15% of people with bipolar disorder will die from suicide. And we don’t hear their stories because they’re gone. Because podcasts like this don’t cover it, because there’s no intervention that, we can’t raise the dead. There’s nothing we can do. We focus on suicide prevention. We focus on helping family members, the survivors of suicide. But I, I feel pretty strongly that we don’t do a good job acknowledging that 15% of people diagnosed with bipolar disorder will succumb to their illness and will die. And I think that creates this illusion that we are sweeping them under the rug.

Dr. Nicole: I think you’re right. It does create that that illusion. And I don’t think we are. I think it’s our not knee-jerk reaction, but I think it’s our reaction to focus on the people who are still here, because we want to be able to support the people who are left behind. We want to be able to support those people who have, many more than 15%, who actually attempt in their lifetime. So I think the numbers range anywhere from 25% to 60% of people who have bipolar disorder will have an attempt. I think we choose to put our energy into the people who are still here, that we still have an ability to affect, not that we discount those other people that we’ve lost. But I think ultimately there’s a place in our hearts and in our brains where we know that there’s nothing we can do about those at this point, but we can fight like heck to try to save the ones who are left with us.

Gabe: It’s really hard to talk about suicide in terms of honoring people who have completed suicide is even as I’m sitting here talking, I’m stuttering. I, I usually have something to say for everything, but all I can say is they lost. Right? Their illness won. It beat them. And even as I’m saying that, I can read emails where they’re like, well, how could you say that they lost? That’s not fair. You’re victim blaming. And there’s this piece of me that’s like, well, that that that’s true too. I don’t mean it that way. It’s just really hard to acknowledge this thing. But I think it’s important to acknowledge, in fact, I know it’s important to acknowledge, uh, despite all of my stuttering and despite my not having strong ways of stating this unequivocally, it creates an idea that these people are no longer important. But I think that there’s a data collection problem here as well. Anybody who’s been on social media has always seen this thing where I drank out of the garden hose. I rode in the back of a pickup truck. I played with sparklers and lawn darts and I survived. Share if you survived, too. And then it has, you know, 1.8 million shares and people are like, see, that’s the good childhood right there. But of course, the problem is, is that all of the people who died from doing those things, they can’t click share.

Dr. Nicole: Yes.

Gabe: They’re, they’re, they can’t click share. So I do think that we need to talk about this. And no matter how uncomfortable it is, because people who have died by suicide, which is ultimately the ugliest side of bipolar disorder, can’t click share.

Dr. Nicole: I think it also goes back to how we think about death and mental illness and mental health disorders. When I was in training, I had an attending who I admired deeply, and I remember a conversation that he and I had about losing patients to suicide. As a psychiatrist, that is that is a very tough thing to deal with. Um, you know, my colleagues who are in oncology or general medicine or surgeons and it in some ways feels more acceptable for them to lose patients than it does for me to lose patients as a psychiatrist. So for me to lose a patient to death, that’s not a natural one. There is always this sense of, uh, like, what did I? What did I do? Like, did I do something wrong? Could I have done something different? Could I have done something better? And so how we even deal with that as a, as a field and how we process through the loss of patience and believe you and me, there is a very there’s a very deep feeling of sadness that happens for most of us when we lose a patient to suicide, when you have fought with somebody and kind of held their hand and walked along the trenches with them in this very deep, dark place, and you’ve done everything you felt like you could do for them, and ultimately they still ended up losing their life to suicide. Like, that’s a very tough place to be as a doctor. Um, and to know what to do with that.

