Help for a bipolaroid afraid of free time
August 9, 2012 8:16 AM   Subscribe

I've been diagnosed with Bipolar II. I've been having a very hard time as of late, in part because of previous inadequate or incorrect treatment, and my new doctor has recommended I take medical leave for the rest of the year. In the past, I haven't done well with unstructured time, and I want to make sure that I spend this break as (therapeutically) productive as I can.

Before getting a new psychiatrist, I was seeing one that primarily acted as a pill dispenser, and who treated me more for depression than bipolar disorder. After he retired, and after spending about a year in bed during any free time, I finally found a therapist, who found me a doctor who specialized in bipolar disorder. We've been working well together, and he recommended I take the rest of the year off work to focus on getting better and finding the right combination of medicine. (I'm a teacher, so going back in the middle of the semester would not work.)

I followed his advice since I can't say for sure whether I'll be able to function from one day to the next, and since I have bad reactions to so many meds I'm trying out. But I don't do free time well, and I'm out of practice. For the past 10 years, my days have been completely filled with work and parenting. I can't remember the last time I've had six hours to myself on a regular basis. When I do have time off, I tend to spend it in my pjs, in bed, surfing the web or playing video games. (My concentration is shot, so reading has become difficult). Or I get manic, clean half the house, and then collapse and let the rest fall further into chaos. Or worse, buy a bunch of cleaning/organization apparatus that then gathers dust in a corner.

My main issues, besides the resulting listlessness from downtime, are a lack of concentration, chronic insomnia, a herniated disc that seems to resent regular exercise, and an impending dip in my finances.

But I want to getting better during this hiatus, and ideally, I want what I do during this time to carry over to the next year, so that I go back to work ready to be a productive employee and (more importantly) a good parent. Has anyone ever been in a similar situation (bipolar, medical leave), and if so, what did you do with your time to make your life better, not worse?
posted by Lectrolamb to Health & Fitness (8 answers total) 10 users marked this as a favorite
Can you spend a few hours a week volunteering in a low-stress environment? Something you'd enjoy, but where you'd also be responsible, such as walking dogs at the local animal shelter or sorting clothes at a Goodwill?

Getting yourself out of the house and maybe out of your head for a little bit regularly could be helpful.
posted by xingcat at 8:20 AM on August 9, 2012

That much unstructured time would scare the hell out of me! In your shoes, I'd commit to something in the morning. A 10 am shift in the soup kitchen 4 days a week or something. Ideally, it would an exercise class, but if no one's relying on me, I'd just skip it when I was depressed, so it wouldn't work.
posted by small_ruminant at 8:39 AM on August 9, 2012

Best answer: As a freelancer, sometimes I have unstructured time or projects due 3 weeks later, which can lead to something similar to what you describe (pjs, naps, metafilter, work in tiny spurts on the work related project), so I've had to find ways to deal with making sure that I don't have 10 nap days and/or still interact with people , so below I'm going to put things that I've done, but also ideas for you:

• The most important thing so that it doesn't turn into an entire day of naps,pjs, low energy is to do some exercise at the start of the day. I'm not sure how limiting your herniated disc is...but can you work with a physical therapist to identify exercises to strengthen your back muscles? Or find very low impact exercises (i.e. walking, movement in the water).Start every day doing this. It gives some energy and doesn't lead to a pajama day.

• Find a way to connect to people and give to a community (and for you, stay updated in your field so that you could be a phenomenal teacher when you return). I can't see where you live, but if is big in your area, find groups (or contact schools) that provide to starting teachers, read a small amount of material each month and discuss, tutor, whatever it is. Something that gives you an exchange with people and keeps you active in your field.

• How much support do you have for your bipolar besides therapists? See if there is a bipolar support group-it may help to discuss this with people who are experiencing this/have experienced this (everything from medical leave to being disabled).

• What about starting a blog? Either a blog for teachers or a blog for people with bipolar or a blog to explain what your experience is like? Or what if it is for your own career development - what would you do if you had more time for your teaching? Make more activities? Research new activities? It is up to you to keep the blog open to the public or locked, These posts could be written in short intervals of time to deal with the concentration problem. But put it on your schedule to do M,W,F or whatever works for you.
posted by Wolfster at 9:44 AM on August 9, 2012

Best answer: I spent a lot longer than that focused on getting well. Some things that helped me get through it:

1) I took things one day at a time. What do I need to accomplish today? Make that list, which often boiled down to "shower, dress, eat, get groceries, take my meds and do other stuff to take care of myself", and then get each thing done. Most days, I put my blinders on for anything longer term than "what do I need to do today?"

2) I took lessons from my time-blind oldest son for structuring my life around goals and milestones instead of schedules and deadlines. Getting well was going to take the time it took. It didn't have to happen by a certain date. I needed to do things (i.e. Milestones) in a certain order rather than at a certain time.

