Making Amends

Grant “Skip” Treaster remembers his hand trembling the day he sat down to write a long-overdue letter to his son. It was his son’s 39th birthday. And Treaster, diagnosed with bipolar disorder in 1995, hadn’t seen his son since he was a 9-year-old boy.

“I wish I could just say sorry, that this card is a couple days late,” Treaster wrote his son. “But it’s been more like a couple decades. I don’t know where to even begin to say I’m sorry, but I truly am.

“I’m sorry I just up and disappeared from your life,” his card message continued. “I never really intended to do that. But I turned out to be one of those men who leave. Leave jobs when they get too hard. Leave relationships when they get too complicated. Leave town when things get hot. I’m sorry I left you and I’ll never be able to forgive myself for that.”

Treaster, a former advertising executive who lives in Arizona with his fourth wife, has spent the past several years rebuilding his world after battling bipolar disorder for decades without a diagnosis. As part of the process, he’s beginning to try to make amends to those he hurt, including his three adult sons from his first marriage—whom he all but abandoned—as well as two adult daughters from his second marriage.

“I’ve left quite a wake of ruined relationships and destruction in my path because it took so long to get diagnosed,” says Treaster, now 59. “And even the diagnosis doesn’t change things, necessarily. It takes time. And a diagnosis doesn’t undo all the past mistakes.”

Indeed, we have all been hurt, or have hurt others in relationships. Whether unintentional or purposeful, it happens. But when bipolar disorder is at the source of the wound inflicted on another, things such as out-of-control spending, infidelity, anger outbursts, or long periods of isolation brought on by depression can amplify and confuse those hurts. The pain is real, but how can we hold a grudge against someone who has a mental illness? On the other hand, if we have a mental illness, how do we begin to make amends for things we did when we were ill?

While medication and therapy are the building blocks to recovery from mental illness, making amends and seeking forgiveness play a role as well. As Treaster has discovered, asking for forgiveness—and forgiving himself—have been the hardest part of his climb to wellness.

Read the rest of the article, including tips for healing here.

Mental Illnesses: Misunderstood

(Thanks to Debbie Pearson for this post:)

Dead Horse Theory

The tribal wisdom of the Dakota Indians, passed on from generation to generation, says that, "When you discover that you are riding a dead horse, the best strategy is to dismount."

However, in government, education, corporate management and health care, more advanced strategies are often employed in such situations, such as:

Buying a bigger whip.

Changing riders.

Appointing a committee to study the horse.

Checking the internet for information on various means of riding dead horses.

Lowering standards so that dead horses can be included.

Reclassifying the dead horse as living impaired.

Hiring an outside contractor to ride the dead horse.

Harnessing several dead horses together to increase speed.

Providing additional funding and/or training to increase the performance of the dead horse.

Doing a productivity study to see if lighter riders would improve the performance of the dead horse.

Declaring that as the dead horse does not have to be fed, it is less costly, carries lower overhead and therefore contributes substantially more to the bottom line of the economy than do other horses.

Rewriting the expected performance requirements for all horses.

Promoting the dead horse to supervision as an incentive.

Doing a needs assessment on the dead horse and then establishing best practice findings to address the needs.... of the dead horse.

This year let's consider that tribal wisdom and simply dismount.
Happy 2009!

Holiday Triggers

Holiday stress and depression are often the result of three main trigger points. Understanding these trigger points can help you plan ahead on how to accommodate them.

The three main trigger points of holiday stress or depression:

• Relationships. Relationships can cause turmoil, conflict or stress at any time. But tensions are often heightened during the holidays. Family misunderstandings and conflicts can intensify — especially if you're all thrust together for several days. Conflicts are bound to arise with so many different personalities, needs and interests. On the other hand, if you're facing the holidays without a loved one, you may find yourself especially lonely or sad.
• Finances. Like your relationships, your financial situation can cause stress at any time of the year. But overspending during the holidays on gifts, travel, food and entertainment can increase stress as you try to make ends meet while ensuring that everyone on your gift list is happy. You may find yourself in a financial spiral that leaves you with depression symptoms such as hopelessness, sadness and helplessness.
• Physical demands. The strain of shopping, attending social gatherings and preparing holiday meals can wipe you out. Feeling exhausted increases your stress, creating a vicious cycle. Exercise and sleep — good antidotes for stress and fatigue — may take a back seat to chores and errands. High demands, stress, lack of exercise, and overindulgence in food and drink — all are ingredients for holiday illness.

