Many people with bipolar disorder miss the feeling of mania despite its destructive nature. Today, we discuss the complexity of treating bipolar disorder, emphasizing the importance of patience, concrete examples of symptoms, and the fact that medication can help stabilize and potentially hinder a patient’s cognitive functions. Gabe and Dr. Nicole both agree on the need for people with bipolar disorder to be strong self-advocates, involve support systems, and work closely with their healthcare professionals to achieve stability and recovery.

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: 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: I have a confession to make. It’s gonna blow your mind.

Dr. Nicole: Okay, okay. Let’s see, let’s see.

Gabe: I miss mania. I do remember all of the episodes about how mania has the best PR team in the world. Mania is bad for you. Everybody thinks that mania is great and romanticizes it, but it’s actually evil and it’s doing harm. So can you believe I miss it? I do.

Dr. Nicole: No, I can’t, and I, no. I cannot, I absolutely cannot.

Gabe: Here’s why. Mania did feel good. It was destructive, but it felt good in the moment. And more importantly, I got used to the speed that my brain was going. I got used to the feeling of energy. Now my brain going that fast and having that energy really didn’t turn into anything. It wasn’t productive. But Dr. Nicole, I, I, I gotta tell you, it did in the moment feel fantastic and it was difficult for me to adjust to my mind moving slower and my body moving slower and my energy levels moving down to a more normal pace because I was so used to these higher energy levels. And I think it’s something that that a lot of people with bipolar disorder struggle with.

Dr. Nicole: It is something that a lot of people struggle with because it’s something that I hear all the time. I do a lot of hospital work, and so I have the opportunity to see people who come into the hospital in a manic state. And at the end of that stay, one of the biggest complaints I hear is I just feel so tired. I feel like I’m moving slow. I feel like I’m walking in quicksand. I feel like I have concrete blocks tied to my feet. I just feel like I’m moving super slow. For me, the hard part is, you know, I’m thinking, but you’re not, you’re not. I’m looking at you. You’re walking fine. You’re moving, you’re moving fine. Moving normal. Everything looks great. You know, I’m hoping that you would say, man, thank you for slowing me down, that that level of speed was a little bit dangerous. But that’s not what I get. Because you all feel so slow. Whether it’s real or otherwise. It’s how you feel. So I think you’re well. I know you’re not alone in that feeling.

Gabe: I do want to say thank you to my Dr. Nicole, for slowing me down because even though I was moving really, really fast and my mind was moving really, really fast and I felt like I had all this energy and I did, I, I keep saying I felt like I had all this energy, I had all this energy. Oh, I had so much energy. But the productivity wasn’t there. I’m going to use Cars. Remember the movie Cars? The kid’s show?

Dr. Nicole: Yes.

Gabe: Cars where the the old guy races the young guy

Dr. Nicole: Yes.

Gabe: Car just speeds out of there like, boom, right? And he shoots out and the guy just sits there and he doesn’t move and everybody’s like, but you’re going to lose the race. You’re going to lose the race. And of course he the car hits that first corner. He goes off the road, he lands in the canyon, blows all his tires and the quote unquote old guy, the slow-moving guy just moseys on up, looks over and says, yeah, you went too fast. And that’s why I’m just going to slowly win this race. Well, while all of your speed did nothing for you, that’s what it reminds me of. But I still want to say, I bet Lightning McQueen felt awesome being able to shoot off that line so fast and right up until he ran off the road, I bet he felt fantastic. But that feeling didn’t ultimately win him the race, and he looked stupid in front of the Studebaker or the Hudson or whatever the hell car it was. It’s been a long time since I’ve seen the movie,

Dr. Nicole: Yes,

Gabe: But does that resonate? Do

Dr. Nicole: I,

Gabe: You understand what I’m coming where I’m coming from?

Dr. Nicole: I mean, yes, but I think your analogy is not one that somebody who’s coming off a mania wants to hear. Nobody wants to be compared to the old guy. I don’t think anybody who’s coming off a mania says, wow, but slow and steady wins the race. That is not where any of the patients I see. That’s not where their mindset is. And I’m pretty sure that’s not where yours was either.

