10 Ways to Reduce Stress and Prevent Burnout

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Recently, someone on another website reached out to me and asked what they could do to reduce stress, and in turn reduce their chance of burning out and relapsing in mental illness and substance use. This is what I wrote back.

What works for one person won’t necessarily work for everyone. I will say that I learned some useful stuff from DBT skills group (but not everything was useful for me — I took what worked), so you could look for a DBT program in your area. Unfortunately, DBT programs tend to not take insurance, so it can be expensive.

Here are some things that work for me:

  1. Distractions: it may not be super useful at work, but when I get stressed I watch something on TV — either something that will get my attention, or something that I’ve seen before (Star Trek and Pokémon series are good ones for me) just to take my mind off of whatever is bothering me. Video games are good too. It comes down to personal preference.
  2. Sudoku: When I really need something that commands my whole attention (to take my mind off something), I sometimes play Sudoku. I usually play on easy and strive to make no mistakes. If I’m playing on paper, I use a pen so that I can’t erase my mistakes. Maybe for some people playing with a timer is better. You could also try some other puzzles, like KenKen. I play Sudoku because it’s easy to get paper booklets. But you can also readily get apps on your phone. Experiment with it.
  3. Pets: If you have any animals in your life, it may be helpful to consult them when you are feeling stressed. I have a cat and she definitely keeps me alive sometimes.
  4. Creativity: When I need to let off some steam, I sometimes do something creative. For me, I’d choose painting or writing/journaling. But there’s tons of options here that could work. The ideal hobby would not make you feel competitive and thus add to your stress. I’ve found that since I write professionally, it’s less useful as a distraction. But, painting takes a bit of setup, so if I plan to do that it helps to set up a day or so in advance. I keep a folder of inspiration/references that I can use when the mood strikes. Ideally, you’d get a feeling of accomplishment from your creative works, as well as distracting your mind.
  5. Medication: I have medication that I use for severe agitation or anxiety. I also use THC, but I don’t recommend that for everyone, especially people on the schizo spectrum because it can make things worse. Since you said you’re schizoaffective, I’d steer clear of non-prescription medications, but you can definitely ask your psychiatrist about something to use PRN/in emergencies. Benzodiazepines are definitely helpful but they may not want to prescribe those to someone with substance use history. Strong antipsychotics are also good, though, and they should definitely be willing to talk about that. Olanzapine/Zyprexa is great since its main side effect is weight gain and that shouldn’t happen with a PRN (something you don’t take every day). Haloperidol/Haldol is also very effective and the main side effect is movement disorder, which can be at least somewhat alleviated by a medication called benztropine.
  6. Self-care: Eat right (whatever that means to you), exercise if you can, practice good hygiene, and treat physical health problems. These things will make you more resilient to stress. They are boring, but effective.
  7. Comfort items: I have certain plushies that bring me comfort in times of stress. Some big ones I like to sleep with, and I also have small ones that I can carry around with me.
  8. Socializing: While it may be the last thing you feel like doing when you are very stressed, talking to friends or family to let off some steam can really help. It may be a time to practice the DBT skill “opposite action”, which (for example) dictates that when you feel like isolating, you should seek out social interactions.
  9. Cold water: This is part of the DBT skill “TIP” (Temperature, Intense exercise, Paced breathing) — it’s the part that works best for me. Technically, you’re supposed to submerge your face in ice water and hold your breath for as long as possible to trigger the mammalian dive reflex, which lowers heart rate and anxiety. For me, that’s too many steps, so I use a cold shower.
  10. Music: I’ve heard from people who hear voices that white noise can be very triggering. If you have to be around white noise, try playing music through headphones. I would actually avoid active noise canceling since it uses white noise.

Things that I found useful living in the Upper East Side of Manhattan

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About six months ago, I moved out of my parents’ home on Long Island. I had been living there since I graduated with my PhD in Psychology. About three years, I think. I was eager to have my own space and spent many hours looking at furniture, most of which I could not afford. My apartment is a studio, though it has two levels and separate bathroom and kitchen areas. It has a certain charm to it. (I did buy one piece of furniture over $150 or so — this dresser, in ivory. I love it, it’s perfect for my space.)

Anyway, this post is about things I found useful while living in NYC. Just as a disclaimer, I will link to the products I bought wherever possible, but I have not been paid off by any of these companies.