12 tips to prevent holiday stress and depression

When stress is at its peak, it's hard to stop and regroup. Try to prevent stress and depression in the first place, especially if you know the holidays have taken an emotional toll in previous years.

Tips you can try to head off holiday stress and depression:

1. Acknowledge your feelings. You can't force yourself to be happy just because it's the holiday season.
2. Seek support. If you feel isolated or down, seek out family members and friends, or community, religious or social services. Consider volunteering at a community or religious function. You don't have to go it alone.
   
3. Be realistic. As families change and grow, traditions and rituals often change as well. Hold on to those you can and want to. But accept that you may have to let go of others.
   
4. Set differences aside. Try to accept family members and friends as they are, even if they don't live up to all your expectations. Practice forgiveness.
   
5. Stick to a budget. Before you go shopping, decide how much money you can afford to spend on gifts and other items. Then be sure to stick to your budget. Don't try to buy happiness with an avalanche of gifts.
6. Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Expect travel delays, especially if you're flying.
7. Learn to say no. If you say yes only to what you really want to do, you'll avoid feeling resentful, bitter and overwhelmed.
   
8. Don't abandon healthy habits. Don't let the holidays become a dietary free-for-all. Some indulgence is OK, but overindulgence only adds to your stress and guilt. Continue to get plenty of sleep and schedule time for physical activity.
9. Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.
10. Rethink resolutions. Resolutions can set you up for failure if they're unrealistic. Set smaller, more specific goals with a reasonable time frame. Choose only those resolutions that help you feel valuable and that provide more than only fleeting moments of happiness.
11. Forget about perfection. Holiday TV specials are filled with happy endings. But in real life, people don't usually resolve problems within an hour or two. Accept imperfections in yourself and in others.
12. Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, unable to sleep, and unable to face routine chores. If these feelings last, talk to your doctor or a mental health professional.

Read the whole article from the Mayo Clinic here, cut yourself some slack and have a relatively safe and sane holiday season:)

Study Finds Happiness Is Infectious

Forget six degrees of separation. How about three degrees of happiness? Researchers from Harvard University and the University of California, San Diego have mapped the relationships of happy people and found that happiness is a collective phenomenon that spreads like a virus through social networks - affecting even strangers three times removed from each other. The theory builds on the notion of emotional contagion, the process at work when a person smiles back at someone who smiles at him. Human emotions appear in clusters, behaving like stampeding animals, says study co-author Nicholas Christakis.

"You would never think to ask a particular buffalo in a herd, ‘Why are you running to the left?'" says the Harvard Medical School sociology professor. "The whole herd is running to the left."

Misery, on the other hand, does not love company as much as happiness does. "Unhappiness doesn't spread as intensely or as consistently as happiness," he says.

The research, being published today in the British Medical Journal, is the latest analysis of data gleaned from the Framingham Heart Study, a longitudinal U.S. survey begun in 1948. The researchers, who have previously published similar findings on the spread of obesity and smoking from the data, focused on 4,739 individuals over 20 years, accounting for 50,000 social and family ties. As the mantra goes in real estate, the top factor in happiness is location, location, location.

Using a standard measure of well-being, the Center for Epidemiological Studies Depression scale, they found that when an individual becomes happy, a friend who lives nearby experiences a 25-per-cent increased chance of becoming happy. And the more centrally located you are in your social cluster of happy people, the more likely you are to become happy.

Read the rest of the article by Tralee Pearce here.

Feeling SAD?

Darker days making you feel blue? Suffering from unrelenting cabin fever? Are you sleeping more, lacking energy, craving sweets? You may be feeling SAD, or seasonal affective disorder, a type of depression that can seriously impact your daily life. As many as half a million people in the United States may have winter-onset depression and another 10% to 20% may experience mild SAD according to the American Association of Family Physicians.

