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Some people with bipolar disorder (manic depression) have managed to control their illness so well that they do not give the impression of having a mental disorder. In this article, I will deal with the secrets that have been put into practice by these people, secrets which helped them to tame their bipolar disorder.

In recent years I have read books and articles about bipolar disorder, and I have discovered that these secrets are becoming more and more widely known in the English bibliography. I should mention that they have to do with the holistic model of therapy, which has come into practice in other countries rather recently, and which is not yet widely known in Greece. I personally apply this model and have seen very good results.

It is not feasible for someone to apply this advice 100% in a short period of time, or shortly after an episode. It took me several years to be able to apply about 90-95% of the ideas I will elaborate on below. If you want to try to put some of these things into practice, it is important to remember that progress is at a snail’s pace, in small steps, and sometimes we even go backwards. A start can best be made when you are in a normal mood (normothymic). It can be difficult to make a new beginning and try to change the habits of a lifetime when you are in a manic or a depressed phase. If you really want to put the holistic approach into practice, then you will need to take the steps I describe below when your mood is stable.

Here are the tips!

  1. Be sure to go to bed and wake up at about the same time each day. In other words, develop a stable sleep routine. You will need to sleep not less than 7 – 8 hours a day when you are normothymic. Limit your late nights, and when you do stay up late, be sure to make up for the sleep you have lost. A regular routine is a good idea, not just for sleep but also for meals and medication.
  2. Cut out caffeine altogether (coffee, black tea, colas), energy drinks (eg Red bull), alcohol, fizzy drinks, narcotics, and in general any substances which act as stimulants or sedatives. Avoid sugar as much as you can. Avoid smoking – even passive smoking.
  3. Have any silver mercury dental fillings removed. Also, try not to expose yourself to exhaust fumes, as much as possible.
  4. Include physical exercise in your daily routine – or at least nearly every day. Find reasons to walk rather than take the bus or drive.
  5. Adopt an orthomolecular diet, using organic products. Eat slowly, and chew every mouthful well. Drink plenty of water using a good quality filter.
  6. Arrange psychotherapy – individual, family, or group therapy as the occasion demands.
  7. Take good quality dietary supplements (always with medical advice) definitely including omega 3 fatty acid supplements (fish oils).
  8. Learn about your disorder – this is called psychoeducation. In Greece psychoeducation is not widely available, so seek it elsewhere. You can read books written for the non-specialist, or search on the internet.
  9. Take your medication every day, in spite of any side effects. If the medication really does not suit you, then this means that your psychiatrist will need to make some changes.
  10. Fill your life with activities which provide structure in your life, whilst at the same time allowing you to express your creativity. Find something that gives your life meaning, something about which you are passionate. Include fun and laughter in your life. It’s not easy, but it is possible.
  11. If you are an adult, and relatively well stabilized, if it’s at all possible don’t live permanently with your parents, especially if there is tension in your relationship with them. Make it one of your targets to leave the parental home as soon as your condition permits.
  12. Keep in touch with your good friends. Try to avoid contact with old friends who encourage you to drink, to take the substances listed in point 2, or to stay up late.
  13. If you are not working, make this one of your targets. Obtain qualifications. Get help with vocational guidance. Find out which job you would like and would be good at and go after it as soon as you can. If you are working and your job is not satisfying, then make it your target to change your job.
  14. Remove as much stress as you can from your life. Maybe your psychotherapist will be able to help you spot the things which are most stressful for you. Then make plans to avoid them.
  15. Just as you avoid feeding your body with junk food, so you should avoid feeding your mind with junk. Instead of using your time in front of the television, zapping from one stupid programme to the next, become a more discerning viewer, and use your time for some activity which is more useful for you (reading, exercise, chess, clubs, associations, selected television viewing, cooking etc).
  16. Take part in support groups and self-help groups.
  17. Get organized. Unite your voice with others in your position. Campaign for your rights as a patient to good quality mental health services in the public sector, campaign against the stigma of mental illness, fight the under-funding for mental health. Mental health service user organisations provide one such framework.
  18. As much as possible, keep your space tidy and clean (at home, in the office etc.)
  19. Take care to find ways of handling your finances. Ensure that you cannot act impulsively and get yourself into debt.
  20. Take responsibility for your mental health into your own hands. Take your medication yourself. Make your own decisions about yourself and your illness, including treatment decisions. Ask your psychiatrist not to be dogmatic, to discuss things with you, and to take your opinion into account.

