STEPHEN FRY

Hmm... I don't know. I can't control it.
I'm kinda used to be depressed, but in mania phase I can't help
myself at all.

I had that period - parties, little sleep etc. I was manic and mania
is so hard to control. That's why I stopped drinking alcohol, smoking,
partying etc. Oh wait.. Or it was because of depression ?
What came first - alcohol+drugs+parties or mania? X-D
Actually "depression" comes without any noticeable reasons.. Or maybe I
should be more observant.

Forget it, I don't know my "triggers" . But typing helps anyway

Hi Making it clear that my diagnosis is not Bipolar Disorder but Complex PTSD with BPD, as a result of some discussion a few weeks ago here i went and asked two of the people who work with me in my care plan 'What was the NHS's response to Bipolar Disorder?'

This is what they said, and i think is quite tied in to your question, Charlie -

...... I had my weekly session with one of the sets of psychotherapists this morning. At the end of it i asked her a few things about Bipolar Disorder specifically (rather than my stuff - borderline personality disorder, which is what she sees me about). The key part about speaking to her in particular is that she is Head of Psychological Therapies for the (Gloucestershire Partnership) Mental Health Service Trust. She heads up the entire county team of psychological therapies provision, and i think it is fair to say she knows this stuff thoroughly, but importantly she is also involved in planning of delivery of these services as part of the national development of the response to users of mh services, ie she knows what is current thinking and how these services are being developed as a health strategy... i know her views on what a mh trust should be capable of doing, and what trusts 'national' aims and expectations are, including those in London.

In rough terms (and i'm sure you already know most if not all of this ,but crucially may not have put it together in this order or interpret it this way)...

.....4 meds and 'talking' therapies can work together

5 talking therapies can be effective, either with or not with meds

6 in particular behavioural work based on responding to the change in mood/thoughts/behaviour assessed by the sufferer herself can CHANGE the OUTCOMES of events/situations


The point about (6) is that it is the experience someone has that defines their quality of life.

In a way, because Bipolar Disorder has a strong physical neurological component, as you say, it doesn't matter so much that they have the disorder, it's the effect it has on the persons life that matters. so it follows from this two things...

it becomes a meaninfgful and real response to instigate changes in thoughts/feelings/behaviours in their own right so the person has a more acceptable experience of their conscious life, and second, perhaps quite important to you [someone i was writing to] in how you descibe your current life events, the person's behavioural responses to the broader issues they face (ie bus fares or phone calls) are more effective... this is because 1 they would be feeling more in control of their reactions to stressors and 2 they would be 'in a better place' to deal with those external stressores eg unhelpful CPNs.. and their lives would begin to increasingly become more 'smoothed out', in a virtuous upward circle. Don't mistake me, they would still have Bipolar Disorder, but the experience of being in the social environment would begin to become better.

I do believe there is a substantial difference between this portrayal and the idea of 'thinking your way out of the shit', as it were, or somehow magically 'changing how you perceive things' and 'just getting it together'.


And the second inquisition for my long-suffering health care team brought this ...

Since I spoke to Alex S, the psychologist, on Thursday, I’ve also had my 2-weekly meeting with my named worker, Louise. She is a CPN, but more-so these days the manager of the community mental health day centre here, which is where she fits into my life.

I spent about ten minutes of the half hour talking with her about working with Bipolar Disorder (BD). I asked her ‘What is the aim of therapeutic intervention with a client/patient with BD?’

This was her response, in pretty uncompiled form, from my journal I wrote later in the day, at home:

‘What is the aim of therapeutic intervention with a client/patient with BD?’

The aim would ultimately be to reduce symptoms that interfered with functional day-to-day living

To reduce negative impact of mood shift on person’s life i.e. dysfunctional circumstances/difficulties of situation e.g. job retention etc.

To cause no harm, and to remain on client’s agenda whilst still developing choices for client

To bring more choice/control to client’s life

To do this by the client responding to her mood shifts with behavioural actions based on the cognitive understandings (of the client)

Her comments:

Medication is not a pre-requisite. Newer drugs are available in place of Lithium and/or anti-psychotic drugs [I know you know this]. ‘Frequent cycling’ has its own sets of issues. However, even so, there is a small window when the precursor to mood shift is cogniscent to self/others around (partner, friends, health workers etc.), and THIS is the opportunity to work for reduction of mood change. A person may choose to go into either mood shift (up or down) because doing so is attractive to them. It is IMPORTANT the person recognises this is a choice, and also the reasons why they might ‘permit’ mood change to occur. (This is the part that cognitive therapies can act on. Adjusting outcomes of mood shift is the behavioural component).

This is Louise’s view of it, based on many, many years of training, and community and ward experience.


