db psyc 620
MasterQ37
transcriptHelpingaYoungWomanManageHerBipolarDisorderSymptoms.docxHelping a Young Woman Manage Her Bipolar Disorder Symptoms
1: Opening the Session
0 seconds DR. DAVID J. MIKLOWITZ
[00:00] DR. DAVID J. MIKLOWITZWell, thanks for coming in. I'm David as you know, Pam . Are you as nervous as I am? PAM: A little bit. DR. DAVID J. MIKLOWITZ: Uh hun . Well, it's kind of hard being under the lights like this. So, what I propose we would do was have you tell me a little bit about yourself and I understand you've had some issues with mood and bipolar disorder? I also understand you're a therapist yourself. PAM: Uh hun. DR. DAVID J. MIKLOWITZ: So that's an interesting role to be in. PAM: Yes, it is. DR. DAVID J. MIKLOWITZ: Where are you with your degree program? PAM: I have about a year and a half to go. DR. DAVID J. MIKLOWITZ: Congratulations . PAM: Thank you. DR. DAVID J. MIKLOWITZ: And, what will you be doing when you're done with your program? PAM: Um, hopefully counseling
37 seconds PAM
[00:37] PAMat an agency. Eventually, I'd like to have my own practice. That's my goal . DR. DAVID J. MIKLOWITZ: What's your specialty? PAM: Well, it's going to be community counseling. I specialize in addictions right now, so I haven't really quite figured out what it's going to be when I finish. DR. DAVID J. MIKLOWITZ: Uh hun. PAM: So, I'm kind of working on that. DR. DAVID J. MIKLOWITZ: Is it with adults or
57 seconds DR. DAVID J. MIKLOWITZ
[00:57] DR. DAVID J. MIKLOWITZadolescents? PAM: I like adolescents. I would really like to work with adolescents and adults
1 minute 2 seconds PAM
[01:02] PAMas well. I like individual counseling. Family counseling is o.k. because it's necessary. It's not something that I really like doing as of right now so, I like to work with the young people. DR. DAVID J. MIKLOWITZ: So, you must have run in to a little bit of
1 minute 17 seconds DR. DAVID J. MIKLOWITZ
[01:17] DR. DAVID J. MIKLOWITZbipolar disorder yourself, with your own counseling? PAM: Actually
1 minute 22 seconds PAM
[01:22] PAM, it was very interesting for me because when I would sit in doctor staff-ins at work, when I started to have some of these issues and I would listen to staff and the kids and their symptoms it's kind of how I started to identify that I might have bipolar disorder. DR. DAVID J. MIKLOWITZ: From working with people who were having mood swings. PAM: Absolutely. I started to kind of become aware of my own depression and the mood swings - actually it was about a year after I got married. DR. DAVID J. MIKLOWITZ: How long ago
1 minute 52 seconds DR. DAVID J. MIKLOWITZ
[01:52] DR. DAVID J. MIKLOWITZ? PAM: It was about four years ago. DR. DAVID J. MIKLOWITZ: Oh. PAM: And, I had started the depression
1 minute 57 seconds PAM
[01:57] PAM, is what happened. I'd always been a very- I don't want to say hyper person, but I've always had a lot of energy. It started to get to the point where I had so much energy where I couldn't sit still, and then I started to get the depression to the point where I actually started to have like suicide thoughts, which I had never had before in my life. Um, ironically, I actually took my husband to the counselor because I thought that he was having the winter depression and it ended up coming out with all the stuff that was going on with me and that I was depressed and I was thinking about suicide and all these things that were happening . I don't know if it was the transition from living at home to getting married. DR. DAVID J. MIKLOWITZ: So, you were about 22 at the time
2 minutes 42 seconds DR. DAVID J. MIKLOWITZ
[02:42] DR. DAVID J. MIKLOWITZ? PAM: About, yeah I think, no 28
2 minutes 47 seconds PAM
[02:47] PAMnow. DR. DAVID J. MIKLOWITZ: You're 28 now? PAM: Yeah. DR. DAVID J. MIKLOWITZ: O.k. so we're talking about...(crosstalk) PAM: 24, 25. DR. DAVID J. MIKLOWITZ: You know what I would
2 minutes 52 seconds DR. DAVID J. MIKLOWITZ
[02:52] DR. DAVID J. MIKLOWITZsuggest we do - as you know my specialty is bipolar disorder and one of the things I think is very useful is for people to kind of go through their history and figure out what strategies they've used to cope with it - whether there are any that they haven't tried yet that I might be able to suggest . So, does that seem like a reasonable way to go? PAM: Absolutely. DR. DAVID J. MIKLOWITZ: O.k. And, if I'm not covering anything that you think is important, then interrupt me and tell me what you think that we should be focusing on. But, you were starting to get into what you experience as mood symptoms of highs and lows. Can you tell me a little bit more about what it's like to have a manic episode? Do you have the full manias? Or, do have more hypo manias ? PAM: No. I've never had like full mania but I've had where
3 minutes 37 seconds PAM
[03:37] PAMI experience more of the depression part of it . That caught my attention more than the mania part of it. Because, when I would feel good, I would just kind of go with it . Actually my husband had pointed out to me, you know, you can't sit still and watch a movie. You're up doing this and doing that - the racing thoughts at night. I could not sleep. I'm thinking about - I couldn't even tell you. Every possible scenario was going through my head, constantly, constantly - can't stop the thoughts, can't stop the thoughts and then I would start to get depressed. I actually - which kind of provoked me was, I had gotten to the point where, before I would go to work, I couldn't leave my house . I was like afraid to go outside. DR. DAVID J. MIKLOWITZ: When you got depressed? PAM: Yeah. DR. DAVID J. MIKLOWITZ: Did you experience
4 minutes 27 seconds DR. DAVID J. MIKLOWITZ
[04:27] DR. DAVID J. MIKLOWITZdramatic shifts from one to the other? Was it over night? Was it gradual ? PAM: Um, I would say it was gradual and I started to
4 minutes 37 seconds PAM
[04:37] PAMget that dramatic shift when the suicide thoughts kind of started to come. But, it was more for me - I was noticing it more and the highs weren't really coming as much. What had happened was I went and saw a psychiatrist. DR. DAVID J. MIKLOWITZ: We're still talking about when you were
4 minutes 57 seconds DR. DAVID J. MIKLOWITZ
[04:57] DR. DAVID J. MIKLOWITZin your early twenties? PAM: Yeah. I went to the counselor that I had been seeing for years and she had told me - she's known me for a long
5 minutes 2 seconds PAM
[05:02] PAMtime- that she was concerned. DR. DAVID J. MIKLOWITZ: So, you had seen her before? PAM: Uh hun. DR. DAVID J. MIKLOWITZ: When did
5 minutes 7 seconds DR. DAVID J. MIKLOWITZ
[05:07] DR. DAVID J. MIKLOWITZyou start seeing her? PAM: When I was in high school, actually. And, we
5 minutes 12 seconds PAM
[05:12] PAMhad kind of - you know. When I had graduated from high school, I'd see her for a while and then not and then see her for a while and then not - kind of worked through some things with my marriage and that whole transition . And, I had just, I felt, that I was not in control any more. I had stopped exercising. I had gained a lot of weight . I felt, I just felt terrible about myself, about everything - very out of control. I lost touch with friends. My husband kind of became my, I don't know what - the center, kind of.
