BipolarAssociation.org

Managing how you feel using the Miller Mood Map

2011-07-25T22:57:00.000-07:00

: With the right strategies, you can manage how you feel

Successful people behave in successful ways. This means doing what you need to do, regardless of how you feel.

Understanding how you feel and why you feel that way, is the first step. Unless you (as opposed to family members, advertisers, companies and governments) control of your actions, you cannot succeed! If you run away when you are anxious, instead of sorting out what you need to do, you cannot succeed. True emotional intelligence means you understand the way you feel, and why you feel that way. You understand that it is just a feeling and that you have to act despite the way you feel.

People tend to worship feelings. Not like my Grandmother who used to say,
"Sticks and stones can break my bones,
but words will never hurt me!"

These days, damaged feelings have a price, especially in the High Court. Compensation for hurt feelings and a damaged reputation can be worth more than life or limb.

How did that happen?

Someone whose emotions are running their life is a lost soul. Someone who has lost a limb, with good emotional intelligence, and an ability to make the most of whatever happens to them can be successful. WIthout good emotional health, a person is condemned to life as a victim. I do not agree that someone with emotional damage to be compensated more than someone with physical damage. But I can understand that they may be more disabled. The answer - better emotional education!

MoodMapping helps develop emotional and social intelligence. It is no fun being anxious, not compare to the sense of satisfaction that comes from sorting out problems and making a success of whatever life throws at you.

Top left (high negative energy) on the Miller Mood Map represents ANXIETY, Top Right (high positive energy) represents ACTION - doing what you need to do, to sort out the problem. For example, you are concerned about a leak in the roof, you make a plan and you either get onto the roof yourself or get a roofer to sort the problem out. You have taken action and the result solves your problem. Not all problems are so easily sorted, but letting them mount up will not help.

The more problems you solve, the greater your mental fitness to solve more problems. If you do the mental equivalent of spending your life in bed, problems increase.

A word of warning! People get stressed more easily when they are tired and in pain! - especially overtired. In these cases, the best solution maybe a rest, and sort out what you need to do in the next morning, once you have recovered.

This may not be easy for everyone. There is often no respite from small children, from the debt collector, and from ongoing family and work problems. It is therefore important to learn different ways of coping with anxiety so that you can take the action you need to solve the problems.

Nonetheless, if you want to improve your mental wellbeing, it has to be your top priority. It won't happen on its own!

Mental wellbeing has two parts, how good or bad you feel and how much energy you have. Anxiety consists of high levels of negative energy. You can improve your energy by improving your diet and cutting down on alcohol. No one makes you eat junk food, and no one makes you drink more than is good for you. Its a life style choice. And the older you get, the more important it is to make the right lifestyle choice to improve your mental wellbeing.

Come along to the workshops on MeetUP, learn more about MoodMapping and how it can help you. The first and second Saturdays each month teach you about moodmapping with a weekly group to offer support

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Workshops for 2011

2011-01-19T07:36:00.001-08:00

MOODMAPPING ™ Workshops 2011

The dates of the workshops in the coming year are as follows, each one focusing on one aspect of mood mapping
5th February, Saturday - Bipolar and MOODMAPPING™
8th February, Tuesday - Teaching and MOODMAPPING™
19th February, Saturday - Anxiety and MOODMAPPING™
5th March, Saturday - Creativity and MOODMAPPING™
8th March, Tuesday - Team and MOODMAPPING™
19th March, Saturday - Procrastination and MOODMAPPING™
2nd April, Saturday - Bipolar and MOODMAPPING™
12th April, Tuesday - Teaching and MOODMAPPING™
16th of April, Saturday - Anxiety and MOODMAPPING™
7th May, Saturday - Creativity and MOODMAPPING™
10th May, Tuesday - Team and MOODMAPPING™
21st May, Saturday - Procrastination and MOODMAPPING™
Maximum 10 people per workshop
The cost is £20 (Saturday) - £30 (Tuesdays) From 10 - 4.30 pm In Fulham
Booking - please email me the date(s) you are interested in attending

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Team and Mood Mapping

2010-11-02T15:11:00.000-07:00

This Saturdays workshop focuses on mood and team. Mood is the glue that holds a group of people together. Without a common mood, people have little in common.