Gabe: I agree with you. Nobody wants to hear it. But isn’t this what we need to hear? You use the exact phrase nobody wants to be compared to the old guy, but doesn’t everybody want to be compared to the winner? And in in that analogy, the slow and steady wins the race. He’s the winner. He won. He has all the control. He knows what’s going on. And ultimately everybody looks at Lightning McQueen like he’s the idiot stuck at the bottom of the of the canyon or the turn. And ultimately, Lightning McQueen learns a lesson. I don’t know how we ended up on a Cars theme for today’s episode, but I do think about this a lot, because two things can be true.

Dr. Nicole: Mm-hmm.

Gabe: I want to go as fast as Lightning McQueen, but I also want to be the winner.

Dr. Nicole: Mm-hmm.

Gabe: I want to be the person who is ultimately in control, knows what is going on, and I want to be able to balance those. And, and just to tie this little analogy up in a perfect knot. Once lightning McQueen learned that lesson, he was able to both go fast and be the winner. And I think that’s really the lesson for all of us. How do we get there? Dr. Nicole, when people say this to you, I am positive that you don’t just say, oh,

Dr. Nicole: [Laughter]

Gabe: Slow and steady wins the race.

Dr. Nicole: [Laughter]

Gabe: You do, in fact, drop vast amounts of knowledge and wisdom. What do you tell people when they give you this complaint?

Dr. Nicole: You know, first I have to figure out what do they mean by slow? Do they mean I physically feel slow, or do they mean I cognitively feel slow? Are they telling me my thoughts are slower? Are they telling me I don’t think as quickly on my feet? Or are they telling me that they physically feel like they’re moving? I have to figure out what exactly that means, and I have to look for firm examples of what were you like before that you think you’re not able to do now? Because I have to figure out, is this even based in reality?

Gabe: What advice do you have for the person who feels physically slower?

Dr. Nicole: I think the question for people is, do I seem like I’m moving slower than I typically move? And that really is the question, because a lot of times people feel like they’re moving in slow motion because they’re comparing the drop.

Gabe: So the reality check that you want people to check in isn’t am I moving slower? It’s am I moving slow? Am

Dr. Nicole: Yes.

Gabe: I am I dragging? Am I no longer productive? Is that people around you thinking,

Dr. Nicole: Yes.

Gabe: Wow, you need to speed up, keep up, keep up, keep up. Is that really the reality check that you’re asking people to check in on?

Dr. Nicole: Yeah. And you and you can even check in on your. Is it taking me longer to do things? Is it taking me longer to get a load of laundry done? Just regular stuff. If I go iron a shirt, is it taking me longer to iron that shirt than usual because I’m moving slow? If I am in a career where there are certain tasks I do, and I know how long it takes me to get them done, is it really taking me a longer amount of time to get those things done? Those are some very tangible things. You can look at getting the opinion of the people who know you well. To determine, am I really physically moving slow, or is it because of that drop, because you went from way up there to kind of a normal level of slow, which feels, I am certain. I’ve never been manic, but I am certain it has to feel like the bottom has plummeted out of your energy and it’s just gone.

Gabe: I really like your comparison there, because I’ve got to tell you, once the mania was removed, I felt like I was moving in slow motion. I felt like nothing was happening. I felt like I was just sitting there like a stump. But when I started comparing actual productivity. During mania, I started 800 projects and finished zero. I really felt like I was king of the world and that I was moving at this rapid, highly productive speed. But when I really looked at what did I accomplish in the last month before being treated for this? And it was I finished nothing. Started a lot of stuff, had a lot of great ideas, but the execution was off then and now I’m moving in slow motion and that’s how I felt. I really felt like now I’m moving in slow motion. But I finished the laundry, I

Gabe: Cleaned the kitchen. The project that I started, I completed, I was evaluating projects, and I was like, this is not this is not a good use of my time, money, effort or friends. In some ways it’s a sad story, but it’s a real story. When I came up with the idea to start this very podcast, this very business, this the whole speaking thing, I asked somebody to bankroll me. I said, hey, I need some money to get this done and I don’t have it. And the person started crying and I thought they were tears of joy. I was like, oh, they’re so proud of me that I’ve got this wonderful business plan. And the person said to me, I’m trying to decide how much money I’m willing to spend to keep you as a friend because you’re not going to accomplish this. This is just another thing that you’re going to start and another waste. And I, I was upset, I was like, why are you saying this to me? This is a really good idea. And she said, you’ve never completed anything ever. And that hurt my feelings. We got in a fight. But then I looked at it and I was like, yeah, she’s right. I’ve never completed anything ever. Now this one worked. But. And I love to tell her all the time, hahaha, you were wrong.