NOTES, FURTHER INFORMATION, CLARIFICATIONS

  1. Sleep: You can’t be mentally healthy if you’re not sleeping enough or without interruptions. Research has shown that a regular daily routine, particularly as far as sleep is concerned, is crucial for a person with bipolar disorder to stay normothymic. Explain to others that your sleep pattern is vital when they try and encourage you to stay up late, or otherwise interfere with your routine.
  2. Stimulants and sedatives affect your highs and lows (that is they interfere with the mechanisms that are responsible for maintaining normal mood). In particular coffee negatively affects the balance between the sympathetic and parasympathetic nervous systems, something which is essential to mental health.
    If your sleep is regular, your medication is right for you, and you are exercising regularly (regular exercise gives you energy), you don’t need any stimulants. You don’t need coffee. If you feel you need some kind of tonic, that means that either you’re not sleeping properly, your medication is stronger than it needs to be, or you have overloaded youself with more obligations than you can handle. If you like the taste of coffee, you can drink decaffeinated. If you live a healthy life, you’ll soon be full of vitality and your mood will greatly improve. (My psychiatrist tells me that those who don’t drink coffee visit their therapists noticeably less frequently than those who do.)
    If you use narcotics, ask for help from a service which specialises in treating addictions. Alcohol interacts with your medication, and also with the natural physiology of your body.
    All of the substances mentioned in point 2 have negative consequences for your health. Remember “sound mind in a sound body”.
  3. Silver mercury dental fillings are highly toxic (poisonous). They should be replaced by other kinds of fillings. Also, exhaust fumes contain lead, apart from other substances which should be avoided. Mercury and lead, together with other metals (eg. aluminium etc.) are toxic and exposure to them should be avoided as much as possible. Try not to use aluminium cooking utensils or food packaging.
  4. Exercise may seem unimportant. Research shows however, that without it, your health will suffer in the long term, and you can not be truly healthy, or mentally healthy. A wise person once said “those who don’t find the time to exercise will certainly find the time to be ill”. Exercise has a positive effect on depression, because of the endorphins produced by the body when you exercise. (Endorphins are chemicals produced in the body which improve the mood). They promote a normal mood. All alternative medical practitioners today agree that exercise is essential. You should avoid strenuous exercise if you feel that your system isn’t up to it, and especially last thing at night. If you are taking lithium, excessive sweating can raise the lithium to toxic levels. You need to exercise at the level that is right for you. Mild exercise may suit you better, especially if you are overweight.
  5. The orthomolecular diet is a programme of eating that allows you to eat the foods which suit your system, and promote your health, but you must avoid the foods to which you are intolerant. (Food intolerance is not usually immediately evident. It causes hidden damage from the innapropriate foods you eat, which undermines your health in the longterm.)
    Take note that if you have a bowel problem (eg irritable bowel syndrome) the orthomolecular diet is essential to your health. It’s the only way to control your digestive problems without taking medication for the gastrointestinal tract – at least to a certain extent. The orthomolecular diet can also help to reduce the negative consequences of the metabolic syndrome, which can arise from the use of psychiatric medication (including obesity, insulin resistance leading to diabetes, hypertension, dyslipidaemias leading to high cholesterol and cardiovascular problems). Every 6 – 8 months you need to do a test of your food intolerance. The test is entirely individualized and can be done either with a blood sample, or with bio-resonance (a newer method).
    Chewing food properly is very important for good digestion and the proper absorption of nutrients by the gut. You shouldn’t swallow your food unless you have chewed it until it reaches a homogeneous porridge-like consistency in your mouth. In order for this to happen, you need to give yourself enough time for your meals. Incomplete chewing exacerbates the leaky gut syndrome, which in turn can adversely affect your mental and bodily health.
    The water you drink needs to be of good quality. Tap water contains chlorine, which can damage your health. Drinking bottled water damages the environment through the large quantities of useless plastic which accumulate, even when the bottles are recycled – a process which requires both water and energy. You can limit your intake of bottled water to the times when you are away from home, but I recommend that you use a good quality filter when you are at home. You need to drink at least 2 to 3 litres of water a day, and quite a bit more if you are taking lithium.