5 minutes 52 seconds PAM
[05:52] PAMIt wasn't working for me. DR. DAVID J. MIKLOWITZ: Sure. Let me ask you to look at
2: Symptoms of Bipolar
5 minutes 57 seconds DR. DAVID J. MIKLOWITZ
[05:57] DR. DAVID J. MIKLOWITZsomething here. This is a list of symptoms that people often have when they have manic or depressive episodes. Can you kind of walk me through which one of those you experienced back when you were 23, 24? PAM: Thoughts that go really fast
6 minutes 12 seconds PAM
[06:12] PAM. Increase energy and activity. Talking fast. Maybe feeling really good about myself, but like I I said, that kind of wasn't really happening. Need for less sleep. Depressed moods. I started to get decreased energy - sweets and carbohydrate cravings, Oh! That's why I gained weight because all I would do is eat; could not stop . The decreased energy. And, lack of thoughts? Or, - I couldn't like even at work. I couldn't put things together . DR. DAVID J. MIKLOWITZ: And the work at this time was what? PAM: I was still at the substance abuse. I'd been there for eight years . DR. DAVID J. MIKLOWITZ: So, it was harder for you to work with the clients
7 minutes 2 seconds DR. DAVID J. MIKLOWITZ
[07:02] DR. DAVID J. MIKLOWITZ? PAM: Yeah. Just lack of motivation and just
7 minutes 7 seconds PAM
[07:07] PAMnot really - very confused. I was very confused. My family has a history of a lot of things. There is mental illness in my family . DR. DAVID J. MIKLOWITZ: I'm going to ask about that in a minute because I think that's an important component of all this. One of the
7 minutes 22 seconds DR. DAVID J. MIKLOWITZ
[07:22] DR. DAVID J. MIKLOWITZthings I'm wondering though is how did your husband respond to this when you were in the high periods and when you crashed in to the lows? How was his reaction ? PAM: Well, in the winter time, he was kind of depressed with me (laughter) but
7 minutes 37 seconds PAM
[07:37] PAMhe started to get frustrated and he started to say to me, you know, there's something wrong because you can't focus and you can't sit still and you know, can't we have a conversation. You're jumping from one thing to another, to another and something is not right. So, he found frustration with it but I don't really think he knew what was going on either . DR. DAVID J. MIKLOWITZ: And, how did you feel about the way he was reacting to it? PAM: I think he handled it fairly well because he was very supportive of me when I went to go see the doctor - because that was a very, very difficult thing for me. DR. DAVID J. MIKLOWITZ: To go back to the doctor
8 minutes 12 seconds DR. DAVID J. MIKLOWITZ
[08:12] DR. DAVID J. MIKLOWITZ? PAM: Just to go to a psychiatrist because I had never been to one. DR. DAVID J. MIKLOWITZ: But, you had said you'd seen one since you were 16 ? PAM: A counselor. DR. DAVID J. MIKLOWITZ: A counselor, o.k. Not a psychiatrist. PAM: Not a psychiatrist. This was the first time that I ever had
8 minutes 22 seconds PAM
[08:22] PAM(coughing inaudible) DR. DAVID J. MIKLOWITZ: What was the reason you went to see the
8 minutes 27 seconds DR. DAVID J. MIKLOWITZ
[08:27] DR. DAVID J. MIKLOWITZcounselor when you were 16? PAM: Well, that brings me to my next point. I actually
8 minutes 32 seconds PAM
[08:32] PAMhad substance abuse issues when I was in high school. So, that's what actually brought me to her and then, of course after that, it was just dealing with emotional things. When I was - I think I was 12 or 13, I was sexually abused by my neighbor. So, there was a lot going on; a lot of things that caused me to use the substances and then stop doing that and then working through a lot of that emotional stuff - for me trying to find out who I was and kind of working through that stress. DR. DAVID J. MIKLOWITZ: Plus the trauma of having been abused and what
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[09:12] DR. DAVID J. MIKLOWITZrole that played, I'm sure. PAM: Right. DR. DAVID J. MIKLOWITZ: What kind of drugs are we talking about? PAM: Marihuana, alcohol,
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[09:17] PAMinhalants, things like that. I never really did too many hard drugs. DR. DAVID J. MIKLOWITZ: O.k. Now
9 minutes 22 seconds DR. DAVID J. MIKLOWITZ
[09:22] DR. DAVID J. MIKLOWITZ, looking back on that, do you think that those were mood swings as well or...(crosstalk)? PAM: Yeah. DR. DAVID J. MIKLOWITZ: What kind of mood swings do you think? PAM: Um, I think it was like the depression. Because, when
9 minutes 32 seconds PAM
[09:32] PAMI would feel good and then I would kind of get down or I would just not really care about what people thought about me, didn't care about myself- that's when I would start using...(crosstalk) DR. DAVID J. MIKLOWITZ: Uh hum. PAM: …to feel better. DR. DAVID J. MIKLOWITZ: Right. PAM: I guess. DR. DAVID J. MIKLOWITZ: So, it was self medicating
9 minutes 47 seconds DR. DAVID J. MIKLOWITZ
[09:47] DR. DAVID J. MIKLOWITZin a way? PAM: Yeah. DR. DAVID J. MIKLOWITZ: And I could recognize that now. I haven't used anything in over 11 years . Good for you. PAM: Nothing. No alcohol, no nothing. DR. DAVID J. MIKLOWITZ: I imagine working with substance abusers has probably helped with that? PAM: Yeah. It has. (laughter) DR. DAVID J. MIKLOWITZ: It's good to be on the other side from time to time. PAM: Uh hum. DR. DAVID J. MIKLOWITZ: So, during your high school years you had some substance problems and some mood swings and you got a handle on that somehow? PAM: Well
10 minutes 12 seconds PAM
[10:12] PAM, it seems like I had gotten a handle on it and I started to go to school and I was working full time , I was going to school full time and then in two years, I was planning a wedding. So, I was very busy . DR. DAVID J. MIKLOWITZ: And, how did you meet your husband? PAM: Actually I met him in the program, 12 step program . (laughter) It's kind of a funny story but we just tell people sometimes - well we just met through friends , because we really don't want to tell anybody, you know - see, we had this drug problem and we kind of met that way - but that's how we - we've been together for nine years now , I think. DR. DAVID J. MIKLOWITZ: And, he's a counselor as well? PAM: No, he's actually a carpenter. DR. DAVID J. MIKLOWITZ: O.k.