1. A small bag

A small backpack or crossbody bag is essential for traveling around in the city. Lately I’ve mostly been using a mini backpack from Timbuk2 that I picked up a few years ago, or a crossbody from Mokuyobi similar to this one. Avoid carrying anything with designer logos. They might make you a target for theft.

    2. ANC headphones

    As an autistic person, I wore these even in the suburbs, but the city is crazy loud. I highly recommend getting a quality pair of headphones with active noise cancelling (ANC) unless you’re in the minority of people for whom ANC causes motion sickness. I wear Bose QuietComforts. Wow, I’m eyeing that blue color!! Mine are just black.

    3. Hiking shoes

    It should go without saying that you need comfortable walking shoes in NYC. In the winter, however, sidewalks can get slippery. You’ll want a shoe with decent traction. Sure, you could wear boots, but most boots are rigid and difficult for me to get my foot into (due to my dyspraxia). But there’s a subgenre of sneakers with high traction: hiking shoes! I got (and love!) the Oboz Emma Low (in Charcoal).

    4. Neutrogena City Shield

    It’s important to keep moisturized, especially in the winter as aging heating systems make the air indoors very dry. It’s also important to protect your skin from the sun year-round. This is a product that does both, and it also contains antioxidants to protect skin from pollution.

    5. Fan

    Of course, having a fan to circulate air in the summer is a no-brainer, but if you don’t have space to air dry your clothing outdoors, you can use a fan to dry them.

    6. Scooter

    I know some people love their e-scooters but I’m talking about a manually powered kick scooter. I have a Micro Flex scooter, but an adult sized Razor will do. You can take it on the subway and you can ride on the sidewalk. Another option is a bicycle (or hybrid electric bicycle), if you’re confident enough to use the bike lane.

    Note that the Micro Flex is discontinued; if you think you might use the 2 year warranty, or you weigh somewhere between 220 and 250 lb, I recommend buying a Micro Suspension directly from Micro.

    7. Long johns

    NYC doesn’t usually get extremely cold, but each year there will be a handful of days that are frigid to the bone. Most people in the city walk and/or take public transportation everywhere they go. That doesn’t change just because it’s freezing outside. I recommend layering; easy enough to do with tops, just wear a hoodie, sweater, or sweatshirt under your coat. Bottoms are a little trickier. That’s where cold-weather underwear like long johns come in. I bought a nondescript pair from Amazon; wherever you prefer to buy them is just fine, I think Uniqlo sells them.

    8. Warmies stuffed animals

    Another cold weather hack, especially if you’ve got kids. Warmies are stuffed animals that come in a wide variety of shapes and sizes. They are scented with lavender, and have a pleasant weight to them, but that’s not the only thing they can do. Pop them in the microwave and they stay warm for quite some time.

    9. Sun lamp

    If you have bipolar disorder or depression, you’ve likely heard of these. You may be asking, do they really work? And the answer is… sometimes. The most effective ones are made by the company Carex and are 10k lux and 12″ wide. But they are ugly, so I got one made by Circadian Optics which is smaller, and it seems less effective, but it’s not ugly and it does have some effect. The time of use differs depending on diagnosis. People with depression should use it for one hour in the morning, while people with bipolar disorder should use it for one hour around midday. I use mine in the afternoon because I’m a rebel. But take this as your warning that using it at night or for more than one hour runs the risk of triggering mania.

    10. Minimalist wallet

    Okay, this one is less of a need in New York specifically, and more of something that’s nice to have in general. Paying attention to details like your wallet can also make you seem more stylish, which is good in a big city. I tried two minimalist wallets: one made by Ridge and one made by Ekster. In terms of size and weight, the Ridge wallet is smaller. It’s easy to operate; while the Ekster wallet has a trigger that makes your cards pop out, for the Ridge wallet, you simply push them out with your thumb. That said, I prefer the Ekster wallet. It’s pretty, and the trigger is quite cool. Note, however, that while any Ridge wallet is compatible with their AirTag options, using the Ekster wallet with an AirTag will require installing a plain black backplate or using one of the wallets that are specifically made for AirTag compatibility. You can’t use just any Ekster backplate with an AirTag strap.

    11. Adjustable belt

    When traveling around NYC, one encounters a lot of stairs, particularly in subway stations (many of which are not wheelchair accessible). This calls for having a good belt. But, being bipolar, I can gain or lose weight quite rapidly. I also need a belt that is easy to get on and off due to my dyspraxia. The belt I settled on is the Groove Life Belt (in Walnut/Brown). It adjusts, but securely, so it won’t fall down while you’re climbing all those stairs. It also has some slight stretchiness for comfort, and it is held together with strong magnets that are surprisingly easy to disconnect with a tiny bit of practice. I was concerned about going through any metal detectors because the magnets should set them off, but it hasn’t come up even once so far. Just be aware that might happen. I would just take the belt off at the airport, but I would do that with almost any belt since they usually have small metal components.

