Inside Bipolar Podcast: Signs of Progress: How to Recognize Recovery

Inside Bipolar Podcast Episode Transcript:

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: Thanks for listening everyone. 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 before we jump into today’s episode, we need topics. So all you have to do is email us at show@psychcentral.com and suggest them. And hey, they could be the basis for the next episode. Now this week, Dr. Nicole, we agreed to talk about how do you know if you’re getting better? And I have to say, I think you and I are going to approach this from very different perspectives.

Dr. Nicole: What I, I mean, I would think that we would have the same thoughts about how, you know, when you’re getting better. So I guess we’ll find out.

Gabe: I suppose, in fairness, it is possible that Gabe Howard and Dr. Nicole Washington do share similar beliefs on this. But the reason why I say that, that we would have different perspectives is because often whenever I can get in a room with medical personnel, with psychiatrists, with therapists, with general practitioners, with anybody, and I say, what are your goals for your patients? And I have them write them on a little index card,

Dr. Nicole: Mm-hmm.

Gabe: And then I bring them all up and I collect them, and they all say things like, be on time for the appointment, be med compliant, be more forthcoming, share better. And I’m like, okay, those are the goals for your patients. And they all sit there in the room bobble heading like, yeah, this is all very reasonable. And I say, okay, here’s the disconnect. If you ask your patients what their goals are, it’s go to Hawaii. It’s get a job. It’s find love. It’s not way lay awake at night hating yourself. It’s feeling happy or connecting with others. They don’t care about any of these goals. And in fact, a bigger disconnect is they don’t even see the psychiatrist or the medical personnel’s goals as leading into their goals. And of course, I use this as an example of where patients and doctors aren’t thinking along the same lines. Now, Dr. Nicole, you, of course, are an involved doctor.

Gabe: You’ve had the the distinct honor of working with my ridiculousness. And of course, I have had the distinct honor of learning from you as well. But stereotypically, out in the world, patients and doctors have different answers about what it means to get well.

Dr. Nicole: I don’t actually think we have different goals. I think they fall under the same categories. We just are viewing them from what makes our lives a little bit easier, if you think about it that way. So if the overarching goal is, you know, better organization, that includes things like being able to get a job that includes things like showing up on time for your doctor’s appointment, showing up on time for, say, a job. How do you get a job and keep it? You show up on time. That may be a good first step. Same thing I want for you for your appointment. So I think they are often in the same family or the same overarching category. It’s just that when you break down all the things that fall under that very large category, when you ask me what I want for them, I may frame it from things that make our interactions easier, and they’re going to frame it from the rest of their life. The other, you know, 29 days of the month when they’re not looking at me. So I do think our goals are the same. We just need to get on the same page and be able to see that they’re actually the same.

Gabe: This is definitely one of those examples of identifying the problem as the first step to solving it. Right. So patients obviously think this is a problem. Doctors obviously think that these are concerns. And when everybody gets on the same page you can identify that and move forward. I want to be very clear I love the Dr. Nicoles of the world. I don’t think anybody who listens to this podcast would be surprised that I get along with medical professionals. Dr. Nicole would not host this show if I just berated her and called her stupid for 45 minutes,

Dr. Nicole: That is a fact [Laughter]

Gabe: And, obviously, yeah, yeah, and Dr. Nicole clearly respects the patient voice or she wouldn’t agree to host it with me. And I wouldn’t agree to do this if Dr. Nicole just berated me and called me stupid for 45 minutes. So clearly there has to be some movement toward the middle. And when I think about, though, the question that we’re tasked with, how do I know what I’m getting better? I really do talk to a lot of patients, a lot of people in support groups, a lot of people managing bipolar disorder who cannot see the forest through the trees. They

Dr. Nicole: Mm-hmm.

Gabe: Do not think that they’re getting better and they express frustration. They express frustration because they’re telling their doctor, Nicole, I’m not getting any better.

Dr. Nicole: Mm-hmm.

