What I Did to Stay Out of the Hospital

Today marks the beginning of Mental Health Awareness Month.

I committed myself for five days at South Coast Medical Center (now Mission Laguna Beach) when I was 47 years old and then attended their partial (out-patient) program for another six months. One thing that negatively impressed me were those people for whom hospitalization was a revolving door: they visited several times and probably have been back since. I resolved not to be one of these, so I made a plan for staying out. I have followed and improved upon that plan ever since. That episode in 2005 was the only time I went in, so far. These are the things that I did:

I faithfully reported to my psychiatrist as we arranged.

I kept every one of my appointments.

Coping with bipolar disorder demanded that I manage the symptoms of my illness. They changed from week to week, at first, so dosages and types of medication needed to be adjusted. My psychiatrist also assured me that things would get better which encouraged me to stick to the treatment.

I had not been honest with her or with my two previous psychiatrists about my condition. I had symptoms such as irritability, paranoia, grandiosity, religiosity, and suicidal ideation — among others — which would have changed my diagnosis. Believing that I could handle these on my own, I kept silent about them. Deep down I did not want my diagnosis to change. I am not sure whether this was due to dread of stigma or the different drugs I would have to take. My anti-depressants were enough, I thought, and through what those didn’t erase, I believed I could boot-strap my way. When the hospital psychiatrist finally presented me with a different take on the strange constellation of indicators that betrayed my bizarre state of mind, I actually felt relief.

One of the first things I did was thank my regular psychiatrist for convincing me to check myself into the psych ward. She had saved my life. And she would do it again.

I took my medications.

It took three years to get the dosages right for my bipolar disorder. Just this past January, I started taking them for ADD as well.

The Guinea Pig Stage is one of the most difficult to pass through. I was lucky at first because I responded well to lithium. But then two years down the road, I suffered kidney damage due to my diabetes and needed to change. In the course of switching the meds, I discovered that there were a few symptoms that I had overlooked. I hallucinated, lightly, but enough to affect my driving. The rapid passage through the country would stimulate my brain. Things would pop out in the corners of my eyes and disappear. Sometimes I braked for them, believing they were coyotes or children that had run into the road. This made me a road hazard. I believed that everyone saw these, so I ignored them. When I went on risperidone for suicidal ideation, these disappeared.

When I arrived at my ultimate mood stabilizer, carbamazepine, my psychiatrist and I made a deal: I could adjust my dosages. I feared the fuzzy-headedness that was part of the getting used to the drug. Naturally, I took the lowest dose possible. The my manias returned, but in a way that I thought I could control. But I annoyed people with my rages. I ran red lights. I made bad choices of friends. In the end, I surrendered to the higher dosage and it has made all the difference. Eventually the fuzziness disappeared and I felt normal again.

I attended support groups.

I did not like being alone in my symptoms. My friends did not understand and many abandoned me. So I sought out others who would not freak out when they heard me talking about my manifestations. DBSA has been an important part of my life ever since I first sat down in the circle at Huntington Beach Hospital. The other members of the group consoled me when I was low and pointed out my impulsiveness when I was high. They helped me stay the course when I struggled with my medications.

Eventually I started my own chapter in an area much closer to home. I made new friends and kept some of the old from Huntington Beach. Through the years, I have come to appreciate the many ways that the illness affects us. But I have also found hope and I have shared that hope with others. Helping other people doesn’t cure the illness, but it takes some of the edge off and reinforces those things which I have found essential for my recovery.

I saw a therapist.

I won’t tell you that the meds fixed everything. I had developed some bad habits as I fought the disease which needed to be unlearned. Meds put down the floor so I could build the walls of a new house of mind.

I cannot stress the importance of finding a therapist who understands you and who can help you with your issues along the way. You don’t want someone who belittles your trials and you don’t want someone who acts as if you can pretend that you don’t have the disease now that you take the meds. Your therapist is your ally, someone who can tell you when you go overboard, someone who will stick with you when you struggle with the Demon Machine. They shouldn’t scold but guide. If your therapist is continually annoyed with you, you aren’t going to get better. The most worthless type of therapy is that which attempts to let you figure out for yourself what you are and what to do. The better therapist explains things to you and doesn’t flinch when you falter or correct you when you break a petty rule such as calling yourself bipolar. (Most of the people I know who do that don’t identify themselves with the disease as the therapists insist they do.) He lets you choose what issues to work on and doesn’t try to force his own agenda on you. A therapist who humiliates you or who encourages you to act while you are symptomatic is one you should drop.

The therapist has many tools which he or she can use to help you. CBT and mindfulness are but two of these. Here in California, psychologists (who have a Ph.d) can diagnose (but not prescribe medication). Mine tested me at my request for ADD; now, I take medication for it which has made a lot of difference in my life.

Your therapist may not be your friend, but he is close to one. Be honest as you are honest with your psychiatrist and listen.

I kept a mood chart.

I learned about this while I was browsing the InterNet and I have kept one ever since except for a few weeks last year. A mood chart lets you see many things: whether you are stable over a period of time, how you felt on Monday, how a new medication or life event affected your mood, your anxiety, and your irritability. You can show it to your psychiatrist and your psychologist for better help with your symptoms. It is a necessary tool.

I got enough sleep.

I used to stay awake until four in the morning or until dawn then wake up around nine or eleven which was only six hours. This tipped me into manias which were followed by depressions where I slept for most of the day.

I heard at a conference once that the time you go to sleep is not as important as the time you get up. No matter what, I get up at the same time every day. What I find is that I get tired at the same time every night — 7 to 9 hours before my waking time. If I have to get up early, I come home and take a nap. Those 7 to 9 hours are precious.