  6. About psychotherapy now. Even though some psychiatrists don’t value psychotherapy, those who are involved seriously in the psychotherapy of psychoses, especially researchers, consider it essential. I consider it more necessary than medication. Psychotherapy is necessary, not only for those of us with a mental disorder, but also for the general population, for everyone. From time to time you should go for individual, group, couple and family therapy, depending on your life circumstances. Good quality therapy will greatly change your quality of life for the better.
    There are certain issues to be considered concerning psychotherapy. First, the cost. Psychotherapy is expensive (prices currently range form 50 – 80 € an hour). Note that you won’t be in therapy for the rest of your life. You may need to be in some kind of therapy for some years though. Look for an experienced mental health professional, who has completed a recognized training course (psychoanalysis, psychotherapy, systemic family therapy, cognitive behavioural therapy, primal therapy etc.), and whose personality will enhance the therapeutic relationship. He must also adhere to ethical principles which uphold the dignity and individuality of each individual undergoing therapy. If the cost is too much for you, try to find another way to fund it. For example, ask your therapist for a better price, by offering to do some kind of work for him (for example, doing his shopping). Don’t forget that the mental health services in the public sector also employ psychologists/psychotherapists. You may be able to find a therapist in the mental health centre which serves the area (sector) you live in, or in one of the psychiatric hospitals. The main problem with the public sector (system) is that the psychotherapists are often overloaded with work, and can’t give you as much time and attention as a private practitioner can.
    In the private sector (system), things can be even worse, but in a different way. If you can afford to go privately, the biggest problem you will face is the structure of the psychiatric system. (Here I am referring to the situation in Greece).
    If you choose to see a psychologist practicing privately, ascertain that he has experience in bipolar disorder, because most psychologists, and private practitioners in particular, working outside the psychiatric system, work mainly with “normal” people and they can even do harm because they may have not been adequately trained about the characteristics of bipolar disorder. If you are not very well stabilized, I suggest that the psychologist you see is well known to your psychiatrist, and that they communicate with each other frequently about your condition.
    As for psychiatrists, most private practitioners try to “cure” you using only medication, without the help of other mental health professionals (mainly psychologists). Very few collaborate with psychologists and other mental health professionals (eg. social workers, case managers etc). So the problem in the private sector is that there are no private mental health centres, approaching the problem in an all-round way. On the other hand if you chose to have psychotherapy with a psychiatrist, make sure that he is adequately trained in psychotherapy. Some psychiatrists practice “psychotherapy” without being properly trained for it. Personally, I would trust a well-trained, talented and experienced psychologist rather than a psychiatrist to do psychotherapy with.
    Finally, I’d like to mention that sometimes in therapy you can feel stuck. What do I mean by stuck? There are times during a session when you feel that you and your therapist don’t have anything to say to each other. Silences are prolonged. You feel you are wasting your time talking about anything rather than your real problems. Sometimes months pass and you feel that your problems are not being solved, and you are not making changes in your life. If that happens, and you feel you are not getting anywhere, change your therapist. It might be that this particular cycle of therapy has come to an end. Or it may be that you should have less frequent sessions. Or that another mode of therapy would be more appropriate at that particular phase of your life (eg stopping individual therapy and going for, say, family therapy).
    Read lay books on psychology and psychiatry, so as to assist your therapy with new stimuli. I personally have found this very helpful, because I can work through the new information I find during my sessions. The best way would be to determine your most important problems with the help of your therapist, and to read up on them – problems such as self esteem, emotional intelligence, anger etc.
  7.  Omega-3 fatty acids from fish oils are essential to the well being of everyone’s brain. Research has shown that they are particularly helpful to people with affective disorders. Bipolar patients should take capsules containing purified fish oils (except for cod liver oil).
    The ratio between the Omega-3 and Omega-6 fatty acids which we consume on a daily basis is vitally important. According to certain researchers, the ratio we should aim for in the brain is 1:1 Omega-3 to Omega-6. Our diet contains a great deal more of the Omega-6 fatty acids than of the Omega-3s, so it is often necessary to take supplements, in order to maintain the optimal ratio between the two.