10 minutes 47 seconds DR. DAVID J. MIKLOWITZ
[10:47] DR. DAVID J. MIKLOWITZAlright. And, was it a fast relationship leading to marriage or was it a couple of years? PAM: No. It was a couple of years. We'd been together about four years before we got married
10 minutes 57 seconds PAM
[10:57] PAM. We dated for two and then we were engaged for two. When I graduated with my Bachelor's degree is when we got married DR. DAVID J. MIKLOWITZ: Uh hum. And, you say that the onset of the more severe mood swings
11 minutes 7 seconds DR. DAVID J. MIKLOWITZ
[11:07] DR. DAVID J. MIKLOWITZoccurred after you got married? PAM: Uh hum. DR. DAVID J. MIKLOWITZ: Do you connect those two somehow? PAM: Well, you know what, the thing with that is I
11 minutes 12 seconds PAM
[11:12] PAMhad talked to someone about his and what was kind of pointed out to me was that there was so much stimuli going on for me. I was living at home also with school, with work, with the wedding that I really never really had a chance to sit still - and it was like after I got married, all the let down of that- I wasn't in school anymore . I was just working. Things got back to normal. I lived with someone, who I guess- I started to see more of what was going on. It became more apparent to me because I didn't have all this extra stuff going on, that I started to recognize- o.k., something's not quite right. DR. DAVID J. MIKLOWITZ: Something
11 minutes 52 seconds DR. DAVID J. MIKLOWITZ
[11:52] DR. DAVID J. MIKLOWITZinside me is not quite right. PAM: Yeah. DR. DAVID J. MIKLOWITZ: But the relationship how was that at the time ; the first year or two after marriage? PAM: The first year was great, I think
12 minutes 2 seconds PAM
[12:02] PAM. Like I said, I just - it's like I lost myself . I never thought, believe me - never thought I was bipolar . That was the last thing on earth. I mean I, I - still even sitting here talking about it, I still - it's that stigma thing
3: Views of Bipolar Disorder
12 minutes 22 seconds PAM
[12:22] PAM. I have worked through it. DR. DAVID J. MIKLOWITZ: Have you experienced
12 minutes 27 seconds DR. DAVID J. MIKLOWITZ
[12:27] DR. DAVID J. MIKLOWITZthe stigma directly? PAM: No. DR. DAVID J. MIKLOWITZ: Have you felt like there's been any discrimination? PAM: No. But, I do see it sometimes like with the kids I work with
12 minutes 37 seconds PAM
[12:37] PAMor when people talk - just in general when we talk. We talk about bipolar; how everyone has a picture of what it really is and they don't realize that it's not, you know, the person from Mr. Jones, you know, hanging on top of the building ...(crosstalk) DR. DAVID J. MIKLOWITZ: Right. PAM: …that it comes in different forms. DR. DAVID J. MIKLOWITZ: Sure. Actually, that was one thing I was going to ask you
12 minutes 57 seconds DR. DAVID J. MIKLOWITZ
[12:57] DR. DAVID J. MIKLOWITZabout because, uh, you know there is the reputation that bipolar disorder as this glamorous illness in some ways and that the mania goes more with creativity. Have you experienced it that way or has it been more the depression? PAM: For me, it was more of
13 minutes 12 seconds PAM
[13:12] PAMthe depression. I never got to the super manic phases that some people have where they've gone out and spent all kinds of money and felt - I have had points where I was like , pretty, pretty high up there but never to the point where I was doing anything compulsively, like that . DR. DAVID J. MIKLOWITZ: Did the highs ever interfere with your marriage, do you think or your ability to work
13 minutes 42 seconds DR. DAVID J. MIKLOWITZ
[13:42] DR. DAVID J. MIKLOWITZ? PAM: Um. Actually, a little bit. When I
13 minutes 47 seconds PAM
[13:47] PAM- originally, they first put me on Lexapro. I felt like I was - I've never done crack but I felt like I was and I was at work and let me tell you after five days, people at my job looked at me and said you need call your doctor because you look like you're - I was like, climbing the walls . DR. DAVID J. MIKLOWITZ: Right. So, you know about they way antidepressants have a way of kicking off manic episodes
14 minutes 12 seconds DR. DAVID J. MIKLOWITZ
[14:12] DR. DAVID J. MIKLOWITZ. PAM: And, that’s when my doctor had said, "Well, we have our diagnosis now." I'm like, oh great. Thank you
14 minutes 17 seconds PAM
[14:17] PAM. (laughter) DR. DAVID J. MIKLOWITZ: So, you learned the hard way, in other words. PAM: I did . Then, she put me on Lamictal, which I took 200mg of that up until, actually, three days ago . The last four months, we've actually worked together. I had changed a lot of things. I started exercising again. I started eating better. I lost a lot of weight. I changed things. I started coming to school . I've worked on a lot of different things to help where I just felt, she felt as well. I'm not trying to diagnose myself here. She said, "You know what, I feel like you've changed a lot and you don't have to take the medication any more." So, three days ago … DR. DAVID J. MIKLOWITZ: Your doctor said this? PAM: Uh hum. I actually take Omega 3 fish oil , which has been helping a lot. She actually told me that it was really good for mood disorders. So, I haven't taken medication for three days and...(crosstalk) DR. DAVID J. MIKLOWITZ: And, you had been taking it pretty continuously? PAM: Yes. Every day since I started it. DR. DAVID J. MIKLOWITZ: O.k. One way I might be able to be of help here
15 minutes 27 seconds DR. DAVID J. MIKLOWITZ
[15:27] DR. DAVID J. MIKLOWITZis, when people go off medication, of course there's the risk of them having a recurrence. Maybe we could talk a little bit about what it feels like when you go in to a recurrence and what you could do if those symptoms reappear, given that you're not taking medication right now. Would that be useful? PAM: Yes. I kind of worry about that a little bit. DR. DAVID J. MIKLOWITZ: O.k. Can you tell me a little bit about the role of sleep in all this? PAM: Um,
15 minutes 52 seconds PAM
[15:52] PAMsleep. I always had a hard time going to sleep. Actually, the first night I didn't take it - I was only on a 25mg pill, it couldn't be nothing in my system , but the first night, I could not sleep. I was like , tossing and turning and I don't know, I was like dreaming and I woke up and was like- it actually really scared me. I was like, o.k., what is going on ? The last two nights, I've gone right to sleep. I had no problem . It's been the racing thoughts. DR. DAVID J. MIKLOWITZ: The racing thoughts. So
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[16:32] DR. DAVID J. MIKLOWITZ, are the racing thoughts the first prodromo sign you get at the first inclination that maybe you’re cycling? PAM: Uh hum. Yes
16 minutes 42 seconds PAM
