If a Manic Depressive goes nuts in the woods, and no one is around... is it still a manic episode?
September 1, 2010 12:08 PM Subscribe
How to approach - Bipolar but still want to take a year long wilderness immersion program?
I know, I will talk with my psychiatrist. I have a great psychiatrist but just like all psychiatrists in the west, everything is pills and surface medical facts, not inner conscious depth. I'm looking for some human stories here from the green, not more diagnosis.
I feel, and have felt since before my first manic episode 6 years ago, that a lot of what causes my imbalance and illness is detachment from Nature and being stuck in this, honestly, quite sick society we live in... but that's a long story.
ALSO, yes I have been hospitalized once and involuntarily committed a different time. That was 5 years ago and have been healthy since. Obviously with the expected ups and downs we all have.
Now I am on and trust my Lithium, it is a basic natural salt, I accept it and I have a good relationship with that drug. I am also on a prophylactic anti-psychotic which I grudgingly take but don't like because it is synthetic, unnatural and I think it is polluting my body.
OK, all that is just history, so the question:
-Should bipolar, meds, etc, be an insurmountable obstacle to taking an immersion wilderness survival class? Aside from the logistics of keeping pills on me all the time, but that is like many other chronic illnesses that require daily medicine right? (obviously I will consult my pshyc doc about this).
-How ought I inform the program? Before application? After application accepted? Are many programs likely to bar me? Can they?
- I don't really think so, but is this "dangerous"? Have other bipolar patients tried this? Good results or bad results, please share if you can.
-Finally, is there any credible medical evidence about the healing powers of being in nature and away from normal society for Bipolar? Something that can ease the mind of my Family?
Thanks Green!
Throwaway email - ithurtstobesane at Mailinator dot com
I know, I will talk with my psychiatrist. I have a great psychiatrist but just like all psychiatrists in the west, everything is pills and surface medical facts, not inner conscious depth. I'm looking for some human stories here from the green, not more diagnosis.
I feel, and have felt since before my first manic episode 6 years ago, that a lot of what causes my imbalance and illness is detachment from Nature and being stuck in this, honestly, quite sick society we live in... but that's a long story.
ALSO, yes I have been hospitalized once and involuntarily committed a different time. That was 5 years ago and have been healthy since. Obviously with the expected ups and downs we all have.
Now I am on and trust my Lithium, it is a basic natural salt, I accept it and I have a good relationship with that drug. I am also on a prophylactic anti-psychotic which I grudgingly take but don't like because it is synthetic, unnatural and I think it is polluting my body.
OK, all that is just history, so the question:
-Should bipolar, meds, etc, be an insurmountable obstacle to taking an immersion wilderness survival class? Aside from the logistics of keeping pills on me all the time, but that is like many other chronic illnesses that require daily medicine right? (obviously I will consult my pshyc doc about this).
-How ought I inform the program? Before application? After application accepted? Are many programs likely to bar me? Can they?
- I don't really think so, but is this "dangerous"? Have other bipolar patients tried this? Good results or bad results, please share if you can.
-Finally, is there any credible medical evidence about the healing powers of being in nature and away from normal society for Bipolar? Something that can ease the mind of my Family?
Thanks Green!
Throwaway email - ithurtstobesane at Mailinator dot com
My concern is that with lithium you need to have regular blood testing, and it's important to monitor your fluid intake, etc.
I understand what you mean about connecting with nature but I think you would be better served starting with things such as gardening, and weekend trips. Because even if this yearlong program has the health benefits you are looking for, at the end of the year you will be where you are now.
(And as a former sufferer of this brand of imbalance myself, you should know by now that having enthusiasms such as this can be part of the disease and should be treated as such till proven otherwise. Sorry if that harshes your mellow, but my brain lied to me a lot back then and you can't totally trust yours either.)
Baby steps, dude, baby steps.
posted by St. Alia of the Bunnies at 12:36 PM on September 1, 2010 [7 favorites]
I understand what you mean about connecting with nature but I think you would be better served starting with things such as gardening, and weekend trips. Because even if this yearlong program has the health benefits you are looking for, at the end of the year you will be where you are now.
(And as a former sufferer of this brand of imbalance myself, you should know by now that having enthusiasms such as this can be part of the disease and should be treated as such till proven otherwise. Sorry if that harshes your mellow, but my brain lied to me a lot back then and you can't totally trust yours either.)
Baby steps, dude, baby steps.
posted by St. Alia of the Bunnies at 12:36 PM on September 1, 2010 [7 favorites]
I have a great psychiatrist but just like all psychiatrists in the west, everything is pills and surface medical facts, not inner conscious depth.
Not all psychiatrists fit this model. You may want to consider finding a different one who is more closely aligned with your need for introspection.