Dr. Nicole: [Laughter]

Gabe: You were wrong. But the reality is, is based on the information she had at the time, she made the absolute right decision not to invest a single minute or dollar in me. But even though I moved slower, this has been wildly successful. I’m in a room with a doctor. I get to work with doctors now.

Dr. Nicole: Oh, gosh. But I, I think. In my opinion, this is more problematic and a bigger issue for people who historically have hypomania versus the mania people. The mania people, their highest can be so high and typically so high, that that that we expect this. The hypomania people, it’s a little bit harder to, to get them to buy in to this concept of slower, more productive, you know, normal level, normal pace. Because a lot of times the hypomanic folks are able to get things done. They really are like they are able to get stuff done. Depending on their careers, their hypomania can be downright beneficial. I have folks who are in sales and man those outbound sales calls through the roof. They are more charismatic, they’re more personable, they have more energy, they’re brighter, they sound more into what they’re doing. And sometimes that translates to productivity for them. So it is really hard for those people.

Gabe: But where does the bottom fall out? There’s obviously something that got them to you. Something got them in the room.

Dr. Nicole: Yes.

Gabe: I’m not trying to be the I’m not trying to be the wet blanket, but nobody calls up a Dr. Nicole because everything is going well and they’re making lots of money.

Dr. Nicole: No, but what goes up must come down. And we know that a lot of people, after their hypomania, they have a crash, there’s a severe depression. So if our goal is to prevent the crash, it may also be that there were other behaviors in the hypomania in addition to that energy part. Maybe it’s the spending, maybe it’s promiscuity. Maybe, you know, those things that go with it. There’s always something else. But specifically trying to convince them that they’re more productive when they’re moving at a normal pace may fall on deaf ears for that person who who’s kind of only had hypomania. And that’s they love that zone. They love, love, love that amount of energy. So it may be a hard sell, but that that physical feeling, slow, feeling like they’re moving in slow motion is exactly the terms that people use subjectively. That’s how they feel. But objectively, when I’m watching them walk around the unit and fix coffee and do all these things, they appear to be moving at a pace that is conducive with productivity. And that is what I’m going for. But that’s not what they want to feel. They want to feel that because you’re right that I, I don’t know, I’ve never been in extremely energetic person, but I would imagine there probably is some level of this feels amazing. I could see how you’d want to hold on to just that part and just that little piece.

Gabe: One of the big things I learned from people who experienced hypomania in the exact situation that you just gave, who were excelling in sales, who were excelling at their job, is that the hypomania is biggest, biggest, biggest deficiency is they lack the ability to say no. They were over promising. When their clients were like, hey Gabe, we want to sign with you. Can you have this done by Wednesday? You’re damn right I can. And they’d say that to four people. They just didn’t want to tell anybody no, because they were king of the world. And that is when it came crashing down for them. It felt great to constantly be saying yes. It felt great to be the king of the world. It felt great. And everybody wanted to call them because everything that they were promising was great. So. So of course they got all the sales, but they lacked the bandwidth. And I’m just using sales. And as an example, you’ve got to apply it to, to you. But again I go back to it’s not sustainable. Nobody is I don’t really think anybody is listening to this because they were able to sustain it. I don’t

Gabe: Think anybody in the emergency room or on the unit or talking to their Dr. Nicole is because everything was going well. Clearly something crashed. And while it may have felt good and while it felt like they were moving fast, even in hypomania, eventually it did hit a brick wall. Now we promised everybody that we would also talk about how it feels cognitively. That this this idea that your brain used to be, you know, zoom zoom zoom zoom zoom zoom, zoom, fire in all cylinders. And now it feels muddy and slow and your thought process is diminished. What advice do you have for your patients who say, look, my mind is just not thinking rapidly, and I don’t like that.

Dr. Nicole: This is a, this is a space of radical acceptance for people who have bipolar disorder. And this I think is one of the biggest accomplishments in therapy that a person who has been diagnosed with bipolar disorder can make. For you to be able to take this diagnosis, to accept some of the really crummy, crappy parts about it, and to figure out how to continue to enjoy your life on the other side of this diagnosis. Because the reality is, I’m not going to sit here and tell you that you may not be feeling cognitively impaired. That’s where it gets a little trickier. You can tell me, I feel like I’m physically moving slower. I feel like it’s taking me forever to fix a cup of coffee. It’s taking me forever. And I can tell you, well, in my opinion, I’m watching you around the unit. I’m watching you walk to this room. I’m watching you come from the door to your chair. I’m watching you come to my office. I’m watching all these things. You don’t appear to be physically slow. That’s one thing. I can’t just look at you and tell you that you’re not cognitively slower.