Gabe: And their Dr. Nicole says things like, well, that’s not true. When I first saw you, you were suicidal and now you’re not, so you’re better. And they say, that’s stupid. So just, I don’t want to die and that’s better. And I’m like, well, yes, as point of fact, yes.

Dr. Nicole: Yes it is.

Gabe: But I also understand their frustration.

Dr. Nicole: Yes.

Gabe: They really consider not wanting to die just to be the barest minimum

Dr. Nicole: Mm-hmm.

Gabe: Of results. And the fact that somebody is classifying that as you’re doing better is frustrating to them.

Dr. Nicole: But don’t we do that all the time? I mean, I know I’m always saying like this, these things are not unique to bipolar disorder. That’s I’m always saying that. It’s so true. Think about the person who wants to lose weight. When you say, I want to lose 20 pounds, if you go back to the doctor in six months and you’ve only lost 5 pounds, then that person is like, oh, I failed, I didn’t, oh my God, I failed. It’s like, well, but you didn’t gain weight and you lost 5 pounds. And when was the last time you lost 5 pounds? That that is a success. That is a win. I think we all have difficulty sometimes seeing our wins because we want these really, really big wins to happen very quickly. Same thing for your bipolar disorder. It takes time to recover from a mood episode, whether that’s mania or depression, it takes time. So absolutely, when you say I’m not any better, these meds aren’t working at all. And then I start going down the symptom list, the depression checklist, and I say, well, how’s your sleep? And you’re like, well, you know what? I actually have been able to get better sleep.

Dr. Nicole: So that part is better. That’s okay. Well, tell me you know, you still less irritable getting along with people? No, I mean, my wife did say that she noticed that I wasn’t getting as upset with the kids and not snapping at them as much. So, I mean, I guess that is better. So then what do you want me to do? I mean, what do you expect from me? I’m like, but you. So you’re telling me I’m not any better? My meds aren’t working. This sucks. But then we can go down the list and you can say, well, yeah, I mean, you know, I wasn’t eating at all, and I am at least eating one meal a day. I’m like. Like, all those things sound better. So is it just that you’re not as much better as you’d like to be? Like, why? Why are you frustrated? And specifically, sometimes it feels like you’re frustrated with your Dr. Nicole. So why? Why are you frustrated at my optimism? Because that is my job.

Gabe: Well, first off, we’re frustrated with your optimism because, duh. I mean, optimism is terrible. I. Well, I. Optimism is awful. We’re not an optimistic people. Now, I suppose it’s not fair to say that people with bipolar disorder are an optimistic, but I, I do liken it to nobody is having a great day when they’re seeing their Dr. Nicole. They’re almost always discussing things they want to forget. They’re talking about problems they want to resolve. They’re being reminded of crisis points that got them to this point. I unfortunately, there’s just a lot of unresolved trauma that comes with a bipolar diagnosis. And when somebody’s sitting there all happy and optimistic, it’s not gelling with our feelings. But that’s probably that’s probably a topic for another time. What I do want to say is I really liked your analogy of weight loss. And the reason why I like that analogy is because I was that person. I was that person who went to a weight loss center. I remember I was very obese, I weighed 550 pounds. I had a very distinct binge eating disorder. I was obviously eating because of bipolar disorder. That was in many ways my drug of choice was food.

Gabe: We’ve talked about this on this show, and the very first several times that I went, I really didn’t lose any weight, I maintained. And I was extraordinarily disappointed because I went through hell for those two weeks. And then I come back after doing all the things that they tell me to. And, and I’m basically the same weight, maybe a pound or two, but mostly it’s just the same. And they fired back at me immediately. This is probably the first time in several years that you have not gained weight. You know, I had described to them having to buy new clothes every couple of months. I just I was rapidly expanding. You don’t get to 550 pounds without continuously gaining weight. And I stopped that. And that was very powerful to me that I was like, that is a really good point. This is the first time in many years that I haven’t gained any weight. So here’s my question for you. What’s the equivalent of that for bipolar disorder? Because you can’t just plop me on a scale and show that I have stopped getting worse. Or can you?

