It isn’t always possible to prevent a manic episode, but in today’s episode, we discuss possible techniques to try and stop mania in its tracks. Bipolar disorder is a cyclical illness and it’s important to remember that despite our best efforts, we can fall into mania.

Join us as Dr. Nicole and Gabe discuss some strategies for preventing mania and tips for minimizing the potential damage from a manic episode.

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 Howard: Hello, everyone. My name is Gabe Howard and I live with bipolar disorder.

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

Gabe Howard: Dr. Nicole, you and I have covered many topics, and we usually cover the topics like from this sort of angle. Here’s the thing that’s bothering us, and here is how we can get out of it. And we were called on it. We got some emails and they’re like, Hey, you know, it’s fantastic. We get it. We have a lot of problems living with bipolar disorder, but do you have any advice for how to not find ourselves in that situation? And I was like, we’ve done some of that. And I wrote back because I like to defend the show. I like to like to defend us. And like, Yeah, but you didn’t do it for mania. Everything with mania is you find yourself manic. People told you you were manic and, and yeah, yeah. You know, listeners they’re smart, smart people and were wise to listen to them. So, today’s episode is preventing mania, how to just not end up there in the first place.

Dr. Nicole Washington: Anybody who’s listened to me talk, I’ve probably said several times, stay ready so you don’t have to get ready, because I really do tell my patients that over and over and over again. So, this is a perfect time to put that into action.

Gabe Howard: First and foremost, I want to say that preventing anything is a sticky wicket, right? Because it sort of has this patriarchal kind of, oh, well, don’t get yourself into these situations and then you won’t have a problem. As if we have complete control. As somebody who lives with bipolar disorder, I sometimes cringe at these, oh, well, if you do the following things, you won’t end up there in the first place because it seems so mean, right? Like the reason I got there is because I didn’t prevent it. And I just want to touch on that for a moment, because sometimes you can do everything right and boom, the bad thing happens.

Dr. Nicole Washington: It is important to remind yourself that this is a cyclical illness. You can do everything right. And if you’re listening, you can’t see me putting right in air quotes, but you can do everything right and still have an episode because that’s just the nature of the illness. So, it doesn’t mean, oh, I failed manic or I had an episode. It just means that for whatever reason, your body and brain decided that now was a good time and we don’t know when that’s going to be, but we can prepare on the front end because chances are we know what your mania looks like because everybody’s mania is different.

Gabe Howard: I also want to touch on the idea that some people aren’t trying to prevent mania at all. They’re trying to steer into it. They have this idea in their head that, hey, a little bit of mania is a good thing and I don’t want to fall down a rabbit hole and discuss it. We’ve discussed it in other mania episodes of Inside Bipolar. I’ve made the joke that Mania has the best public relations team in the world because mania never gets blamed for anything. Your mileage may vary. I do think that sometimes people romanticize mania. Again, we’ve discussed it ad nauseam and other episodes, that’s not what this episode is about. So, Dr. Nicole, for the purposes of this episode, we are going to work from the premise that mania is something that you want to prevent. It’s something that you understand is not in your best interest and you do want to prevent it, because so often people wake up and they’re just like, Hey, I feel really good, but why am I on this park bench? And what day is this and what happened? They have this idea that things went well, but their environment around them shows them that things did not go well. And that’s how it always was for me. I would feel really, really good, but all of a sudden there would be these little breadcrumbs like, Where did all my money go? Why won’t anybody call me back? What day is this? Why am I not home? Why? Why am I wearing these clothes? Why do I no longer have a job? Why is everybody mad at me? I would feel good, but the environment would not match up with the feelings.

