Inside Bipolar Podcast: Fear of Relapse? Navigating the Lingering Shadows of Bipolar Disorder

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, welcome to the podcast. My name is Gabe Howard and I live with bipolar disorder.

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

Gabe: Dr. Nicole, when I was really sick before my diagnosis, I experienced really long stretches of depression and I also experienced like acute moments, days, even up to a week where I couldn’t get out of bed, where I slept the entire time, where I didn’t bathe myself, where I, I ignored basic hygiene, where I was so sick that, you know, people sometimes describe depression as like staring into the abyss. And I’ve often described depression as being so, so sick. I wasn’t even aware of where I was. I don’t know if there was an abyss or not. Staring is an action, and I was completely unable to do any action. Now. Now that I’m in recovery, you would think that that would be all behind me. And in fact, a lot of people talk to me like, oh, thank God you’re not like that anymore. That sounded so terrible. And I want to be fair. They are right. I’m not like that anymore. But there are lingering side effects. There’s a there’s a

Dr. Nicole: Mm-hmm.

Gabe: Lingering trauma of having experienced that that has not go away, even though I’ve been in recovery for well over a decade.

Dr. Nicole: So when I see people and they tell me, you know. Yeah, I’m doing well, I’m doing great. Things are great. They don’t tell me about these little things. I don’t I don’t think I don’t think patients tell me that. Do you. Do you share that with your doctor? Nicole do you say when they ask you the obligatory, hey, how’s it been going since we last saw each other? Do you say, well, yeah, I’m still having this and that, or do you just say I’m okay?

Gabe: Oh, you’re calling me out on the show I did. I work very, very hard. Not to say I’m just okay. I do, I do, but the impulse is there. The impulse is to answer in the moment, which is why we’ve talked about on this podcast before about like keeping a journal or writing down your top three concerns, or bringing somebody with you who will hold you accountable for

Dr. Nicole: Mm-hmm.

Gabe: The entire duration. Appointment to appointment. And not just the last few days, but but that said, maybe to answer your question a little more specifically, I don’t know that I’ve ever told my Dr. Nicole or a therapist or even really anybody outside of maybe a personal friend that I’m scared of becoming depressed again. I kind of feel like that’s just something that I need to deal with now, because after all, I’m not depressed. So what do I really have to report? I mean, sincerely, I feel sort of like this would be like going to the fire department and saying, I’m worried my house will catch on fire. They would say, but it’s not on fire. Why are you here? That that’s how I feel about telling people that I’m scared of this.

Dr. Nicole: I think I probably hear about it in a roundabout way. So if a patient shares those kinds of feelings and thoughts with me, it usually isn’t directly. Usually what happens is I ask about mood symptoms and have they had any depression days since they’ve seen me last? And they may say, well, I did have. I did have some depression since I saw you last. And then as I go digging and I realize, well, maybe it wasn’t depression, maybe it was a moment of sadness because they were thinking about previous episodes, or they were thinking about what happens if I have another episode, or they were just thinking about that, that invisible cloud that sometimes follows you when you have an illness like bipolar disorder, because you’re looking like waiting on something to fall from the sky and hit you in the head, and that episode. So that’s usually when I learn about it. I don’t usually get that information directly either, so I bet that most people listening are the same way.

Gabe: The mental fallout of trauma is not well understood, and the mental fallout of depression is not well understood. And all of this, of course, is this floating bipolar disorder is not well understood. And even people who are in recovery were constantly trying to figure out what is a symptom and what is an emotion, what is a symptom and what is an emotion. And I got to tell you, it doesn’t help that if we say, hey, that’s an emotion and we’re wrong and depression is looming, that we then immediately reflect back, wow, you can’t even keep yourself safe. You had every warning in the world and you ignored it. And that’s how we treat ourselves. It also doesn’t help that the people around us are like, what’s wrong with you? Why didn’t you use your coping skills? Why didn’t you take your medication? Why didn’t you tell your Dr. Nicole? We’re constantly hearing about how any time we’re symptomatic, it’s our own fault. We believe it. Society believes it. Do you, as a psychiatrist, believe that depression is the fault of the person who’s suffering from it?