    12. Magsafe battery

    Ah, Magsafe. The future is here with wireless charging for iPhones. The future should be here for Android phones, too, but for some reason it’s not. If you have an Android I guess you’re stuck using wired charging. But if you’re like me and you have a reasonably new iPhone, you can stick a charger to the back of your phone and keep your battery going while you’re out and about. I just have a generic one myself, although I’ve eyed the Magsafe Power Banks made by Casely.

    13. Umbrella

    Yes, that’s right. In NYC it rains (and snows, and every step in between). I prefer having a clear umbrella so I can see where I’m going. I have one from Totes in color lemonade which has a cheerful yellow trim and handle.

    14. Indoors shoes

    Everyone knows the city streets are gross. Especially the sidewalks. Dogs pee on it. I recommend designating footwear for inside. Which you should choose depends on personal preference. Kizik hands-free shoes might be a good option, especially if you have private outdoor space. But sandals or slides or even slippers are all valid options here.

    That’s my list! Did I forget anything? Let me know in the comments!

    P.S. I know I didn’t include a granny cart. They are widely used in NYC, but I personally had a lot of difficulty using one.

    Stim Kits for Neurodivergent People

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    A little while back, I started looking around to make a kit of stim tools that I could use to help me sit through long meetings and lectures. Although the combination I’ve settled on (for now) isn’t perfect, I thought it might be helpful to share what I’ve learned and what I’m doing right now.

    Why use stim tools?

    It’s widely known that autistic people make use of stim tools like the ones I’m going to be talking about. For autistic people, using stim tools may be a method of stimming or “repetitive behaviors”. Many ADHDers use stim tools as well. However, it’s not just autistics and ADHDers who can benefit; for example, bipolar people can definitely use them, particularly in a manic (or mixed) phase. Stim tools can also be used by people who struggle with compulsive behaviors like skin picking (dermatillomania) or hair pulling (trichotillomania). Finally, stim tools can be used to help anyone, regardless of diagnosis!

    Making a stim kit

    I started out making a single stim kit, but I soon found it might be more beneficial to make several kits of different sizes. However, the first “stim kit” I want to talk about doesn’t usually come out of a box or a bag — I’m talking about wearable stim tools! Chewable necklaces are very popular among people who bite their nails or non-chewable objects such as pencils. Mine, though, is a little different…

    I made this out of a lanyard (this one is from the Pokémon North American International Championships a few years ago) and a bike chain keyring fidget. This is often my go-to stim tool as I wear it around my neck and don’t have to fumble around in my bag for it. It’s also pretty cheap; there are multiple Etsy listings for $5 plus shipping (like this one) and even listings for fun pride-themed colorways which I might just buy right now! Be right back! (By the way, I have no affiliation with any of the products I may link to in this article, nor am I receiving any compensation for including them.) Anyway, these little fidgets are silent, small, and I think they make a particularly satisfying stim for people who may be prone to skin picking. And you can use any lanyard your heart desires!

    Now, onto the actual stim kits…

    Pocket kit

    I’ll call the smallest one the “pocket kit” because it just fits in the front pockets of my jeans (American Eagle Womens’ Jeggings). It easily fits in the front pocket of my mini backpack, as well as my bigger backpacks. As you can see, I’m using a Pokémon box (this will be a theme) which is on sale at the Pokémon Center for $20. It also comes with dice and cute status markers for playing Pokémon Trading Card Game, but my favorite asset was this box. So what’s in it?

    • Magnetic Haptic Slider from clickbricks — I like this stim tool a lot! It’s not completely silent, but it’s quiet enough to fly under the radar in most situations. To me it feels kind of like flicking a lighter, which is something I do… a lot.
    • Another keyring bike chain fidget!
    • Nicotine gum, for reasons stated above…
    • One stick of Crystal Light lemonade and one bag of Tazo Earl Grey tea.

    I’m looking for new stim tools that will fit in the pocket kit, so if you have any recommendations, please send them to me! I really want to hear from you.