Dr. Nicole Washington: If it was all about just feeling good, then we wouldn’t bother. Right? I mean, nobody would care if you were manic. If the really only symptom you had was that you felt good. We all want our loved ones to feel good. We just don’t want to have to deal with the aftermath. And we don’t want you to have to deal with the aftermath of a manic episode. Being out of money and depleted savings and infidelity and all of the bad decision making that comes with mania, which we all have to agree in the moment, it sounds like really sound decision making in the moment. You think this is a fantastic idea. I’m going to pull everything out of my savings and start this business. I’ve written this plan for the last three days on five legal pads. Surely, it’s going to be successful

Gabe Howard: When it comes to preventing mania, one of the things that I look for is this euphoric feeling and euphoria in and of itself is not bad, like, we want to be excited. I want to get excited for things. But for me, when I have that excited feeling, that euphoric feeling and it doesn’t match up with anything, right, I can’t connect it. That’s when I start to get concerned. If I’m really, really excited because Christmas is coming, I’m not so worried. If I’m really, really excited because vacation starts on Friday, I’m like, Yay! Then I’m not so concerned. But if I have this invincible feeling, this euphoric feeling, this excited feeling, and I look around and nothing’s going on, I start to ask myself, okay, is this the start of the escalation? Is this the start of something bad happen? That is a real big clue for me.

Dr. Nicole Washington: And there’s a difference between euphoria and being excited about something like being excited about the holidays, being excited about a vacation. Those are perfectly appropriate emotions to deal with. But euphoria takes that to a whole other level. Euphoria is excessive, right? Being happy or being excited about something good that’s going on in your life, that’s normal. That’s what we all hope to achieve. But euphoria is not the same thing.

Gabe Howard: So, it sounds like the first step is excitement. And we don’t want people to panic at excitement. We want people to be excited. Excitement is a is a great emotion, but maybe make a note of it, right. Just keep it in the noggin. But then we move to euphoria. Now, euphoria is where we want you to start being concerned, right? Is that when you want people to call you? Because I have to imagine as a psychiatrist, every time somebody gets excited about a vacation or Christmas, you don’t want them calling you up and saying, hey, I think I might be manic. But you also don’t want to get that call that, hey, I’m in full blown mania, I’ve spent all my money, quit my job, left my spouse. I just and I. You also don’t want that call either. Dr. Nicole, from a medical perspective, when do you want people to report that they might be becoming manic?

Dr. Nicole Washington: Yeah. Please don’t call me every time you are excited about something good in your life. That would not be a good use. But I do think you’re right. You know, when you’re excited about random things that you don’t typically get excited about and you start to get worried, that might be a good time. If your loved ones tell you, oh, little up there today a little bit more than typical because as always, you know, I’m always going to recommend that you have those conversations when your mood is normal with those people around you so that they can help you catch when you’re getting a little bit too high. Because there is a fine line between, I’m in a really great mood and I’m approaching mania like it can be a very, very fine line that we can’t always defined. We have an easier chance of defining that on the front end. So, if we’ve already discussed in session that this is when you should call me, and that’s a great conversation to have with your psychiatrist, with the person who prescribes your meds, go back almost do like a little autopsy of your previous manic episode and say, okay, this is what happened. These were the first signs I had. This is when everybody around me knew, if I experience that again, should I call you? Like, have a plan in place. Don’t just blindly wait for it to happen. Have a plan in place, and you and that person will know. But when you start to get a little too expansive, a little too excited about day-to-day things, that may be a good time to go ahead and make that call.

Gabe Howard: I’m a big believer in using my support system to help manage mania. I think that they see things before I do, but I want to be clear. I think sometimes people here use a support system and they think that means everybody who knows you. It does not. I have said before on this show, if my mother or grandmother is concerned about me, it doesn’t even register. I comfort them and I say, thank you so much for telling me. I don’t discourage them. But it doesn’t change an iota of my behavior because my mother and my grandmother are not. They’re really worried. They hold the stick really tight and they love me so much. And of course, they have been traumatized by my previous behavior that they’re not a good indicator of mania. For me, that doesn’t mean that I insult them. And I understand that they come from a place of love. But yeah, I can’t utilize them. But my wife, she’s been well trained. Not only has she been well trained on mania, on bipolar disorder, but she’s been well trained on Gabe’s mania. Gabe’s bipolar disorder, Gabe’s episodes. So, when she says something, I drop everything, literally drop everything and say, okay, what are we going to do? And I have a couple of other people in my life that I can do that with.