My concern for you is, would you be able to maintain regular and meaningful contact with your practitioner during this program? If the answer is no, I would discourage it. Medication needs can change, and over the course of a year, those changes may be significant. But don't loose hope! (I meant lose, but I think that type was meaningful, so I'll let you have it both ways!)
I would suggest starting with a shorter program and seeing how you do, because as St. Alia says above, the bipolar brain can be very...convincing. (I have an ADHD brain, and was told as a child that I was bipolar. My ADHD brain is a handful. I can only imagine having a truly bipolar one.)
Access to nature definitely has an effect on mental health. But so does socialization. If you find yourself in a group of people that is totally unwilling/unable to respect or understand your need for lithium and other prescriptions, your experience will be vastly different from participation in a group that recognizes the validity of modern medical approaches.
posted by bilabial at 12:39 PM on September 1, 2010
Not all psychiatrists fit this model. You may want to consider finding a different one who is more closely aligned with your need for introspection.
My concern for you is, would you be able to maintain regular and meaningful contact with your practitioner during this program? If the answer is no, I would discourage it. Medication needs can change, and over the course of a year, those changes may be significant. But don't loose hope! (I meant lose, but I think that type was meaningful, so I'll let you have it both ways!)
I would suggest starting with a shorter program and seeing how you do, because as St. Alia says above, the bipolar brain can be very...convincing. (I have an ADHD brain, and was told as a child that I was bipolar. My ADHD brain is a handful. I can only imagine having a truly bipolar one.)
Access to nature definitely has an effect on mental health. But so does socialization. If you find yourself in a group of people that is totally unwilling/unable to respect or understand your need for lithium and other prescriptions, your experience will be vastly different from participation in a group that recognizes the validity of modern medical approaches.
posted by bilabial at 12:39 PM on September 1, 2010
For many bipolar patients, stress and an irregular sleep schedule is a really good predictor of a slide into hypomania, which, unchecked, can easily lead to a manic episode. For these many patients, a substantial part of managing their illness is managing their stress and sleep schedules.
An immersion wilderness survival course sounds like a really good predictor of stress and an irregular sleep schedule.
posted by Zed at 12:54 PM on September 1, 2010 [3 favorites]
An immersion wilderness survival course sounds like a really good predictor of stress and an irregular sleep schedule.
posted by Zed at 12:54 PM on September 1, 2010 [3 favorites]
I would give the same advice to anyone who asked this question, bipolar or not: don't start with a year-long program. Go for a hike, go camping, and eventually ramp up to at least week-long trips before you commit to a year-long program. For you specifically: test your hypothesis by being out in nature for shorter periods and observing your reaction.
posted by ssg at 1:09 PM on September 1, 2010 [3 favorites]
posted by ssg at 1:09 PM on September 1, 2010 [3 favorites]
Have you brought up this needing nature thing with your psychiatrist? Have you tried a weekend campout and seen how that worked (or not)? Do you have a buddy you can run things by to make sure you aren't in manic territory? Do you have a carefully laid out plan for medication management and your finances over the entire year? Do you have a passport and all the equipment you need, and were they acquired at least three months ago? Have you narrowed down your choice of wilderness programs to just one, after evaluating several?
Your post read to me as it did to St. Alia, basically. If you want deep introspection, think about seeing a therapist rather than just your psychiatrist. Make sure your answers to all of my questions are "yes.". Don't do this thing till next spring. Make sure the program knows what meds you are on (you will probably have medical forms to fill out, and may need a doctor's OK.) Consider using a program that is targeted at people with mental health needs (Outward Bound rather than Cheapo Amazon Camping Tours R Us.)
I have never seen research about managing the symptoms of bipolar I (which is my guess, due to the involuntary commitment) that didn't include active medication management (I don't see how that's possible during a year-long retreat.) But, I don't know the subject that well.
posted by SMPA at 1:12 PM on September 1, 2010
Your post read to me as it did to St. Alia, basically. If you want deep introspection, think about seeing a therapist rather than just your psychiatrist. Make sure your answers to all of my questions are "yes.". Don't do this thing till next spring. Make sure the program knows what meds you are on (you will probably have medical forms to fill out, and may need a doctor's OK.) Consider using a program that is targeted at people with mental health needs (Outward Bound rather than Cheapo Amazon Camping Tours R Us.)
I have never seen research about managing the symptoms of bipolar I (which is my guess, due to the involuntary commitment) that didn't include active medication management (I don't see how that's possible during a year-long retreat.) But, I don't know the subject that well.
posted by SMPA at 1:12 PM on September 1, 2010
If you're thinking of NOLS or Outward Bound-type programs, the applications have detailed questions regarding health, both physical and mental, and medications. It would be extremely irresponsible to lie on the applications, as the programs have to evaluate whether they can accommodate your medical needs (pills, etc.) as well as the balance and dynamic of the group of participants.