[16:42] PAM. DR. DAVID J. MIKLOWITZ: How do you identify them as racing thoughts? What's different? PAM: Because I can't stop them. It's usually when I'm laying in bed . It's like, it'll keep me awake . I had kept - I would like to plan on doing this with myself each day on my calendar, I would write how I was feeling that day. Simply because, that's what she told me to do. DR. DAVID J. MIKLOWITZ: Mood chart? PAM: A mood chart, and I think now I have to do that because I need to be aware of - and I've told my husband, "o.k. I'm doing this because we've agreed on this and I really want to try this without anything but you need to be aware and tell me if you see me, you know, if you think I'm depressed , if you see me getting really hyper and acting the way I did. I need help." I need people to point out to me. (cross talk) DR. DAVID J. MIKLOWITZ: Right. So, what on this list would you tell - sorry to interrupt you, by the way. PAM: Oh, that's o.k. DR. DAVID J. MIKLOWITZ: Which on the list
17 minutes 42 seconds DR. DAVID J. MIKLOWITZ
[17:42] DR. DAVID J. MIKLOWITZwould you recommend your husband look for? PAM: Um, DR. DAVID J. MIKLOWITZ: And, which would you look for ? PAM: The talking fast, thoughts that go really fast, lots of ideas
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[17:52] PAM, just being um, yeah . DR. DAVID J. MIKLOWITZ: So, it would be mainly what's happening in your mind. Would the sleep be
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[18:02] DR. DAVID J. MIKLOWITZdisturbed at that point? PAM: Yeah. Because if I'm going more than a couple of days without
18 minutes 7 seconds PAM
[18:07] PAMbeing able to sleep, that would definitely be a problem too. DR. DAVID J. MIKLOWITZ: Uh hum. How about your moods
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[18:12] DR. DAVID J. MIKLOWITZ? What would that be like? PAM: Um, DR. DAVID J. MIKLOWITZ: As you're going up or going down ? PAM: I would have to say depressed
18 minutes 22 seconds PAM
[18:22] PAMwould be like not exercising, not wanting to do anything . Because like, we would make plans and I would be so excited about the plans and the day - this is what bothered me the most, the day would come and I would be depressed and I didn't want to go. I hated that. That was just like - because I would be so excited and then that day would come and I would be depressed and it just killed me because I had no control . So, I guess like big events or just not wanting to do things - laying on the couch a lot . DR. DAVID J. MIKLOWITZ: Is that a gradual change
18 minutes 57 seconds DR. DAVID J. MIKLOWITZ
[18:57] DR. DAVID J. MIKLOWITZ? Or, do you think it's more...(crosstalk) PAM: From where I'm at right now? DR. DAVID J. MIKLOWITZ: Right. Like when you cycle in to a depression, do you notice a distinct period? PAM: I usually can tell when it's coming because
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[19:07] PAMit even has like physical symptoms; like my stomach will kind of hurt or I'll feel tired or I'll feel like uncomfortable . DR. DAVID J. MIKLOWITZ: So, you're very good at being able to identify these subtle
19 minutes 22 seconds DR. DAVID J. MIKLOWITZ
[19:22] DR. DAVID J. MIKLOWITZchanges in yourself. PAM: I've learned over the last couple of years, with medication management
19 minutes 27 seconds PAM
[19:27] PAM. I've really learned. I'm learning even now, more so, how to gauge myself and really because I do not want to go back to where I was . DR. DAVID J. MIKLOWITZ: Sure. Understandably. PAM: Believe me. That was the scariest place I'd ever been in my life. DR. DAVID J. MIKLOWITZ: The highs
19 minutes 42 seconds DR. DAVID J. MIKLOWITZ
[19:42] DR. DAVID J. MIKLOWITZor the lows? PAM: The lows. DR. DAVID J. MIKLOWITZ: The lows, and the suicidal thinking. Does the suicidal thinking appear only at the worst part of depression or does that sometimes come up when you're having your thoughts, when you're laying there at night? PAM: It's usually when I'm really depressed
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[19:57] PAM, is when they come up. Usually, at night, I'm not having thoughts like that. DR. DAVID J. MIKLOWITZ: What kind of thoughts are
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[20:02] DR. DAVID J. MIKLOWITZyou having? PAM: Um, gee, so many
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[20:07] PAM, like, you know um, am I doing my job right and did I clean the house?, Did I close the door?, Did I do this, did I do that? Did I work on that paper? What am I supposed to do (inaudible/indiscernible). It doesn't stop. DR. DAVID J. MIKLOWITZ: So, it's more like ruminations really. PAM: Yes. DR. DAVID J. MIKLOWITZ: Do you ever get the thoughts that some people get of
20 minutes 27 seconds DR. DAVID J. MIKLOWITZ
[20:27] DR. DAVID J. MIKLOWITZ: gee, I feel full of energy and power. I can do incredible things - the kind of grandiose thinking? PAM: No. DR. DAVID J. MIKLOWITZ: You don't get that? PAM: Uh un
20 minutes 37 seconds PAM
[20:37] PAM, (no). And, if I feel that way, I'd check myself a lot. I check myself a lot with my co-workers and just with people in general. Like, I will tell them , o.k. I'm thinking this way and I'm feeling this way, am I on target? Or, am I like out of my mind. Because, I need people to keep me balanced, because I don't know. I realize that I have this and just because I'm not taking medication doesn’t mean it's going to go away. It's something that I have to constantly - it's like I have to eat right. I have to exercise , because if I don't, I don't function well . I'm getting to the point where I can sit and kind of listen to music and meditate, but I'm a very physical person. So, if I'm feeling anxious, I need to run six miles and get my energy out, otherwise, I'm not going to be...(crosstalk) DR. DAVID J. MIKLOWITZ: But that also sounds like
4: Problem Solving for Cycle Shifts
21 minutes 32 seconds DR. DAVID J. MIKLOWITZ
[21:32] DR. DAVID J. MIKLOWITZan adaptive way to handle it. PAM: Yeah. DR. DAVID J. MIKLOWITZ: Let's talk more about that. So, let's imagine a scenario where your mood is starting to cycle. Let's say it's going up and your thoughts are going fast and you're worrying about a lot of things - feeling like you're jumping out of your skin and your husband, perhaps, I saying, "Gee, you can't sit still." If that were to occur again, and you're not on medication, what would you do? What do you see as your options? PAM: That's a good question (laughter)
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[22:02] PAM. DR. DAVID J. MIKLOWITZ: Would you like me to help you with that? PAM: Yes. DR. DAVID J. MIKLOWITZ: O.k. Tell me what you've done in the past
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[22:07] DR. DAVID J. MIKLOWITZ? Have you ever been in that circumstance before? PAM: Um, yes. DR. DAVID J. MIKLOWITZ: And what did you do ? (reaches for papers and hands her a sheet) PAM: Um,
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[22:17] PAMwell, if I'm feeling really like energetic or it's misplaced energy , usually I exercise. DR. DAVID J. MIKLOWITZ: O.k. So, exercise is one thing that you can do
22 minutes 32 seconds DR. DAVID J. MIKLOWITZ
[22:32] DR. DAVID J. MIKLOWITZ. PAM: Yes, I have to exercise. DR. DAVID J. MIKLOWITZ: Have you ever thought of actually making a list of those things you could do when your mood is going up? PAM: No, but that's a really good idea. DR. DAVID J. MIKLOWITZ: Just have a kind of a card you could take a look at - first thing I'm going to do is…second is…third. Where in that list would be calling your doctor and seeing whether you should go back on medication? PAM: Um