Dr. Nicole: And one of the things that he brought up was that we are very comfortable with death being the end place for cancer patients, for people with certain chronic illnesses. We’re very comfortable with that. We are not comfortable with the reality that for some people with mental illness, death is going to be their endpoint and it may be a self-induced death. And I still don’t know over the years, I think about that frequently when I lose patients to various reasons. When I have to face this issue, I still think about it. And sometimes I agree with him. Sometimes I don’t agree with him. It just depends on the case, I guess. Kind of where I am in life and how I feel. Um, but it does come down to like, you know, what do we think about death and how do we how do we approach that? I have people who sit in front of me every day who tell me, I just want to die, like I I’m not going to do it. I, you know, I have all these reasons that I wouldn’t. Um, but ultimately, there are people out there with bipolar disorder who are fighting just to have a desire to want to get out of bed every morning. And I think that’s hard for us all to deal with, loved ones to deal with, doctors to deal with, peers to deal with. Like it’s hard for all of us to deal with because what do you do with that?

Gabe: We don’t do a good job of talking about death in this country, in America. Right? It’s just it’s always thoughts and prayers. It’s my condolences. We give you three days off work, I guess, and then you’re just supposed to be over it, right? Grief and death is just not something that is handled well. And then you put suicide on top of that, and it just. It’s just a mess.

Dr. Nicole: And I still go back to those people who are still walking among us, but who every day as part of their bipolar illness, whether it’s because of their depression or impulsivity or whatever it is, they just find themselves in this constant fight to even have the desire to breathe. And I think that is just a very tough spot for a person to be in. But there are people that that is their story. So I guess I do agree with the listener who sent the email in. In a way we do tend to wrap everything up with, but you know, if you just do this and if you just take your meds and we can get your mood better and maybe you won’t feel so hopeless and maybe those suicidal thoughts will go away. But I, I know that there is somebody out there listening who thinks that Gabe and Dr. Nicole are full of crap because they say, I’ve done all those things and it hasn’t gone away. And I guess it’s important for us to say, yes, we hear you. Like we understand that that is some of your stories that you deal with every day. We absolutely hear you.

Gabe: We do hear you and we do see you, and we do understand. And that’s the genesis for this podcast, because we don’t want you to be there anymore. We. So I guess what I’m saying is bipolar disorder sucks. It sucks, it sucks, it sucks. It’s evil, it’s bad. It’s awful. I don’t really know that we need to create a podcast to remind people that it’s shitty. I, I think we, by definition, have to create a podcast where we remind people that it’s possible, but I think maybe we move the pendulum too far. And I wonder, Dr. Nicole, as we acknowledge some of these things, like being suicidal every day and not knowing in which direction to go. Is there something that you and I can do better to both acknowledge where people are, but still give them hints, tips, supports and ideas to move forward? Because I don’t want people to think we don’t see them.

Dr. Nicole: Yeah, that’s what we’re doing today. I mean, that that is the whole that is the whole conversation behind do we do this episode? Because I think, like you said, we both started off with but don’t we always talk about the ugly side? Like is there a? Is there an attractive side to having bipolar disorder? And I mean, the only people who think that are people who know nothing about bipolar disorder. So I, I think this is we’re doing it today. So keep the questions coming. Keep your comments coming. There are plenty of ugly sides to bipolar disorder. It’s a prism with lots of ugly sides. Suicide is one of those sides. The massive amounts of legal problems that a person can encounter the, the family relationships that may never get mended. Those are all very, very ugly sides. And maybe we just don’t talk about those things as much.

Gabe: I think we talk about them. We just talk about them too happy and I can respect that, especially if I’m in the middle of it. One of the things that I thought about Dr. Nicole is it is so, so, you know, I’m boisterous, right? I’m boisterous.

Dr. Nicole: You?

Gabe: I’m loud. I’ve got to.

Dr. Nicole: Hmm?

Gabe: Yeah, yeah. Me.

Dr. Nicole: Oh,

Gabe: You didn’t know?

Dr. Nicole: I had no idea.

Gabe: [Laughter] And I use humor. We use humor.

Dr. Nicole: Yes.

Gabe: Right? Just and bringing up heavy subjects and using humor. That’s how I’ve made my entire career. But I can see how somebody might think you’re joking about it, so therefore you’re not taking it seriously. And I want to be clear, I’m I am completely taking it seriously. And I’m not the only one. A lot of people, a lot of mental health advocates use a lot of humor surrounding these concepts with bipolar disorder because, well, frankly, we think they’re funny. And because I can only speak for myself because I’m in a place where I see the humor in it. But I want to be clear, there was no humor when it was happening. I inserted the humor as a defense mechanism later on down the road. And the biggest, biggest, biggest area that that I think people make jokes about are hypomania and mania.