3) I pursued constructive time-fillers. When totally brain dead, this might include watching tv. When too brain dead to accomplish anything but not brain dead enough for tv, I played computer games. I often did this when I was going through withdrawal from medication and needed something to occupy my mind and time that wouldn't create new problems. Withdrawal was a bad time to, say, hop in the car and drive somewhere. It was also usually a bad time to try to chat online with most folks.

4) Similar to counting your blessings, when I was really going nuts, I would enumerate what I was getting done. I would list how many medications I no longer needed. I would list how much less time it was taking me to get showered and get groceries. Etc. I would look at any evidence I could find that my big picture goal of getting myself well and functional was on track and making forward progress. Then I would return to #1 above and get through the damn day. Again.

Hth and best of luck.
posted by Michele in California at 9:50 AM on August 9, 2012 [2 favorites]

My partner has bipolar II and we're talking about him maybe needing this kind of leave. I think it's great that you're thinking about this so proactively and have good therapeutic support!

I would absolutely recommend some form of regular planned social contact - a support group might be great (my partner seems to find it helpful), a low key volunteer gig, a couple of friends who will alternate planned Friday coffee dates with you - whatever. If you need to, and have people able to, enlist others to support you in this.

Try to get a little sunshine. A daily walk would be great, but if your back isn't up to that, maybe you just plan to sit outside for fifteen minutes every day the weather allows.

As you probably know, structure can be really good for peope with bipolar disorder. Try to build some structure into your days, especially good sleep hygiene. Again, enlist allies - friends, other people you meet through a NAMI support group, someone you can talk to who wants you to feel better and will be willing to help keep you accountable.
posted by Stacey at 9:52 AM on August 9, 2012

Best answer: Oh, wow, hi. I feel like this question was written for me! I'm Bipolar II and currently on extended medical leave to try and get meds/etc. adjusted. Welcome to the club! We are mighty and... somewhat few in number (though not as few as depression tends to tell us we are.)

Your question actually was the thing that got me out of bed today (at a not-that-respectable 1:30pm) when even the promise of watching rhythmic gymnastics qualifications on TV failed, so I have to keep this briefish if I'm to make sure today doesn't become a morass of not getting much done.

We should talk; feel free to MeMail.


This is my second time around on this particular ferris wheel, so I feel like I can actually give a bit of advice and sort of have a system that I use, though it's to a greater or lesser degree of success on any given day.

1. Do not feel bad about feeling bad. This is very important. If at any time you realize you are telling yourself things that amount to "oh I suck I did that again I always do that I am awful," you must stop and return to step #1.

1a. Do not feel bad about doing what you have to do. This is also very important. If you find yourself saying "I know I should go out and get something to eat and do my laundry but this person asked a question on MetaFilter and I really have to answer it because [whatever]," you must stop and return to step #1a. Note that this means you may have to do things you don't much like, in order to get things you need. For me that means asking for help with stuff I haven't been able to make myself do, but that have to happen if I'm going to eat, or bathe, or whatever. If you have to go to a therapist or apply for aid from the government to get something vital done, you have to do it, and should stop going along with the self-talk that says you should feel bad for doing it. This also means you have to be honest with your psychiatrist and therapist and try not to think things (some of which are cognitive distortions and some of which are true) like it makes more work for them or makes you look like an idiot or will make you into a "difficult" case or whatever.

2. Self-care comes first. Take care of making sure you eat, drink water, bathe, stay in the shade, put on clean clothes, etc. This is more important than any of the other rules: if you realize that you're following rule #3 but that you're miserable, you ignore rule #3 and go back to rule #2 until you're not starving/dehydrated/whatever anymore. I try to keep in mind Maslow's hierarchy of needs when figuring out what "self-care" really means.

3. Structure is your friend. Try to be planful about your days, weeks, etc. It helps a lot to write down a to-do list or actually fill out a day planner (you can use one of these things to figure out areas of the day that are targets for specific kinds of activity.) I also find it helps to do things like decide to watch a specific TV show on Netflix, all the way through, rather than flip idling through the channels. But remember, if it makes you miserable, you have to abandon the freaking structure. Note that this means that you may have to prioritize your self-care activities a little: the fact that doing my laundry is on my to-do list does NOT outweigh the fact that I should not be at the laundromat at 2am, acting like a drill sergeant with myself.

4. Try to learn more and become better at handling this whole illness thing. Oh my gosh do some psychoeducation while you're out. Also do things that target the crappy side effects of depression, like cognitive dysfunction. And try and do things like CBT exercises (thought records are really handy for figuring out why you stayed in bed all day when you planned to do something else.) You can do some CBT online, too. Exercise is good, too, obviously - you get significant benefits just from walking around slowly outside, BTW.