Gabe Howard: And then I have other people that when they say it, I know that they’re insulting me just to just to fill out the village. Right. You’ve got your village idiot, right? You’ve got your village elder and then you’ve got your village wise person. And I believe that everybody has some number of these people in their lives. But you’ve got to choose them and you’ve got to choose them when you’re well. So that said, when the right people, right, the people that I have chosen to listen to tell me that something’s going on, that’s very preventative for me. But the reason I told this long and involved story is I think you need to pick the people who you’re going to listen to before there’s a problem. You’ve got to know who you’re going to trust before you need to trust them. And I think that’s something in mania we don’t do. We tend to do it in suicide prevention, but we don’t understand who we’re going to listen to when it comes to mania.

Dr. Nicole Washington: And that’s a great point about making sure they know your specific bipolar disorder. The fact that your wife knows you well enough as a person, she knows your general temperament, your general quirks, she knows you. So, if I know you and I ride in the car with you and somebody cuts you off in traffic and you get angry and you yell and you give them a fancy hand signal. I may not be concerned for mania if I know that. Well, he’s the kind of person who, if someone cuts him off in traffic, he’s likely to curse and give him a fancy hand signal. If that’s not your typical behavior and all of a sudden, you’re very edgy and angry because we’ve talked about euphoria, but we haven’t talked about people whose mania is mostly agitation. Everybody’s mania isn’t euphoric. Some people, when they’re manic, they are meaner than a junkyard dog for no reason. They are angry, angry, angry, picking fights, cutting people off in traffic, chasing people down who cut them off, just behavior that is very, very unlike them. So, I think we have to we really, really do have to know people intimately to be the best support to them to recognize those mania symptoms.

Gabe Howard: And depending on where you are in your recovery, you may not have developed this yet. I was diagnosed back in 2003 as is as much as it sucks to get older. There are some perks and one of the perks is I’ve had almost 19-20 years to develop all of these things. These are not systems that I had in place on day one. One of the things that I think about is when I start getting all of these ideas and I get excited about these ideas now, it’s great to be excited about ideas, and some of my ideas have turned into great things, so I don’t want to turn off idea excitement because that would be problematic, right? There are good ideas that we want to invest our time, talents and energy in, and we don’t want to lose that. But what I think about is when I come up with an idea and I have no cons, that worries me, I don’t think there’s anything in the world that doesn’t have a con.

Gabe Howard: I don’t care what it is. I think there are cons to literally everything that we can do. If everything in your idea is nothing but sunshine and roses, that is a clear indicator. Oh, there is no, there is nothing bad about this idea is the greatest. If there are no negatives, no negatives, no drawbacks, you know how often I hear that from people? There are no drawbacks to this plan. Ah, the minute that starts circulating in your little brain, mania is a brewin.’ You know how they say, every cloud has a silver lining? That means every silver lining has a cloud. Sincerely, this is not Gabe being pessimistic. This is Gabe being realistic. And look, I’m going to turn this into an MBA show real quick. If you start a business and you don’t see your weaknesses, if you don’t see your cons, that business won’t work anyway. Forget about mania for a minute. That’s just bad business. But this is a mental health show. That is a clear indicator to me. If I can’t see any drawbacks in the plan, I know that I need to call my Dr. Nicole. I need help. I need to take a break.