22 minutes 52 seconds PAM
[22:52] PAM...(crosstalk) DR. DAVID J. MIKLOWITZ: Would that be down or high on the list? PAM: Probably be in the middle . DR. DAVID J. MIKLOWITZ: O.k. PAM: Because I just want to be o.k. and I just want to feel o.k. and um I think if I have some acceptance to the point where for me, it's about my health and me feeling good . If at some point again, that involved having to do that , I don't think I would think twice about it. I would because I know that's not for me - it's not an ending, nor is it a beginning, it's just what it is , and I want to be o.k. DR. DAVID J. MIKLOWITZ: So, you've really come a
23 minutes 32 seconds DR. DAVID J. MIKLOWITZ
[23:32] DR. DAVID J. MIKLOWITZlong way with this. It sounds like you've gotten a handle on accepting that this is part of your brain chemistry and part of what life has dealt you . PAM: It's taken a while. It was very hard just to walk in to that doctor's office -I like walked in there like this
23 minutes 47 seconds PAM
[23:47] PAM(gesture covering face with paper). DR. DAVID J. MIKLOWITZ: Uh hun. PAM: I'm like, I hope nobody sees me in here, wondering if everybody else is in here for the same reasons - what am I worried about? It was just, I guess, having some acceptance with myself that, you know what, it' s o.k. that you have this and it's just something that, for me with the medication, it helped me change a lot of things. Because, I was unable to do that with being all over the place. DR. DAVID J. MIKLOWITZ: Sure. PAM: So it's like now , I have to vigilantly manage that and I'm very aware of that. I don't have the luxury of just laying around for a week and doing nothing. I've kind of had to with what's happened to me recently - but just , I have to be vigilant. I have to be aware of myself because I could slip back in to it very easily . Like what happened to me before. DR. DAVID J. MIKLOWITZ: Sure. PAM: I never thought that , o.k. I'm going to get married and then this is going to happen to me? I never thought that. DR. DAVID J. MIKLOWITZ: Sure
24 minutes 42 seconds DR. DAVID J. MIKLOWITZ
[24:42] DR. DAVID J. MIKLOWITZ. PAM: But, when you work in the field and you see it every day
24 minutes 47 seconds PAM
[24:47] PAM, for me it was like, how can I sit here and you know give someone advice when I'm feeling these symptoms myself? I need to take my own advice. DR. DAVID J. MIKLOWITZ: Although, I guess, the flip
24 minutes 57 seconds DR. DAVID J. MIKLOWITZ
[24:57] DR. DAVID J. MIKLOWITZside of that is that having this disorder has probably helped you to be a better therapist for people who have it and for adolescents. PAM: It has. Believe me my perspective has changed so much and I understand now
25 minutes 7 seconds PAM
[25:07] PAMyou know being young and - I hate to say a label but sometimes you feel like that. DR. DAVID J. MIKLOWITZ: True. PAM: You know, I would sooner tell somebody that I'm a drug addict than I would tell them that I'm bipolar. (laughter) DR. DAVID J. MIKLOWITZ: That's interesting. So, you feel like there's more of a stigma in a way to
25 minutes 22 seconds DR. DAVID J. MIKLOWITZ
[25:22] DR. DAVID J. MIKLOWITZbeing bipolar. PAM: Yeah. I do. DR. DAVID J. MIKLOWITZ: Why do you think that? PAM: I don't know. I guess because it's
25 minutes 27 seconds PAM
[25:27] PAMmental illness and there's um , I don't know. There's more glamour around drug addiction than there is around mental illness. DR. DAVID J. MIKLOWITZ: Uh hun. So
25 minutes 42 seconds DR. DAVID J. MIKLOWITZ
[25:42] DR. DAVID J. MIKLOWITZ, would it be the case then that if your mood was going upwards and you were to call your doctor, would that bring back all that stuff about stigma and having to acknowledge it. PAM: I don't think so because I really like her. She is a fantastic woman. She has been really
25 minutes 57 seconds PAM
[25:57] PAMgreat with me. She's actually helped. She's actually my doctor that works with us at my job . She's actually my psychiatrist, so, she's just a wonderful person . We've kind of processed and I've come to understand that , it's not really about the label it's about feeling good. DR. DAVID J. MIKLOWITZ: O.k. PAM: It's about being good in my life and living my life each day enjoyably . Why would I put myself through unnecessary pain if I could just take a pill to help . DR. DAVID J. MIKLOWITZ: Right. So, you wouldn't be averse then to making that phone call? PAM: No. DR. DAVID J. MIKLOWITZ: Would that be true if you were getting depressed as well
26 minutes 32 seconds DR. DAVID J. MIKLOWITZ
[26:32] DR. DAVID J. MIKLOWITZ? PAM: Yes. DR. DAVID J. MIKLOWITZ: And, she were to say, 'gee, we ought to try the Lamictal again or a different medication ? You'd be open to that? PAM: I'm sure I'd be disappointed at some level but I understand
26 minutes 42 seconds PAM
[26:42] PAMthat it's a life long thing. DR. DAVID J. MIKLOWITZ: Sure. You know I think of medication
26 minutes 47 seconds DR. DAVID J. MIKLOWITZ
[26:47] DR. DAVID J. MIKLOWITZthe same way I think about wearing glasses. And some people are born with eyesight and they have to have a corrective lens. People are born with chemicals that go awry from time to time and the medication is necessary to straighten out their brain chemistry . Although, that of course - there is the other issue which you're raising which is the whole stigma. How it makes you feel about yourself to take a medication. PAM: Uh hun. DR. DAVID J. MIKLOWITZ: But, you seem like you've come a long way with that . PAM: I've had to. I've just had to and I have actually
27 minutes 17 seconds PAM
[27:17] PAMhad instances where a few of the kids that were having a really, really, really hard time - I've told them and they were like, "Really?!" I'm like yeah - my - they know at work- they pretty much know everything about me . DR. DAVID J. MIKLOWITZ: It probably makes them feel less stigmatized to do that. PAM: Yeah. It's not something you just walk around and tell people. DR. DAVID J. MIKLOWITZ: You're right. Absolutely. PAM: Especially when you work in the field, you're not going to put yourself out
5: Resources for Support
27 minutes 42 seconds PAM
[27:42] PAMthere like, 'hey'...(crosstalk) DR. DAVID J. MIKLOWITZ: Sure. PAM: …Guess what?... DR. DAVID J. MIKLOWITZ: When you look
27 minutes 47 seconds DR. DAVID J. MIKLOWITZ
[27:47] DR. DAVID J. MIKLOWITZat this list here, do you see anything on there that would help you when you're going up or down; particularly when you're going down? We've talked about medication, what about uh, do you feel like you have people in your life you can talk to ? PAM: Well, using communication and problem solving would be good, um, social,
28 minutes 7 seconds PAM
[28:07] PAMfamily, community supports… Yeah, I have a lot of support. DR. DAVID J. MIKLOWITZ: From your family
28 minutes 12 seconds DR. DAVID J. MIKLOWITZ
[28:12] DR. DAVID J. MIKLOWITZ? PAM: No. Not necessarily from them. Kind of from them but...(crosstalk) DR. DAVID J. MIKLOWITZ: Are your parents still alive? PAM: Yeah. DR. DAVID J. MIKLOWITZ: And, are they local? PAM: Uh hun. It's just that