NOLS and OB also specifically say that refunds are not offered to participants who leave as a result of preexisting conditions or, importantly, are asked to leave as a result of behavior that is deemed risky or otherwise unacceptable.
posted by charmcityblues at 1:42 PM on September 1, 2010
NOLS and OB also specifically say that refunds are not offered to participants who leave as a result of preexisting conditions or, importantly, are asked to leave as a result of behavior that is deemed risky or otherwise unacceptable.
posted by charmcityblues at 1:42 PM on September 1, 2010
IANYP but am nthing St. Alia. They type of adventure you're talking about will change your fluid input and output quite a lot, which can drastically change your lithium levels. Being out in the wilderness is not where you want to find out that you're slipping into a manic episode or inching towards toxicity. You probably know this.
That said, the kind of daily physical exertion that your trip will require will likely be very good for you, assuming you're body's healthy and up for the task. Yes, nature is a powerful balm for the soul and IF you can find a way to stay stable, it will probably do you a world of good. It won't cure your bipolar, but it might help you discover that you can find some peace with it.
The if part, however, has me concerned. A year is a long time to be without any monitoring. If you go you'll need an excellent contingency plan. You'll need to discuss early warning signs of trouble with someone on the trip so they can help you should your judgement become shaky. If you go off the anti-psychotic, do so well in advance of your trip with the help of your psychiatrist. Again, being out in the wilderness isn't the place to find out you need it. If staying on the anti-psychotic is the price of admission for a year in the wild, then perhaps it's a good idea to keep an open mind about ditching it.
Another thing to consider - how stable has your lithium dosage been over the last two years, the last year? Have you had to make many adjustments in your meds? If so, you might want to go on a shorter program since you won't have the luxury of fine tuning things once you're gone. If you can't go a year without tinkering in normal life, I seriously doubt you'll be able to on your trip.
I'm not saying don't go, just do massive, thorough, scrupulous, honest and realistic planning before you go.
posted by space_cookie at 1:49 PM on September 1, 2010
That said, the kind of daily physical exertion that your trip will require will likely be very good for you, assuming you're body's healthy and up for the task. Yes, nature is a powerful balm for the soul and IF you can find a way to stay stable, it will probably do you a world of good. It won't cure your bipolar, but it might help you discover that you can find some peace with it.
The if part, however, has me concerned. A year is a long time to be without any monitoring. If you go you'll need an excellent contingency plan. You'll need to discuss early warning signs of trouble with someone on the trip so they can help you should your judgement become shaky. If you go off the anti-psychotic, do so well in advance of your trip with the help of your psychiatrist. Again, being out in the wilderness isn't the place to find out you need it. If staying on the anti-psychotic is the price of admission for a year in the wild, then perhaps it's a good idea to keep an open mind about ditching it.
Another thing to consider - how stable has your lithium dosage been over the last two years, the last year? Have you had to make many adjustments in your meds? If so, you might want to go on a shorter program since you won't have the luxury of fine tuning things once you're gone. If you can't go a year without tinkering in normal life, I seriously doubt you'll be able to on your trip.
I'm not saying don't go, just do massive, thorough, scrupulous, honest and realistic planning before you go.
posted by space_cookie at 1:49 PM on September 1, 2010
Please, please, please, please inform any program that you are applying to (when you are applying) that you are manic depressive and are taking lithium. Please.
I have worked in outdoor education for the last 10 years, and believe me, it does you or them absolutely no favors to hide your health history until you show up bright and shiny on their doorstep. Each wilderness program has its own levels of comfort with this stuff, and trains their staff accordingly. If you don't give them a heads up in the application process, then you're not allowing them to evaluate whether or not they can take care of you for an extended period of time in the wilderness. If they decide they can't, I'm sorry, but the wilderness is not a frakking joke and things can go very wrong in the backcountry in about five minutes on a normal day anyway. Any attempt on your part to weasel your way into a program that isn't actually prepared to take care of you could have some very serious consequences--not just for you but for the entire group.
I'm sorry if that sounds harsh, but consider the following scenario: You are in a group with 2 instructors and you are all attempting to summit a mountain. Your meds aren't working as well as they might, because you're working harder than you used to at home and therefore are metabolising it faster than usual, but you have no standing orders from your doctor about what to do in that situation because you didn't talk to anyone about it before you left. So you have a major manic episode that day and your manic mood peaks right as a big storm is coming in. Because you're feeling really manic, you think everyone should keep going all of the way up to the top, even though the instructors have decided that it's time to go down, and you put up a fight about it.
So now one instructor has to talk you down and then spend the entire way down keeping you talked down, because she needs you to pay attention to where you're walking and also not do something stupid like try to bolt back up. Meanwhile, the other instructor is essentially solely in charge of taking 11 other students down the rest of the mountain, which is a long steep slope of loose rock. That second instructor has to make the choice: 'Do I lead the group, so that we take the best and fastest way down, even though I'll be too far away to help if some one in the back slips and starts falling? Do I go in the middle and put my strongest students in the front and hope they pick their way down well enough and fast enough that that storm doesn't move in on top of us before we get down, even though if I'm in the middle and someone at the very front falls, there will be no one to catch them?' Can you see how these things snowball?