    Next, the medium kit…

    Medium Kit

    This one is also related to Pokémon! It’s a Japanese deck box. One of my favorites, so it seems fitting I put some stim tools in there. If you’re not familiar with deck boxes, they are generally not too large. I think this one is around 3 in (height) x 3 in (depth) x 4 in (width). The NeeDoh Nice Cube just fits inside.

    • NeeDoh Nice Cube — I love this squishable sensory tool! It’s a little bit like a stress ball but it feels soft/gooey, almost like putty or slime. It’s not as sticky, though. It’s got a nice weight to it and the size is perfect for my hands. That said, they make other products at NeeDoh; the cube is probably the most popular.
    • Infinity Cube — I got this one at a gas station somewhere on Long Island, but the Etsy creator who I linked carries some really cool colors and right now they’re on sale for $3. Totally worth it! Infinity cubes can be folded into different configurations almost, well, infinitely. I’ve enjoyed using this one for years now. It’s a tried and true inclusion.
    • Fidget Cube — The fidget cube isn’t my favorite fidget, but I do like some of its functionalities. It is nearly silent. I like the buttons (especially the clicky ones, which do make a subdued sound) as well as the switch/lever and the thumbpad (circular appendage).

    That’s right… everything in the medium kit is a cube! (✿◡‿◡) A happy little accident.

    Large kit

    Now, I don’t want to lie to you, so here it is: a fidget spinner can just barely fit in the deck box I’m using for the medium kit. But, I’m afraid of doing damage to the box by overloading it… so my 2 fidget spinners were included in this amazing bag I got from the Pokémon Center. It’s sparkly! But any toiletry bag should do. Pick your favorite or buy one that suits you!

    • 2 fidget spinners — The blue sparkly one is plastic and lighter than the iridescent metal one. They were both gifts and I quite enjoy using them during long lectures.
    • Another bike chain keyring fidget in “unicorn” colors.
    • Tangle Therapy Relax — Has textured segments with a slightly give to them. I generally like to manipulate it in my hand and don’t like pulling the pieces apart, but Tangles are good for either!
    • Keyboard fidget — This uses mechanical keyboard testers as a stim tool! Mine is 4×1 keys and uses Blue switches (Cherry MX I believe?), so it’s quite clicky and noisy, like typing on a typewriter. However, this listing on etsy says they also have linear switches (which are much quieter) and I bet they could even use both!

    Have I missed an important stim? Let me know in the comments!

    Atmosphere stims

    There are some stim tools that can’t be carried around in a box or a bag, but rather, are meant to be used at home or in a private space. Here are some of those things:

    • Candles/incense/air freshener — I highly recommend Morning Star incense!! They even come with a little holder.
    • Weighted blanket or sleep pod
    • Bubble bath or epsom salts
    • Large stuffies — I have a Pikachu!
    • Swings, indoor or outdoor
    • A medium-sized fan — or bigger; for summer

    So that’s what I’ve learned! Share in the comments your favorite stim tools and how they help you!

    Showering is too much. What can I do?

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    I won’t lie to you; there are many days where showering just seems like too much. This post is just a list of things that might be helpful if you struggle with showering every day. I am not an Amazon affiliate; I do not earn anything from recommending certain products, it’s simply a matter of my personal taste.

    Face: It’s very important to me that my face stays blemish-free because I have skin-picking issues. First, I cleanse my face at least once a day with a makeup remover wipe. Any of these wipes should do the trick, my favorites right now are Burt’s Bees Micellar (I prefer the rose water one) and Neutrogena Hydro Boost Wipes.

    After cleansing, I use Pixi Glow Tonic (an exfoliating toner that helps shed dead skin cells). I prefer the “to go” variety with pre-saturated pads. I wouldn’t start using exfoliating toner every day; start by using it every 2 or 3 days and let your skin get used to it.

    Finally, since I just used a toner with glycolic acid, I definitely want to finish up with something that has SPF and moisturizing. My skin tends to be a little bit red and this step definitely helps. There are many products you could choose, but I go with something easy: Neutrogena City Shield Water Gel. It absorbs rapidly into my skin, reducing redness and protecting my skin from sunburn.

    Body: Unfortunately it’s hard to compare to a real shower, but you can get by on baby wipes. Always freshen up your deodorant of choice every day. I use Dr. Squatch aluminum-free deodorant in the cooler months where I don’t sweat as much. During the summer, I use Old Spice Wilderness Antiperspirant and Deodorant.

    I’ve tried Lume deodorant and it doesn’t play well with my skin condition (hidradenitis) but that or another “whole body” deodorant might be helpful.