28 minutes 22 seconds PAM
[28:22] PAM- me and my mom communicate but not on deep levels because when we'd start talking about like , you know, she always has like a diagnosis and something to change it and help it (laughter) . DR. DAVID J. MIKLOWITZ: O.k. PAM: It's kind of like that. She's not the person. DR. DAVID J. MIKLOWITZ: Sure. PAM: But um...(crosstalk) DR. DAVID J. MIKLOWITZ: How does
28 minutes 37 seconds DR. DAVID J. MIKLOWITZ
[28:37] DR. DAVID J. MIKLOWITZthat affect you when she has advice for you on what you should be doing differently? PAM: Um, you know I
28 minutes 42 seconds PAM
[28:42] PAMactually didn't tell her that I was taking medication for a while nor did I tell my mother-in-law for about a year . Eventually they found out and it was really not a big deal but I was really scared about that. DR. DAVID J. MIKLOWITZ: About how they would respond? PAM: Yeah, and you know...(crosstalk) DR. DAVID J. MIKLOWITZ: How did you think they would respond
28 minutes 57 seconds DR. DAVID J. MIKLOWITZ
[28:57] DR. DAVID J. MIKLOWITZ? PAM: I don't know. I don't know, I guess I just thought they would like judge
29 minutes 2 seconds PAM
[29:02] PAMme and - 'oh, you're not that' or ' oh gees we know she's bipolar so we've got to be careful what we say around her .’ I have a sister that has been diagnosed with but she doesn't take medication. DR. DAVID J. MIKLOWITZ: She's been diagnosed
29 minutes 17 seconds DR. DAVID J. MIKLOWITZ
[29:17] DR. DAVID J. MIKLOWITZwith bipolar disorder? PAM: Uh hun And, she clearly...(crosstalk) DR. DAVID J. MIKLOWITZ: Bipolar I or II? PAM: I don't know
29 minutes 22 seconds PAM
[29:22] PAM. DR. DAVID J. MIKLOWITZ: Uh hun. PAM: But she's always been a little off. Honestly, I'll tell you, looking at my mom too , I know - looking at how they react to life is probably part of the reason why I took medicine. DR. DAVID J. MIKLOWITZ: Uh hun. PAM: Because I decided that I didn't want to react to life like I see other people reacting to life. I wanted to be better about it. DR. DAVID J. MIKLOWITZ: And had it done that
29 minutes 42 seconds DR. DAVID J. MIKLOWITZ
[29:42] DR. DAVID J. MIKLOWITZfor you? PAM: Yes. DR. DAVID J. MIKLOWITZ: O.k. PAM: Absolutely. DR. DAVID J. MIKLOWITZ: So, to what extent would you feel, if you were getting depressed that you could - would it help to talk to mom or dad? PAM: No
29 minutes 52 seconds PAM
[29:52] PAM. DR. DAVID J. MIKLOWITZ: Or, do you feel it's better to talk to...(crosstalk) PAM: Friends. DR. DAVID J. MIKLOWITZ: Friends. Uh hun. O.k. PAM: Friends, yes. DR. DAVID J. MIKLOWITZ: That's good to know. PAM: Friends, my husband , you know, my old counselor. I have a lot of resources and people I can tap in to when I need to. DR. DAVID J. MIKLOWITZ: What happened in the past when you tried to talk to your parents
30 minutes 7 seconds DR. DAVID J. MIKLOWITZ
[30:07] DR. DAVID J. MIKLOWITZabout this stuff, like when you were a teenager, for example. PAM: Um, well, a lot
30 minutes 12 seconds PAM
[30:12] PAMof it with my mom. My dad was pretty good with it but he's not a real talker so it was like he's not the type of person you could kind of sit down and have like an hour conversation with. My mom was more reactive . She was like, all of a sudden, one week it's her fault and then the next week, it's your fault, then the next week, it's society’s fault . It was very - see my grandma was, I think my grandma had schizophrenia back in the day. My mom has never been able to see her records but I think my mom has such a - she's passed for 20 something years now. My mom has a real hard time with that because of her family and it's just - she's just a reactive person . She's getting better because we're learning from each other. But, she's never been to counseling , would never go to counseling so it's - I know what I can tell her and what I can't. DR. DAVID J. MIKLOWITZ: O.k. so, one thing you have learned is what will help regarding
31 minutes 12 seconds DR. DAVID J. MIKLOWITZ
[31:12] DR. DAVID J. MIKLOWITZyour family of origin, whether or not it's a good idea. PAM: Yes. By telling the things and getting reactions, I've learned, o.k.
31 minutes 17 seconds PAM
[31:17] PAMthis is what I can talk to you about and this is what I can't. DR. DAVID J. MIKLOWITZ: Right, and does that contribute to the depression, do you think,
31 minutes 22 seconds DR. DAVID J. MIKLOWITZ
[31:22] DR. DAVID J. MIKLOWITZwhen you're...(crosstalk) PAM: Not any more. DR. DAVID J. MIKLOWITZ: Not any more. You're able to separate it? PAM: Yeah. I have acceptance with her and like I said
31 minutes 27 seconds PAM
[31:27] PAM, I have a support network of people that I know I can talk to and that makes a huge difference . I've developed that and an understanding that I can't get everything from her nor can I get everything from my husband so I have to have other people that I can get different things from. DR. DAVID J. MIKLOWITZ: And, who were some of those people? Friends, are you talking about? PAM: Friends - there's a lot of people that like - in the program. There are lot of people here at school. There are some professors I can talk to . There's my old counselor. DR. DAVID J. MIKLOWITZ: So, if you were starting to sink in to a depression you
31 minutes 57 seconds DR. DAVID J. MIKLOWITZ
[31:57] DR. DAVID J. MIKLOWITZmight call one of your fellow counselors and talk about it? PAM: Absolutely. And, I have a lot of friends here in the program
32 minutes 2 seconds PAM
[32:02] PAM. DR. DAVID J. MIKLOWITZ: Uh hun. PAM: I actually - I have about thirty people I could call. DR. DAVID J. MIKLOWITZ: Good for you
32 minutes 7 seconds DR. DAVID J. MIKLOWITZ
[32:07] DR. DAVID J. MIKLOWITZ. PAM: That I could just be completely honest with - o.k. this is what's going on. I
32 minutes 12 seconds PAM
[32:12] PAMneed something DR. DAVID J. MIKLOWITZ: Sure. PAM: And then they...(crosstalk) DR. DAVID J. MIKLOWITZ: So, Two things we've established already is that when
32 minutes 17 seconds DR. DAVID J. MIKLOWITZ
[32:17] DR. DAVID J. MIKLOWITZyou go in to the highs, you'd be comfortable with exercise , to kind of burn off some steam, you'd be comfortable calling your psychiatrist if it got worse. When you're sinking down, it's better to be talking to people such as your friends in the program. PAM: Absolutely
32 minutes 32 seconds PAM
[32:32] PAM. DR. DAVID J. MIKLOWITZ: Your husband to some extent as well? PAM: Uh hun. DR. DAVID J. MIKLOWITZ: He's understanding at those times? PAM: Uh hun
6: The Importance of Sleep
32 minutes 37 seconds PAM
[32:37] PAM. DR. DAVID J. MIKLOWITZ: Are you able to regulate your sleep wake cycle
32 minutes 42 seconds DR. DAVID J. MIKLOWITZ
[32:42] DR. DAVID J. MIKLOWITZ? Because, one of the things that really affects people, as you know with bipolar disorder, is even a minor change in the sleep wake cycles. So, going to bed an hour late for example could make you feel hyper or sleeping too much on the weekend can make you feel more depressed. Have you had that experience? PAM: With my job, I work afternoons until - like sometimes I work
33 minutes 2 seconds PAM