    When the Omega-6 fatty acids we get from our diet (meat, milk products) are destroyed or converted to saturated fats through cooking or processing of foods, then it becomes necessary to take Omega-6 supplements also to balance the ratio.
    I recommend that you have your dietary supplements prescribed by a naturopathic or holistic doctor, who is well informed about dietary requirements, rather than by a conventional doctor.
  8. Psychoeducation. In certain countries, psychoeducation is not readily or widely available. However, I do feel that the most important thing is for the patients themselves to be informed. The mentality which dominates in the psychiatric field holds that the patient is incompetent, irresponsible and incurable! That if someone has a mental disorder, woe betide her family, her husband, her carer, her social contacts and so on. NO! THIS IS WRONG!
    Mental disorder can be controlled, 100% if we use the right tools. If we face patients as incompetent, incurable and irresponsible, then they can never get really better. If on the other hand, we give them the means to inform themselves, to learn about their disorder, and to assume responsibility for their health and their life, then I can assure you that their progress will be dramatic, until they reach the point where they can control their disorder and balance their life again. For some time, they may be incompetent, and need other people’s help, but certainly not for ever. I am really optimistic about the potential of the patients themselves.
    Practically speaking, I think the most understandable psychoeducation for bipolar disorder is available through lay books, and several websites. There are many lay books on manic depression in English, most of which have been written since 2000, that is fairly recently. Visit the electronic bookshop www.amazon.com and search for “bipolar disorder”. You will find at least 20 books which are not very expensive. There are also some books which you can’t get through amazon, but you can order them from some other large book store.
    There are many websites available in English, and in other languages about bipolar disorder. I list some of them at the end of the article.
  9. Medication. I won’t go into this in great detail. Medication is necessary, despite its side-effects. The most common side-effects are metabolic syndrome, which leads to weight gain, a tendency for diabetes due to insulin resistance, hypertension, dyslipidaemias, and cardiovascular disease. Most patients relapse if they don’t take medication. Personally, I take my medication, which has side effects, but it helps me to stay stable and functioning well. I control my highs in good time (see the relevant article “Going High”), and this has helped me. Although I wish I could manage without them, in practice, when I’m facing a high, I haven’t found another way to handle things. (Both psychotherapy and homeopathy have helped me a great deal with my depressions).
    I do hope that each of you can find the right medication or combination of medications, to suit your biological type. In order to do that you will need to cooperate closely with your doctor, with frequent two-way communication. Remember that by using (and not misusing) medication in the right way and with the right supervision, you can reduce side effects to a minimum.
    Nutrients can be an alternative solution to psychiatric medication. They are becoming more and more popular now and the results are usually very good. However, even if you choose to discontinue your meds and take nutrients, you still need to be under the close supervision of an (integrative) psychiatrist.
  10. People with bipolar disorder are usually very creative. To live fully, there must be something creative in their lives. People with bipolar disorder also need structure and order in their lives so as to be stable. Structure can be provided by routines such as housework, paid work, various hobbies for example dancing lessons, learning languages or a musical instrument. Take care to include both structure and creativity on your life.
    Research has shown that patients whose lives have meaning respond much better to treatment. If you can’t find meaning in your work, or in your family life, you can find it in your free time (for example, voluntary work).
  11.  It’s common sense that a person close to you, a first degree relative, will manage to love and care for you much better than someone not so close, even if he’s a mental health professional. Be careful though: in many families with a psychotic member, there are disharmonious relationships between the parents. This disharmony can adversely affect the peace of mind of the person with psychosis. Sometimes there is tension between the person with psychosis and one of her parents, or some other member of the family. This can also get in the way of improvement. Your psychotherapist or your family therapist can probably help out here, and provide the necessary guidance. (Don’t forget that your treatment plan also includes psychotherapy with your family. Your family therapist needs to work closely both with you and with your family)