The common mood keeps teams together. Common beliefs, values and moods bind a group of disparate individuals into a team. When the mood is right, the team wins and when the mood goes, the team falls apart.

Every week the Apprentice shows that when the project manager manages the team mood, 90% that team wins. Where the mood is out of control, behaviour becomes chaotic and extreme personality traits emerge. When people behave in an extreme way, it is impossible to get the cooperation needed to achieve goals and get results.

This Saturday's workshop looks at the relationship between mood and teams - in Fulham between 10 am and 4.30 pm. Cost £20

Email liz@lizmiller.co.uk if you would like to attend

Mood Mapping - Available Now!!

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Bipolar, creativity and Mood instability

2010-10-25T23:48:00.000-07:00

For nearly twenty years I have resisted the idea that there may be a link between bipolar disorder and creativity. Yet everyone I know with a psychiatric diagnosis, tells me about the link between their diagnosis and their creativity. A couple of years ago I took part in a debate at the Institute of psychiatry where I took the view that creativity and madness were not linked. In my view poor mental health is inextricably linked to poverty, ill-health and adverse life events.

I now think that there is a difference between poor mental health and madness. The two are related yet separate. In many ways poor mental health is akin to being physically unhealthy. Just as eating a junk food diet and not exercising affects one's physical health it also affects mental health, with the result that people cannot enjoy life to the full. Improving mental health helps somebody feel better in the same way as improving their physical health does. It is impossible to be a world class athlete while at the same time failing to train and not looking after once body.

Most poor mental health is a result of poor mood management. this leads to anxiety and depression, as well as impulsive behaviour and lethargy.

Madness on the other hand, more than poor mood management. it is likely to be as much due to the hyper specialisation of the brain in particular areas to a failure to live a balanced life. Madness in its extreme form is as much a talent has the ability to play the violin beautifully or take mathematics beyond the edge of the known universe.

Poor self management, which is largely poor mood management and a failure to properly manage one's mind means that it is impossible to take advantage of the mental gifts that are on occasions called madness.

A pianist must learn their scales, and so must any creative artist learn the vehicle by which they express themselves. The poet must learn to speak a language and use that language to give expression to their gift.

In the same way, someone the gift of schizophrenia bipolar disorder, and autism needs to learn the basics of living in order to give expression to their gifts. Self management and the ability to live within normal society are the musical scales of living through which these gifts must be expressed. Unless the unique insights that madness brings can be enjoyed by other people there are meaningless and self-indulgent. There is no point in Rachmaninov living on his own or a desert island playing his piano to the ocean. The scientist's insights are is only meaningful within the framework of our current understanding.

The debate between mental health and madness is still ongoing. The reason that I debated that mental health is the result of poverty, adverse life events and stress is because this is true for the majority of people who receive psychiatric medications. On the other hand, the ivory tower psychiatrists at the Institute of psychiatry deal with people with severe madness. These are people with highly specialised brains, whose difficulty in managing their genius is in being able to find expression for their exceptional abilities.

At the fringes of this debate, Goldman Sachs has already started employing autistic people to help them with their computer algorithms. Their problem is in managing such people. I had one patient who was a obsessional compulsive abattoir inspector. His abattoirs were the cleanest in north-east England. On the other hand other days when he could not leave his front door for the severe anxiety and number of checks that he had to make. In the modern failing economy such inconsistency is inefficient, regardless of the talent that he brought to his work.