[33:02] PAMlike other day shifts so I'm trying - or I don't stay up past midnight. Sometimes I do and I feel it usually the next day but I try to make myself go to sleep and then wake up earlier. Like, if I need to get some things done - like, o.k., I'm still going to go to bed at this time but I'm going to wake up earlier. It's better for me to get up earlier and go to sleep at a regular time at night , than to go to sleep later a night and wake up later. DR. DAVID J. MIKLOWITZ: Then one
33 minutes 32 seconds DR. DAVID J. MIKLOWITZ
[33:32] DR. DAVID J. MIKLOWITZthing I can suggest is, if you find yourself going up higher, that's a really good time to make sure you have almost a militaristic regime that you follow because I think it's very difficult to have a chaotic sleep/wake cycle at the same time. It's hard to go to sleep when you're feeling that way. PAM: Uh hun. It is. DR. DAVID J. MIKLOWITZ: Have you talked to your psychiatrist about that at all - the difficulty with sleep? PAM: Well, I haven't seen her yet. I'm going to see her on the 16th
33 minutes 57 seconds PAM
[33:57] PAM. DR. DAVID J. MIKLOWITZ: O.k. PAM: Because I was supposed to stop the medicine and then she's going to see me on the 16th to kind of process it. There're some herbs and things I know you can take at night that will help you sleep. So, I was planning on like getting some teas, some nighttime teas and some whatever the herbal stuff. DR. DAVID J. MIKLOWITZ: Right. PAM: That will help kind of knock you out, just in case I need it . DR. DAVID J. MIKLOWITZ: What about - do you keep track of your sleep? You said you kept track of your mood. PAM: No. I don't . DR. DAVID J. MIKLOWITZ: That might be a good thing to do, is just to, when you're feeling well - what's the typical time you're going
34 minutes 27 seconds DR. DAVID J. MIKLOWITZ
[34:27] DR. DAVID J. MIKLOWITZto bed, what's the typical time you wake up and what's your mood like on that day ? If you keep that over a series of weeks, you may find that your mood - track your mood and your sleep/wake cycles get very intertwined. If your sleep is getting chaotic your mood is going to get more chaotic. If you're sleeping too much, you can get more depressed . So, that's one way to kind of keep data on yourself, particularly when you're not taking medication . PAM: I need to also do like a ritual before I go to sleep. DR. DAVID J. MIKLOWITZ: Uh hun . That's a good idea. PAM: Because I have a tendency to go, go, go - come home from class - come home from chaotic work day and try to go to bed
35 minutes 2 seconds PAM
[35:02] PAM- where I'm trying to- my husband actually made me a meditation room . I want to get in to the habit of, for 15 minutes, lighting a candle, reading a book, putting on some music and then going to sleep. DR. DAVID J. MIKLOWITZ: That's a good idea. PAM: Because I think that would really help me adjust better than trying to just - because I have to decompress . Sometimes I don't allow myself the time. When I'm laying awake for 45 minutes , I could probably take that 15 minutes and decompress myself, I might just be able to just fall asleep. DR. DAVID J. MIKLOWITZ: That's a good point. PAM: So, I think that's something I need to do too, is a little more structure at night . DR. DAVID J. MIKLOWITZ: So, maybe what you could do after this session is make some notes of the various things you could do when you're sinking
35 minutes 42 seconds DR. DAVID J. MIKLOWITZ
[35:42] DR. DAVID J. MIKLOWITZlower or when you're going higher as a way of kind of stabilizing yourself.. PAM: Absolutely
7: Intrapersonal Triggers for Shifts in Mood
35 minutes 47 seconds PAM
[35:47] PAM. DR. DAVID J. MIKLOWITZ: Sure. Another thing on this list, by the way, is the whole issue of
35 minutes 52 seconds DR. DAVID J. MIKLOWITZ
[35:52] DR. DAVID J. MIKLOWITZinterpersonal provocation. Do you think that there are events in your social life or in your marriage that contribute to your mood swings ? Are there things you can point to when this happens - my mood is more likely to shift? PAM: Um, I
36 minutes 7 seconds PAM
[36:07] PAMused to have issues like when my husband would get depressed, especially in the winter , it would trigger me. I've really worked on that. DR. DAVID J. MIKLOWITZ: Uh hun. How
36 minutes 17 seconds DR. DAVID J. MIKLOWITZ
[36:17] DR. DAVID J. MIKLOWITZhave you worked with it? PAM: I've learned to - even if he's - try to get him off the couch to go
36 minutes 22 seconds PAM
[36:22] PAMfor a walk and if he doesn't want to, I'll go to the gym for an hour and then come home and try to be more … And, he's working on it too. He's taking the omega 3's, trying to exercise . He's aware of it now too and I've told him. I know winter time is difficult around here for a lot of us. I just have to - you know, if you're going to lay on the couch for four hours and watch videos, I'm going to go do something, because I need to . DR. DAVID J. MIKLOWITZ: Sure. PAM: Because, me laying on that couch - you might be able to get up in two days . I might not be able to. So, I can't allow myself to sink in to that . DR. DAVID J. MIKLOWITZ: Have you and your husband ever talked about a plan to kind of
37 minutes 2 seconds DR. DAVID J. MIKLOWITZ
[37:02] DR. DAVID J. MIKLOWITZstay activated when the winter comes, since both of you are having trouble with depression during the winter ? Have you thought of having a structure to your day, for example, something to do in the morning, something to do in the afternoon, when you're not working? PAM: We've kind of talked about that but we've
37 minutes 17 seconds PAM
[37:17] PAM...(crosstalk) DR. DAVID J. MIKLOWITZ: It's hard to do. PAM: … we haven't put anything in to place ; which is a very good idea. DR. DAVID J. MIKLOWITZ: There're people who, of course, feel better when they're staying active, yet the very
37 minutes 27 seconds DR. DAVID J. MIKLOWITZ
[37:27] DR. DAVID J. MIKLOWITZproblem, the circle you come into, of course, is that when you're depressed you don't want to do anything. PAM: Right. DR. DAVID J. MIKLOWITZ: But yet, that's part of what contributes to the depression. So, making a plan to do something every day that's rewarding can often be helpful . PAM: It's a good idea too, because that's what happens sometimes. We'll just sit around
37 minutes 47 seconds PAM
[37:47] PAM- 'do you want to do something? No, I don't want to' then it's like, before you know it, the weekend's over and we're like , we didn't do anything and I feel like crap. (laughter) DR. DAVID J. MIKLOWITZ: Sure. PAM: So, that's
8: Summary and Follow-up About Family
37 minutes 57 seconds PAM
[37:57] PAMthe - that's definitely a good idea too. DR. DAVID J. MIKLOWITZ: Let me uh, since we're running low
38 minutes 2 seconds DR. DAVID J. MIKLOWITZ