  12. Sociability. Since man first appeared on earth, he has lived in groups. Friendship is healthy. But, we must choose our friends carefully. If our old friends promote an unhealthy lifestyle, it’s up to us to break away from them (if we want to, of course). You can make new friends, in new settings, finding new hobbies and generally making changes in your life. Find real friends, because you need them, and they will be there for you at those difficult times. Don’t forget that man is a social animal. Don’t stay alone for too long.
    And there’s another trick: if you try for instance to give up smoking and coffee, and your friend smokes heavily and drinks coffee all the time, but is really a good person and you like him, try and keep in touch by phone, or computer chat, rather than meeting up face to face for hours on end. Or invite him for a walk in the mountains, or for a swim, once you have explained your reasons to him.
    You can check how well developed your social network is if, at a time of need, you could call on at least five people (not counting your parents, your children and your dog) who would immediately come to help if you called them. If you have less than five good friends who would do so, then it’s a sign that you should invest more time and energy into making friends.
  13. Work. Find yourself a job in a setting which you can control. Don’t even think of working shifts, or taking frequent trips into other time zones. Your work must respect your biological clock, your dietary requirements, and most of all, your regular sleep routine. You could always try two or three part time jobs.
    Don’t choose jobs which include a lot of running around, or stress, because they will quickly destabilize you. If you choose to run your own business, find something structured that doesn’t involve too much financial risk. An example would be a franchise shop with low turn over, rather than a big business.
  14. Stress. Remove stress from your life as much as you can. Live simply, focusing on your daily activities, and the things which are important to you. You can’t be perfect at everything. Look for people to help out with the things you can’t do, or don’t like doing. If you find the appropriate specialist, do therapy for stress management. Stress is the worst enemy of your normal mood.
  15. Stay away from junk viewing. It not only takes up your time, but it can do you harm. Television and the press can be dangerous if you are going through a psychotic episode or an episode of mania or depression. Make the most of your time using time management. Psychotherapy can help you make the most of your time, and reduce your stress level.
  16. If you get involved in a self help or a support group for people with bipolar disorder this will help you a lot. You will be able to help others in the same situation, and you will get help from them. You will have a group of people that you can trust, with whom you can share your worries, your fears, and your problems.
  17. Becoming organized to fight for the rights of people with mental disorder is both your right and your obligation. If your want legislation to be more favourable for us, if you want to be treated properly in psychiatric hospitals, if you want the reform of mental health services not to lose out because some politicians have misused funds, if you want less stigma on the part of society, then it is necessary to create a strong lobby composed of mental health service users. Only then can we hope for respectful behaviour from the state and from society as a whole. Let us join our voices against stigma, and fight for what we deserve, and not for the crumbs which are thrown in our direction in the name of social policy.
  18. Include saving in your life, even if its only small amounts. Divide your income into sub-units, the same every month, for your regular expenses. Make a note of your expenses at the end of every month, and assess your economic situation. Don’t gamble or play games of chance. Avoid getting a credit card if you have a tendency to overspend. You don’t need a cheque book either.
  19. Tidying up. Try to throw out, or give away, the things you don’t use. The more cluttered your space is, the more difficult it is to keep clean and tidy. Try not to put off tidying up and cleaning.
  20. Remember that the person who is responsible for you and your health is you and you alone. You must carry the responsibility for your health, both mental and physical. Take the responsibility for your treatment into your own hands, become a responsible patient. For example, it is your job to see that you take your medication, it is not your mother’s job to give it to you. Your parents can make a much more valuable contribution by funding for example your English lessons, rather than secretly putting drops of haloperidol or risperidone into your orange juice. (Unless, of course, deep down you don’t really want to be well, which is another matter – we all know that mental illness has secondary gain).