Gabe: We make a lot of jokes about these things, and we laugh a lot about them. And we even say things sometimes like, oh, I wish I could get the mania back. My house would be so clean. There’s just a lot of jokes surrounding mental illness that I personally laugh at all the time. And I’m going to continue laughing at them. This isn’t my I’ve realized I was wrong and I’m going to stop doing it moment. This is my life is complicated. And when I was going through it, I did not see the humor in it. But now that I’ve moved past it, I do see the humor in it. And this becomes very, very difficult because depending on where you are with your bipolar illness, you may or may not find this comforting, funny, or even healthy. And that’s tough because we’re trying to reach a huge range of people. Um, but to, to circle back mania just sets itself up for so many jokes. I mean, they practically write themselves.

Dr. Nicole: And you are right. Humor is a very mature defense mechanism as far as defense mechanisms go, and we use it for a lot of things. I have seen people joke about, you know, losing their hair to chemo after they had cancer. We know cancer is not funny, cancer is not funny, and chemo is not funny. Losing your hair is not funny. But we’ve seen people take those moments and find bits of humor in them because that’s how they deal with them and that’s how they cope with them. And I think we have to be comfortable letting people handle their things the way they need to. So for you as a person living with bipolar disorder, if cracking jokes about your previous mania or hypomania is something that allows you to cope and to handle it, so be it. Do what you do. It is not appropriate, though, I think for me as a doctor, for a loved one, maybe you aren’t the one to crack the joke, right? Like you can, you can, you can snicker at the joke. You can giggle. You can give a look like, oh my gosh, hey, what are you saying? But you are not necessarily the one to bring up the jokes. So I think context matters. We’ve talked before about people being able to deal with stuff in their own way.

Dr. Nicole: You can call it what you want. You can you can laugh at it if you want to. I can’t tell you not to laugh at your stuff, but it doesn’t take away from the fact that we know this is serious. We deal with this every day. I mean, I sit with somebody on a weekly basis who has horrible things that have happened to them in their life as a result of their mental illness. They’re recovering from so many different things. I know how serious this is, I absolutely do. Gabe knows how serious this is. He’s lived it. And sometimes we can strike a nerve with people. And I would just say, if we have struck a nerve with you, you know, not intentionally, not in attempts to make light of your situation, but it may also be a good time for you to kind of reflect and think, you know, why? Why is this striking such a nerve with me? Because that’s usually a place, a place for you to do some growth. I know for me, when I am deeply offended by something, regardless of what it is, it usually is a time for me to just kind of sit with it and figure out what in the world is going on.

Gabe: You know what I think a great title for this episode would be, Dr. Nicole? I think we should call it the Gabe and Dr. Nicole Apology Tour.

Dr. Nicole: [Laughter]

Gabe: But [Laughter]

Dr. Nicole: We’re not, but we’re not. I mean, I don’t think we’re apologizing.

Gabe: I know, I know.

Dr. Nicole: I think we’re saying like, hey, we do. Both things are true. We do. You know, we do joke. We do, you know, lightly talk about things. Um, but we are still realizing that this is a very serious issue. I don’t think we’re apologizing. I think we’re just stating the both and, uh, aspect of the things that we talk about. I don’t think we’re apologizing. I think we’re good. I think we’re good.

