The Chicken or the Egg?

The place of triggers in bipolar disorder is well known. I am wondering about the impact of life on the illness as opposed to the impact of illness on life.

I am beginning to think that my mental health is made worse by my life situation. My problem is that my symptoms make it hard to address my life's issues. This strikes me as a bit of a Catch-22 situation.

I hope I have expressed myself clearly. I would appreciate any thoughts on this. Do you feel the same?

Clive~ i'm all too familiar with what you are talking about. what i found to be helpful is to focus on recovery of skills and competencies to the exclusion of all else, worry about nothing else... life will continue, bad things will happen, and if we pay attention to all the other "Stuff" in our lives, we will never have time to regain our coherency. if it's of interest to you, i also used meditation and a relatively obscure technology called CenterPointe. you can google it, or there is a post about 2 months old in the Alternative Therapies forum. best wishes,, Gus

I totally hear you.

It was however life situations that finally caused me to crack, seek professional help and land up with a diagnosis

It is a catch-22 and can completely relate. My work at one point was so stressful with long hours, and a lot of travel so that there was no consistency in my life; then the illness began to impact my work and began to affect my abilities. I was all over the place. The illness finally shut me down, no life at all and just began to survive, and just barely. I had to change life circumstances to accommodate my illness. Then even after I found consistency and getting into a routine, things got a little better but the illness still triggers episodes that continue to interfere with life and will throw me for a loop and then vice versa, life circumstances throwing the illness a curve, almost like a contraindication. Preventing me from accomplishing the things wanted to accomplish and having some kind of quality of life. At least with the routine and consistency, I can gauge better where symptoms stand to try to manage outside influences and can deal with stresses better as well now. I also can't do it without support, of pdoc, T, and friends.

I KNOW that they impact each other and can minimize it but still it IS a vicious circle. Your analogy of the chicken or the egg is perfect.

I agree Clivewild. For me my illness can be triggered by life situations, but I also find if I'm symptomatic (especially depression) it can cloud how I view life situations. For something that normally wouldn't affect me when I'm unwell it can seem like the end of the world.

Yep, catch-22 for sure. I'm trying to get better at recognizing the things in my life that I can improve, simplify or remove completely, just to give myself a better chance at staying in balance. I've never been a meditator, my attention span is way too short, but I'm learning to be more aware of the now, if that makes sense.

For me..this is actually the case..in fact...life caused this illness and sometimes it feels the need to nurture it's creation.

I was not medicated properly this past May when my Dad died I had been "functioning" through life up until that time ok on the wrong meds. At that point I snapped and then the cycling started. Once started my job became a huge issue for my BP. In the end I went on medical leave. At this point I was on the right meds, but I was fighting delusions/mania/depression rapid cycling. My job continued to hurt me while on medical leave trying to have me resign based on my BP. This made my BP worse and worse. Then my job wrote me a letter while I was on med leave that stated that I voluntarily quit. Talk about another huge tailspin. Back to my pdoc major issues. Now I have to fight them for unemployment for 6 weeks. During all of this my BP is being controlled "somewhat" with meds although I am the lowest I have been in 15years thinking that I can't take anymore and that not being around would be better. Finally I win the case and my BP starts to settle down and now I am letting the dust settle, but I am not back to "normal." Any little bit of stress that comes up I freak. I can be manic in a second. I saw my Pdoc last week and he said well maybe in another month you will be ok... I am a ton better than I was a week ago I know that, but I know that I couldn't have a job right now and that is sad.

So with all that being sad YES life totally impacts my illness. I was doing fine and then Life got in my way. Had my Dad not died I would be great right now. Had the place I work not ran out of money and turned into tyrants I would be great right now.

And then there is the issue of me not having enough meds when those things happened... I think I still would have been a mess.

Hello Clive. This, “I am beginning to think that my mental health is made worse by my life situation.” is the most resonating sentiment I've read on here in long long awhile. This is really profound and if you don't mind, I'd like to share some of my experiential insights into that same notion. If you take that realization as fas as it can possibly go, you can potentially change the effect of the illness on your life. I will give you some examples.

Here is an obvious one. When I got out of abusive family life and stayed away from people who were abusers, the drama in my life plummeted. Consequently, my stress levels plummeted also.

Similarly, (and I say this with a certain sensitive care) when I avoided people I knew whom were themselves mentally ill, like severely depressed, manic or rageaholics, the intensity of emotional situations and attending interpersonal drama in my day-to-day life, also plummeted. It was, I say a little self-consciously and selfishly in present company, a huge weight off my back. It lightened the burden in my world and made my life qualitatively better, to stop associating with certain negative people who were in the process of using other people or detonating their own lives or the lives of others (not saying you all are those types of mentally ill folk, just that they do exist and you probably know some like that in your own lives).

I can't overstate that enough. The stress in your life, the urgent phone calls at inopportune times, the police contact, it all just stops when you make concrete boundaries for yourself and create distance between you and those kinds of people. As a young adult, I had enough on my plate dealing with my own issues. I couldn't spare the psychic and emotional energy to deal with other people's.