 

Psychoeducation:

I) Books
Book about bipolar disorder in Greek: ALL OR NOTHING, pub EPIPSY, tel: ++302106170822-4
Books about bipolar disorder in English:
A) All the books listed at the back of ALL OR NOTHING
B) Other books:
1) Psychology today: Taming Bipolar Disorder – Lori Oliwenstein,
Pub. Alpha (Penguin Group USA Inc)
2) The Bipolar Handbook : Real-life questions with Up-to-date Answers –
Wes Burgess, Pub. Avery (Penguin Group USA Inc)
3) Bipolar Disorder: A guide for patients and families (2nd edition) – Francis Mark Mondimore, Pub. The John Hopkins University Press.
4) Bipolar Disorder for Dummies – Candida Frank, Pub. Wiley Publishing, Inc.
5) The Bipolar Advantage – Tom Wootton
6) The Bipolar Disorder Survival Guide – David Miklowitz, Pub. The Guilford Press
7) Loving someone with bipolar disorder – Julie A Fast, Pub. New Harbinger Publications
8) Friends and Family Bipolar Survival Guide- Debra Meehl.
9) Living Well with Depression and Bipolar Disorder: What your doctor doesn’t tell you… that you need to know – John Mc Manamy, Pub. Collins (Harper Collins Publishers)
10) Too good to be true? Nutrients quiet the unquiet Brain – A Four Generation Bipolar Odyssey- David Moyer. Pub: Nu-Tune Press (I think this is excellent. It’s a bit tiring for a non-native speaker of English to read, but I think that all patients, and all psychiatrists should read it)
11) Healing Depression & Bipolar Disorder without drugs – Gracelyn Guyol, Pub. Walker & Company (A very interesting point of view)
12) The Omega-3 Connection: The groundbreaking Antidepression diet and brain program – Andrew Stoll, Pub. Simon & Schuster (A must-read)
13) The Natural Medicine Guide to Bipolar Disorder by Stephanie Marohn, Pub. Hampton Roads Publishing Company, Inc. (The relationship between bipolar disorder and alternative medicine)
14) Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families and Providers – E. Fuller Torrey, Pub. Perseus Books Group (Basic Books)
15) Overcoming Depression and Manic Depression (Bipolar Disorder) A Whole-Person Approach – Paul Wider, Pub. Wellness Communications
16) (Autobiography) An Unquiet Mind: A Memoir of Moods and Madness – Kay Redfield Jamison, Pub. Vintage Books / Random House Inc.
17) (Combination of a biography and a lay book on bipolar disorder) Brilliant Madness: Living with Manic Depressive Illness – Patty Duke, Pub. Bantam Books
18) (Autobiography) Call Me Anna: The Autobiography of Patty Duke – Patty Duke and Kenneth Turan, Pub. Bantam Books
19) Manic-Depressive Illness – Frederick K. Goodwin MD and Kay Redfield Jamison, Pub. Oxford University Press, New York 1990 (A rather big book, more for specialists. It was a key text in its time, but it could do with updating by now, although it still has a lot to offer)

You can find all these books at www.amazon.com at very reasonable prices.

II) Websites
In Greek: www.mednet.gr/psycho
and www.alternativebipolar.gr
In English: www.isitbipolar.com/article/5136.22.aspx 
and http://custom.intuition.com/az/bipolar/index/html 
(Webpage by Astra Zeneca about bipolar disorder)
www.mcmanweb.com
http://bipolar.about.com
www.bipolarworld.net
www.mhsanctuary.com
www.mental-health-today.com
http://psychcentral.com
www.psycheducation.org/index.html
www.wingofmadness.com
www.moodgarden.org
www.bpso.org
www.mdj.ogr.uk/
www.eufami.org/ 
www.gamian-europe.com/
www.bpkids.org/
www.psychiatry24x7.com 
www.dbsalliance.org
www.drada.org
www.bpchildresearch.org
www.nmha.org
www.nami.org
www.nimh.nih.gov
www.suicidology.org
www.alternativementalhealth.com
www.truehope.com
There are also some web addresses in the book ALL OR NOTHING, and a lot more in the English books listed above.

I would like to thank the psychiatrist-psychoanalyst, Professor Stelios Stylianidis, the psychiatrist-homeopath, Dr Georgos Loukas, and the ENT & holistic doctor Dr Thomas Christidis for the exchange of views, and the constructive criticism they offered about this article before it was published.