Treatment Concerns Continued

Patient/Doctor Mismatch Substance Abuse Inadequate Support Net Financial Instability Emotionalising



 Patient/Doctor Mismatch



The first thing to realise here is that sometimes you are going to be flat out wrong in your assessment of your doctor/therapist and his/her's motives. You won't always be able to determine when your doctor is being aggressive, uncaring, (name your bitch here) and when he/she is pushing you to explore some part of you you'd rather not look at. Solution??? Not any clearcut ones, but if you are feeling under attack a bit, before you run and hide, get some guts about you and say something like the following to your therp. "Look, I'm feeling angry and threatened by your approach. Are you aware of your tone and is there a reason for it?" There's a good chance that eliciting an assertive response was exactly what your doctor was hoping for..or maybe he/she's had a crappy day and will say so...the point is, open your yap and hold your ground. There is absolutely nothing to be gained from silent suffering. All you end up with is two people who misunderstand each other's agendas.

The other common problem, besides a mismatch in personality mentioned above, has to do with what I call the therapeutic stalemate, You've been with your therp/pdoc for awhile; you've beaten all your personal demons to death; and now it's all a rehash of the same old garbage that just doesn't seem relevant to you anymore. So what are your options at this juncture? And how did you two get in this sorry mess anyhow? No mysteries here. Your therp and you have become the quintessential old married couple: comfortable with one another, but bored to death with covering the same old topics. The answer isn't to manufacture a problem to talk about, it is instead to:



1. reevaluate the necessity of ongoing regular therapy, (maybe a phone check-in once a month or so will suffice)
   
   
2. make all old topics verboten unless you the client bring them up,
   
   
3. decide to talk about anything except the same old "problems." Music, art, hobbies, kids, school, crappy neighbors, his bad hairdo, her recently-acquired puppy. It doesn't matter what you discuss, troubled spots have a habit of finding their way to the forefront of a conversation and it won't matter if you were originally talking about the dentist appointment you just had or your kid's new teacher.. Besides, part of what a good therapist does as you and he/she chat is observe your general demeanor, including body language, speech pattern, animation and agitation, all of which can best be done when you are at ease with a current topic. And finally.....
   
   
4. The goal of therapy is supposedly to get you over the roughest spots and able to cope for the most part on your own. It is entirely possible that goal has been achieved, at least for the time being. In which case it is time to change the relationship to that of med-manager/med-taker which may require nothing more than necessary monitoring tests like lithium serum readings. Many therapists will not tell you that you don't need them anymore. To them, a sign that you are ready for less intervention on their part is your ability to flat tell them so. So if you genuinely think you need less therapy, then by all means tell your pdoc/therp that is the case.
   
   



 Substance Abuse   



Sorry to look so grim here, but the truth is that many bipolars are substance abusers who, by virtue of that fact, are seriously courting a date with the coroner. We guzzle booze, pop pills, snort coke, and smoke dope to excess simply to combat our personal demons. Sometimes we aren't lucky to live long enough to see those demons corraled and somewhat civilised. We die..we die by intentionally getting messed up, and unintentionally finding there's no exit when shit happens. I won't preach to ya..you know that any treatment for your bipolar condition won't work if you continue to abuse drugs and alcohol. So...end it, attenuate it, or go ahead and take that last sad ride. Choice is yours. If you want to know what you can do to help yourself just take one more risk and follow me.





 Inadequate Support Net



Way too many of us have inadequate support systems, mostly because we've managed to lose contact with friends and/or alienate family thanks to our illness. So what you need to try to do in order to guarantee yourself the best possible chance to remain treatment compliant (and sane), is recreate that net of friends and family if possible. Because bipolars are so difficult to be around, too often they end up on the streets alone and isolated. Since you probably have at least some resources (else it would be unlikely you'd be on the internet), use them to ramble through these pages and find online support as well as addresses, phone numbers, and email addresses for both online and offline support.





 Financial Instability



It goes without saying that it's damned tough keeping a steady job, let alone a well-paying one, with this disorder. Most of us have bounced from job to job, some of them pretty good ones too, but our bipolar demons too often have their evil way and sabotage us. We rage dysphorically, withdraw, miss work, or find our personalities so inflated there's no room for others in its presence. Add to the above the lack of adequate healthcare, disability aid, and help in general from government, and it's no great surprise that so many of us can barely keep our noses above water. Sadly, it is often these poor circumstances that precipitate and aggravate some of our worst symptoms. I know of no bipolar people who aren't of above average intelligence. Unfortunately, people with above average intelligence expect more from a job than low pay and boredom, but that is often all they can expect. Those who manage to maintain a good job struggle endlessly to keep their symptoms from sabotaging it. Adding to the difficulties is the fact that one can't always be open with employers about this illness. There's still a great deal of work to be done before the public comes to an adequate understanding of bipolar disorder. Until then, it's a real scarey toss-up as to whether you ought to divulge your illness to employers or not. My choice is to be upfront about it for now, but that may change.





 Emotionalising:



What does it mean to "emotionalise" when your entire life is a roller-coaster affair already? Well, it means that you've developed the habit of thinking without thinking. Being bipolar leads us to view the world in a skewed fashion. Our lenses are distorted and we interpret everything through them, hence it's no wonder we have problems distinquishing between what is a legitimate complaint on our part and what is, instead, our illness talking. Don't be quick to attribute everything to your condition, but at the same time, don't talk yourself into thinking something isn't wrong when it clearly is. For example, when your motor starts to run and you're feeling great, don't talk yourself into believing it might not be a problem. Assume it is, assume it's the early phase of mania and check in with your pdoc. Then if it's not, no problem, but at least you will have hedged your bet on the side of safety. Best short answer advice I can give you about thinking is to urge that you confine your tendency to second guess yourself to inconsequentials. Never, ever second guess the mania or depression. Wanna learn how to think? I don't mean mucking around in the quagmire of your emotions darn it! I mean really learning to think. Ok, no time like the present then. Let's get going!



The first two modules of the think class are now available :)