Dr. Nicole: Well, I mean, of course, I don’t think it’s the fault of the person who’s suffering for it, but I do in a lot of ways, think it is your responsibility. It does become your responsibility to manage it. So you do all the things that you need to do to manage it. You meet with your doctor regularly. You see your therapist regularly. You make sure that you do the things that you know, keep you together, so to speak. You also know that it’s your responsibility to avoid the things that derail you, and that can can lead you into one of those episodes. Those things are all your responsibility to talk about it, to bring it up. But it’s not your fault. And I think those are two very different concepts. And sometimes the line can get blurred.

Gabe: Believe it or not, I am in complete agreement with you. I do agree that it’s our responsibility. But. But responsibility comes with a lot of pressure. I think about every parent who I know, who I knew before they were a parent. They were happy go lucky. They took lots of risks. We’ve done things together and now they’re petrified of their kid playing in the backyard.

Dr. Nicole: Yep.

Gabe: And I think what happened to you? I have seen you do crazy things and not care about life or death or consequence, and now you’re terrified of your kid walking out to the car to get something out of the back seat without you staring out the window. So, so clearly, something switches on in our brains where we become fearful of these things now.

Dr. Nicole: Mm-hmm.

Gabe: But. But to bring that back to what we’re discussing, this fear of this depression can become all consuming. Because if I take every emotion and decide that, that’s that step one, I’m never going to leave the house. And that can lead to all kinds of of of, as you say, bad juju.

Dr. Nicole: Bad juju. Bad juju. You know you can’t experience a major depressive episode or severe episode, you can’t experience being given a diagnosis of bipolar disorder or schizophrenia or whatever diagnosis you’re given, and not have that change you in some way. You can’t get a cancer diagnosis and not have that change. You you just can’t. I think we don’t always understand this mental fallout that we’re talking about. But if you think about it, why would there not be mental fallout? Why would you not be forever changed mentally? Your lens, the way you view the world, it’s just going to be a little bit different than it was before the diagnosis. You use the word trauma earlier when you were talking about that experience and that, you know, we could get into the argument about does being diagnosed with bipolar disorder, or having a depression, or having a manic episode count as a trauma? We could go into the semantics battle. You know, we can go into the deathmatch. We could do that. But to me, it doesn’t matter. There are a lot of people in mental health that will go into that battle with you, and you will use that word trauma. And they might say to you, well, that doesn’t really qualify as a trauma. Like, you can’t have PTSD because you had depression. You can’t have PTSD because you have bipolar disorder. I don’t argue with people about what they want to call things they experience. Diagnostically, no, it wouldn’t count as a PTSD trauma criteria thing, but I can 100% see the correlation.

Gabe: The I love the semantics argument about trauma, because I do think that trauma is one of those words that is often overused, and it’s definitely one of those words that is misunderstood. But I also think that we need to pay attention to individualized trauma. Meaning if you think it’s a trauma, it is. I’d also like to point out, just because I can’t not run head first into an argument, Dr. Nicole, that

Dr. Nicole: [Laughter] Of course not.

Gabe: Trauma is defined. I, I know I can’t, I can’t help it. I wish people could see Dr. Nicole shaking her head right now at me.

Dr. Nicole: Go ahead, Webster. Go ahead and tell me. Tell me, tell me what Webster says about trauma.

Gabe: So? So trauma is specifically when we experience very stressful, frightening

Dr. Nicole: Yes.

Gabe: Or distressing events that are difficult to cope with or out of our control.

Dr. Nicole: Yes.

Gabe: And I, of course, would argue that bipolar disorder is the ultimate in distressing

Dr. Nicole: Yes.

Gabe: And out of control. And I think there’s a lot of research into trauma and how to cope with trauma that is just relevant to what we’re doing here. Now, this episode isn’t about trauma, so I don’t want to fall down that rabbit hole, but there’s just not the same research into managing bipolar disorder as there is to managing depression. So I think we can learn a lot from that research.