Dr. Nicole Washington: Mm-hmm. But that is not a skill that most people I see have. So, I will say to all the listeners out there, this is something that you have to work really, really hard to develop, because I really have only had a very, very small percentage of people have the ability to say, Oh, I think I’m approaching a place that I don’t want to approach because it feels so stinking good, right? Like, it’s so good to feel on top of the world and to think that you’re invincible and all those things that come with mania, it feels so good. It’s like the most selfish state a person can be in because all they care about is them feeling good. They don’t care if they cheat on a partner because they felt good, right? Their sex drive was really high. The other person couldn’t keep up. Yolo. We’re out here. I’m going to do what I got to do. You know, I have worked on this business plan for the last five days. I’m going to start my business. I don’t care if I’m wiping out my life savings. I’m going to do what I want to do. It’s a very self-centered phase, and everything feels good about it. But I just don’t know that I see very many people who have that skill set. So, you know, I mean, I don’t know how do we help people get to that point? What conversations did you have with family and friends? How did you get to that point? Because this is not a zone that I am used to seeing people who have bipolar disorder in.

Gabe Howard: When it comes to mania prevention, I think one of the things that we need is radical honesty. See, so often in prevention of mania, anything good that happens, we give to mania and anything bad that happens, we give to depression, we give to anxiety, we give to some other symptom of bipolar disorder. And that makes us less afraid of mania. One of the preventative things that we need is to understand that mania is damaging and dangerous. So, for example, I did not have this skill either. This this is a skill that took a long time for me to understand because whenever anything went bad, I thought, oh, depression. Depression is so terrible. And that made me be on guard for depression. And I wanted to be on guard for depression because depression felt terrible and I was less on guard for mania because mania felt fantastic. But then the harsh reality seeped into my life. And this was a big turning point for me. I realized that right before many of the depressive episodes, many of the episodes where I lost friends and relationships and jobs, there was mania. So, mania was first and I did nothing to prevent it. And then depression kicked in and I lost my job. So, when I did my chain analysis, when I did my first step in depression, I realized, oh, it’s mania.

Gabe Howard: Mania kicks in and caused me to do a lot of these things. Preventing mania is understanding that you need to be fearful of it, that it leads to negative things. That was a big turning point in my life. Preventing mania for me was understanding the damage that I did to myself and others because of mania. And once I saw that for what it was, there became a natural inclination to prevent it. Right. I just the listen, I believe that that many, many humans will not intentionally put themselves in harm’s way. I don’t want to say everybody you know, there are goalies that jump in front of 100 mile an hour pucks. But I do point out that they wear protective gear. When we’re talking about preventing mania. I believe that one of the things that we need to understand is that it is dangerous. If we do not accept that radical truth, that mania is dangerous, I think that will impede our ability to prevent it because frankly, we’re not even trying.

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Dr. Nicole Washington: And we’re back with what you can do to prevent a manic episode.

Gabe Howard: Dr. Nicole, I want to touch on something that you said, that it feels good. Yes, it feels good.

Gabe Howard: Right. And for many people listening who do not have bipolar disorder, you’re just like, well, I can kind of see that. I can kind of see where, you know, you want to feel good and that’s why you’re not afraid of mania. But now I want to speak to my people with bipolar disorder. Right. Suicidal depression feels awful. Loneliness feels awful. Those you’re sitting at home and you don’t know if you want to live or die feels awful. And then you have the literal opposite of that. It’s not that you go from feeling normal to feeling great. It’s that you go from feeling the worst you’ve ever experienced in your entire life to feeling great. And that is addictive. And I chose that word very, very specifically. Mania can be addictive, and I think that we need to approach it in that way. We need to approach it like it’s an addiction because addictions, they feel good in the moment and we understand that. That’s one of the things that keeps people addicted. But as we’ve learned from addiction therapy, it’s very short-lived and it ruins the rest of your life. Dr. Nicole, I’m just spouting that off from somebody who lives with mania. What’s your thoughts on that as a doctor?