    Hair: Advice on how to keep hair fresh varies by hair type. If you have Type 1 or Type 2 hair (straight or slightly wavy) most likely a conventional dry shampoo will work best for you. You spray it in your hair, it absorbs grease, and you comb it out. I have Type 3 hair (curly), which means I avoid combing my hair like the plague. Instead, foam shampoo — like this one from Not Your Mother’s — works great for me.

    I’ve also used foam shampoos meant for pets and that works as well if you’re on a budget! I’ll admit I’m not sure what the best products are for Type 4 hair, but please drop any recommendations in the comments!

    Neurodivergent App Review: Habitica

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    It seems like everyone’s got their own favorite app for managing daily tasks and to-dos, but so far my favorite is Habitica. I think it could be really useful for neurodivergent people with the right personality — Habitica is very much a “menus” game. If you love fine-tuning and deep personalization, Habitica could be perfect for you.

    Habitica is available as both an app and a web interface. They both have utility, which I’ll discuss, and having both available may be great if you spend a lot of time at your desk. It is free with paid upgrades available; I haven’t paid for any upgrades and none of the features I’ll mention in my review are paid features. When you start playing (we are “playing” since Habitica is all about gamification, or turning your life’s to-do list into a game) you get a pixel avatar, which you can level up, equip items and pets to, and more. But the pixel avatar isn’t even the best feature of Habitica, in my opinion. You could play quite efficiently paying no attention to the avatar at all — more on this later.

    Set habits, dailies, and to-dos all in one app

    It’s possible to use two or even three different apps to track all of these kinds of tasks. A more precise definition:

    Habits: Tasks you want to do regularly (or reduce doing — habits can be negative), but that don’t have a fixed schedule for their occurrence.
    Dailies: Tasks you want to do at specific times, for example, every day, or every 3 days, or every Tuesday and Thursday.
    To-dos: Tasks you need to do once.

    Each task can have checklist items, which increase the value of the task. In fact, there’s a pretty crazy level of detail and precision that can be attained in the settings menu for each task. And the system can have a learning curve, but that in itself makes the system appealing for menus-type people.

    Pause damage as you need it

    For neurodivergent people, it’s important any app can be flexible to avoid overwhelming us. Habitica normally inflicts damage on your character for missing dailies — however, there is an option in the setting menu to pause damage. No damage will be inflicted on you until you turn damage back on again and there is no cost or downside to pausing damage. You can continue to get rewards as usual.

    Custom rewards

    Habitica comes with many built-in rewards, including items for your avatar, eggs and hatching potions (which create pets), and so on. But the primary currency of the game is gold, and you’re able to set custom rewards for in-game gold. I set up a Pokemon TCG pack for 40 gold. Any reward can be integrated into Habitica! Try using a preferred treat, video game time (or any favored activity), or small amounts of spending money as rewards.

    Personalization of the app and the web interface

    The Habitica app allows you to choose from an impressive number of color themes, sound themes, and even custom app icons. Meanwhile, the web interface allows you to see everything you have to do at once — and gives the option to toggle tasks that are not due today so that they are invisible.

    The thoughtful design and customization features of Habitica are what make it the best app I’ve used. It can be overwhelming, though, for people intimidated by those features. But it’s free, so why not give it a try?

    *I am not affiliated with Habitica.

    Subtle Signs of Bipolar Disorder

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    Since the early days when Emil Kraeplin defined the characteristic symptoms of bipolar disorder, a certain set of core features have been used to identify the disorder. Changes in mood, energy levels, and sleep all spring to mind. Then, there are other things… symptoms or signs that aren’t core to the identity of bipolar psychopathology, but might indicate a relatively higher or lower risk among individuals who are otherwise at a comparable level of risk for bipolar disorder. In other words, there are subtle signs that can help identify whether or not a diagnosis of bipolar disorder would be applicable to any given individual. Perhaps you’re looking out for these signs in your own behavior — or, perhaps you’re making observations about a friend or family member who you suspect may have the disorder. In any case, here are a few subtle signs.

    You don’t have a consistent bedtime.

    People with bipolar disorder are known for their changeable sleep schedules. Most people, when asked a question like, “When do you usually go to bed?” have a quick and easy answer. But if that question gives you pause and necessitates a complex timetable calculation in order to answer, it could be a sign that your circadian cycle is out of whack.