I have changed my position because after 10 years of intensive self management, I now feel that I have a healthy mind. And yet my mind is still different, if anything I fit in less with society than I did before I cleaned up my act. I have learnt communicate to talk effectively, I am learning structures by which to write plays by which to write comic scripts and I am learning the way to express that creativity. None of this gets round the need for me to be able to manage my moods and manage my mind. Yet I am beginning to see the difference between feeling ill because I have not exercised and those deeper feelings which provide insights into the human condition. just as if I were a great Javelin Thrower I would need to have a healthy working body to express that talent, I am beginning to believe that I have talent for writing and communication and that in order to express it I needed to develop a healthy mind.

In conclusion today, mental illness as a combination of poor mental health and severe maladjustment. yet that maladjustment stems from a genius of specialisation and such creativity is essential if we are to come through the 21st-century largely unscathed.

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The right diagnosis ? bipolar, schizoaffective, severe anxiety or autistic spectrum

2010-10-22T14:05:00.000-07:00

I know three people who diagnosis of bipolar is almost wrong. Nothing about their experience suggests extreme moods of high exuberance, deep depression and extreme behaviours of spending, extravagance, promiscuity and delusions of grandeur. And yet all of them have a diagnosis of bipolar disorder. What does this mean?

This is because psychiatry has lost its way. It has lost its intellectual framework and treatments are increasingly random and pragmatic and given out like to smarties.

The psychiatric algorithm is now

Mild Symptoms - treat with the latest and cheapest antidepressants you know the name of eg - Citalopram Severe Symptoms - treat with antipsychotics eg olanzapine orquetiapine

No thought required

Yet it is impossible to not to believe that a person's personality in some way contributes to their psychiatric problems. Tall people are at risk from bumping their heads on low doorways, short people may not be able to get food from the top shelf. There is no right or wrong, it just happens this way.

The personality type at risk of grandiose and extreme moods of true bipolar disorder is Talk and Do.
The personality type at risk of severe depression and even schizoaffective disorder is Think and Be.
The personality type at risk of severe and generalised anxiety and even Obsessional compulsive disorder is Talk and Be
Finally, the Think and Do personality type is likely to become embedded in their routines, distressed by change and at risk of Autistic spectrum disorders.

In all of these cases, a person's moods may be unstable, but unstable moods are not on their own, enough to make the diagnosis of bipolar disorder. Unstable moods indicate stress rather than bipolar disorder.

The wrong diagnosis leads to the wrong treatment which at best is unhelpful and at worst destructive. A person with an already flat affect and low mood is not helped by a mood stabilising drug. It will make their mood flatter and make it harder for them to "do" those things that they need to do to in order to solve the problems they face.

People with a naturally flat mood are made worse by a mood stabiliser. Their problem is not Bipolar Disorder, they do not experience the extremes moods of the Talk and Do personality. Neither do they spend money extravagantly, behave promiscously, drive fast and hard or endanger their own or other peoples' lives.

The right diagnosis is a critical step to understanding yourself and managing your own mental health. Without the correct "label" it is hard to understand what has happened to you and your treatment is random.

Come to a MoodMapping workshop, first and third Saturdays of the month and discuss this further.
The next workshop is Saturday November 6th 2010 10.00am - 4.30 pm in Fulham, London - all welcome
Cost £20 and concessions are available

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Copyright (c) Dr. Liz Miller
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2010-08-05T03:27:00.000-07:00

Non Medical alternatives for Bipolar Disorder

2010-01-01T00:38:00.000-08:00

Do you want to take medication or drugs for the rest of your life? This was my first question when I finally accepted that I had a problem and that this problem had been labelled "Bipolar Disorder" by psychiatrists.

Accepting that I had a problem was tough, probably one of the toughest things I have ever done. I was proud of my mind, or brain. It could do extraordinary things, and yet here I was told, I had a problem and that problem was a mental illness. As a doctor, I found it particularly hard to accept, because accepting that I had a mental health problem went against twenty years of medical education and meant that I publicly agreed that I was a deeply flawed human being.