Gabe: I think. I think we are too. I think we are too. You know, I want to make sure that we stay on track with the ugly side of bipolar disorder. We’ve done episodes about mania before, where I’ve been very clear that mania is one of those things that people remember as going well, but they actually went horribly. Uh, we just we just remember it wrong. And I don’t think that I can talk about an ugly side of bipolar disorder without mentioning that mania is extraordinarily destructive, but it feels really good. And I think that’s what’s so ugly about it. It’s that you have this memory of how great it feels, but in actuality, it did great damage. And you wake up depressed, which is my long and involved way of saying, let’s, let’s talk about depression with bipolar disorder, because I think that’s another one of those things that never really gets covered. Well, people talk about, well, I couldn’t get out of bed. Well, I couldn’t get out of bed. And I immediately, whenever anybody says that, I offer my 3,700-step method to get out of bed and get out of the house, and that’s not really a joke, because what I say is you need to write everything down, make everything like step one, get out of bed. Step two put on your pants. Step three comb your hair. Like, write it all on the mirror and cross it off one at a time. And if it takes you five hours to get out of bed, that’s fine, because your only goal today was to get out of bed. So five hours is actually. See. And I’m doing it now, right? I’m, I’m on to that positive side.

Gabe: But let’s talk about laying in bed. Because there are some harsh realities when we talk about the ugly side of bipolar disorder that are just never mentioned. And for many people, when they can’t get out of bed, eventually they still have to urinate, Dr. Nicole. And many people with bipolar disorder who have not been able to get out of bed ultimately urinate themselves because they think, you know what, I’m not moving. And it just it becomes a choice that gets made. And I don’t think that that gets talked about a lot, because honestly, I’m not really thrilled about the idea of admitting to people that, you know, I, I peed the bed because I was too depressed to get out of it. It’s

Dr. Nicole: Yeah.

Gabe: Not it’s not something that adults want to say, but it is. It is a reality for many people with severe depression.

Dr. Nicole: Yeah, you’re right. We don’t talk about severe depression enough. Yeah. The person who, you know, hasn’t changed clothes or hasn’t showered in days and days and days and who has strong body odor and nobody in the house wants to be around them, or, you know, who hasn’t eaten in days or who’s eating food that was maybe not even safe to eat, because it has literally sat there at their bedside and they took random bites here and there like those, you know, I, I have I at a time in my life I used to do, uh, home visits. I used to do home visits for people who had severe mental illnesses. The great majority of my patients had either schizophrenia or bipolar disorder. And you see those depressions and you, you walk into somebody’s house and you know, when they’re in a severe depression and you see the signs and those are things that I think had I not seen for myself with my own eyes, I don’t know that I would have even had a great idea or understanding of what depression can look like for somebody. And so I, I get why we don’t get it, but it can be very, very impairing. Think about being so depressed that you are not getting up and going to work, or you’re calling in because you’re so depressed, and then you lose your job, and then you’re facing evictions and you don’t know how you’re going to pay your bills, or you’re sitting in the dark like, these are some of the darker sides of depression that we just don’t always talk about.

Gabe: I was really fortunate, urinating on myself and smelling really bad because, you know, I hadn’t showered in a few days was really the worst of it for me. But you are right. Let let’s talk about this. You brought food next to you or somebody brought you food, and then they don’t show up for a week. And that food just sits there, and then that food gets moldy, and then that food attracts critters. It attacks roaches, ants, etc.. Uh, and then now your environment is it? Well, frankly, it’s unsafe. It’s unsafe. There’s mold, there’s rot, there’s mice, there’s cockroaches, there’s ants. Whatever. So now you’re looking around, trying to trying to muster the courage to move forward. And you’re looking at pizza with green stuff all over it. And I’m not talking about mushrooms. No, nobody needs to say I don’t like mushrooms either. I can’t even get through this without trying to interject some humor. But the many people end up with houses that are that unsafe and start to reflect that because they just don’t have the ability to take care of themselves.