Research at Loyola University seems to indicate that SAD is first and foremost a physical disorder where reduced exposure to natural light leads to biochemical imbalances in the brain. This may be a sort of genetic leftover; the human equivalent of hibernation. But rather than retreat to the nearest cave (with a bag of Oreos,) try some of these mood lifters:

• Get outside for at least 30 minutes a day, preferably at mid-day. Lunch walk anyone?
• Take a multivitamin that includes magnesium, B-complex and minerals.
• Aerobic exercise. (My favorite.)
• Avoid caffeine. (You've got to be kidding me.)

If you're less than thrilled with these suggestions, you might try light therapy. Light therapy mimics outdoor light and causes a biochemical change in your brain that lifts your mood and relieves symptoms. In light therapy, you sit a few feet from a specialized light therapy box so that you're exposed to very bright light. Light therapy is generally easy to use and has relatively few side effects. However, light therapy hasn't been officially approved as a treatment by the Food and Drug Administration because of a lack of definitive evidence about its effectiveness in clinical trials. Before you purchase a light therapy box or consider light therapy, consult your doctor or mental health provider to make sure it's right for you. (Got my light from Costco...)

Most people experience some days when they feel down. But if you feel down for days at a time and you can't seem to get motivated to do activities you normally enjoy, see your doctor. This is particularly important if you notice that your sleep patterns and appetite have changed — and certainly if you feel hopeless, think about suicide, or find yourself turning to alcohol for comfort or relaxation. More than usual. (Frankly, just thinking about the impending holidays makes me feel hopeless, think about suicide, and turn to alcohol for comfort.) Find more info here.

Talk it out...

For decades, lithium was the front-line treatment for bipolar disorder. The mysterious salt—doctors still don’t know exactly how it works—stabilizes the intense high and low moods that are hallmarks of the illness.

But after its use for nearly 40 years (the U.S. Food and Drug Administration approved lithium for control of manic episodes in 1970), doctors and consumers have come to the realization that lithium—as well as other mood stabilizing medications—are not the cure-alls initially hoped for.

“It took the field about 25 years to notice that outcomes were not always so good,” says Ellen Frank, PhD, a psychologist and a professor of psychiatry and psychology at the University of Pittsburgh School of Medicine, and director of the Depression and Manic Depression Prevention program at Western Psychiatric Institute and Clinic.

“We don’t know why [people] relapsed—whether there was a non-adherence to medication, or if the early results for lithium were overly optimistic or there was a co-morbid use of illicit drugs, or a combination of those things,” Frank says.

Indeed, lithium’s limitations led researchers to reexamine psychotherapy’s role and potential. In the 1950s and 1960s, therapy for bipolar consisted chiefly of psychoanalysis, founded by Freud; and psycho dynamic therapy, which focuses on a patient’s previous experiences to understand current conflicts, according to Gregory Simon, MD, a psychiatrist and researcher at Group Health Cooperative, a consumer-governed, nonprofit health-care system based in Seattle, Washington.

“Then more came out about the inheritability of the illness, which led people to look for [other] treatments,” says Simon, who is also chair of the Scientific Advisory Board of the Depression and Bipolar Support Alliance (DBSA).

Over the past decade or so, researchers have developed several psychotherapies that are specifically designed for the treatment of bipolar disorder. Most of these therapies, including cognitive behavioral therapy (CBT) and interpersonal social rhythm therapy (IPSRT), were retooled from existing therapies for other mental illnesses, such as those for anxiety and depression, according to researchers.

Early results have been promising: Clinical studies indicate that therapies targeted for bipolar—when combined with appropriate medication—result in greater mood stability and medication compliance, reduction or elimination of hospitalizations, a faster recovery from a bipolar depression, and better overall quality of life.

According to Joseph R. Calabrese, MD, bipolar disorders research chair and professor of psychiatry at Case Western Reserve University, “The best treatment for bipolar disorder includes both a mood stabilizer, which is used to prevent future mood episodes; and psychotherapy/counseling, which is used to help people learn how to manage the symptoms of their illness. Either alone does not work as well.”

Excerpt from Psychotherapy retooled from the Fall 2008 issue of bp Magazine