Dr. Nicole Washington: I completely equate substance addiction to mania. And when I talk to patients about it, we talk about how people who use drugs like cocaine and methamphetamines and the high that they get. And if you ever listen to someone who’s had an addiction to one of those drugs when they talk about it, I mean, they talk about it like a loving previous partner or like a loving. I mean, they just talk about it with such love and in the high points. And they don’t always talk about the low points. And that is what support groups and therapy for addiction can help you do. It can help you see the reality of your substance use disorder. I don’t think people with bipolar disorder use therapy as much as they could or support groups or things like that. I think a lot of times when it comes to illnesses like bipolar disorder and schizophrenia, people think, oh, well, it’s a medicine-based illness. Like I don’t need to do therapy for bipolar disorder. I need to just take my meds and that’s all I need. But therapy really is where you can talk about your ideas, about your illness, how you felt about your episode, how did things go between you interpersonally with the people you love, people in your support system. That’s where you can develop these really, really great plans. Like that’s where it happens. It’s when you can do that because unfortunately for me, so often when I’m seeing someone for bipolar disorder, I am focused on meds. I am focused on making sure your mood is as stable as it can be, and we’re not having too many highs or lows and that that’s where it’s going to. I mean, that’s what that’s where all the work happens, right? Is in therapy. Anybody who’s ever gone to therapy, whether it’s group or individual, that’s where the breakthroughs happen. You don’t typically get those with the mes of the world. That is where it happens, though. So, take advantage of therapy. Even if you have an illness like bipolar disorder that you think is all about the medicine.

Gabe Howard: I am so glad that you brought up therapy. I don’t know how we got to this idea that treating bipolar disorder, a chronic illness, a serious and persistent mental illness was one tool. I mean, there’s more than one symptom. So, it stands to reason that you need more than one tool. Could you imagine if your toolbox at home to do home repairs could only have one tool? It just doesn’t make any sense. But we’ve talked about noticing these signs and as you mentioned, therapy can be helpful in noticing these signs. And we use a staircase analogy. So, you’ve noticed that you’re moving up the staircase, right? You’re on step number two or three. You’ve gotten ahead of it. You recognize it. You’re like, okay, I listen to this great podcast. It’s great. Love the hosts, They’re wonderful. And they said that I need to call my psychiatrist. Okay. They have called you, Dr. Nicole, and they’re like, Hey, I think I’m on step two or three. I’m moving into mania and I’m worried, what would you do?

Dr. Nicole Washington: If someone called me and said, Hey, Dr. Nicole, I have noticed that I’m not sleeping, I’m up cleaning all night. Usually, that’s a sign of mania for me. Whatever it is. And I will probably have them come in or I will talk with them on the phone and we’ll make maybe an adjustment to medication over the phone and then have them come in. We can approach it several different ways. But that’s why it’s important to have the conversations on the front end and the relationship be there so that when you do call, I know, Oh, Gabe’s calling. I should probably do something. You know, Gabe knows his illness. Gabe knows when he’s getting mad at. Gabe knows. Now it’s all about the words, too, right? It’s important to be able to put it into language and so that you are both speaking the same language. Right? That is the problem. So, people will call, though, and say, well, I’m getting manic or I’m scared, I’m getting manic, but can’t give me examples like can’t tell me why they think that. I’m just excited about stuff. Well, being excited about stuff can be normal. Part of just being a human. So being sure that you’re using the right words and you’re using the right language is so, so important. So call and say, I notice that I’m not sleeping as much. I noticed that I have so much energy. I am running five miles a day. Every day I’m spending 3 hours in the gym. My spouse is concerned, say what’s going on? Like put a descriptor, paint a picture for the person that you’re talking to. That is what’s going to be very helpful for them.

Gabe Howard: You brought up sleep a few times as an indicator of mania. Now, for Gabe Howard personally, sleep issues are an indicator of depression for me. Can you talk about what to look for in sleep that could be moving into mania?