Yet even though I accepted the diagnosis on the surface, underneath I was still searching for a "cure" or at the very least a way of managing bipolar disorder without medication. Especially when the psychiatric establishment was telling me I would need drugs for the rest of my life. That advice didn't seem right.

Without doubt, some people find drugs helpful. For them, medication seems to take the edge off their symptoms and enables them to lead more fulfilled and happier lives. But these are strong drugs, and an alternative approach is needed.

For me, that approach is returning myself to health in as many areas of my life and work as I can. I have developed a "non medical alternative" for bipolar

First - I see bipolar as mood instability rather than a deep flaw to my nature. Fluctuating moods are part of who I am and as long as I am sensible, they don't fluctuate too wildly

Second - Nothing gets between me and my health. I am no use to anyone if I am ill, so as long as I don't become selfish or greedy, I accept that I need to look after my health first

Thid - I need lots of friends around me, to help keep me right and I hope the relationship benefits both sides.

This is where the previous reader comes in. Are there any groups around the world which specifically look at non medical ways to manage bipolar disorder? Not many! but sites such as the Icarus project click here
are helpful

As to face to face groups, I am not aware of any apart from our Tuesday evening group. We accept the need for medication but we are also keen to develop our ability to manage our own condition and experiences without medication. And most of all, we like to have fun!

For those readers in the US, you can buy Mood Mapping from Amazon.com Click here and some UK sellers will export to the US

Copyright (c) Dr. Liz Miller
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Happy Christmas

2009-12-27T04:05:00.001-08:00

Find out more - Buy the Book!

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Mood Mapping Courses 1st Saturday of the month

2009-11-04T02:37:00.000-08:00

Learn Mood Mapping 1st hand

Places are available: up to 10 people

7th November
5th December
9th January (because of the Bank Holiday)

10.30 - 5.00pm
in Fulham

Be the Early Adopter in your neighbourhood

Email me at liz@Lizmiller.co.uk if you would like to come along

You will

Learn how to Map your own moods,
Understand what causes your moods and the 5 keys to mood
Understand what area or areas of your life cause you most trouble
To gauge other peoples' mood
To learn to influence other peoples' mood

The book is the Course manual, please bring your copy with you - with additional notes as needed,

Most of all, it will be fun!

£15 or thereabouts to cover lunch, teas and coffees

Copyright (c) Dr. Liz Miller
www.lizmiller.info

Find out more - Buy the Book!

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Talking points 6

2009-09-05T00:27:00.001-07:00

Saraswati from the Yoga studio has kindly put together these points to combat stress. Yoga of course, is a great way to counteract stress, just a few exercises for even a few minutes a day can make a difference. Saraswati's website is here www.theyogastudio.org.uk

A quick look down this list shows you lots of ways to manage your mood, which is of course the goal of mood mapping - putting you in charge of how you feel!

The next meeting of the Tuesday night group Bipolar Association is 8th September and then 22nd

Ways of coping with stress

1 Clear some clutter from life

2 Save time for things you enjoy, not just work

3 Do something creative

4 Have a warm bath if wound up

5 Have a shower if tired

6 Practice breathing to a count of 3 or 4

7 Take short periods of complete relaxation

8 Become aware of situations which cause stress for you

9 Repeat a mantra when going to sleep

10 Work out the root causes that repeatedly cause stress, do they still apply

11 Confide with close friends, talking helps release stress and lets you see things more objectively

12 Learn self massage or have or give a massage

13 Learn a mantra to repeat silently use in stressful situations

14 Realise you have a choice in how you act, speak or think, take a moment before acting in stressful situations to think about the consequences of your actions