    Bipolar disorder is one cause for circadian rhythm dysfunction. There are others — some, like non-24 hour sleep/wake disorder, cause a person’s bedtime to cycle predictably around the clock. But the changes in bipolar disorder are unpredictable. People may stay up late for weeks or even months, only to crash overnight into a routine of sleeping half the day or more. There is currently no way to know for sure when someone’s moods will change.

    You have hyperfixations.

    Have you ever become obsessed with a new hobby, concern, or passionate interest, only to grow bored of it and abandon ship before completing a grand project? Bipolar people are often known for their various pursuits (especially in the creative domain), as well as their mercurial sense of motivation to finish the tasks ahead of them. If you take on far too many tasks, or frequently change tasks without completing the initial task, you may be bipolar — or perhaps you just have what scholars call a “cyclothymic temperament”.

    The term hyperfixation comes primarily from the ADHD world, but like many symptoms of ADHD, they’re a subtle sign of bipolar disorder too. Similarly, more generalized difficulties paying attention and staying focused are subtle signs.

    You’re physically absent a lot.

    As a rule, I don’t think people with bipolar disorder are emotionally absent from the lives of our loved ones — all too often, it’s actually the opposite, and our powerful emotions can impose themselves on people and situations. However, we are physically absent… quite a lot. Maybe you’re calling out sick from work again, or you’re about to drop a letter grade due to your absence from class; as a child, you may have been disciplined at school. This tendency to not show up to things can hinder achievement both personally and professionally.

    You have neurological soft signs.

    Neurological “soft signs” refers to certain problems with motor coordination and sensory integration that are observable on an exam from a neurologist. This includes difficulties with fine motor skills, errors in sequencing motor commands, and challenges with sensory perception. These problems are commonly talked about in reference to schizophrenia. However, it stands to reason that they also have at least a moderate association with bipolar disorder as well. Both bipolar disorder and schizophrenia are mental illnesses with a neurological or neurodevelopmental origin, and they have genetic overlap, as well as overlapping symptomatology (psychosis is the hallmark of schizophrenia and may be present in bipolar disorder as well).

    Are there any other subtle signs you can think of?

    5 tips to living your best life with bipolar disorder

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    I’m medication resistant, meaning that meds don’t fully stabilize my cycling. I’ll never be the person who can say “nobody even knows I am bipolar”. In fact, I have to disclose my bipolar disorder to most of the people I work with, due to how it impacts my working hours.

    I’ve tried every atypical antipsychotic approved for use in psychiatric patients in the United States except for clozapine (although that has been on the table) plus two typical antipsychotics, three anticonvulsant mood stabilizers, and many other drugs including benzodiazepines, antidepressants, hypnotics, lithium, and so on. I’ve taken the tour.

    Currently, this is my regimen: olanzapine, risperidone, lithium, diazepam, and amphetamine salts. I continue to experience symptoms, even with all of that on board. So how do I live and continue to work? The answer is not one-size-fits-all, but for me there are a few key components.

    1. Consistent sleep times

    I try to go to sleep at the same time every night, and wake up at the same time every morning. Of course it doesn’t always work out that way, but I try. I also make sure not to schedule any meetings that are too late at night, and not to stay out too far into the evening, as both of these things will keep me awake. Each person’s natural bedtime is different, so I can’t tell you what time is correct for you, but for me it’s usually between 10 PM and 12 AM (a fairly wide window, I know).

    Sleep is super important in managing bipolar disorder.

    2. Structure during the day

    It helps me if I am able to maintain some regularity and consistency throughout my days. Since I’m an academic and my work schedule is flexible, this is something I largely have to impose on myself. When I’m really struggling I’ll schedule events in my Google Calendar, even for things I don’t “have” to do — recreational activities, like video games or watching anime. The point is to stay busy, but not too busy. Make sure to build in plenty of breaks. This also helps me get the things on my to-do list for work done efficiently.

    I use Google Calendar for this.

    3. Take meds religiously

    This one doesn’t need a whole lot of explanation, but it’s an important point. Don’t stop taking your meds. At least for me, it always ends in hospitalization, and that’s a huge disruption to my life even though I’m quite used to it by now. Don’t get me wrong — sometimes hospitalization is necessary. However, it’s best to avoid it as much as possible, so that I can stay in contact with my friends and family.

    Medication is the primary treatment for bipolar disorder, and it must be taken regularly.