Dr. Nicole: No, I agree with that. I do believe that sometimes the energy is is just wasted on arguing with somebody about if what they experienced is actually a DSM trauma. Right. I don’t have that kind of time. My visits are short. I don’t have time to argue with somebody. If they said they experienced something that was traumatic to them, then I believe it was traumatic to them. Not going to lie to you, I just don’t have the energy to argue with people about those kinds of things because it is more important to me how they felt. But I 100% can see how dealing with mania, dealing with hypomania, dealing with depression, dealing with the ever-looming imaginary friend following you around and you’re like, okay, when are they going to show up? I can only imagine that it feels like you have to be on guard all the time.

Gabe: One of the things that comes up when we talk about trauma and that that feeling on guard all the time is a is a concept called post-traumatic growth. And it’s this idea that the trauma doesn’t have to make you worse. The trauma can make you better. And I think people struggle with that idea because they think that if the trauma makes you better, that that means you’re saying that the trauma was a good thing. And I want to point out that all of the research into post-traumatic growth is very clear. Trauma is bad, and you’re allowed to grow from it. You are allowed

Dr. Nicole: Mm-hmm.

Gabe: To be better because of it. And I, I want to spend a few moments and talk about that, because depression absolutely did not make me better. I want to be very clear. It almost killed me. I almost died. Living with bipolar disorder has not made me better or stronger, but my life has improved as I’ve gotten well and as I’ve gotten older. That’s in spite of depression. Not because of it, but I did have to take responsibility and do the right thing. So I think we can still be better.

Dr. Nicole: The decision is I let this thing take me down, and I just go sit in a dark room and never, never go out and live life. Or I say, despite this thing, I’m still going out there when a person has a bad physical health outcome, they lose a limb. I don’t think anyone who has lost a limb in a in a freak accident or in a traumatic way would say, wow, that that sure was a good thing that happened to me. No, it was a horrible thing. But your options are a I go lay down and let this thing overcome me, or I decide that I am going to rise regardless of what has happened.

Gabe: And I love those stories. I do. And obviously Hollywood loves those stories. Television loves these stories. Comic book loves these stories. Batman is the greatest example of post-traumatic growth ever. His

Dr. Nicole: [Sigh]

Gabe: Parents were murdered in front of him, and then he saves Gotham. And people really love this story.

Dr. Nicole: You think Batman is the best?

Gabe: Batman is, I mean.

Dr. Nicole: Batman is the best story? I mean, out of all the rising from the ashes and.

Gabe: Who’s your favorite?

Dr. Nicole: I don’t know, but Batman, I mean, I.

Gabe: Batman is incredible. He dresses like a bat and fights crime with his bare hands. He doesn’t have any magical superpowers.

Dr. Nicole: Oh, okay.

Gabe: You know how brave you have to be to put on a rubber suit and go out and fight criminals with guns?

Dr. Nicole: No, he’s got a lot of money. People who have tons of money like that, they’re they’re much more likely to take risk because they can typically afford to handle the bad juju that comes. I’m not impressed.

Gabe: There’s no perfect analogy. Superman was poor, but he was invincible. You can’t be brave when you’re invincible.

Dr. Nicole: Hmm. Whatever. Anyway go ahead.

Gabe: Aww.

Dr. Nicole: Go ahead with your story. Go ahead.

Gabe: Aww.

Dr. Nicole: Go ahead. You ruined it with Batman. But go right ahead.

Gabe: I ruined it with Batman?

Dr. Nicole: [Laughter] Go right ahead.

Gabe: Dr. Nicole is not impressed

Dr. Nicole: I’m not.

Gabe: By Batman, ladies and gentlemen.

Dr. Nicole: I’m not.

Gabe: The reason that I use Batman, aside from the fact that he is in fact my favorite superhero, is because the story is as old as time. Something bad happened and that provided the impetus for something amazing. This story is told time and time and time and time and time again. I would argue that every TV show, every movie, every main character is based on this rising from the ashes mentality. So I want to say to all the people

Dr. Nicole: [Sigh]

Gabe: Who haven’t risen yet, hey, it’s people like redemption. People like this for a reason.