When I lived in poor urban areas, I was triggered constantly by the locals and the things that they did to each other, day and night. I suffered anxiety, fear for my safety, and sleep deficits, due to hypervigilance. When I moved to a quiet suburban area that abutted a nature preserve, most of that stress burden vanished as well.

When I was a young adult I didn't take care of myself very well. I was toxic from a one to two pack a day nicotine habit. I drank enough caffeine and sugar to sustain the alertness of a battalion of soldiers at the front lines during the winter. It was like my speed. When I quit those things, I noticed at first, that I felt horrible. But after a short while, I felt much, much better. My intake of those substances had slowly ramped up from adolescent use to adult abuse. I didn't realize how much of the various energy spikes and drops, as well anxiety or restlessness was a result of my changing blood levels of all these different combined stimulants, until they were gone from my system. I became a lot healthier without those things and some of the overall noise inside me was gone.

I found that when I worked evenings or graveyards, I slowly built up a sleep deficit which wore on my depression and energy levels as well as my irritation threshold. I tried to deal with it by taking melatonin supplements, but it only helped so much. Only by changing my job to one with a 'normal' daytime work schedule. and making sure I got enough sleep, could I avoid the negative effects of gradually increasing melatonin and sleep deficiencies on my overall state of mind-body health.

Entertainment. How you amuse yourself in your spare time. There must be a million things to get stressed out and bummed out over in our world. You can read politics or world news or finance news and get worked up in some way to those things. Your own thoughts and reactions to what you read effects you emotionally, and if you are in a delicate or unstable place in your life, reading about those things can make you more ill at ease inside yourself.

Likewise, the music you listen to can have a huge effect on you. Now I don't know about the rest of you, but I know that when I was depressed, I tended to listen to extremely moody music. This enhanced my depression. Like music to self-injure by. There is a huge difference in listening to angsty or melancholic tunes, compared to listening to say, the sound of the ocean surf or a summer night filled with cricket and frog song, in terms of how those sounds make your insides feel.

Debt. Lingering debt sucks. Especially if money is hard. The awareness of debt is a frankly taxing thing. It's super stressful. If you can get late utility bills paid up or your rent paid in advance or you pay all your borrowed money from friends, this can take a huge weight of anxiety completely out of your life. It just one less stressor, one less burden, and one more way of stacking the daily stress meter in your favor.

Now then, let's say you do everything in your power to micromanage everything, from your diet and nutrition, to your job, to your neighborhood, to the things you read and listen to, to the company in your life that you keep, even to your credit and debt—over a long enough period of time, stabilizing all these different factors is quite likely going to stabilize you in some way.

If you learn where your stress limits and triggers are, and respect them, and you have a healthy coping mechanism which reliably creates mental and physical peace for you, such as dancing, yoga, or qi gong, or whatever, and you maintain that lifestyle until further notice, your brain and nervous system can, and potentially will be, positively altered, very slowly and subtly.

If you spend time, a long time, practicing something like mindfulness or insight meditation, you can actually see how your own thoughts slowly begin to cause the elements of depression, anxiety or mania inside you. You can sense and feel the emotional and energetic ripples of cause and effect internally. Knowing how you do it and practicing settling yourself and learning to let go of the very thoughts which excite you in some destabilizing way before they get really overwhelming, can over time, teach your being to, essentially, prevent future episodes.

It's really the art and science of mental illness preventative medicine is what it is. Total lifestyle and mind-body awareness. I know of several people, myself included, whom have used this overall strategy and have managed to stay in prolonged remission state where mania and depression sort of forget to show back up.

Month after month goes by as you carefully and delicately disarm all the things externally and internally that can lead you to becoming symptomatic, and a new mind-body balance starts to take over. That is, you were unbalanced and now you are not, or far less so. You slowly become a person who is more often stable than not.

So by meticulous control over your environment and your life situation (assuming you can achieve this, as certainly, depending on where they are in their life, not everyone can), given a long enough period of time, you can potentially, hugely reduce, and even eliminate to a greater or lesser degree, the effects of mental illness on your life, as you slowly get used to not being ill, and that gradually becomes the norm for you, and not the exception.

Thanks Clive for your post. Since being diagnosed just recently I have been looking back over the years and can recall that seriously stressful things that went on in my life triggered my hypomania and then the serious long bouts of depression.Just last year I took an LNA course .It was my first time in a class room in decades. I did exceptionally well but the stress of it( almost immediatly when it ended) caused a 2 week hypomanic period and then several months of serious depression and that was when I finally called for help. Doing great on my meds & feel almost normal! lol

I totally understand what you are saying:
Our life triggers our illness, our illness affects our ability to live life... which in turn can lead to more life triggers and so on...
The improvement in my mood due to medication allowed me to deal with my life triggers and that has further improved things, making the cycle turn backwards.

Wow !! I seem to have resonated with a lot of people. I am happy to have connected with you and I thank you all for the well thought out responses. I hope I have picked up some useful tips from your replies.