Dr. Nicole: I can’t, I wish I could. I absolutely wish there was a wand that I could purchase and just wave over your head, and it would just tell me, like, he’s this percent better. He’s this much. I wish I had that kind of capability, but we don’t. We’re not there yet. But it’s like the stuff I just talked about, it’s the how many hours of sleep are you getting before? We’ve talked before about how we are both great fans of tracking moods, and that can be as intense as you would like to get and as deep and detailed as you’d like to get, or as basic as you’d like to be. But tracking those things really does help where you can see, oh, I rated my mood. You know, a two out of ten and zero is like the worst. And I rated it a two for two months in a row. This last month I rated it a five. Well, let me tell you something, people. A five is still pretty low and a five still pretty much sucks for you, I’m sure. And a five is going to make you feel like, well, I’m still super depressed. I’m still not going anywhere. I’m still not, but at least we’re moving in the right direction.

Dr. Nicole: Even if it’s a slow movement, we are moving in the right direction. If you were getting the few hours of sleep and now you’re getting up to six and you’re like, but that’s not enough for me, I get it. But it’s better than three. Well, I’m going to sleep and I’m not waking up as much. Okay, that’s a plus that that is a win. I’m actually eating I; I actually am getting up on the weekends and I’m showering and I’m putting clothes on. I went and visited my mom. Those things are all pluses. So I think we just have to have a really great idea of where you are at the depression point or at the manic point, and we just have to use those particular symptoms as our check marks to see where we are. And I am going to always celebrate the small steps, even though you’d like to take big old giant leaps that are unrealistic, I am going to be the one to say, but we’re doing great. This is good. This is where we should be. Because I do get that. Sometimes it’s just hard for you to be in that place, because regardless of whether your depression is a two or you’re at a five, you still feel like crap.

Gabe: There is a lot of wisdom in celebrating the little victories and whether we’re ready to hear it or not, I do agree that our Dr. Nicole should be pointing them out to us. I, I don’t want to gloss over the fact that having an optimistic cheerleader for a Dr. Nicole is absolutely valuable. It’s really important. I’ll be the first to admit that I didn’t like it when it was happening to me. I rolled my eyes. I thought this this person doesn’t know what they’re talking about. But eventually, as I moved further and further down the road, I started to see the wisdom of it. I started to get into it, and it’s sort of, if we can’t beat them, join them thing. I just want to make sure that people do hear that. But what I also want people to hear is facts matter, data matters. And again, like in the weight loss analogy, you have the scale to know how you’re doing. Well, we do in fact have those things at our disposal for managing bipolar disorder. And here’s where I’d like to take a little fork in the road kind of deal, because there’s, there’s two things that I’m thinking of. One which is going to be administered by your doctor, Nicole, and one that you can do at home. Dr. Nicole, you already alluded to I don’t know exactly what it’s called, but this, that little check in thing that that many doctors, therapists, Dr. Nicole’s, etc. give to their patients and you fill it out and it’s a screener of sorts. What is that called?

Dr. Nicole: The one for depression that people use most often is called a PHQ-9. Is that the one you’re thinking about?

Gabe: That’s exactly the one I’m thinking about.

Dr. Nicole: It asks you questions about your. Your answers are not at all several days, more than half the days, nearly every day. And if we ask you that at every visit, or if you fill that out before every visit, that’s going to tell us if you scored or nearly every day for little interest or pleasure in things, or nearly every day in sleep difficulty, but then you come back and we can compare. And now you’ve gone from saying nearly every day to more than half the days, or from nearly every day to several days, that’s huge. That that is that is a win. And it’s a win for us. I mean, you can you can decide if you think it’s a win, but it’s always going to be a win for us.