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Gabe: And we’re back discussing the ugly side of bipolar disorder. ​​

Dr. Nicole: And we compare because we say oh well I mean I know somebody who had depression and they were able to go to work every day. I know somebody who had depression, they still took care of their kids. But trust me there, there, there are folks out there whose depression is so severe they’re not taking care of their kids. Their kids are eating, you know, lollipops and cereal out of a box because it’s all they can do is open the box. You know, it’s all they have, the energy, the motivation to be able to do. So, it can get very ugly. Uh, and sometimes those ugly moments call for they call for extra support. They call for extra planning. We do talk a lot about planning on the front end. You know, my motto is stay ready so you don’t have to get ready. You know, most people who’ve had severe depressions like that, you’ve had those before. Most people, this isn’t your first severe depression like that where you’re functioning was impaired. It’s time when you do pull out of that, even if just a little bit, when you pull out of that enough to think, oh my gosh, I’m filthy. Oh my gosh, I smell, oh my gosh, there’s bugs in here. If you pull out of it just enough, it’s time to start planning for what in the world happens when this happens to me again. So I can try not to stay in this place? That’s the time to start thinking about it.

Gabe: I like how you still interjected a little hope.

Dr. Nicole: I can’t help it.

Gabe: I just, you got a little

Dr. Nicole: I can’t help it.

Gabe: I know, I know.

Dr. Nicole: I can’t help it.

Gabe: It, it’s what makes you a good doctor. I really really does. Let’s. When we talk about other ugly sides of bipolar disorder, I really think that we do need to discuss incarceration. Unfortunately, jails and prisons have become sort of de facto insane asylums, uh, people who can’t get treatment, people who aren’t getting help, and then they have a crisis in public. They’re often arrested by well-meaning law enforcement officers, but untrained. They don’t know what’s going on. And I’m I want to be super clear. You know, I talk about being lucky and having a lot of privilege with bipolar disorder as, as a middle-aged white guy in a big city. I, I, I’ve never even been questioned by the police for my behavior, let alone arrested. I, you know, I was able to do many, many things that we’ve talked about on this show before, uh, and, and yet not gotten so much a side eye. Right. It’s, it’s the, just the truth for me. Uh, but we talk to a lot of people and they get arrested for public intoxication, even though they weren’t. It was it was a symptom of bipolar disorder. They get arrested for, uh. Well, frankly, just being loud in public because they were scaring people, because they were yelling things that are unreasonable because of depression or psychosis or mania or a symptom of bipolar disorder. And now they’ve got a record or at the very least, thousands of dollars in legal fees they’re trying to figure out and on and on and on and on and on. I really think a very, very, very ugly side of bipolar disorder is that we’re discussing the risk of law enforcement intervention at all, and an illness in the same sentence. I don’t see cancer groups sitting around and talking about ways to avoid law enforcement when they’re diagnosed with cancer, and yet that’s a real reality for people with bipolar disorder.

Dr. Nicole: It absolutely is. And, you know, during mania, some of those behaviors can be so intense that they can draw lots of the kind of legal things that don’t just go away, that don’t just fall off your record. I, I cannot tell you over the years, I mean, I’ve been practicing for a while now, and I’ve had lots of patients with bipolar disorder who during who during mania have done things that have gotten them on sex offender registries. And once you’re on a sex offender registry, you don’t just fall off, you’re on that registry. I have people who have who have been naked in front of the wrong people. Right. And they have, uh, been charged with indecent exposure and they’ve been put on registries. I’ve had people who have engaged in risky sex behaviors with maybe someone not quite of age and not having the ability to think through that appropriately before they did it because of the mental state they were in. Those people are on registries. That increased sex drive has led people to do a lot of things that have gotten them into a lot of trouble. Those things don’t go away. You’re a sex offender for life. You can’t live near a school. You can’t go to your own kids’ school functions. You can’t go to your kid’s birthday party. There are lots of things that get affected by those kinds of things, and those are some of the things that we just.

Dr. Nicole: We just don’t talk about them. Uh, so. So I guess when we, when we talk about do everything you can to prevent the mania, do everything you can to prevent the mania. It’s not because we don’t want you to have energy, and we don’t want you to be able to get things done and to feel good and have a good time. We’d love for you to do that. But we don’t want you to do it because we know that the ugly side of bipolar disorder is that that good time can come with some super heavy consequences that you just can never escape from. So. So our push to always and maybe we don’t complete the sentence. Maybe we say, well, it’s important to prevent the mania. It’s important to prevent the mania. We should be more like moms who scare their children to death. Like, don’t do that. You’ll fall and bust your face open, and then you’ll have to go have 50 surgeries and blah blah blah, blah, blah. Like maybe we should complete the sentence and keep it going. But really, it’s the ugly side of bipolar disorder. That’s why we’re always harping on like, stay in treatment, take your meds. Like prevent the mania. It’s because we know, we know this stuff is here.