Dr. Nicole Washington: You know, with depression, you can experience trouble sleeping. You can experience too much sleep with depression. It just depends. Everybody’s depression is a little bit different. With mania, it’s not so much that, oh, I just can’t sleep. It’s I don’t need to sleep. It’s I can function nightly on 1 to 2 hours because I have so much energy and so many things to accomplish that sleep is not something I need in my life. I’ll sleep when I’m dead, right? It’s that mentality because you just don’t need it. Your energy is so high. You have all these great ideas flowing through your head. The business plans, the redecorating, the travel, the promiscuity. You’re busy, you know, you are booked and busy. You don’t have time to be sleeping. So that is really the hallmark of sleep problems with mania. It’s a you just don’t need it.

Gabe Howard: Once you’ve gone through anything, once you’ve got a lot of data there. I am a firm believer in the post mortem and when we talk about managing mania, when we talk about preventing mania, what I recommend that everybody do right now, even if you’re feeling fantastic, even if you haven’t had a manic episode in five years, ten years, I don’t care how long it’s been, I recommend that everybody think back. This is a really big mania prevention technique. Think back to your last manic episode, a big one, a damaging one, and start to ask questions, start to really dig into it. How did you feel two days before? How did you feel two days after? What do you remember doing? What are the people around you? Start to get that data. This is incredible data to mine. And so many people are like, No, no, no, no, no. I want to look forward. I want to focus on the positive. I’m not looking backwards. I’m not going that way. No, nobody said that you were. I love memes as much as the next person. I’ve got the cute hang-in-there kitten poster on my wall. I don’t, but I probably would if somebody gave it to me.

Gabe Howard: But that’s not good advice. You should look backwards. You’re not going that way. But if you don’t want to end up in the exact same place, you’ll learn from the past. Look back at that last big manic episode and figure out, figure out the entry points. How did you behave a week before? What was going on? And that will give you some indication of how to prevent it. Dr. Nicole, one of the things that I think about is, okay, as we said at the top of the show, sometimes you do everything right, literally everything right. We’ve got to get out of this idea that if you hit mania, you did something wrong and it’s your fault. You can do everything right. Mania hits. This isn’t mania prevention; this is mania protection. What are some thoughts that you have to protect yourself from the damage that you can do when you’re in full-blown mania? And I know you have a few and I love them. I almost thought about just delivering them as my own and just pretending that these were all my ideas. But no, it’s seriously. So, this is not mania prevention. I want to be very, very clear. This is protecting yourself if mania hits.

Dr. Nicole Washington: If you are one of those people that have a manic episode that’s characterized by a lot of increased sex drive, promiscuity, risky sexual encounters, you may want to talk to your primary care physician and or your psychiatrist about what it is that you can do to help you and to prevent really bad juju. If you do find yourself in a manic episode and unable to really come out of it before you do something dangerous or potentially dangerous. So, there are prep drugs that are available to prevent HIV for certain populations. For male patients, I do have a handful who have literally made the decision to end their ability to have kids all together. They’ve decided that they didn’t really want kids of their own or they were done having children and they decided to just have a vasectomy because they could not stomach the thought of having a manic episode and dealing with an unwanted pregnancy that occurred in that way. But for my ladies out there, you know, we also, no woman wants to have an unexpected pregnancy.

Dr. Nicole Washington: You definitely don’t want that to come as a risky sexual encounter that happened when you were manic and you do all the things to prevent men and women. We do everything to prevent. But sometimes it happens. And when you’re in that moment, you may want to consider a form of birth control that doesn’t rely on you taking it every day. You may want to think about IUDs or implantable things or injections, but have those conversations with your OB/GYN, your primary care doctor, have them on the front end and the doctor in me is always going to caution you against, risky sexual activity. But we also know that when you’re a manic, sometimes your brain doesn’t allow you to think about those things. So those things won’t prevent you from contracting certain sexually transmitted illnesses. But if we can prevent you from becoming pregnant or impregnating someone, I think that would be worth it.