15 Use some music to relax you

16 Do some physical activity when very wound up, work stress out of your system

17 If possible find something absorbing to concentrate on ie a good book or film

18 Train your mind into thinking positively about yourself and your life

19 Practice yoga postures, breathing exercises, relaxation or meditation daily even 10 minutes

20 Treat yourself, look forward to your treat and remember it when you are under stress

21 Try to avoid letting too many stressful situations build up in your life over a short period of time

22 Gradually cut down on stress inducing “crutches” ie tobacco, caffeine, alcohol

23 Slowly build up a sound nutritious daily diet; lack of proper nutrients creates stress in the body

24 Experiment with vitamin and mineral supplements, you may be lacking something

25 Do not try to change your life overnight: every change causes stress

26 If you are in a relationship / job / situation that causes great pressure and makes you miserable try to find ways to improve it. If all else fails leave!

27 Make sure you have enough sleep, you should not need an alarm to wake you up

28 Eat regularly, being hungry puts the body into a state of panic

29 Check your posture often, holding muscles tense unnecessarily causes stress

30 Avoid situations / people that make you feel stressed, be more assertive

31 Learn to appreciate yourself and believe that you can achieve fulfilment by taking life gently; peace of mind comes through relaxation not worry

UNHELPFUL THINKING

Below are types of unhelpful thinking that lead to worry and create an uncomfortable internal world. When noticing any of the following start three three breathing. As soon as possible put alternative kinder thoughts in your mind. It might help to ask yourself “What would a contented person think in this situation? What would I think in this situation if I were feeling really well right now?”

TYPES OF UNHELPFUL THINKING

Taking the blame

This involves taking responsibility for something when it is not yours eg “he was really angry I wonder what I can do to make it better?” – not your problem!

Mindreading

This involves believing that you know what other people are thinking eg “she thinks I am fat/thin/ stupid. He doesn’t like me”

Discounting the positive

This involves rejecting good things as if they did not count eg “She only said that to make me feel better. He was just being polite. Or anyone can do that”

Emotional Reasoning

This involves mistaking feelings for facts eg I know everyone can see how I am feeling inside. Or I am angry inside so it must be someone’s fault

Catastrophising

This involves believing one thing going wrong is a total disaster “everything is ruined” “I will never be able to show my face again”

Over-generalising

This involves assuming that because things went badly once they always will eg spilling a drink at a partly means you are “always clumsy”. Or failing to see a joke mean that you are always stupid or dumb

Predicting the future

This involves thinking things such as “I will always be on my own” “I will always be shy”

Labelling or name calling

This involves being mean to yourself eg thinking “I am useless/ stupid / ugly. Other people are horrible / hostile / superior”

Wishful Thinking

This involves supposing things would be better if they were different eg If only I were more attractive / wittier / enlightened / famous / rich / etc

Taking things personally

This involves supposing that some body else’s actions were directed at you personally eg When someone looks distracted while you are talking, assuming it is because of you

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Bipolar Disorder Article

2009-08-31T20:09:00.000-07:00

I wrote this article on bipolar disorder almost ten years ago. It is on my website www.med4u.co.uk Med4u is an Internet Marie Celeste, floating deserted and crewless in cyberspace, long since abandoned once I realised that consulting over the Internet was too labour intensive and too individual to be commercially viable. The Internet is a place where size matters, the size of your mailing list, the size of your website and so forth. Never mind the quality, feel the Bandwidth.

Ten years later I still agree with what I wrote, Click here for the original link and because of that I have copied it here.

Bipolar disorder

Bipolar affective disorder is a mental health problem, rather than a physical illness or disease. It is a condition in which moods become difficult to regulate and may swing from one extreme to another. This causes periods of deep depression, when life no longer seems worthwhile with no energy for normal activities, and periods of elation or hypomania which are associated with excessive activity. These mood changes may become so extreme that an individual loses contact with reality. A person with manic depression becomes more vulnerable to stress, both physical stresses, like illness and lack of sleep and mental stresses, like unemployment. In addition they may suffer from severe anxiety.

