Tag: healing

Bipolar Disorder in Men

I was asked to share my thoughts on the topic of Bipolar Disorder in Men by the wonderful International Bipolar Foundation. They provide education, advocacy and support for those living with Bipolar Disorder….here’s the piece I contributed.

As a psychiatrist living with bipolar disorder, I have been both a care receiver and a care giver. Over the span of my career, I have treated many men with bipolar disorder having the luxury of viewing them through the lens of being both a clinician and a patient. Though men and women have the same lifetime prevalence of bipolar disorder, it has been my experience that the expression and co-morbidities differ notably between the genders. To begin with, allow me to review some basic facts.  It appears that men have an earlier age of onset of bipolar disorder than do women.  Men are likely to exhibit their first symptoms at age 22, on average, with women typically having an onset three years later.  The literature, affirmed by my own experience, suggests that men are more likely to have their initial mood swing be mania while in women it is more likely to be depression.  Some studies suggest that men have a greater number of manic episodes over the course of their illness than do women and these manias are associated with more intense levels of aggression in men.  As well, depressive episodes in men are more frequently associated with irritability than is the case with women.  Of note, men with bipolar disorder are much more likely to have co-occurring substance use disorder than women.  Some have suggested (I agree) that it can be more difficult to diagnose early onset mania in men because some of the typical manic symptoms (aggression, over-confidence and boldness, for example) are traits that we often associate with masculinity. 

signpost with man and woman written

Gender Stereotypes

Our cultural gender stereotypes play a large role in how men react to having a psychiatric illness.  There is great stigma attached to having a mental health condition, especially for men, in my opinion.  Males in our society are encouraged to be invulnerable, self-sufficient, in control and emotionally level-headed.  Expressions of affect are frowned upon and judged as being “weak”.   We expect our men to be stoic and “strong” and harshly judge those who fall short of this unrealistic and unhealthy expectation.  It is no surprise then that men are more likely to deny their illness than are women.  I shunned treatment for far too long even though I was a psychiatrist and knew my diagnosis.  Those with untreated bipolar disorder suffer needlessly and the higher rate of suicide amongst men is heartbreaking.

Reasons for Hope

Though these statistics are sobering, there is much to feel hopeful about.  It is clear that men respond just as well to treatment (medication, therapy and group support) as do women.  Exercise, healthy eating habits and good sleep habits are the three pillars of self-care that many with bipolar disorder regularly incorporate into their daily lives.  Millions of men across the globe have stepped forward and are receiving the care that they need.  We hear with regularity from those in the national spotlight (celebrities and sports figures, for example) who come out of the mental health “closet” and publicly acknowledge that they have bipolar disorder. My own experience is reason for others to be hopeful.  I shunned psychiatric treatment for far too long for fear of being judged and because of the stigma against mental illness in the medical community.  When I have shared my diagnosis at conferences and with colleagues, family and friends, I have been stunned at the response, receiving more affirmation and hugs than I could have ever imagined possible.  My own harsh self-judgements evaporated as I have been fully embraced.  Mine is a story like countless others.

Courage

I believe that all those who share their journeys reap unexpected benefits.  For me, there has been something even more important.  I now embrace having bipolar disorder.  It has allowed me to connect with others in genuine, heart-felt ways and to be part of a wider group of kindred spirits.  There is nothing quite so powerful and freeing as authenticity.  Being true to who we are requires fortitude and courage. In my work over the years, I have seen time and time again that men are much more likely to accept their diagnosis if they view doing so as an act of courage.  Which it is.  So, I would offer this advice to my fellow male travelers: when you are ready, tell your story.  We change the culture of silence one conversation at a time.  Have the audacity to be part of this long overdue dialogue.  You will engender the respect of others in ways that you hadn’t thought possible.  When you do, you will see a man staring back at you from a mirror filled with humanity, authenticity and pride.

Covid: Give your Gifts Away

Pablo Picasso was a painter, printmaker, ceramicist and theater designer.  He is widely regarded as one of the greatest artists of the 20th century.  As I have read about him, I’ve come to see that he was as wise as he was talented.