When "I had a life", I experienced a lot of the things you have described. I have not worked in 5 years and not very much in the last 10 years. I have been closing down my life as a defence mechanism. I am now scared to do anything for fear of problems. I survive on a mundane routine that is largely based on daytime TV. I increasingly isolate myself. I think my lack of a purpose is my biggest trigger to my worry and anxiety.

It is nice to meet you all.

Hi ((((((Clive))))) I only just saw this thread. Thanks for starting such a thought-provoking debate!

The sentence above really jumps out at me. Yes! This is exactly my problem too. Lacking a sense of purpose makes me extremely anxious and this seems to get worse the older I become.

And then, as you say, the catch-22 effect kicks in because my anxiety prevents me from taking the steps necessary to create more purpose and meaning in my life......And yet, the prospect of my life continuing along this path of doing increasingly less and less and only being able to function within the confines of a narrow "comfort zone" fills me with panic. And so the vicious cycle is complete and I remain firmly stuck!

What I am trying to focus on is taking "baby steps". The withdrawing from life doesn't tend to happen overnight. It tends to happen gradually. I can really see over the past few years how my habits have changed and how my fears have taken over. Equally, it's bound to take some time to reverse that. So I'm trying to change some of my habits and start slowly moving forwards again (easier said than done!)

It was brilliant that you went on that vacation recently, Clive. That was really brave! I hope you're able to do more things like that so that you feel less lonely and have some fun. Anyhow, baby steps!!!!!

That is where I am now...Isolated away from the world...although I have a two year old going on three so my day time TV is not the same as yours (I hope ) . I have been trying to get out of the house with her more because I know that I could cause her a lot of damage if I don't. She was a very social child with a ton of friends before I fell off the face of the earth in September. I have tried to get out for my Husband and older children too. I really just want to curl up and never leave again. Friday I am taking the baby to a Christmas party at her old daycare. I have to get dressed and get her dressed and drive 30 minutes and buy a present and deal with people and lots of kids - the thought of this is killing me, but I am going to do it because she talks about these kids less and less and I know it's hurting her not being with them and being stuck in the house with me all day. She loved daycare - couldn't wait to get there and didn't want to leave when I went to pick her up - she just loves to play all the time, very social and it's great. I feel so bad having her cooped up all day. Being on unemployment I can't afford to put her in daycare.

Hello sundog. Thanks for your response. It makes me feel far less alone and maybe less lonely. I have analyzed the situation in the same way as you and I agree it is not easy to reverse the problem. I'm delighted that my post has triggered such an intelligent discussion. I thought nobody would reply !!

I think I have reached the point where I can get no more isolated. I could maybe stay in bed all day !! I might do that if my bedroom wasn't so cold. I keep thinking of the baby steps. I know some things I need to do. So far it is just thinking. I have become an expert at cancelling things. This week, I have cancelled social engagements at my support group and my weight loss group. I didn't really feel up to either. The shame is that I don't get many opportunities to socialize. I never did find socialization easy.

Maybe we can encourage each other? I am not sure whether I have said, but I lived in California from 1984 until 2000. I might be there now except for the bipolar wearing me down. My marriage also contributed.

Take care ! {{{hugs}}}

I have suffered from this illness my entire life and I understand what you are saying. I believe that being bipolar made me afraid to do all the fun things my siblings did. I had no idea how to enjoy my life. In my experience situations can trigger a depression for me and the deep depression can trigger a manic phase. So you are right our life situations trigger a bipolar reaction but being bipolar determines how we deal with these situations. At least that is the way it is for me. I hope I expressed myself clearly also. Take care

Hard to tell.
I know have been bipolar since early puberty, but without admitting till 3 years ago. For some reason - intuition? I have always stuck to the lifestyle recommendations, mostly found joy within those frames, and had a reasonably good life.
Now, I see that it was rather exhausting, more than I can take now approaching 60.

I had my Bipolar One regulated effectively for 20 years with lithium. Then my mother died last year and I got a little hypomanic which made me less than perfect in my med compliance. Within a week I had spun into a full blown manic episode that required hospitalization. That is not to say that when I decompesate into a manic or depressed episode it is purely caused by circumstance. I've also become symptomatic for no reason at all except for brain chemistry. But I always keep aware that stressful events make me vulnerable to relapse.

Clive - yes, I think it's both. I also find it amazing what a deliberate change in my behavior/thinking can do to improve a situation. I have found that if I happen to be in a good mood, I seem to like the people I have to interact with and vice versa. Or, if I dislike someone, even to the point of thinking that they might be stealing from me, mistreating me, etc., that I can change this perception, and the behaviors of theirs that contributed to it, by intentionally asking about and/or expressing concern over their particular problematic circumstances, i.e. making them a friend, rather than foe.

Hi ((((((Clive)))))) Wow! I didn't know you used to live in California! What a coincidence! And I used to live in England!! It's a small world!!!! Yes, let's encourage each other with those baby steps!!!