Gabe: I could not agree with that. We should start doing that right. If you don’t treat your bipolar disorder, you will have 50 surgeries.

Dr. Nicole: Well, I mean, maybe not 50 surgeries, but we could say

Gabe: [Laughter]

Dr. Nicole: If you don’t stop yourself from getting mad, you could get manic and you could go out and get naked in front of the wrong person, and you could end up on a sex offender list, and that could hurt you for the rest of your life. I mean, that’s a reality. And we don’t take it that far because we don’t want to be, you know, so negative and always like something really horrible is going to happen to you. But that is the reality. And I think for those people out there who are listening who say, yeah, that was my reality. You know, I think it’s important. Maybe sometimes we need to we need to finish that out.

Gabe: I feel like my joke, treat your bipolar disorder or you could put an eye out would be ill timed after your example,

Dr. Nicole: Yes.

Gabe: But it may or may not make it into the episode.

Dr. Nicole: [Laughter]

Gabe: We’ll see what the censors say. In the same line with, with, with, you know, law enforcement intervention and incarceration being an ugly side of bipolar disorder, the stigma and discrimination against people with bipolar disorder is an equally ugly side. We talk about it a lot. But again, we say it like we understand it, but we just kind of gloss over it and get to the get to the meat of whatever it is we want to talk about. Right? And we don’t really understand the weight and the gravity of these words. Stigma and discrimination is something that people think they understand. But I think people with bipolar disorder understand it differently than the rest of you to, to, to be quite frank. And, and in talking about what it actually looks like to us is, is very different than when people discuss it. And, and we talk about it sometimes in like high levels, right, like trouble getting a job or trouble fitting in with friends or family, etc., or feeling like everybody’s looking down on you and I, and I think those are good examples. But I want to give some other examples, like, let’s say that you want to volunteer for the Big Brothers Big Sisters program, and they see bipolar disorder, like, you can’t be around kids.

Gabe: Uh, let’s say that you want to work with kids in any way. And somebody has an example of, well, there’s that bipolar guy who’s on the registry, and for some reason, all bipolar guys are now the same, even though that’s some other bipolar who has nothing to do with me. Uh, some people believe that people with, you know, bipolar disorder can’t do other activities. Let’s say that you, uh, want to be an Olympic sharpshooter. And people are like, I don’t I don’t know, I don’t I don’t like the idea of you owning a gun. And even though this has been your hobby since you were a kid, you keep having to justify your right to continue this hobby and this constitutional right, and that becomes problematic. And I’m just trying to give a whole bunch of different examples of where something that every other American has the right to do is somehow not available to you because of a diagnosis that you don’t want and that you didn’t ask for.

Gabe: And then that kind of snowballs because these were your hobbies. These are the things that you enjoyed. These were the things that you loved. These are the things that that that occupied your time, that gave you the warm and fuzzy feelings. And those are gone. But you know what? It’s replaced with nothing. So now you just have time to rock back and forth thinking about it. So what it gets replaced with is resentment and anger. And of course, you’ve got this illness that really loves to fan the flames of resentment and anger. So when we talk about stigma and discrimination, it’s it really is this, this despicable thing. And I think that many people don’t understand it the way people with bipolar disorder understand it. So an ugly side is, of course, stigma and discrimination. But I think another ugly side is that people are like, oh, well, yeah, Gabe’s been stigmatized against, but he got over it. He’s fine. I’m not fine. It still hurts my feelings to this day.