    4. Light and darkness

    Research has shown that light/dark cycles have a dramatic impact on bipolar moods. I use a light box (or “sun lamp”) for a couple hours daily in the winter. You can buy a clinical strength sun lamp on Amazon (I am not affiliated, and do not gain anything from this) but be aware that the market is flooded with lamps that are not full clinical strength. The recommended protocol for bipolar disorder is to start at noon for 10 minutes, then add 10 minutes every day until you reach 1 hour. This is because the sun lamp does run some risk of triggering mania. At the same time, when you go to sleep (or ideally, when it’s naturally dark outside) there is an equivalent if not more important factor: darkness. Total darkness at night has been shown to dramatically stabilize patients who did not respond to conventional treatments.

    Sun lamps can help with low mood and low energy.

    5. Mindfulness and psychoeducation

    The point of mindfulness in this context is to be able to recognize what mood state you’re in. Likewise, it helps me to be as educated as possible. I read tons of papers, but these are not super accessible to everyone; if you trust your psychiatrist, I recommend asking lots and lots of questions so that you can understand as much as possible. I also compiled a list of some of my favorite bipolar books. The insight into what you’re going through can save your life, even if it doesn’t change what you’re going through.

    Keeping track of your mood takes time and practice, but it can be a huge advantage in managing bipolar disorder.

    Bipolar disorder and media consumption

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    Recently, on Twitter, I confessed that I had not been able to complete reading NeuroTribes (a very interesting book, and also a lengthy one). The other person insisted that a PhD student should be able to read a book and accused me of lacking academic integrity — basically, that I am lazy and don’t deserve my PhD.

    I’m here to say that attitude is inherently ableist. But to give the benefit of the doubt, perhaps most people don’t know that bipolar disorder actually can affect your ability to read. I learned to read early as a child — I was a prolific consumer of text, and I had a college reading level in elementary school (this is called hyperlexia). But after being medicated for bipolar disorder, my ability to sustain focus and momentum while reading a long document has been very limited.

    Lithium is probably the biggest offender. It kind of affects how you see words on the page — like a pseudo-dyslexia, the words seem kind of blurry and distorted. It can be impossible to read full books. I can still read journal articles because they generally have a defined structure and an abstract. I can also read poetry, which I enjoy. I recommend seeking out these kinds of texts if reading is something you struggle with.

    Most of all, I want you to know that this is common, you are not alone in having an acquired inability to read and you still deserve your career, whatever that may be. It’s not a matter of “intellectual thoroughness”; it’s part of a disability, and it’s more common than you think.

    I also find it difficult to watch videos, TV, or movies. The information conveyed through video media covers many modalities — sound (music), speech, visuals, movement (spatial), and the overall plot you’re supposed to be following. Sitting for the length of a movie is hard, but it’s also just hard to follow so many things at once. My brain gets overwhelmed with too much information of different kinds to process (evidence of poor sensory integration, a symptom of autism). But it helps to reduce the overload by using captions (combining speech with visuals, thus reducing the number of information modalities) or watching something animated, which compresses the demands of visual and spatial information greatly.

    Have you ever had trouble consuming media?

    What strategies have you used?

    What is the goal of psychiatric medication?

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    The goal of medication isn’t to make everyone neurotypical. That would be boring as fuck. — Dr. Coats (my psychiatrist)

    Different psychiatrists no doubt have different philosophies about the point of psychiatric medication, and different patients have their own goals for treatment which naturally vary. To some people, bipolar disorder is a gift to be tamed; to others, it’s a curse to be extinguished. Regardless of whether you choose to take medication for bipolar disorder or not, you surely have your reasons for doing so. Many of these reasons seem to hinge on what the perceived goal of treatment is.

    Some goals are specific: for example, “I’d like to be able to go back to school and get my degree”. Some goals, on the other hand, are more vague: “I’d like to be well again”. What does it mean to be well? Certainly, it means different things to different people.

    As my psychiatrist, Dr. Coats, has said, the goal of psychiatric medication isn’t to make everyone neurotypical. There are some psychiatrists who may believe that the optimal outcome for everyone looks like neurotypicality (the complete suppression of bipolar symptoms to look like a “normal” person), but for many people with bipolar disorder this isn’t one of their goals. Furthermore, for many people with bipolar disorder it simply won’t happen.

    This tends to happen.