Gabe: And obviously that has to be administered by your Dr. Nicole. If they’re not using a form like that, maybe inquire about it, ask if there’s any sort of data that they can collect so that you can get an idea of how you’re doing over the weeks and months and years of being in treatment. I do think it’s very, very powerful to have that. Now over on our side, there’s something that we can administer to ourselves. And I, I, I, I always say this by, by rolling my eyes internally at myself because when it was first brought up to me, they called it a mood diary. They said, Gabe, you need to keep a mood diary. And I

Dr. Nicole: Oh, I don’t like that. Diary sounds very I don’t know. Diary sounds very adolescent. Teenager-y angsty. I don’t like diary.

Gabe: I would like to pretend that I am above all this, but 26-year-old Gabe, who is suffering from bipolar disorder. All I heard was, you’re a little girl and you’ve got to keep a diary with who you want to slip a note to in study hall,

Dr. Nicole: Dear Diary [Laughter].

Gabe: Especially the way that I was raised, you know, by a truck driver who didn’t really discuss emotions

Dr. Nicole: Yeah, yes.

Gabe: And things like that. I thought, no, I’ve given up so much in this process. I’m not keeping a diary. Now, I want to be very, very clear. I kept the diary. They’re now called mood journals, which I agree with you, Dr. Nicole.

Dr. Nicole: Mood journals, logs, charts. Whatever floats your boat.

Gabe: Yes,

Dr. Nicole: Whatever floats your boat.

Gabe: Yes. I don’t like that name either, because it conjures up this idea of like you sitting alone in your room writing into this book, and when you’re done, the book has like a lock on it that you keep a little key around your neck. It conjured up this idea that I was a girl, it really did. First and foremost, I want to say I never should have rejected this right, I. Writing down your thoughts, your emotions and your feelings. I think it’s very good if it’s something that you want to do.

Gabe: But it was also poorly named. It is much better to name it a mood chart, or a mood tracker or a even a mood journal, because what we’re actually talking about here is just a way to track certain things about your day. So first I want to make sure that I anchor this in 2024. You can absolutely go to the App Store or Google Play and download an app. Many of them are free. Some of them are cheap. You know, $0.99 $1.99. I think even some of the most expensive ones I saw were like $10 a year. You can absolutely do it that way. I don’t have any to recommend. It’s entirely up to you, but I don’t really feel like you even need to do that.

Gabe: You can go down to your local office, supply store, or even grocery store and buy a wall calendar. Literally a wall calendar or a desk calendar or a pocket calendar. Just anything that has rooms for you to write in each day. And for me, just to keep it simple, I used a three-point scale. Okay, one was bad, two was okay, three was wonderful, and that’s it. And what I ranked was how my day was just 1, 2 or 3. That’s it. That’s all I had to write their how was my day? One, 2 or 3. And then I also ranked sleep. How was my sleep? One, 2 or 3? Because as my sleep went, as my moods went, the next thing that I wrote down is when I woke up and when I went to bed. So, and that was it. And then in in after a few months, because I was having some problems with some medication, I also started writing down what time I took my morning dose and what time I took my after or my, my evening dose because the doctor asked me to track that. That wasn’t for me, that was for them. But still, it did end up in my in my journal.

Gabe: And that’s it. That’s it. And I carried that calendar, just the calendar that you hang on the wall to my appointments every six, eight, 12, three months, whatever. And we would add them all up. Now I would add them up before I went because you only get 15 minutes. Don’t start doing math in front of your Dr. Nicole. But I was really shocked to see. The differences because when I was asked how I was doing, I always asked based on how I felt in that moment. That’s it. It was just the last week. That’s all I cared about, right? But when I actually looked at the thing, it’s like, you’re right. I’m writing down way more twos than ones. When this got started, it was 1111111, which for those playing at home is bad, bad bad bad bad bad bad. Then all of a sudden it’s mostly twos. Well that’s that that that that’s a huge raise. Now if you want to get more mileage out of this, you can absolutely do a five-point scale. But I’m really bad at math, so I just stuck with the three-point scale. But Dr. Nicole, do you have patients who do things like this that track their own moods?