Gabe: I know for me the racing thoughts and that’s what they were, right? If I’m calling a spade a spade, they were racing thoughts, they were racing thoughts, they were racing thoughts. But it felt like I was I was looking at all of this information all at the same time. So, so Dr. Nicole and I, we would we would be in battle, right? It’s a podcast battle. Dr. Nicole would say one thing and I would think, okay, now I’ve got to think of this, and I would think of 100 examples. I would be like, yeah, I’m going to win this. And I’ve got I’ve got the example of Diet Coke is better than Pepsi, pizza is better than a hamburger, and purple is better than orange. And all of that would fly into my mind right at the same time. Because again, I am masterful and my brain works super fast. And I would say pizza, hamburger, orange, Dr. Nicole, boom, mic drop. And in my mind I just won because I gave three examples because my brain fires so rapidly. And then when Dr. Nicole gives me this look and she’s even giving me the look now, and she knows it’s an example and I’m like, see, I won so much, she’s got no comeback for my awesome.

Gabe: I bring all this up because what actually happened is I spouted nonsense. Dr. Nicole now realizes that she’s dealing with an idiot and she goes away. Right. But, when something feels good, it’s hard to consider it an impairment.

Dr. Nicole: I think if you go to any social media forum group where people have bipolar disorder, you can always find a thread somewhere where somebody’s saying, I have bipolar disorder, I was manic and now I’m no longer manic and now I’m just not functioning. I’m not firing on all cylinders. Is a common phrase that people use. I’m not, you know, they may say, well, I just feel like I’m not as sharp. I can’t multitask like I used to. I can’t process information quickly. So what if I work in an industry where I have to make very rapid decisions? I feel like that’s hindered. That’s real stuff. And I don’t I don’t know, I don’t know how to convince people of that. I still struggle with that to this day. And I’ve been doing this for a very long time. I do believe and I know for a fact this is an under-researched area of mental health. We do not have a lot of data out there to talk about the cognitive impairment in bipolar disorder. Even when a person is no longer manic, no longer depressed, and how they may cognitively be behind. I don’t know that I can’t argue with people about what they feel. I can’t tell people in their brain what they’re feeling.

Dr. Nicole: I, I can believe it though. I mean, mania is a is a brain disorder like it is a hit on the brain. Can you imagine what your brain looks like manic? Have you seen these Pet scans where they look at people’s brain activity when they’re manic and when they’re depressed and when they’re not? It? I just cannot imagine that your brain doesn’t go through some level of like, whew, I’m tired. You know, like, I just can’t imagine that collectively, if your brain could talk, it would literally just lay down and say, I’m done. I’m unable to can anymore. I’m tired, I can’t, I’m done. So it would make sense to me that a person would have some cognitive impairment. And there are some studies out there that show that there is some cognitive impairment that we see. I just don’t think we have enough. I think it’s real. I mean, it’s real. It is a real thing.

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Dr. Nicole: And we’re back discussing feeling slow when you have bipolar disorder.

Gabe: How do you feel about this idea of a mourning period? You know, I had to mourn the loss of mania, and I had to mourn the loss of the way my brain used to work because it my brain worked this one way my entire life.

Dr. Nicole: Mm-hmm.

Gabe: And then one day I woke up and somebody said, the way that your brain worked your entire life was disordered. It was a disease process. It was an illness. And it never should have worked that way. And just because you’re used to it doesn’t make it good. And that’s all fine and well. But I, I couldn’t help but say, look, it it’s been doing it for 26 years. It’s literally all I know that hurt.