Dr. Nicole: Yeah.

Gabe: And apparently it’s really easy to do. You just you just

Dr. Nicole: [Laughter] Yeah

Gabe: Get a rubber suit and you just go out and

Dr. Nicole: Yeah,

Gabe: Fight crime.

Dr. Nicole: Yeah. Well, that’s the problem with all these movies and TV shows and books and all these accounts of what happened. They accelerate the timeline so they make it look like.

Gabe: Exactly.

Dr. Nicole: Oh, this person went from despair to hope in such a short period of time. Why is it taking me so long? That’s not real.

Gabe: I am so glad that you brought that up, Dr. Nicole, because I know from the time I was diagnosed at the time I reached recovery took four years, and from the time I reached recovery to the time that I felt comfortable in my own skin took more years than I can even name. Because frankly, I’m not convinced that I’m comfortable in my own skin with bipolar disorder and that I can tell the difference even as we sit here right now. And I was diagnosed over 20 years ago, and I think there’s really good analogies for this, and I’m going to use true crime podcasts. The reality is, is the legal system moves very slowly.

Dr. Nicole: Yeah.

Gabe: It takes a long time to go from the crime to the arrest, to the investigation, to the trial, to the pretrial, to the appeal to this takes years. Yet people listening to a true crime podcast get the entire story in a few hours and they’re like, oh wow, that was amazing. And I think that if they ever get involved in any legal issues, they’re like oh, this isn’t anything like it was portrayed on television. And I think that bipolar disorder is and depression and how we feel about it. I think there’s excellent examples there. We have to make incremental changes very, very slowly. But that can be difficult because while we’re waiting on those incremental changes, we’re suffering. I’m, I’m suffering because of thinking about where I came from, and I don’t know how to move forward from it.

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Gabe: And we’re back discussing not living in fear of a bipolar depression relapse.

Dr. Nicole: It’s easy to be patient when you don’t feel the effects of the thing you’re waiting for. It’s very easy. So then, it is very difficult for a person who has bipolar disorder and there’s this, there’s this lingering sense of, okay, it could happen, you know, am I am I going to wake up tomorrow depressed? Am I going to have a manic episode? How do you manage them? How do how do you decide that you’re not going to let that one night of you not being able to sleep well, send you into the anxious spiral of what if I’m manic now? You know, how do you do that?

Gabe: I really wished I knew the answer to this question for everybody. So the first thing that I want to say is it’s very individualized, right? So I have my coping skills and that’s all I’m really qualified to share, is just a couple of coping skills that I use and that I’ve heard other people use. The first one is to answer your question very, very specifically, how do I not catastrophize one night of sleeping? And that is, I have learned through therapy, through working with my Dr. Nicole’s, through going to peer support groups, from talking to other people that lots and lots of people experience sleepless nights. Not lots and lots of people with bipolar disorder. Not lots and lots of people who have experienced depression. Just lots and lots of people. And that’s a really big protective factor for me. I’ve asked my Dr. Nicole, how many sleepless nights should I be worried about? How many in a row? Now, there doesn’t seem to be a specific number, but it’s significantly more than a couple. It’s many. And then the question becomes, okay, what did you do about it? Start asking yourself these follow up questions? Hey Gabe, you’ve had a lot of sleepless nights. What’s going on? Oh, I’m on vacation with my family, and it’s really loud. Okay, well, then it’s probably not bipolar disorder that’s causing the sleeplessness. It’s your loud family. It’s being on vacation. Maybe you need to look into shorter vacations. Maybe you need to stay not in the condo with your whole family, but get your own room. Maybe you need to leave a couple of days early because, etc. so it’s really examining things in a really open and honest way and asking yourself this question, Am I handling this okay? Am I comfortable? And if the answer to either one of those questions is no, then you have to ask yourself the next question, which is what changes can I make?