Dr. Nicole: Yeah, it’s the first I want to say, Gabe. You know, men and women can have a diary. Not just not just girls. I think

Gabe: Yeah, I know.

Dr. Nicole: I just want to make sure that we hit on that fact.

Gabe: It’s not exciting to admit. I do want to take a moment to say this is not my finest moment,

Dr. Nicole: [Laughter]

Gabe: But nevertheless, it was true. I rejected something because of an internal bias

Dr. Nicole: Yes.

Gabe: That I had. I do want to own that to the audience and not pretend like every single thing that was ever offered to me, I just accepted on my way to wellness. This is something I rejected because of something that I was taught in the third grade, frankly, by men who

Dr. Nicole: Yeah.

Gabe: Were not doing their best.

Dr. Nicole: You were taught that diaries are for girls. Well.

Gabe: That’s what I was told. My sister had a diary. It had the little key.

Dr. Nicole: Oh my gosh. You have to figure out what works best for you. There are no 100% things that work for people based on groups, right? We know that. We know that. Journaling diaries for me would be dreadful. It would not be something that would work well for me. Conversely, I have male patients who love a good diary, a good a good entry, a good journal. So I think you just have to figure out what works for you. If you are the kind of person who enjoys the writing, it can be twofold. It can be therapeutic. And just getting it out and what you felt that day and what your emotions were like and what happened. Sometimes that is so beneficial because if you go back three months ago when you were at your low and you look at some of the themes of your writings, and then you look at today, here you are three months later, six months later, in a better space, even if you’re not able to actually see it, you can’t argue with the fact that, oh my God, like back then all my stuff was negative.

Dr. Nicole: I didn’t write anything positive, I never talked about anything great. And now I even said I had a good time at lunch the other day. I never talked about things I enjoyed before. Those are patterns you can see. So if you’re a journaler diary entry kind of person, go for it. Write until your fingers cramp up. We don’t care. But if you are the kind of person who’s a little bit more practical and you want, you want firm data. So I’m a data numbers person. I like to go back and look and trend. I mean, I’ll make a chart for a patient. I get excited about numbers. I’ll make a chart and show them like you were here. And then I have like a little line graph. I just get into it. The nerdy, math loving side of me loves this stuff. If that’s what you need to be able to see it, then that’s fine. And you use your own scale. If you can do a three, do a three. If a five is your jam, do a five. I personally prefer a 20-point scale.

Gabe: 20? 20 points?

Dr. Nicole: Yes, for my people.

Gabe: That’s insane.

Dr. Nicole: No, it’s not.

Sponsor Break

Gabe: And we’re back discussing how you know if you are getting better with bipolar disorder.

Dr. Nicole: For my people who have bipolar disorder. And I tell them to write their mood. I give them three points in that 20. I give them zero, which is life is not worth living. I want to die. That’s zero. And ten is just. I’m in a normal mood space. Like I’m happy when I feel like the occasion calls for it. I’m appropriately sad, appropriately angry. I’m just taking life as it comes my way like everybody else. And then 20 is like the most manic ever. So when I have somebody who has bipolar disorder, sometimes for me, having a scale that that ranges everything because sometimes, let’s face it, your moods are I feel manic one day and then two days later I felt horribly depressed. And in the morning I felt this way. But then later on, I felt this way. Sometimes people need the range. Whatever you need. I guess the point is, whatever you need do. It doesn’t matter if you use three points, five points, 20, whatever you use, it’s going to be valuable because you’re using the same scale and don’t get so caught up in, oh, I don’t know if I’m doing this right. Just do it. And as long as you’re consistently doing it and you take it back to your Dr. Nicole, then you have data and you have numbers. But even if we’re not using that scale, I use them frequently, but I don’t use them with everybody.