I let my spouse help me.

The value of a spouse or parent or friend who understands cannot be understated.

Lynn dropped many hints before my diagnosis. I didn’t listen. When I was at last confronted with the specter of the illness, she wrote a letter that I carried to my psychiatrist which helped her choose the right medications for me.

We made a few pacts. First, I agreed to surrender my credit cards and checkbook when I felt manic. Second, I stopped carrying an ATM card and spent only the cash she gave me for my allowance. Third, we had an understanding that if she ever saw me get out of control, she could call my psychiatrist. Fourth, I agreed to listen and take her seriously. When I started taking my ADD medication, I asked her to watch me for any signs of mania, for example. Finally, when I was diagnosed with ADD, she provided information to my therapist to help her make her assessment.

She was there when I have been at my worst, sitting with me for several days when I crashed into a terrible depression and calling my psychiatrist every day to let her know what was happening.

We got through this and through her chemotherapy together.

I felt my feelings.

Many years ago, in a class I took for depression, I learned that ups and downs are normal. When you are down, don’t make it worse. When you are up, keep it going. You have to adjust that a bit when you have bipolar disorder. You want to be wary of those ups and keep the middle state — where you find real happiness — going.

Flat-lining — which is what I call the state where you are so over-medicated that you feel numb — isn’t a good thing. The goal of taking medication is to make you functional. A good psychiatrist may put you on a high dose of mood-stabilizers when you are first diagnosed to curb the mania, but eventually she brings it down. When she does that, you let yourself be happy — not euphoric–, sad — not depressed — , or angry and deal with those emotions appropriately. Thich Nhat Hahn, a favorite proponent of mindfulness, says to regard anger as your baby and to console it in yourself when you feel it. I have followed that advice.

I learned to curb my worries about going into episode.

Oh, it is so easy for you and for those around you to fall into a state of dread when you feel a little happier than usual or a little sad. Are you devolving into that other you, that Evil Joel? I found that such fears made life unpleasant for me. I learned that I could laugh. It was OK to cry at movies. These didn’t mean that I was going over the edge. They meant I was human.

I learned to trust in my own instincts, in my wife, and in my support group. I learned the signs of going into mania such as seeing colors more intensely, rapid thoughts, a hair trigger, and noticing that women — all women — looked really good to me. If these failed me, I could rely on another thing: if people around me appeared afraid, there was a good chance that I was ramping up.

Depression, of course, was easy.

I avoided people and situations which triggered me or who interfered with my treatment.

Some people just aren’t good for you. They may belittle you. They may try to get you drunk. They may try to convince you that you don’t have bipolar disorder. They may hold grudges. They may try to get you to stop taking your meds.

Ditch these people even if they are your “best” friends or relatives. You need to get better and stay well.

I enjoyed my pets.

We have a Boston Terrier and a cat. The dog goes for walks with me. Until he grew too old for it a couple of years ago, we went hiking in the mountains together several times a week.

You meet a lot of people when you have a dog, so you reduce some of the isolation you feel. (The odd thing is that you don’t learn their names, but you know the names — and temperaments — of all of the dogs.)

The cat has helped me in some hard times. When I had my catastrophic depression a few years back, Little Bo and her sister Fiona stayed with me the entire time. When my wife was diagnosed with uterine cancer and we lost her sister due to pancreatitis that got out of control because our attention was elsewhere, Little Bo and I made a pact: No one was paying us any attention because, of course, everyone was watching Lynn. So we took care of each other. Little Bo fell into a depression — she pulled all the hair off her underside, lost her appetite, and went from room to room mewing as she looked for her sister. I looked after her and she reciprocated. A few people thought my attentions were odd given my wife’s sickness, but I pointed out that everyone was helping Lynn including me, but with Lynn battling the cancer, the cat was my sole support system, so I had to be sure that she got through the crisis, too. No one faulted me for that because they knew that I also lent my strength to Lynn. I was a stronger person because of Little Bo and she is still my second best friend in the world.

I exercised.

Exercise can’t pull you out of a moderate to deep depression, but it can ease the anhedonia. I took long hikes in the parks and national forests around us and walks around my hilly neighborhood. It wasn’t easy at first, but it trimmed some of the weight I had gained on the meds, bulwarked my heart, and stimulated my mind.

I avoided caffeine.

Good sleep is precious.

But I still have a problem with carb cravings. I am working on that.

I volunteered.

Isolation was one of my enemies. Sure, the support groups helped, but I needed to learn how to be out among the unafflicted, too. So I volunteered for a reading program at the local library. When I felt ready for something more than one on one, I started working at the Irvine Ranch Conservancy’s Native Seed Farm every Wednesday. This helped me make new friends who didn’t have the disease. I didn’t have to tell anyone that I lived with bipolar disorder, so I could concentrate on the task. It also sated my hunger for gardening.

I also do things online. A few years ago, I saw a need for a central clearinghouse for bloggers who lived with manic-depression so I founded Bipolar_Blogs. Bipolar_Blogs tweets information about new articles and new medical research. Today it has more than 5000 followers.

I moderate an IRC channel for bipolar disorder and serve as a greeter at healthfulchat.org. These, like the support group, give me a chance to help others like me.

I found new hobbies.

Even if you are an introvert, you need to fill your time with stimulating things to do. Writing poetry became hard for me, so I sought another art which turned out to be photography. I also blog, collect hats and sunglasses, and attend meetups.

This is my list. What things do you do to help you keep your illness in check?