5. Be your own medical office manager. Keep track of all the different drugs they put you on - write down when they start and what wacky things happened and how much of an improvement you felt and for the love of all that is holy and beautiful in the world, when and why you stopped taking it (two weeks ago I was asked exactly when and why I stopped taking Paxil in 1998.) The bitter truth is, no one else is going to keep good records for you. I recommend using mood tracking sheets of one sort or another; there are dozens of examples out there. You may want to check with your psychiatrist to see which one(s) they like best.

6. Connect with other people with these same issues. I strongly suggest you do the NAMI Peer-to-Peer course and Connection support group. There are also lots of us on various message boards; your mileage may vary in terms of whether you prefer Mental Earth or Crazy Boards or whatever.

I have been told I have a structure or plan for everything, and this is accurate; I have a diagnosis of OCPD. So I hope I haven't overwhelmed you. The actual practical consequences of the above rules are that:

1. I shower every single day.

2. I eat something (preferably in at least two distinct meals) every day.

3. I get dressed for at least a few hours every day.

4. I try to make sure I leave my house every day, even though that sometimes means I only just step out my front door and stand there for a few minutes (I have panic disorder w/agoraphobia.)

5. I post on MetaFilter and my message boards and on my blog, and journal, just about every day.

6. When I really don't want to do anything at all, I work the crap out of the 15-Minute-Rule. This is not the self-harm rule, though it is related. You say to yourself something like "I'm going to get up and stand in the kitchen for five minutes, and I will make a decision about whether or not I'll try to make myself lunch now after the five minutes are over. A lot of my problems are inertia oriented, so once I'm in the kitchen, it's much easier to get myself lunch than it was to use the promise of lunch to get myself to get out of my computer chair. I tell myself that getting out of bed and starting my day may seem impossible, but getting out of bed isn't actually physically impossible, so I'll do it for 15 minutes and decide after then whether or not it's actually bad enough that I want to stay in bed. It turns out I spend a lot less time in bed this way, even though sometimes I really do decide that it is too much and I am going back to bed.

7. I try as hard as I possibly can not to feel like crap about asking for help.

8. (Lately) I go to NAMI. I also try to take an active role in the IOP process group (I just finished that yesterday, and conveniently enough NAMI meets tonight.) It was REALLY FREAKING HARD and unpleasant and annoying and terrifying and at least twenty other yucky things to make myself do all of this, and Ativan (plus enduring several days of total agony) was required to get me started on the group therapy. BUT I was told yesterday by two social workers that I've made huge progress and am way less rigid and dysfunctional than I was a year ago. So.

Oh... and if you have experience with CBT and are hearing the screaming "MY PROBLEMS ARE CHEMICAL AND YOU CANNOT CURE BIPOLAR DISORDER WITH CUTE SELF-HYPNOTIC CRAP" voices right now, I get where you're coming from. For me the point of CBT tricks isn't that they'll make me feel better - I know they're not great at that. They don't even create permanent positive change; I do not turn into a happy normal functional girl no matter how much of it that I do, and yes, there is a ton of really irritating CBT/DBT/ACT/etc. rhetoric about how that will totally happen just as soon as your thoughts are correct.

Just ignore that stuff; CBT for serious mental illness is primarily useful for bridging the gap between "I feel like crap and can't get out of bed" and "I feel like crap but at least my clothes don't smell and I can possibly get myself to work a part-time job without wanting to die, given these tricks."

Which is to say that CBT is brilliant for coping with being off work on medical leave while you sort out your meds situation. Interpersonal and Social Rhythm Therapy tricks/rules are also handy, but harder to set up on your own while you're struggling :)

Oh, look, I've been typing for an hour. Whee. Now I'm going to eat for the first time today, at 3pm. RULE ONE. DO NOT FEEL BAD FOR FEELING BAD. Ahem. Yeah.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 11:54 AM on August 9, 2012 [13 favorites]

Response by poster: Wow. That was awesome Fee Phi etc . . .! You've inspired me to get up and shower and . . . I'll figure the rest out later. Thank you all for your helpful replies.
posted by Lectrolamb at 12:04 PM on August 9, 2012 [1 favorite]

What I would recommend too is maybe if you can swing it, a regular gym class. Exercise is awesome to help you get stable (along with the meds) and having a regular class-here I'm thinking something like a spin class that meets three times a week-gives you structure.

Also, once you are on the right meds you'll feel like doing more than just hiding in the bed. I promise! I'm assuming your doc is recommending lamictal, which back when I needed meds was The Wonder Drug.

One other thing. Bipolar II is notoriously hard to diagnose, and if you were being treated for just depression this explains your struggles. But you are on the right track now, and you WILL be feeling better soon.
posted by St. Alia of the Bunnies at 12:10 PM on August 9, 2012 [1 favorite]

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