Dr. Nicole: Sometimes I find that depending on the person, if they’re not in a consistent depression, that PHQ-9 might not be as valuable to me because it doesn’t catch the mania, the hypomania symptoms on it. It just doesn’t catch it all for me and it doesn’t give me what I need. So I may just ask you questions. So you just may have to trust that when I say, oh, two months ago, you told me that you were taking your sleep aid four nights a week because you had four nights a week where you couldn’t get to sleep, and now you’re telling me you don’t need a refill because you haven’t taken it in the past month? That is data as well. So don’t discount the things that I’m telling you because you just tell me stuff in a visit. You just out here talking, you just telling me stuff, you just going at it, telling me all these things and all the while I’m jotting things down. I’m tracking things. So I may come back and tell you something that you haven’t even recognized. Just be okay. With me being your tracker. Sometimes it just be okay with if I tell you this is great, like you’re an expert on you, but I’ve seen multiple yous so I know what to look for in the patterns. It’s okay. Like, trust me, I’m trust us. Trust me. In the other psychiatrist in this army, trying our best to get this thing together and to get you stable. Just trust us.

Gabe: Dr. Nicole’s right. You have a relationship with your Dr. Nicole. She has been evaluating you. I, I this is going to come out wrong, but I mean it. Dr. Nicole is a tool and she is a tool that you

Dr. Nicole: [Laughter]

Gabe: Have hired and have faith in and trust. And that tool is telling you you’re doing better and you just reject it. It’s worth a conversation with yourself, with a therapist, with your support team, with your best friend. Why do I not trust this information? Why am I rejecting it? You do need to ask yourself that moving it on from Dr. Nicole telling you, look around for other people. Many of us have a support system, whether it’s online, whether it’s a support group that we go to, whether it’s just people who we open up with about bipolar disorder, we have people that we can ask, don’t be afraid to ask, hey, you think I’m doing better? And then just let them talk. Don’t argue with them. Don’t fight with them. Just let them talk. Even if you completely disagree with them, just say thank you. Even if you think they are just dead wrong, they don’t know what they’re talking about. Dumbest thing you’ve ever heard. When they’re done, say thank you and then sit with that for don’t say well, but what about it? Don’t. Don’t fight with them. You’ll win. Most people will back down, especially if you get angry or upset or bothered or emotional. They’ll back down immediately to make you feel better. If you want good data, just say, hey, how do you think I’ve been doing? Done. How do you think I’m doing? Done. Let them answer. Think about it and move on. Thank them for the answer. I think that’s extraordinarily valuable.

Dr. Nicole: It is valuable because believe you and me, if they don’t think you’re doing well, they will 100% tell you that they don’t think you’re doing well. So give them the opportunity to give you some feedback, some requested feedback. I’m not a big fan of unsolicited feedback in general, but the people that love us when we’re not doing well will be the first ones to say, well, I know you didn’t ask me, but they’re going to tell you anyway. But just ask them, how do you think I’m doing compared to before? And maybe, just maybe, if they know that you are going to be asking them before your appointments, then they will just wait and they’ll just save all that feedback for when you ask for it because they know it’s coming. Just might save you some heartache too. And that would be extremely nice.

Gabe: I think about this question a lot in my own management of bipolar disorder. How do I know if I’m doing better? It always sort of devolves for me. It’s sort of like trying to answer the question, how do you know if somebody’s rich? There’s not actually a specific amount of money that automatically triggers wealth. And how do you know if somebody’s tall? So many people call me tall, Dr. Nicole. I am six foot three, but I don’t think that other people who are six foot three are tall. I think they are my size now, basketball players who are seven foot 11, those folks are gigantic and other people are like, no, no, no, that’s a whole other level that that’s like that’s like circus tall. And it all sort of devolves into, okay, well, give me a number, give me a way. Tell me how I know I’m doing better. And here’s something that I think we need to get comfortable with. It’s kind of up to us. It really is. I, I do think there are some benchmarks. If you are hospitalized, you are probably not doing better. If you are actively suicidal, you are not doing better. If you are actively symptomatic, you’re not doing better. But then I can tell Dr. Nicole is like, well, but you could be doing better within those confines. So once again, it becomes this murky thing. I can tell by the look on your face that that that you disagree with me. Hit me.