Dr. Nicole: Yeah. Maybe you just need earplugs, right? Like, maybe you just need a good set of earplugs where you can go to sleep and not have to hear all the noises in the house. Maybe it’s super simple, but I think you’re right. I like the fact that you involve your therapist, your Dr. Nicole in these conversations to discuss, you know, what do I do? How many is too many for me to not call you? How many after how many nights of not sleeping? Should I do something different? What does that look like? That’s a good conversation for us to have in a visit of, you know, okay, maybe after a few nights if you’re not sleeping because regardless of the reason why you’re not sleeping, we all know that not sleeping for several nights in a row can then cause that episode. So absolutely staying on top of it, having a plan in place. I love involving your team. Involving your treatment team to help you come up with a good plan for how to how to deal with that.

Gabe: When I think about living with the fear of slipping back into depression and how it impacts my day-to-day life, now that I’m in recovery, I do think about all of those things that have tripped me up in the past and sleep was a big one, but also irritability. And I think a protective factor, again, at least for me, is becoming aware of really what step one was, but also becoming aware of step two and step three. And, you know, Dr. Nicole, I got to say that when I started recording this episode, I wanted to give advice on how not to feel bad about depression or how to get over the trauma of depression. And the more you and I have talked, I really realized that one of the reasons I’m so vigilant is because I remember the depression, and I can’t help but think that that’s a protective factor.

Dr. Nicole: The fact that you can remember it?

Gabe: That I can remember it. Yeah.

Dr. Nicole: Keeps you stable and keeps you keeps you together?

Gabe: I don’t know that it keeps me stable, but it keeps me vigilant. And that vigilance absolutely keeps me stable.

Dr. Nicole: Well, yeah.

Gabe: So maybe it’s not a bad thing that I remember it.

Dr. Nicole: I don’t think it’s a bad thing that you remember it, because I think if you did not, then you wouldn’t recognize it when it was coming and it could sneak up on you very easily and you would all of a sudden find yourself not all of a sudden in reality, but it would feel like all of a sudden I’m depressed. Oh my gosh, like, I had no idea this was coming. When, if you think about it, you had all the all the cues and signals that that this might happen.

Gabe: I think that’s another protective factor to understand that it’s not necessarily a trauma response. It’s just a we’re worried about things that have happened to us in the past because we want to be vigilant. We don’t want them to happen again.

Dr. Nicole: Yes. And you just said we want to be vigilant. You do. You don’t want to be hyper vigilant, right? If you if you’ve been robbed walking down a dark alley, I expect you to be a little apprehensive about walking down a dark alley by yourself, I expect that. I don’t think that’s pathologic. I don’t think that, oh, they must have PTSD. No, that’s being a smart, observant human. That’s someone who wants to be safe and stable. I fully expect you to be vigilant about your symptoms. I expect you to say, oh, I was irritable today. I snapped at somebody. That is not behavior that that is normally aligning with who I am as a person. I need to pay attention to what else is going on. I expect you to be vigilant. I don’t expect you to be so, for lack of a better term, paranoid, hyper vigilant about oh my gosh, I’m manic and it’s affecting you and your functioning for the next several days. I don’t want that, but I want you to be vigilant. I want you to be on the lookout. I want you to question things. You should. It’s healthy.

Gabe: There’s this part of me that doesn’t want to beat this into the ground, but I just I can’t imagine trying to move forward without this knowledge. I went through a lot. I went through a lot because of the depression and the fact that it’s left scars in my memory, the fact that it’s turned me into who I am today. I’m not sure that that should ever go away, but I also don’t want it to hinder me. And, you know, we’re right back to that post-traumatic growth. I want to both acknowledge that what happened to me was bad, and I want to know that and believe it in my heart. I want to know that it was bad. What happened to me was not fair and it was not a good thing. But I also want to know that I’m better off. I’m better off because I put in the work, because I did the things that I needed to do, because I educated myself, because I see my Dr. Nicole I see my therapist, I see my support groups. I educate myself by reading, by listening to podcasts, by being open minded. I want to know that I overcame and rose above it. I I’m not going to dress like Batman. I want to reassure the audience that I know that it’s an analogy,

Dr. Nicole: Whew. Well, thank God for small miracles.