Dr. Nicole: Mm-hmm. And for some people that stigma prevents them from doing things that they need to do to get the treatment they need because they say, well, if I disclose or if I’m honest or if I engage, it’s going to affect me negatively. So I’m just going to ignore it and pretend like it’s not a problem because I don’t want to have to deal with that stuff. And that is a problem in and of itself. In in my clinical life, my medical practice is mostly doctors, doctors, lawyers, C-suite people, um, basically people who are recognizable in their community. So if they’re seen in a, in a, in a doctor’s office and a psychiatrist’s office and a therapist office, they may be recognized by somebody who knows them. They may a patient. Right. What do you think? If you are sitting in the psychiatrist office and your kid’s pediatrician is sitting next to you getting ready to be seen, what do you think? If you’re the person who’s going to operate on you next week, is sitting in a psychiatrist office next to you, getting ready to be seen, what do you think? Do you pause for a second and say, oh, good for them. They have some kind of mental health disorder and here they are getting their things taken care of? Or do you pause and think, do I want this person to operating on me? Do I want? So I see a lot of people who don’t want to be seen in a psychiatrist office because of the stigma that comes with that.

Dr. Nicole: I also have a lot of high performing professional people, top of their career, people who declined to be seen. Because of the fact they know that if they’re seen, if they have to disclose to their licensure boards or their bar associations or whoever regulates their profession, they know that there could be some discrimination. Or at least they think that there could be some discrimination because of how things have been handled historically, and they just don’t get treatment at all, which is more of a problem than having to deal with it. So I think the stigma thing goes so much deeper than sometimes we even realize. And I would challenge and I would say that even people listening who have bipolar disorder who are like, yes, stigma. It is horrible. We feel it. You might also have stigma if you found out that the person that was going to be operating on you next week has bipolar disorder. So how would you feel about that? Would it give you pause at all? And if so, I think it just speaks to the deeper problem of just stigma and discrimination. And what in the world do we do about it? That’s what you need to write and tell us. If you know how to fix it, tell us, tell us, tell us because we don’t know. But how in the world do we deal with that?

Gabe: I love that you’ve called people out on this. And as you were talking, I was like, nope, nope, wouldn’t do that, wouldn’t do that. And you’re thinking, oh, you wouldn’t stigmatize? No, I was agreeing with her. I, I wouldn’t use the surgeon. I wouldn’t use the lawyer, I, I just when I started dating, I was like, okay, I don’t want to date somebody with mental illness. My mental illness is enough. And some people are like, well, that’s not stigma. That’s a personal decision. Like you’ve got to decide what you can handle. Except I hadn’t met the person yet. I just I stereotyped all people with mental illness as being like Gabe, and that was just too much for me to handle. I and I, I’m it’s sort of a moment of brevity where I’m trying to be funny, but it, it’s also lending credence to what Dr. Nicole is saying, which is somebody out there who is doing this high-level thing and recognizes that they are not at their best because of a mental health issue, is now not seeking help for it because they’re right. Somebody with a mental health issue, people would be leery of hiring and therefore it would hurt their career. And now all of us who are like, hey, look, if that person’s getting treatment for mental illness, we don’t want to hire them now, we are in fact hiring them unknowingly, except they’re not getting treatment for their mental illness. And that completes my circle of complexity here, because the thing that we’re trying to avoid, people with mental illness being in positions of power over us, where the stakes are really, really high, like surgery or legal defenses or our money, etc. they’re still there. They’re just not receiving treatment. So we made it worse. We just don’t know it. And somehow that makes us feel better.

Dr. Nicole: It does sound a little, a little odd when you when you put it that way, but it absolutely is true that there are people out here who are not getting their mental health needs met from a variety of walks of life, variety of professions, different socioeconomic statuses. Because you know what? Bipolar disorder does not discriminate. It does not only target poor people, it does not only target people who are not educated. Uh, it everyone is fair game. And so I think we just have to think about our own biases and stigma as we are maneuvering all of this, this world of, of how do we fix it? Because it’s easy for us all to kind of stand on our soapbox and be outraged about stigma and discrimination. But we all to a degree have some have some stigma and discrimination when it comes to this topic.