ON THE OTHER HAND: you should also know that I have seen this work out, but when it does, it's because there's been a lot of pre-course communication--between the student and the administration, and between the administration and the student's doctor sometimes--and when the student's illness is very stable. One reason that the pre-course communication is so essential is that if you are out in the wilderness, working hard for a long time, then your food, metabolism, energy expended, and sleep/recuperation time are all going to be very different than when you are at home. Your doctor needs to know this, in case that changes your dosage and/or how you should monitor yourself.
The short version: please tell them when you're applying, because at the most basic level it's a safety issue for everyone involved.
posted by colfax at 4:42 PM on September 1, 2010 [3 favorites]
I have worked in outdoor education for the last 10 years, and believe me, it does you or them absolutely no favors to hide your health history until you show up bright and shiny on their doorstep. Each wilderness program has its own levels of comfort with this stuff, and trains their staff accordingly. If you don't give them a heads up in the application process, then you're not allowing them to evaluate whether or not they can take care of you for an extended period of time in the wilderness. If they decide they can't, I'm sorry, but the wilderness is not a frakking joke and things can go very wrong in the backcountry in about five minutes on a normal day anyway. Any attempt on your part to weasel your way into a program that isn't actually prepared to take care of you could have some very serious consequences--not just for you but for the entire group.
I'm sorry if that sounds harsh, but consider the following scenario: You are in a group with 2 instructors and you are all attempting to summit a mountain. Your meds aren't working as well as they might, because you're working harder than you used to at home and therefore are metabolising it faster than usual, but you have no standing orders from your doctor about what to do in that situation because you didn't talk to anyone about it before you left. So you have a major manic episode that day and your manic mood peaks right as a big storm is coming in. Because you're feeling really manic, you think everyone should keep going all of the way up to the top, even though the instructors have decided that it's time to go down, and you put up a fight about it.
So now one instructor has to talk you down and then spend the entire way down keeping you talked down, because she needs you to pay attention to where you're walking and also not do something stupid like try to bolt back up. Meanwhile, the other instructor is essentially solely in charge of taking 11 other students down the rest of the mountain, which is a long steep slope of loose rock. That second instructor has to make the choice: 'Do I lead the group, so that we take the best and fastest way down, even though I'll be too far away to help if some one in the back slips and starts falling? Do I go in the middle and put my strongest students in the front and hope they pick their way down well enough and fast enough that that storm doesn't move in on top of us before we get down, even though if I'm in the middle and someone at the very front falls, there will be no one to catch them?' Can you see how these things snowball?
ON THE OTHER HAND: you should also know that I have seen this work out, but when it does, it's because there's been a lot of pre-course communication--between the student and the administration, and between the administration and the student's doctor sometimes--and when the student's illness is very stable. One reason that the pre-course communication is so essential is that if you are out in the wilderness, working hard for a long time, then your food, metabolism, energy expended, and sleep/recuperation time are all going to be very different than when you are at home. Your doctor needs to know this, in case that changes your dosage and/or how you should monitor yourself.
The short version: please tell them when you're applying, because at the most basic level it's a safety issue for everyone involved.
posted by colfax at 4:42 PM on September 1, 2010 [3 favorites]
Nthing the lithium/sweating/fluid balance side of things.
But also be aware that heavy exercise is a classic trigger for mania. In small doses exercise is great, and can serve as one of the most effective non-drug treatments for mood disorders. But engage in a whole lot of sudden sustained hard physical work, and it may well launch you into a place you don't want to be.
So perhaps test this aspect of things before you sign up as well. Try shorter day hikes and build up to two or three days out type thing. If that has a destabilizing effect, it's something you need to plan for with the help of your psych.
posted by Ahab at 1:14 AM on September 2, 2010
But also be aware that heavy exercise is a classic trigger for mania. In small doses exercise is great, and can serve as one of the most effective non-drug treatments for mood disorders. But engage in a whole lot of sudden sustained hard physical work, and it may well launch you into a place you don't want to be.
So perhaps test this aspect of things before you sign up as well. Try shorter day hikes and build up to two or three days out type thing. If that has a destabilizing effect, it's something you need to plan for with the help of your psych.
posted by Ahab at 1:14 AM on September 2, 2010
This thread is closed to new comments.
IOW, have you made small strides to incorporate nature into your daily life and you want to take the next step, or are you jumping into THE MOST NATURE IMAGINABLE all at once in the hopes it fixes you?
posted by Eyebrows McGee at 12:32 PM on September 1, 2010 [1 favorite]