Dr. Nicole: I, I wish y’all could see my face right now. You can.

Gabe: It’s a good look. I actually kind of like it. I wish I could screenshot it.

Dr. Nicole: You. You [Laughter].

Gabe: We’re doing reels.

Dr. Nicole: You can absolutely. You can absolutely still be actively suicidal and better. You could tell me that you were before thinking about suicide every day and now maybe only three days a week. Do you have active suicidal thoughts? That is better. I mean, you can’t argue with the fact that, well, you could try, but I’m not going to let you. That is better. You could still be having hallucinations, and maybe they’re quieter and maybe they’re less negative. Maybe they’re less intense. Not as loud, not commanding you to do things to yourself. You’re still psychotic, but you’re better. So I, I mean, I don’t I think we just have to really focus on ourselves when it comes to the whole, am I better because no two people’s bipolar disorder is the same. You’re all very different. Everyone’s unique, and we just need to compare you to you and you alone and just get out of this whole comparison crap. I don’t like it.

Gabe: There’s that optimism that I think drives people with bipolar disorder crazy, and it definitely drives me crazy. Right? Here is my base premise. If you are actively suicidal, you are not better. Here’s yours. Well, but you could be less suicidal than you were before. That

Dr. Nicole: Yeah.

Gabe: Is an extreme. First off, it’s true. You are right. I’m not going to argue with you. I can’t get around that it’s not true. But I think a reasonable person living with bipolar disorder would not define that as better. Again, I cannot argue with your logic. Right. But I do think the, the, the disingenuous feelings that people with bipolar disorder feel when they argue these points out is like, if you need $10,000 to pay or you’re going to lose your house, right, you need $10,000, you’re going to lose your house. You started at zero. You work really, really, really, really, really, really, really, really, really, really hard. And you get $5,000, right? That is better. It is better to have $5,000 when you need $10,000, then you have $0 when you need $10,000. But the outcome is identical. You didn’t have ten grand, you lose the house. And since the thing that they’re trying to stave off is losing the house, they really don’t see that as the improvement. And I think that is where people like me who and I’m saying that both as a bipolar and a pessimist, I think that is where people like me get hung up when we try to figure out if we’re doing better.

Gabe: But here’s the thing I’m wrong. I know that I’m wrong. I know that I’m being too rigid. In fact, if you are going to lose the house anyways, it’s probably good to have $5,000 handy. You probably learn some stuff along the way while fighting so hard to get that five grand. Maybe somebody noticed you along the way and thinks, you know what? Even though this guy defaulted on his house, I saw how hard he worked to save it. So I’m still going to rent to him. I. I could do this all day. The point that I’m making is, is that it’s just hard, Dr. Nicole, because the thing for us isn’t a house. It’s not raising money. It’s not accomplishing a goal. The doing better part that we’re talking about is we want to feel content, stable and happy. And for many of us, we just don’t. And when we hear a lot of these optimistic examples of, oh, you’re doing so much better, we do dismiss them very quickly. As you know what, I don’t care because if this is better, it’s still intolerable.

Dr. Nicole: And some of this probably goes back to how do you feel about the fact that you have this bipolar disorder in the first place? Like how are you able to come to that space of accepting that this is where I am? This again, happens in other disorders as well. Think about people who may have an autoimmune disorder and they are plagued with fatigue every day. They may literally have fatigue every day, but maybe some days their fatigue allows them to get up and get dressed and help get their kids ready for school and take them to the bus stop. And some days it doesn’t. They’re tired either way. Either way, they’re tired. Either way. They don’t have any energy. Either way, they are dealing with this fatigue, but some days are better than others. You have bipolar disorder. You may have great days, and then you may have days that you aren’t that great. You may have months where you’re doing great firing on all cylinders. You may have months where things aren’t going as well. Better is within the parameters you are given. And I still think we I just still think it’s very difficult when you have not acquired the skill set yet to see it from that angle, because I think as long as you still say, well, I still have bipolar disorder, I still gotta take these meds every day, I still my life still sucks.