Gabe: I don’t want to be defined by the fact that I experienced depression. I don’t want to be defined by suicidality, but I also don’t want it to not be part of my story. And I think that that’s a conflict that a lot of people listening probably have.

Dr. Nicole: Yes. Yes, it has to be a part of your story. Because when you. When you try to make it be this thing that that isn’t there and doesn’t exist, and I’m just not going to think about it. I think one thing we haven’t talked about is, regardless of where you are in your recovery and part of the the fallout of having a mental health disorder like bipolar disorder, is that you have to live with the very real reality of it could come back, you could do everything right. You could take the meds every day on time, same time, see your doctor regularly, see your therapist regularly, go to support groups. Have a coach, have a peer specialist that you talk. You could have all of those things. And unfortunately life happens and you could experience another episode. And that in and of itself is hard because I think for a lot of people, we’d like to think, well, if I just do this and do this and do this, I won’t have to worry about it, right? Like that. That’s fair enough. If I if I just watch what I eat and I eat a right diet and I exercise two times a day and I do these things like I I’ll be okay, right? Like I’ll be okay because we keep telling you, do what you need to do. Do what you got to do. Do what you got to do. And we don’t always talk about the fact that you could do everything and still have an episode. Because it’s an episodic illness. And sometimes life stressors just fall on you, like, just happen out of nowhere, and it can happen. And that is part of it. So you can’t pretend like it didn’t happen or it didn’t exist. Because I think that’s when you set yourself up for failure.

Gabe: It’s not easy. It’s not easy at all. Nobody said this would be easy. If it were easy, this podcast wouldn’t exist. Right. A board-certified psychiatrist and a man living with bipolar disorder would have not needed to get together to discuss this stuff. Because you could just write a little 200-word essay, publish it on the internet, everybody would read it, and this problem would be solved, which I would like to point out was my business plan when I started as an advocate 20 some years ago.

Dr. Nicole: Good thing you changed that plan.

Gabe: Oh, that plan changed quickly. And that’s the final thing that I want to touch on. We have to be nimble. We

Dr. Nicole: Mm-hmm.

Gabe: Have to be nimble. This is always going to be with us, and we need to make the decisions that are best for our lives. Honoring our past, understanding our present, and looking forward to a better future. And I think that if we try to remove any of those pieces, we’re going to get ourselves in trouble. And so often in my own thought process, I say this phrase to myself, how can I get over this? I don’t think that’s a good question to ask myself. I think a better question is how can I accept this and move forward?

Dr. Nicole: Mm-hmm. Yeah. I usually try my best to get people to quit using the. Get over this. And we talk about moving through something as opposed to getting over it. Getting over it can sound so condescending and so dismissive, but I think moving through it because sometimes moving through it is is easy, and sometimes going through it is a little bit tougher. It just depends on the what it is. But I agree, moving through something is a much more valuable visual than thinking of getting over it.

Gabe: And I want you to know that you can do it. And Dr. Nicole wants you to know that you can do it, too. It’s a long process. It’s a process that takes a lot of effort, but it is in fact, doable. And lots and lots of people have done it before us. And lots and lots of people will do it after us. And I believe that that’s a really strong protective factor as well, to remember that at least where we are, others have been.

Dr. Nicole: Absolutely. We believe that any of you can do this because people before you have done it, and I can guarantee you that they probably have hit roads where they thought it was impossible, but they’ve done it. And so we know you can too.

Gabe: And with that, we’ve reached the end of the episode, but we need a couple of favors from you first. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free, and it’s the only way to guarantee that you don’t miss a thing. Next, recommend the show, share your favorite episodes on social media. Mention us in a support group. Hell, send somebody a text message because sharing the show with the people you know is how we’re going to grow. 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 everything is on Amazon. However, if you want to get a signed copy with free show swag or learn more about me, just head over to gabehoward.com. You can also follow me on Instagram and TikTok @AskABipolar.

Dr. Nicole: And I’m Dr. 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: And we will see everybody next time on Inside Bipolar.

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