Most people experience times of sadness and excitement and these changes in mood are part of a healthy response to every day life. Yet for people with manic depression, sudden changes in mood make it hard to know how they will feel at a particular time. Normal mood changes do not interfere with someone's ability to get on with their life. For people with manic depression, these mood changes can be so severe that their inner world overwhelms them. In this state, it is almost impossible to carry on with normal activities.

To friends and relatives, it appears that the person they know has temporarily changed. For example, it becomes difficult to communicate with them and their conversation may not make sense. This can be frightening unless they know what is happening, whether it is a period of depression or hypomania.

This explains a little about bipolar disorder both for people with the condition and for their friends and relatives. It also includes sources of further information and support.

*********************

As yet, bipolar disorder is a condition that can be 'managed' rather than cured. Nevertheless the goal can still be to live as fulfilling and normal as life as possible. This will not necessarily be the same life as before bipolar disorder developed as it is impossible to turn the clock back. It almost certainly means changing your lifestyle and expectations. It means accepting limitations and avoiding excessive stress, mental or physical. It involves the discipline of taking medication. It means finding out and learning about the illness, gaining self-knowledge and being prepared to take appropriate action to help prevent further episodes of illness.

There is no answer to the question 'Why me?'. There is often no reason why one person responds to the environment in a different way to someone else.

Nevertheless, despite these cautions, you can look forward to a life that may be different from what you had hoped, but a life that can be as rich and fulfilling in many unexpected ways. It is not easy to accept the diagnosis of bipolar affective disorder and to learn about the condition. However modern therapies and modern approaches to the illness provide opportunities that were not available, even ten years ago.

About Bipolar Affective Disorder
Bipolar affective disorder named after the periods of severe depression and hypomania that occur in this condition. These represent the two extremes of mood, Bi (two) polar (extremes) Affective (of emotion). It is also known as manic depression. The diagnosis depends upon a person having had at least one episode of depression and one episode of hypomania. People who have depression alone are described as having unipolar depression or simply depression.

Hypomania is a state of high energy and activity in which the ability to sleep normally is lost. The person speaks rapidly, often expressing strange ideas. They may be irritable, paranoid, play loud music continously. They lose their judgement, and spend excessively. They may be sexually promiscuous. In the early stages, the individual may start many projects and appear to work productively and creatively. This breaks down as hypomania continues. Hypomania is not happiness, even if it appears exciting or comes as a relief from severe depression. Although it seems as though the person chooses to behave in this way, they are not in control and are driven relentlessly by their impulses. They lose insight and cannot understand what is wrong with their thoughts and behaviour.

Depression This describes a period when life loses its meaning and seems worthless. The person has neither energy nor motivation. Sleeping is affected, either increased or decreased. Thinking is slow and their concentration poor. The person feels distanced from everything and everyone around them, and suicide is a risk. They may have feelings of severe guilt and anxiety.

Psychosis At the extremes of mood, sometimes people lose contact with reality. Their thoughts become paranoid and contain many delusions. It is difficult to communicate and the person makes up elaborate explanations for their behaviour and experiences.

Anxiety Many people may suffer from severe anxiety. This has many causes, and undoubtedly contributes to unstable moods. It is possible to reduce anxiety by tackling the underlying problems and learning relaxation techniques. Psychotherapy can be helpful. Rarely it may be necessary to take medication.

Stable periods This is when life returns to normal after a period of illness. It is the time to build and repair relationships. It is the time to plan to make sure that further episodes of illness are less damaging - this includes financial planning, and ensuring that children will be properly cared for. It is the time to integrate the experiences of the illness. And it is the time to improve mental and physical health. Finally, it is the time to get on with life and enjoy living.

Patterns of bipolar affective disorder The pattern of illness varies considerably between individuals. Some may have episodes of hypomania followed by depression, others may have periods of depression with only occasional episodes of hypomania. Some people have very few episodes, others may have many more. It is difficult to predict and only experience can show how the condition will develop.