Dr. Nicole: Yeah. Your life was forever changed after you were diagnosed. You were never the same person again. That comes with any diagnosis. It could be a cancer diagnosis. It could be a diabetes diagnosis. Once you know that you have this thing, that you have to make alterations in your life to deal with, or you have to approach the way you handle things differently. You are forever changed. Your life is forever changed. Bipolar disorder is a life changing diagnosis. There is no if, ands or buts about it. It is life changing. You are not the same person you were. So yeah, there’s a there’s a grief period. There’s a mourning. There’s a like I can’t just now walk around like this and enjoy the feeling because I know now I know what else comes with it. I have a responsibility to myself. Forget everybody else. I have a responsibility to myself to be able to kind of work this thing out. So, yeah, I mean, I think having a mourning period, there’s nothing wrong with that. You will be forever changed. And we’re not going to pretend like medication doesn’t add to cognitive dulling or slowness for some people. So I, I’m not going to sit here for the person who’s like, oh, but Dr. Nicole, the medicine you gave me made me slow.

Dr. Nicole: It really could have. I can’t tell you it didn’t. I have no argument with you that there are some medications that lead to cognitive decline. I cannot even fight with you on that. It does. But we can’t just look at the slow part. We can’t just focus in on. Well, this medicine makes me cognitively slower than my kind of baseline. We can’t just focus on that. We have to also think about all the whole big picture of your bipolar illness. What kind of problems did it cause you? What are you infinitely better able to accomplish now that you are on this medicine? I, we, we just cannot focus on just the slowness part. Because yes, the medicine can cause you to feel slower. Having bipolar disorder can cause some cognitive slowness compared to that baseline. All of those things are true, but you still cannot argue with me about the fact that being stable and not having this flip flop in your brain between mania, depression, I’m euthymic, I’m mania, I’m manic, I’m depressed, I’m normal mood. You just cannot argue with me on the fact. That that’s not good. And overall, that not good is much worse than the not good of I’m a little slower cognitively because I either have this illness or I’m taking this medicine.

Gabe: I am so glad you’re here, Dr. Nicole. You know, every now and again you go into medical school just pays huge dividends for me. Just [Laughter]

Dr. Nicole: [Laughter] Glad to know. Glad to know.

Gabe: I. I say that because this entire time, up until literally right this minute, my base premise has been you’ve got mania, you’ve got hypomania, and you need to come down to a normal level, a stereotypical level, an average level, a controllable level, a non-disordered level of thinking. And now you’re mourning the loss of that. And I understand right. The mania felt good but it’s time for it to go away. But you were used to it. I know, but now it’s gone. And you just mentioned like medication side effects. And I was like, oh yeah, that’s like a thing.

Dr. Nicole: It is. It’s a real thing.

Gabe: That’s like really important for people with bipolar disorder.

Dr. Nicole: Yes.

Gabe: To consider because it is possible that it it’s the side effect of the medication is dropping you way, way, way lower than it should be. Now. Now you pointed out the medication is working well, right. So you dropped from the mania, the hypomania to the normal. But the medication is kicking in. But we’ve got to look at everything. We’ve got to look. We got to take a 360-degree view of a person. Holistic medicine, physical and mental health lived together. Rah rah rah rah rah rah. Right, I get it. But I’m thinking, what happens if you prescribe a medicine and you just gum up the works? And the side effect is actually worse than the disease, what do you do then? How do you tease that out? Because it sounds like if somebody says, look, you’ve prescribed me this medicine and now my mind is gunk, you’re going to think, well, that’s good. You’re just coming down from the mania and now we’re normal. How do you know that? We’ve reached normal and you didn’t overshoot.

Dr. Nicole: Yeah.

Gabe: Dun dun duuun!

Dr. Nicole: I know, I mean, that’s a fantastic question. I don’t always have an answer for that. I have to figure out if we have the same treatment goals, because my treatment goal for you may not be your treatment goal for you. So if I say, well, I just want to keep you out of the hospital and I just want to keep you out of jail, and I want to keep you from cheating on your spouse because you’re hypersexual. And I want if those are my goals, because I’m focused on the very big things and you’re more focused. Not that you don’t care about those things, but if in that moment you are more focused on the fact that you feel like when you’re at work, it takes you longer to get stuff done and you don’t feel like a person and you feel like you’re not holding your weight. If our goals are very different, we are going to clash every flipping time. So we have to get to a place where we both have the same goals. I have to know what yours are, you need to know what mine are, and we need to meet in the middle and figure out what we can do. So 100%. Like we gotta get on the same page, but I sometimes and this is where, you know, this is where I get accused and you know, the psychiatrist of the world get accused of treating people like they’re guinea pigs.