Gabe: I have to say, trying to figure out what to put in this episode was a lot harder than I thought. I was like, well, the ugly sides of bipolar disorder? Okay, well, you’ve got depression, you’ve got mania, you’ve got hypersexuality, you’ve got you’ve got symptoms, you’ve got access to care. And it turns out that, well, you’ve already listened to the episode. So you know what we put in there. But I don’t want people to think that that was an exhaustive list. Here’s the reality. The ugly side of bipolar disorder is bipolar disorder. Every single thing that bipolar disorder touches, it ruins, and it makes ugly. The only reason that bipolar disorder has any I don’t I don’t know, like like PR at all is because of the things that we do in spite of it. It’s the way that we rise up and achieve things and somebody’s like, oh, you know that guy who did that amazing thing that I respect? He has bipolar disorder. Hey, you know that woman who did that amazing thing that I respect? She has bipolar disorder. And then bipolar disorder immediately just kind of like slides their card over and somehow gets on the credits, even though bipolar disorder had nothing to do with it. So for my money, bipolar disorder 100% ugly all the time. But well-meaning people like us sometimes fall into the trap of trying to speak highly about the illness, because we don’t want to seem like we’re insulting the people with the illness. So I want to be very clear, Dr. Nicole

Dr. Nicole: Mm-hmm.

Gabe: Bipolar disorder is ugly. People living with bipolar disorder are incredible.

Dr. Nicole: I agree with that 100%. And I think for a lot of people who have bipolar disorder, and we don’t always talk about this part of it, the ugliest part for them is the fact that they never feel like they’re at that normal mood state. We talk about getting to normal mood and how it’s possible, and it is possible, but we never talk about those people who don’t ever feel like they get there. If you think about bipolar disorder existing on this, this line, and there’s a little box in the middle and that’s the normal space, and you have your depression on one side and your mania on the other side. There are people who feel like they are just always outside that box, either to the left or to the right. They feel like they’re always just a little bit manic, or they’re having a little bit of depression. They just never feel normal. And that’s because for some people, their normal changes, the normal they had before illness, they never get back there. For some people, for some people, their normal is fluid. And over time, as their illness progresses, what’s their baseline behavior or baseline mood or what’s normal for them? It just changes over time. So for those people, that can be the ugly side because they’re listening to all of us say, oh, you can achieve normal mood. You can just be normal mood. You can be like you were. No one would ever know, and they don’t ever get there. And that’s really, really hard to live in that space. And so I’m going to be, you know, positive on this again and say it is important to figure out how to accept that this is where you are and that this is your normal. And yes, it might feel like the target keeps moving and you and you can’t quite get to it, but it is possible to still find a place of acceptance and meaning and purpose in life, even kind of just outside the fringe of that, like Gabe said. And you can be amazing with your illness despite everything it throws at you.

Gabe: Oh, and look at that. Even on an episode about the ugly parts of bipolar disorder, we still made it a point to end on a high. We just can’t help ourselves. Dr. Nicole.

Dr. Nicole: No, we can’t, we can’t. We’re delightful people. We can’t help ourselves.

Gabe: I’m. I’m starting to see why people are emailing us. Now. With that in mind, if you have any ideas, questions, comments, anything for the show, open up your email right now, and send them to us. You really do inform what we do here. We can’t thank you enough for tuning in, but we do need a couple of favors. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free. And here’s favor. Number two recommend the show. Sharing the show with the people you know is how we grow. Share it on social media. Send an email. Send a text message. Bring it up in a support group. We just need everybody to get the word out about the Inside Bipolar podcast. My name is Gabe Howard and I’m an award-winning public speaker and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon because, well, just everything’s on Amazon, but you can grab a signed copy with free show swag or learn more about me over at my website,

Dr. Nicole: And I’m Doctor Nicole Washington. You can find me on all social media platforms @DrNicolePsych to see all the things I have my hand in at any given moment.

Gabe: All right, everybody, we will see you next time on Inside Bipolar.

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