Two common patterns are known as Bipolar I - where a person has chiefly episodes of mania and Bipolar II where they suffer largely from depression, with only occasional episodes of hypomania.

Rapid Cycling This is a pattern of illness where a person has four or more episodes a year. Mood changes can be very rapid and this form of illness can be difficult to control. Typically periods of rapid cycling are interspersed with more stable periods.

Treatments

Drug therapy forms the basis of almost all treatment of bipolar affective disorder. It can often be difficult to accept that drugs are helpful or even necessary during a stable period. Nevertheless scientific evidence shows that, as well as treating hypomania and depression, drug treatments help to prevent further episodes. In addition, psychotherapy and self-management are important for the management of bipolar affective disorder.

Drug Therapy
There are three main types of drug used in the treatment of bipolar affective disorder. These are mood stabilising drugs, anti-psychotic drugs used to treat hypomania and antidepressant drugs that treat depression. Other drugs include sleeping tablets and drugs for anxiety.

Mood stabilisers The three most commonly prescribed mood stabilising drugs are lithium, carbamazepine and sodium valproate. If taken continously they reduce the number of episodes of illness. Each drug works differently and has different side effects. It may take time to find the most suitable drug. Newer mood stabilising drugs include gabapentin and lamotrogine.

Antipsychotic drugs These drugs are used to treat hypomania. Rarely, they are used to help stabilise someone's mood over a longer period of time. They can be taken at the start of a hypomanic episode to prevent it progressing further. Examples include, haloperidol, chlorpromazine, olanzapine, risperidone and sulpiride.

Antidepressants These drugs treat depression and may more rarely be prescribed long term to prevent depression. They can have side effects but often they may reduce significantly after a few weeks. Examples include; amitriptyline, dotheipin, prozac, paroxetine, sertraline amd venlaflaxine.

Psychotherapy for depression
Three types of psychotherapy have been shown to help depression. Cognitive therapy that helps people change their 'depressive' style of thinking, 'pleasure seeking' therapy that encourages people to undertake pleasurable activities and social skills training that helps improve communication. These therapies are challenging but are safer and more effective than drug therapy in the long term. A combination of drug therapy and psychotherapy can often be most helpful

Psychoanalysis and counselling therapy may not help depression even though they can sometimes appear to be supportive. In my personal experience, I know three people whose bipolar disorder started during forms of intense psychoanalytical therapy. Psychoanalysis can be destabilising and I would not recommend it for anyone who has potentially unstable moods.

Self-Management
Self management of bipolar affective disorder is not an alternative to drug therapy or psychiatrists. It is an approach that gives an individual a measure of control of their illness, by learning to monitor moods, recognise episodes early and take effective action. This is similar to a person with diabetes learning to monitor their blood sugar and adjust their diet and insulin.

The first episodes of hypomania or depression are often related to severe emotional or physical stress. As time passes, it seems that episodes are triggered by fewer and less severe stresses. Eventually they can seem to happen almost without any cause. Nevertheless, with experience, it is almost always possible to recognise that an episode is starting. By taking appropriate action the episode can usually be managed without too much disruption to ordinary life. The more experienced someone is at managing their condition, the less likely they are to have further severe episodes.

For further information about self-management, follow this link Self-Management

Causes of Bipolar Affective Disorder
The cause is not known, indeed there may be several causes. Often the first episode occurs during a time of severe emotional stress. More rarely it may follow a severe physical illness, head injury or course of drugs, such as antidepressants. Bipolar affective disorder can run in families, about a fifth of people with bipolar affective disorder have a parent with the condition. Searching the family tree further may reveal more relatives who have had mental health problems.

It appears that the mechanism in the brain that controls mood becomes disturbed, either because of a genetic problem or as the result of a severe stress. This disturbance in the brain almost certainly has a chemical basis and this explains why drugs can be so helpful. Nevertheless, drugs alone are not the answer. Just as there are many factors that can cause bipolar affective disorder so there are many factors that can help its management.