I would be interested to know how much sense or resonance this has with people with Bipolar Disorder. Is it an attractive proposition to contemplate?

Best wishes

Chris

Hi

Good to read your interesting post.

There are quite a few significant points in your words. If I may I'll highlight them in a general way, with two qualifications:

a) I'm hesitant to personalise the comment to your individual circumstances, being somewhat unethical in my training due to the possibility of raising issues for you which I can not then respond to adequately, as well as being sensitive to you in a public space. But I feel I can draw out the points in general terms.

b) my current level of training does not allow me to give fully qualified views about what you say so I need to be careful not to give inaccurate info or interpretation.

What I can say is that these types of discussions do give me a lot of challenging ideas which deepen my understanding of psychology and psychotherapy, and stimulate me to join up the different strands of my training. So thanks for your interest.

Crap English I know, it's quite late...There’s quite a lot in your post which strikes me as being connected:

I’m not unfamiliar with the effect of LSD, and this drug is certainly very powerful, with the capacity to influence thinking in certain conditions at times much later than when it was initially used. In some people it can be connected to trauma response, meaning that certain events can ‘reactivate’ moods associated with its initial use. In other words it leaves an echo that can contribute to some people’s later psychological ‘standpoint’.

The ‘trigger’ of being amongst racist people has a big affect on you, eh? It would for most people obviously, but the following quote is important, I feel:

“I feel a sense of complete panic and isolation [when others are complicit with racism - ?and don’t stand up for their principles??]… …this is a big trigger for a bout of depression for me…”

combined with:

“It makes me ill to see it [hatred] in others. It feels like I am soaking it up even when it's not directed at me”

leading to:

“…these moods may be tied to memory function? As time passes and the sharpness of particular memories become blurred so their impact upon us reduces and the effects dissipate?”

...which is clear I think from people’s general experience… but it’s like the racist behaviour resets something in this person’s experience, bringing to the fore strong anxiety leading on to a depressed state.

So the story here is that ‘triggers’ are very effective at ‘re-instating’ emotions that were likely to be associated with different previous experiences. It comes from this that the therapeutic response to someone who felt they wanted to address this would be to alter the meaning the individual put on to the triggering event – in this case prejudice. Anxiety is connected to fear of something and the usual response would be to check out the validity of that fear in the context in which it is being experienced. So this brief trip through your post suggests to me that the meaning to the individual of the ‘trigger’ event/situation is pretty central to how they react, and consequently what they do, their behaviour e.g. depressed so stay in bed etc. Which kinda brings me back to my training which is that what we think affects how we feel – i.e. the individual’s ‘emotional reactions are essentially a function of how [he/she] construes the world.’ (Gross, 2005, p. 827, from Beck, 1967).

Hope this is interesting, and appropriately put.

What do others think about the words of Louise (above but one post) about the NHS response to treating Bipolar Disorder? –

…there is a small window when the precursor to mood shift is cogniscent to self/others around (partner, friends, health workers etc.), and THIS is the opportunity to work for reduction of mood change. A person may choose to go into either mood shift (up or down) because doing so is attractive to them. It is IMPORTANT the person recognises this is a choice, and also the reasons why they might ‘permit’ mood change to occur. (This is the part that cognitive therapies can act on. Adjusting outcomes of mood shift is the behavioural component).

Best wishes C

Beck, A.T. (1967). Depression: Causes and Treatment. Philadelphia: University of Philadelphia Press.

Gross, R. (2005). Psychology – The Science of Mind and Behaviour. London: Hodder Arnold.

I have to agree! did anyone see that documentry on c4, i think it was called 'the most hated family in america'? i felt sick watching it, i couldnt stop crying during it out of sheer disguist and sadness that people say things like that, think things like that...
At one point i couldnt take any more and had to turn it over... and its funny, ive been going downhill since watching it.... over thinking things a lot, you know?

I cannot control mine at all. Stress, extreme stress, causes sleep paralysis at times which is terrifying even though I know what it is. But the moods? Uncontrollable. I can feel like I can fly one day and wake up wanting to lie on the carpet crying for a week. The one thing that got me through those hell-pit episodes was knowing it would pass, I knew I had something like a pendulum swinging both ways but didn't know exactly what it was. Thanks to Wellbutrin I haven't been in the pits for awhile.

To answer that I thought back to when I was in terrible depressions and had no reson why. There were times I thought I would never get out of it, and that did perhaps make it worse. It's hard to explain, but knowing I will go back "up" eventually helps in a way, but does not make the need to lie in bed or cry or stare or anything any less intense. I just feel like dying sometimes, but somewhere something tells me it will go away again. Hope this makes sense!

Actually that is completely on the mark. The downs are as bad, but my ability to tolerate them is better. Perfect!