Dr. Nicole: I still gotta do this. I still can’t stay up late, gotta make sure I sleep or else I get manic. I still gotta. If you spend all your time focusing on that part you’re gonna miss. You’re really gonna miss the part that you actually are getting better within this illness. And you have to figure out what does better look like to you. What is better? If your idea of better is I never have to think about my mood, and I never have to care if I’m depressed or manic and I never have to quit, then that’s probably not a realistic definition of what better looks like or what good looks like. You have to know where you’re trying to get to and and define some of these things. And so that may be the first step, is you defining what does better even look like. And do I have a realistic view of what better for me can look like?

Gabe: Along that same vein, I think we should absolutely discuss how we sabotage ourselves by setting goals and then moving the goalposts. I know when I was first diagnosed with bipolar disorder and a lot of stuff happened to me in pretty rapid succession, including losing my job. And I said at one point to my wife at the time, I said, look, I, I just need to get back to work. If I could just get a part time job and maybe make X amount of dollars. And I had a very specific number, a very specific number of hours and a very specific type of job. And spoiler alert, I got it, I did it. Not instantly, but I earned it. And the very next words out of my mouth are, well, yeah, but I’m not full time. Well, yeah, but I don’t have good benefits. I, you know my, my I don’t make a lot of money. I used to make more money. I just I completely just crapped all over the goal that at one point in my life was my driving mantra. Gabe, why are you getting better so I can get back to work? I did it, I achieved 100% of the goal. Didn’t even enjoy it for a moment. I think many people with bipolar disorder we do this to ourselves and again, comparison is the thief of joy. The reason I thought that was a bad job is because I compared it to other people of my age who were making way more money in more impressive careers. And then I decided that I sucked. But actually I went from unemployed to gainfully employed. That ultimately started me on the path to here. So clearly that employment worked out well, but I didn’t see it at the time. And truthfully, even looking backwards, I still don’t see it.

Dr. Nicole: I’m gonna come back in here again wearing my cape of. This happens to everybody. This is this also is not a phenomenon that is unique to bipolar disorder. With the world we live in today, where everybody’s constantly comparing themselves to other people, people just aren’t really happy with reaching a goal. How often do people reach a goal and take the time to, like, celebrate that goal, celebrate that victory even if it feels small, before moving on to the next one. A lot of people are like this bipolar disorder or not. It’s like, okay, met that goal. On to the next one. And it’s healthy to keep setting new goals as you as you master a task, as you as you get to that that goal post, it’s healthy to start looking for, okay, what’s the next step? And there’s a fine line between sitting in it and becoming complacent and not trying to move forward and not giving yourself the time to even to even celebrate it at all. I mean, there’s a window. Who’s to say how long that window is? But I see a ton of people who just go straight from one goal to the next. And I don’t think that’s unique to bipolar disorder. But like you keep reminding me, this is a bipolar podcast. So here we are. We in it. I am certain it happens for people with bipolar disorder, too. You reach the goal and you’re like, okay, I’m ready to get to the to the next goal. I think for you all the risk is are you pushing yourself too quickly and pushing yourself too quickly can have more serious consequences than maybe for someone who struggles with this and doesn’t have bipolar disorder. So there is a need to take a moment to then redefine what the next set of goals are. How I’m going to get there. There’s a need to take a breath and do that, and I think that need is much more important when you’re living with bipolar disorder.

Gabe: All I can really say is that for me personally, you doing the following things will cement my goals for this episode. First, wherever you downloaded this podcast, please follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. Two. Share the show with everyone you know. Share it on social media. Share it in a support group. Send somebody an email or a text message because sharing the show is how we 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, but listen up. If you go to my website, gabehoward.com, you can get a signed copy and I’ll throw in some free show swag.

Dr. Nicole: And I’m Dr. Nicole. You can find me on all social media platforms @DrNicolePsych or at my website, DrNicolePsych.com.

Gabe: We will see everybody next time on Inside Bipolar.

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