Dr. Nicole: I cannot tell you if I had a dollar for every time in the last 20 years, someone accused me of treating them like a guinea pig, I would be a wealthy woman. Because that is a very common complaint that people have. You people are just throwing things at me, and you people are just treating me like a guinea pig, and I don’t I don’t want your medicine, I don’t want to keep. And it’s not that. So if I can use this moment, we get no joy out of changing your medicine frequently. Absolutely not. Do you know how much more complicated a visit that we’ve already talked about is very short. For the most case, you don’t get to spend 30 45 minutes in a follow up visit chatting it up with your psychiatrist in a short visit. Do you know how much easier it would be if you just said, oh yeah, I’m feeling good, things are good and we leave your meds the same. That is a much easier visit to have than for me to have to figure out in 20 minutes what you’ve taken before, how you tolerated it, what we’re going to do different, what side effects you’re having.

Dr. Nicole: Is it really the medicine? Is it your illness? Like it would be easier for me if we just left it the same. So this this feeling of being a guinea pig, I get it, but really that’s not it. Like it’s just not. But this is the space where we would have to try things and see. Do you feel like it’s really the medicine? If we try a bunch of things and you’re still feeling the same way, is it the medicine? Do we have to have a deeper conversation about having you do some formal neuropsychiatric testing, where we’re testing processing speeds and putting you in front of a PhD person who has dedicated their career to doing Psych testing. That may be where we end up, but this is a put your seatbelt on. It’s a journey. This is a long road trip. This is not a quick, quick hop around the corner so you have to buckle in if you really want to work with me, your psychiatrist, if you really want to work with that person on getting better and figuring out is it the medicine, buckle up, buttercup, because it’s going to be a long ride.

Gabe: I’m. I’m still stuck on this idea of how do you know? Right? Like, I mean, just like I say, hey, so I go to my Dr. Nicole, right. I’ve had mania, full blown mania and everything that that entails. I get put on medication and now I say, look, my mind is moving way too slow. Wouldn’t your knee jerk reaction to be like, well, yeah, compared to mania, it is moving way too slow. How can you tease out? And the reason that I’m so concerned about how you can tease it out is because I want some sort of like validation or verification. Because remember, I have nothing to compare it against. All I have is my disordered brain. And now somebody telling me, no, no, no, no, no, that’s more normal. But are we sure? How can we be sure?

Dr. Nicole: Yeah. I mean, so I mean, the honest to God truth is, we may not be sure initially, I, I genuinely may not know. The answer is if you said to me, hey, I feel super slow, then my questions are going to be okay. In what ways? Like give me, give me examples. You know, somebody who tells me, well, I typically read novels to I can’t read two pages, I can’t retain anything. I can’t, you know, like that’s a big jump from where they were to where they are now. I want to know what is the jump. Can you give me examples of like, these are activities that I used to be able to do in this way and now I can’t. Can you give me firm examples? But if all you have to tell me is, well, I just feel slower, I can’t give you any examples. I’m just. I’m not firing on all cylinders. What does that mean? I mean that that means something different to everybody. So I need specifics like I. And so what? The best thing you can do is start coming up with firm examples of what it is that you’re trying to describe, getting input from people around you. Maybe it’s your spouse who says, hey, did you tell her that when we’re having conversations like you’re having word finding, you can’t come up with the words for things, you’re forgetting little things.

Dr. Nicole: And that’s not like you. Like, I need examples. I need firm examples of what it is that you’re dealing with. So that helps. But even then is this. We have to give your brain time to heal. Is this patience? Because you just came off of a pretty heavy, manic episode, and maybe your brain needs time to recover. It could be that. It could be this medication. Certain medications are known to have that as a side effect. So if I know that, then we’re going to have a conversation and I’m going to say, well, Gabe it could be that we just need to give it more time. It could also be that it’s the medication. What do you want to do? Because I can’t tell you that there’s a right or wrong answer.

My magic wand has been in the shop for two decades now. It just doesn’t work. So I don’t I don’t have the ability to just say, oh, yeah, definitely, it’s this. So it’s not a clear-cut answer.