    One study that followed 258 outpatients, all of whom were taking medication, for one year found that 63% had four or more mood episodes within the year.1 26% were ill for more than 3/4 of the year. It seemed that medication was more effective at controlling mania than depression, as participants spent 3 times more time in depressive states than in manic states. A wide variety of drugs were prescribed to participants in this study, including mood stabilizers, anticonvulsants, antidepressants, benzodiazepines, and thyroid medications. The average participant took 4 different medications. Despite this, only 11% of participants were virtually free of mood symptoms. 89% experienced symptoms to some degree.

    The study identified many subgroups of bipolar participants, each with a distinct pattern of recurrence (or non-recurrence) of mood symptoms. For example, of the 26% who were ill for 3/4 of the year or more, there were several subgroups: A) ultra-rapid cyclers who were essentially ill for the entire year, B) those with predominant depressive episodes (but experienced mood cycling), C) those with predominant manic episodes, and D) those who had chronic persistent depression with very little cycling.

    Based on which pattern is most accurate to describe a given individual, it would be appropriate to adjust one’s goals and expectations for treatment with medication. When I’m ill, I’m closest to pattern A. My goals include slowing down my cycling, reducing the severity of mood symptoms and suicidal thoughts, suppressing my impulsivity and anger, and sleeping regularly each night. For someone with pattern D, goals might look a bit different.

    Me without medication

    I think it’s helpful to identify specific goals. This helps you determine if you’ve made any progress towards what you want to achieve, even if you still experience symptoms. For many people, resuming a completely normal life with no symptoms of bipolar disorder may be a futile effort — or an unwanted outcome. Even in my most well periods I experience cyclothymic changes in mood and energy levels. My work style is somewhat erratic, and I might stay up for 2 or 3 days working on a paper until it’s finished, then be unproductive for a month or two. My goals aren’t to extinguish these features. I’m not trying to be neurotypical. I’m trying to protect my life and reduce suffering.

    Because while bipolar disorder can come with tremendous gifts, it can also be the source of unbelievable pain and suffering. Only you can decide how to reconcile that in your own life. And if stifling mood episodes completely isn’t your goal, that’s okay. It’s possible that you can still harness the benefits of medication to reduce suffering. I recommend being honest about your goals to your treatment team. A good psychiatrist shouldn’t be forcing neurotypicality onto you. Being bipolar in itself isn’t a bad thing.

    Bipolar people are cool!

    References

    1. Post RM, Denicoff KD, Leverich GS, et al. Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH Life Chart Method. J Clin Psychiatry. 2003;64(6):680-690. doi:10.4088/JCP.v64n0610

    Best books for people diagnosed with bipolar disorder

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    When I was first diagnosed with bipolar disorder, my therapist gave me a book that changed my life. Books can influence how you understand your own bipolar disorder, and yourself in relation to it. I haven’t read every single book out there, but here are a few that I have read.

    Welcome to the Jungle by Hilary Smith

    Technically, this is a self-help book. It contains a lot of good information, tips, and recommendations. The thing I like about this book in particular is its humorous and lighthearted style. I read the original edition of this book, and I no longer have it because I gave it to someone else, but I still remember some of the bipolar jokes! I recommend this book to anyone who has just been diagnosed with bipolar disorder but doesn’t know much about it, and needs a source of information.

    Manic by Terri Cheney

    Manic is a memoir. Memoir can be so helpful, in my opinion, because it allows us to have insight into the lives of people who have faced similar struggles as us. This book describes itself as “visceral” — focused on the experience of mania and depression from a very subjective viewpoint. Cheney herself said the focus is “on what bipolar disorder felt like inside my own body”. Paradoxically, it becomes very relatable by just how idiosyncratic it is. I recommend this book to anyone who feels alone in their struggles with bipolar disorder.

    An Unquiet Mind by Kay Redfield Jamison

    This is the book that changed my life. As a freshman in college, it single-handedly inspired me to pursue a career in research, and specifically bipolar disorder — which is now my career. Jamison is an authority on bipolar disorder, but this book is not a textbook — it’s a memoir. In a display of great vulnerability (at the time, nobody could know if this book would end her career) Jamison tells the story of her life, from childhood to a breakdown shortly after completing graduate school, mania, psychosis, depression, and a serious suicide attempt. Throughout it all, Jamison interjects wisdom and knowledge. This book simultaneously provides both deep information about bipolar disorder and a revealing look into the life of somebody who lives with it. I would recommend it to anyone who with a curious mindset, who wants to know more about the science of bipolar disorder and the culture of academic psychiatry, as well as the personal experience of living with bipolar disorder from the perspective of an expert.

    Have you read any good books about bipolar disorder? Feel free to leave a comment!