[38:02] DR. DAVID J. MIKLOWITZon time, let me summarize what we've done so far and then I want to follow up on some more questions I have about your family. PAM: O.k. DR. DAVID J. MIKLOWITZ: So, one of the things we've established is that , right now, you're not on medication but you're not averse to taking medication. That if your mood were to go upwards or downwards, you would think about getting back on Lamictal or maybe some other mood stabilizer. You have a good relationship with your psychiatrist so you're comfortable calling her. You have a good social network and some of those people could help you stay active, perhaps, help you stay with your exercise regime . We talked a little bit about sleep and how important that can be...(crosstalk) PAM: Yes. DR. DAVID J. MIKLOWITZ: …to have a regular sleep pattern. We talked about trying to help your husband in the same way because he's got his own difficulties with depression. And, it sounds like also, the work you do with adolescents is very helpful to your moods as well. PAM: Absolutely
38 minutes 57 seconds PAM
[38:57] PAM. DR. DAVID J. MIKLOWITZ: That helps you to stay stable, perhaps and maybe it's
39 minutes 2 seconds DR. DAVID J. MIKLOWITZ
[39:02] DR. DAVID J. MIKLOWITZhelped you to accept your own disorder in certain ways. PAM: It has. DR. DAVID J. MIKLOWITZ: That's very admirable . I'd like to know a little bit more though about your current relationship with your family. Do you see that as where you want it to be or do you think more could occur between you and your mom or your dad? You haven't talked about your dad, for example. PAM: Actually, things are pretty good with my family
39 minutes 27 seconds PAM
[39:27] PAM. Me and my mom actually communicate pretty well. We've had our ups and downs in our relationship, but I would say over the past year and a half, things have been pretty good. We don't argue anymore . We haven't had an argument, I couldn't tell you in how long. I make time for her. DR. DAVID J. MIKLOWITZ: Good. PAM: Take her out for - I just met her and my dad before thanksgiving. We went out for breakfast. I took him out golfing a month or two ago when it was still warm, because I'm trying to make time for them . I realize that I wasn't doing that and with me being so busy with school and everything , I'm trying to implement that. I realize that my mom is not like the lovey-dovey type of person. She tells you she loves you every once in a while; you treasure those moments. But, I still do that and I tell her that and I tell my dad that and I try. I'm finding that I'm communicating better with them. I feel like I have a relationship with them. DR. DAVID J. MIKLOWITZ: Uh hun
40 minutes 22 seconds DR. DAVID J. MIKLOWITZ
[40:22] DR. DAVID J. MIKLOWITZ. So, you really try to modify how you communicate with them so you don't get triggered? PAM: I do. Because, things had gotten bad in the past. Like I said, my
40 minutes 32 seconds PAM
[40:32] PAMmom is a reactor and my sister got divorced a couple of years ago. It was some crazy stuff . But I learned – and we all learned from each other. We all learned too, that when we're all together as a family, we have an activity to do . We play a game or we do something because if we all sit around for four hours with nothing to do, we argue. DR. DAVID J. MIKLOWITZ: Uh huh. PAM: So by playing the game or watching a movie, we all get along. DR. DAVID J. MIKLOWITZ: So, something structured and that's actually…
40 minutes 57 seconds DR. DAVID J. MIKLOWITZ
[40:57] DR. DAVID J. MIKLOWITZ(inaudible, cross talk). PAM: It's amazing it's taken us, oh, 28 years of my life, to finally figure
41 minutes 2 seconds PAM
[41:02] PAMthis out. Me and my sisters actually talked and we said if we do something structured as a family , we all interact and we all get along pretty good. DR. DAVID J. MIKLOWITZ: It's interesting because
41 minutes 12 seconds DR. DAVID J. MIKLOWITZ
[41:12] DR. DAVID J. MIKLOWITZstructure has been a theme throughout this session. You've really talked about structuring your home life and your work
9: Ending the Session
41 minutes 17 seconds DR. DAVID J. MIKLOWITZ
[41:17] DR. DAVID J. MIKLOWITZlife and how important that is for your mood stability. So, what would you tell a young 16, 17 year old adolescent with bipolar disorder ? What would you tell him or her that you've learned that would help him on the journey ? PAM: I would say that you have to learn about yourself
41 minutes 37 seconds PAM
[41:37] PAM, about acceptance of who you are and you have to learn how to react to life differently. And, that it's o.k. to take medication if you have to and that you don't have to tell everybody that this is what you have - because kids think that a lot and I always tell them - o.k. when you go to school you don't have to tell everybody you have bipolar disorder. They're not going to know you take medication unless you take them home and show them your medicine cabinet. I think there is the need to tell the world or something and think it's just really important to be gentle with yourself and learn what you need. DR. DAVID J. MIKLOWITZ: And
42 minutes 17 seconds DR. DAVID J. MIKLOWITZ
[42:17] DR. DAVID J. MIKLOWITZ, coming to accept your disorder and what limitations that imposes. PAM: Acceptance is the key. It's so the key and that is the hardest road
42 minutes 27 seconds PAM
[42:27] PAMand I think by telling people little by little that you trust, you start to get a little more acceptance. DR. DAVID J. MIKLOWITZ: Right. You impress me in being very far along
42 minutes 37 seconds DR. DAVID J. MIKLOWITZ
[42:37] DR. DAVID J. MIKLOWITZin that acceptance process. You've really come through a lot of hurdles and have come to good terms with it. Is there anything you'd like to ask me that we haven't talked about ? PAM: Um, I don't know
42 minutes 52 seconds PAM
[42:52] PAM. What's your thoughts on the medication? Like, have you heard about the omega 3 (laughter) . DR. DAVID J. MIKLOWITZ: You know, omega 3 doesn't have a lot of research behind it but there is one study that
43 minutes 2 seconds DR. DAVID J. MIKLOWITZ
[43:02] DR. DAVID J. MIKLOWITZshows that omega 3 is useful if you add it to the traditional medications . Bipolar II and bipolar I are a little different. Some people with bipolar II are able to get along without a regular mood stabilizer. The one thing I tell people when they decide to go off medication is that you really need to know your early warning signs . That's the best way to stay healthy is to keep good structure, good sleep, keep your stress to a minimum, don't over work, keep exercising . But, when your mood starts to shift, that's when you really need to put these things in to practice and know what your signals are and how to avoid them and how to minimize them and that maybe when medication comes back. PAM: And, that's good for me to hear too…...(crosstalk) DR. DAVID J. MIKLOWITZ: Right. PAM: …because I need to
43 minutes 47 seconds PAM
[43:47] PAMbe aware of that. DR. DAVID J. MIKLOWITZ: But I think it's very important to know that it doesn't signal a failure
43 minutes 52 seconds DR. DAVID J. MIKLOWITZ
[43:52] DR. DAVID J. MIKLOWITZon your part if you do need to go back on medication because those are the biochemical imbalances that you probably inherited. It's not your fault. It's very easy, I think, to forget that when you're starting to cycle. PAM: Yeah. DR. DAVID J. MIKLOWITZ: Thank you for your time . It was good to talk to you. PAM: Thank you too. DR. DAVID J. MIKLOWITZ: Good luck to you (hand shake) PAM: Thank you.