Dr. Nicole Washington: If you know that your mania causes you to spend, you go a little berserk with the spending, then that is something that we want to try to protect you from. So, what does that look like? There are accounts where you can only withdraw with your debit card what’s actually in your account to protect you from overdraft. Like there is no overdraft. If the money is not there, you don’t do it. So, you can take the overdraft option off of your account. Your bank will not allow you to overdraft, and that way you’re at least limited to what you actually have in your account. And then some people will go so far as to only put or keep rather a certain amount of funds in their checking account. They keep meds in their savings, they transfer over what they need. They just limit what’s available to them because they’ve been burned by the poor financial decisions they made during mania. It can look like you having a limit to where if your account goes below a certain amount that you have that information sent to you. And that email can kind of be a tickler for you to go, Oh, wait a minute, I don’t get this email very often. Am I falling off the wagon? Like, what’s happening? What’s happening? Some people will even get that information sent to a loved one so that somebody can check in and say, Hey, are you good? Because I notice you’re spending a little bit more than usual. So, what’s going on there? Those are, you know, a couple of the things that we can do to protect ourselves from some of the damage that we might end up doing when we’re manic.

Gabe Howard: I love the money advice, Dr. Nicole. And my sister, who does not have bipolar disorder, doesn’t have mental health issues at all. She’s an Iraq war veteran. And she was over there for about three years and when she was in the war. She had she had some stuff going on. Right. She was busy. She was in a war zone, but she still had obligations. She had financial obligations. So, what she did is she put my mom in charge. The money would come into an account and my mother would pay all of her bills, put money in savings. She just handled it however they agreed upon. And then there was another account that my mom put money into. That account was just my sister could do whatever she wanted with it. That was the money that she used when she went out on the economy. That was the money that she used to buy the stuff that she wanted gifts for people on Amazon that she could send all over America because she still wanted to participate in the holidays. When she went to Germany, when she went to France, when she was on leave, she knew how much money she had and she knew that everything was being taken care of.

Gabe Howard: I only share this because when people hear that story, they’re like, Well, yeah, your sister’s a veteran. She’s a soldier. She’s in a war zone. Of course, somebody helped her. What is wrong with you? But you swap out my sister for Gabe and you’re like, Oh, hey, my mom pays my bills with my money. She just handles it and manages it. Suddenly everybody’s like, Oh, you’re an adult. Maybe you should be handling it on your own. What’s? What’s going on? You need your mommy to help you. I don’t know, that feels icky to me. It doesn’t matter. My sister needed help. This was the best thing for her. And she did it. Hero. I needed help. This was in the best interest for me. So, I am also a hero because it is very strong to admit that you need help with something. You receive that help and you’re able to live your best life because of it, rather than paying attention to what all of these people who frankly, it’s none of their business. It’s just sort of this nonsense theory that we have that we get into the minutia of the details and decide that if my mother helps my sister, it’s good.

Gabe Howard: And if my mother helps me, it’s bad. And listen to all the people living with bipolar disorder out there. We feed into it the most. We believe it the most, and we beat ourselves up the most. We do the most self-stigma. My sister didn’t lose an iota of sleep over utilizing her mother to help her because of her situation. And yet, if my mother helped me because I lived with bipolar disorder, I’d beat myself up because I’d think it was wrong. We have to stop doing that. People are going to talk. People are going to say whatever they want. What I want to focus on is if you are getting help with something that you need help with so that you can live your best life, so that you can manage your illness and it’s working for you, don’t beat yourself up over it. And here’s the thing we can give back. We can absolutely give back. Figure out what your mother loves and do it for her. You know what you could just remember to call her on Mother’s Day. That usually makes moms pretty darn happy.

Dr. Nicole Washington: Call me. Call me more than just Mother’s Day. Call me more than I need regular calls. Don’t just call your mom on Mother’s Day. Don’t listen to Gabe. Call her regularly

Gabe Howard: All right,

Dr. Nicole Washington: As a mom.

Gabe Howard: Fine,

Dr. Nicole Washington: Call me regularly.