Covid Disconnection

We are attempting to cope with the Covid pandemic in many ways. We socially distance, we try to maintain structure and routine in our daily lives and we exercise.  And, of course, we stay connected via phone, email or Zoom.  I have been struck, though, that with all this 24/7 verbiage about Covid, we are often saying very little to each other that is truly helpful.  All this “connection” doesn’t, actually, seem to lead us to feeling more connected.

The Gift of Ourselves

Let us acknowledge that we are feeling powerless, helpless, sad and angry.  When we talk about Covid we might say “this is scary.”  Understandable.  But it’s quite a different thing if we were to say “I feel scared” or to ask another, “are you scared?”  When we utter these latter words, we are opening ourselves up in a human way and expressing compassion and empathy.  “This is scary” does neither. We all crave comfort and security in these Covid-saturated times and being on the receiving end of empathic emotional intimacy and tenderness is salve for our souls.  When we show our true selves and when we ask others to do so, we are, in essence, giving away a precious gift.  The gift of ourselves.  It’s ironic that the more we give, the better we feel.  Genuine giving isn’t depleting, it is repleting.  It is exactly what we need right now.  It’s no wonder that our dedicated and giving healthcare workers are as revered as they are. 

Give your Gifts Away


Pablo Picasso’s life purpose was one rooted in generosity and decency.  He understood that no one becomes poor by giving.  Quite the opposite.  So if you wish to feel less scared, less helpless and less powerless these days, give the most precious gifts of yourself away.  If you have compassion and kindness within you, give it away.  Give it frequently, give it generously, give it freely and give it abundantly.  If you do, like Picasso, you can paint a canvas where you will make those around you feel so much better and you will feel at least as good as they do.

Babe Ruth’s Bat

Babe Ruth is widely considered to be one of the greatest baseball players of all time.  He held numerous career records for athletic feats.  His lifetime batting average was 0.342, an astounding feat.  This number means that when he was at bat, he got a hit about one third of the time.  To say it differently, though, he swung and missed two thirds of the time and was still considered a champion.  We measure him using the correct and fair yardstick given how hard it is to hit a baseball speeding toward you.  We consider him a stunning success even though in reality, he struck out most of the time.  

Picture of Babe Ruth Batting

Imperfection

How do we navigate our way through our own imperfections every day? Our own swings and misses?  If being human implies being imperfect, then we are all very, very human most of the days of our lives.  We fall short of perfection every day.  Given this, why do we idealize perfection as we do? Why do we feel so badly about ourselves when we fail to rise to an unattainable level?  A concert pianist will always hear the one note that was mis-hit and the A student will always focus on the one test where the result was an A-minus.  Wouldn’t it be a lot wiser to expect ourselves to fall short and not castigate ourselves when it occurs?  Why put ourselves through such angst time and time again despite the inevitability of our shortcomings?  This doesn’t make any sense.

Perfectionism

Think about this: what yardstick do you use to measure yourself in life? More often than not, one that doesn’t allow you to miss the ball most of the time.  Your expectation is that you’ll swing and hit the ball out of the park almost all the time.  We are not a species that tolerates our human failings. So, we’re not supposed to speak harsh words, to send off angry emails, to mis-hit the piano keys and get that A-minus.  We expect ourselves to be better than one of the greatest legends in the sporting world.  Our batting average is supposed to be 100%.  But what if we were to use a different yardstick to measure ourselves?  What if we used the Babe Ruth yardstick and allowed ourselves lots of swings and misses without self condemnation. A yardstick that allows us to fall short, to reflect upon what we might have done differently but one that doesn’t encourage us to use the bat to beat ourselves up when we are merely human.  Striving to do our best is admirable, perfectionism is corrosive.  

In Life, Choose the Right Bat


So when it’s your turn at the plate in life and you mess up, you have two bats you can pick up to assess who you are.  The perfectionistic bat or the Ruth bat.  Use the Ruth bat. The one that allows you to miss the ball plenty of times without relentless self-condemnation.  If you do this, you’d feel like a champ, babe.