Gabe: If there were two things that I could write on, like giant picket signs and like just march around for people to see, it would be concrete examples and be patient. I think those are two things that often get missed, right? My mind is moving slow is sort of like a small house, right? What’s a small house? If you ask Jeff Bezos, a small house is 30,000ft². If you ask me, a small house is 1000ft². And, you know, Dr. Nicole might think that a 3000 square foot house is a small. The point is, is that it’s nebulous, right? The next thing is the unrealistic expectations. Honest to God, Dr. Nicole, it took me four years from the time I was diagnosed with bipolar disorder to the time that I reached recovery, and I can tell you for the first couple of years, I thought it was because I was doing something wrong. And that was reinforced by the people around me and by the things that I was hearing. I wish somebody would have framed it differently and said, this is complex. This takes a long time. You need to be patient. The people around you need to be patient, and it’s going to take as long as it does. But we’re going to get there, look at it like a yo-yo on an escalator. You’re going to you’re going to trend up right, because you’re going up that up escalator. But the yo-yo is going to go back and forth and up and down. It’s going to take some time. But we believe that you can get there. Dr. Nicole, when people bring you these specific examples though, how do you like to receive them? Should they keep a journal? Should they start sending you emails? Do people text you like,

Dr. Nicole: Oh.

Gabe: Hey, I want you to know I’ve noticed this problem in this moment right now. Like, what’s the best way

Dr. Nicole: [Laughter]

Gabe: To because I know that self-reporting can be complicated. Let’s say that they see you every three months and they want to give you concrete examples. The examples are probably going to be like that week, but there’s like three months’ worth of data that they may be missing. So you’ve got to have some suggestions for data collection. I know you do.

Dr. Nicole: I do. But listen, don’t text me and don’t email me. Please don’t. I barely want people I know to text me, let alone patients to text me. No, I, you know.

Gabe: Why are you looking at me when you say that? Why are you looking at me when you say I barely want people I know to text me.

Dr. Nicole: [Laughter] Barely want people I know to text me.

Gabe: Like that was a. That was a weird look, Dr. Nicole,

Gabe: [Laughter]

Gabe: I don’t. Did you. Did you see that guy? I feel uncomfortable.

Dr. Nicole: I. You know, and I know for a lot of people, they do want to just shoot me an email or they would love to be able to text message me. And technology grows and changes and evolves, and there are some practices who have that capability. It just depends. So just ask your person like, how do you want me to relay this information to you? For me personally, I’m a big fan of the list, so I love it when we keep a list on the refrigerator of things that we want to make sure that I know about when people come in for a visit. So when my patients come to me and they say, okay, Dr. Washington, because that’s what they call me in real life, they say,

Gabe: You’re not a Dr. Nicole everywhere?

Dr. Nicole: No, not everywhere. But they may say to me, this is the list. My wife added this, this is what I noticed. This is and they involve everybody in the making of the list. That is very valuable for me to bring it in at that moment. That’s very helpful for me.

Gabe: Dr. Nicole, I know that we’re at the end of the episode, and I again, I want to make sure that everyone understands that that that that I see you, Dr. Nicole sees you. We see you. That’s the purpose of this podcast. And we want to address things and of course a helpful way. But obviously we can’t do it for you. And just because we see you doesn’t mean that that’s going to do you a lick of good. So I want to make sure. Dr. Nicole, is there any other advice that you have for people who are experiencing this to help regulate themselves and to get there, other than to validate that it’s a real thing? Other people have gone through it, and that the Dr. Nicoles of the world really do understand it.

Dr. Nicole: We get it. And I always encourage people, be a good advocate for yourself. And if you take nothing away from this, be patient. With yourself and the people who are trying to figure out the best medication regimen for you, and to also just arm yourself with all the information that you need to get your needs met. And if that means bringing in other people, bring them in, bring them in, involve other people. This is a team approach and we need everybody on the team on board. So advocate for yourself. Advocate the heck out of that thing. Just go for it. Just get in there with all your stuff. But just be patient and just know that it is it really. It really is a tough thing to manage.

Gabe: And with that, thank you everybody so much for tuning in. We really, really appreciate it. And we have a few favors to ask of you. First, wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free. Next, wherever you downloaded this show, please leave us a review, type something out, leave your words. And finally, and this is the biggest favor, recommend the show to everyone you know. Share it on social media. Share it on Reddit. Share it on a support group. Share it. Ever send people text messages? Connect with people from high school that you haven’t talked to in a while and share them? The link for this show, because sharing the show is how we grow. And my name is Gabe Howard, and I’m an award-winning public speaker who 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 you can grab a signed copy with free podcast swag or learn more about me by heading over to

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

Gabe: And we will see everybody next time on Inside Bipolar.

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