Gabe Howard: Fine.

Dr. Nicole Washington: Yeah. No, no, no.

Gabe Howard: But sincerely, Dr. Nicole, the bottom line is you have to reframe it, trade with people. If somebody is helping you with something that you need help because it’s a weakness in your life, figure out what the weakness is in their life. Everybody’s got something that they’re not good at. Figure out what theirs is and do it for them. This is the way that people move forward. So often when it comes to managing bipolar disorder, preventing the symptoms of bipolar disorder, protecting ourselves from mania, we use language like, Oh, I need a babysitter, I need a lifeguard, Somebody got to watch over me. I’m a child. Stop thinking about it that way. Sincerely, for us, it’s bipolar disorder. For me, it’s bipolar disorder. It truly is. A lot of the things that I need help with do have a direct correlation to bipolar disorder. But so what? It would just be something else. And I figure out what other people’s direct correlations are, what do they need help with? And I help them with that. And that moves my life forward in a much more positive way than me just constantly saying, Oh, I’ve got to be on guard for this. I need a babysitter. Everybody’s watching over me. Yeah, it sucks. I mean, I’m not saying that it doesn’t suck, but. But thinking about it in this way makes it suck even more. And frankly, that is another protective and preventative factor for mania. If you just think that you’re just this huge problem all the time and you’re focusing your attention there, mania is going to have a much easier time sneaking in, isn’t it? Focus your attention on fighting the illness.

Dr. Nicole Washington: That’s 100% accurate. And I love how you said find a relationship where you can give something to them, because so often when people have bipolar disorder, they feel like they’re a burden to everybody. They feel like everybody’s doing something for them, but they’re not returning that. Everybody wants to feel valued. Everybody wants to feel like they bring something to the table. And I think having a relationship where you can you can give and take. I mean, that’s what relationships are all about. And it just helps you not to feel like such a burden.

Gabe Howard: And that’s the final thing that we want to bring up today. Understanding that your life is more than just waiting for mania is a protective factor for mania. It is preventative, doing the things that you need to be doing and building those relationships and feeling positive about your life makes it much harder for the lurking mania. I believe that mania is always lurking and it’s waiting for that opening. Close those openings. Those openings become much wider when you’re sitting around a beating yourself up, when you think that you’re a burden, when you think that you’re a problem, when you think that, oh, I need a babysitter when you start talking that way. Sincerely, if you start with all of that negative self-talk, mania could be just around the corner, as could depression. Just to be fair, this one just happens to be preventing mania. Close those gaps. Contribute in all the ways that you can. Build up your routines and do all the things that we’ve talked about and all the other episodes of Inside Bipolar. It all works together because, as we said, preventing mania is all about having more than one tool.

Dr. Nicole Washington: The one thing I would say is ask your psychiatrist next time you see them how they would like you to handle the call or the bat signal, the notice that you’re giving them that you feel like something is not quite right. That’s not a question that I have. People ask me very often, and as I’ve sat through this episode, I thought I should probably have that conversation more often with my patients who have bipolar disorder. So definitely ask so that you know what it is that you should do if you find yourself in that situation.

Gabe Howard: I can almost guarantee that everyone listening is hoping that their psychiatrist says bat signal. I just I don’t know what the bat signal.

Dr. Nicole Washington: Bat signal, it’s great.

Gabe Howard: For mania is coming on is going to look like. But that’s what we all want.

Dr. Nicole Washington: I believe it. I believe it.

Gabe Howard: Thank you, everybody, for tuning in this week. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also an award-winning public speaker who could be available for your next event. You can get my book on Amazon because, well, everything is on Amazon, but I will sign it and throw in swag if you buy it directly from me, just head over to my website,

Dr. Nicole Washington: 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 Howard: Do us a favor. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and tell a friend. Post it on social media. Send an email, send a text message, bring it up in a support group. Sharing the show is how we grow. We will see everybody next week on Inside Bipolar.

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