Faith: Touching Shadows

Last week, on a bright sunny day, I was sitting in the shade of a maple tree.  As the sun slowly arced across the sky, the shadows cast by the tree moved across the ground.  Were I to reach out and try to touch those darkened areas, all I would feel would be the earth beneath my finger tips.  Touching the shadows that lay in front of me would always be elusive, though they existed right before my eyes.  

Faith written on rural road

Questioning Faith

A week ago, a woman asked me for advice about her son who had bipolar disorder.  She explained that for the past ten years, he would be adherent to treatment for periods of time and then he’d refuse to take his medications, denying that he needed them.  She witnessed him cycle through periods of wellness and illness, impotent to do anything helpful at all, she felt.  She wanted to know what advice I had for her and my answer was two words: have faith.  How naive I must have sounded, suggesting something that could be construed as nothing more than a trite sound bite.  After all, having faith is easy to suggest, but seems near impossible to feel at times of great distress.

Having Faith

I explained to her that her faith would be well placed because of all those working every day to find cures for the many psychiatric disorders that continue to afflict too many of us.  Her faith would be well placed in the many treatments that already exist that can work wonders to stabilize moods for those with bipolar disorder.  Her faith would be well placed because so many people with mood disorders find their way toward mental health and lead wonderful, rich lives.  Her faith would be well placed because her son had periods of time when he was adherent to recommended care, an excellent prognostic sign.  Her faith would be well placed because her son knew that he had a mother who supported him fully in becoming and staying well.  Her faith would be well placed because she loved him.  Her faith would be well placed because she was part of a worldwide community of those whose hearts are in the right place, supporting their loved ones as they walk down the challenging road of life.  Her faith would be well placed because she was not alone.

Touching Shadows

It’s so hard to retain faith during the difficult times that we face in our lives.  But when we are caught in distress, somehow we journey on believing that tomorrow will be a better day.  Even though we can’t know what our future holds for us, we take a step forward during those dark times.  But darkness can be no more than a space on the ground that is cast by a tree on a sunny day.  It’s not something that we can physically touch but we see it right in front of us.  The shadow exists without any doubt.  And here’s the thing:  that shadow is there only because of the light cast down from sunshine on a bright day.

The Discomfort of Vulnerability

A colleague of mine recently asked me for some help.  He was wondering how best to handle a difficult situation at work.  As he reached out, he half-apologized, wondering whether he might be unfairly imposing on my time.  It didn’t feel like it was an imposition at all, quite the opposite.  He’s such a good guy and so respectful that it’s always a pleasure to share my opinion with him and offer my advice.  As he asked, I noticed something: his reaching out made me feel good even before we conversed about his work.  I wondered why that was the case.  After thinking about it, I figured it out.  He was showing me his vulnerability.

Quote by Brene Brown: Vulnerability is not weakness: It's our greatest measure of courage

Leaning into discomfort

His words didn’t make me think something; his words made me feel something.  This expression of human vulnerability allowed for a connection between us, a moment of closeness.  I know that it likely wasn’t so easy for him to ask but here’s the thing: it’s always uncomfortable to show our truest vulnerable selves.  We have a saying in psychiatry that we grow only when we lean into discomfort.  I believe this is true.  By definition, growth is a journey where we enter an unknown world, whether we are stumbling to learn a new language or falling off our bike as a kid.  Leaning into the discomfort of showing another our tender core is as challenging as it is rewarding.  

Embracing discomfort

Ironically, it is only through embracing this discomfort that we can find comfort.  We can’t have it both ways.  We either live behind thick walls, protecting ourselves, feeling alone, or we open up to the joy and pain in life by feeling uneasily vulnerable.  When we say “I love you” first, when we stand at an AA meeting and say “I am an alcoholic” or when we say “I need your help”, we are extending our hands and opening our hearts.  We humans are hard-wired to connect and being openly vulnerable is the only pathway to true intimacy and well being.

I’m going to do my very best to help my colleague.  I’m quite sure he is unaware that he has moved me.  I respect him for doing so.  And perhaps in return, I will navigate through my own vulnerability, open myself up and let him know how grateful I am for this gift that he has bestowed upon me.