Where now?

Bipolar affective disorder is a relatively common problem, 1.2% of the population are affected. (This is similar to diabetes) Typically it develops when someone is in their late twenties or thirties, although it is occasionally diagnosed in childhood. It is important to choose a General Practitioner who knows about mental health problems and is sympathetic to how you would like to be treated.

The future for mental health problems looks promising. There are many new drugs available and many more being researched. Psychotherapy and psychological approaches are coming into their own and are widely available.

Friends, relatives, and bosses
One of the hardest things about manic depression is talking about your illness to other people. It is not advisable to tell everyone, especially at the first meeting. Nevertheless, if you can present a positive picture and, most importantly, show that you are at ease with your illness, the overwhelming majority of people will respond in kind. Bosses, too, if you can show that you are responsible and in control, are likely to be surprisingly sympathetic and helpful. A local MDF group provides a supportive place to learn about and to talk about your condition.

Voluntary Organisations

www.BipolarAssociation.org

Manic Depression Fellowship 020 7793 2600
The Manic Depression Fellowship produces a quarterly magazine for its membership - Pendulum. It produces information booklets about aspects of manic depression. It also runs self-management training courses and organises meetings and lectures about manic depression. Many people find it helpful to meet other people who also have manic depression. Relatives and friends may also find it helpful to other people who are involved with someone who has manic depression. The Manic Depression Fellowship has a large network of mutual support groups that meet regularly.

Depression Alliance 020 7633 9929
Depression Anonymous 01482 860619
MIND

Further Information

Summaries of the latest medical research can be viewed on The Bipolar association web site: Bipolar Association

Lithium Treatment of Manic Depressive Illness. A Practical Guide. Mogens Schou

The Depression Workbook A Guide for Living with Depression and Manic Depression. Mary Copeland. New Harbinger Publications $18.95 ISBN 1-879237-32-6

Malignant Sadness The Anatomy of Depression Lewis Wolpert Faber and Faber £9.99

Mind: The Complete Guide to Psychiatric Drugs A Layman's Handbook. Ron Lacey. Vermillion London ISBN 0-7126-4778-3

www.lizmiller.co.uk
www.moodmapping.com

Tuesday evening - self management group and Mood Mapping

2009-08-31T18:28:00.000-07:00

Many thanks to everyone in the group

We had a new member, who had written to me on a couple of occasions, but had not had a lot to do with self management of bipolar disorder before.

Because I am on the medical register - qualified if non-practising GP until my book is published (Mood Mapping - due date: 2 October 2009) he had expectations about prescriptions etc.

I don't prescribe drugs these days. Its too dangerous. Nonetheless, it was good to get someone with new experiences and a different perspective in the group. It brought home to the group exactly how radical self management is. Most people with bipolar disorder have been "medicalised". They are told to take drugs for a lifetime, most do and some people get back to work, many don't.

Self management is not about stopping drugs because there are times when medication helps. On the whole it is less damaging to take medication than to be continuously ill. But on its own medication is not enough. Medication is at best a sticking plaster, not a cure.

With bipolar disorder, a little bit of stress goes a long way. This does not necessarily mean leading a life wrapped in cotton wool, rather that those people who have a tendency to unstable moods have to learn better coping strategies.

Just as a diabetic needs to monitor their blood sugar, so a person with unstable moods needs to monitor their moods and act accordingly. Mood Mapping is the ultimate Mood monitoring tool. Moods have two components, well being and energy. There are four moods, High energy positive - Active, High energy negative - Anxiety, Low energy negative - Depression and tiredness , Low energy positive - Calm.

This was the first time our new member had seen Mood Mapping. I hope we didn't frighten him with it. Once you have seen a Miller Mood Map, you can start to understand your moods and it is impossible to go back! We always have a mood, and it is always somewhere. As long as you have energy, and as long as you have a state of mind, positive or negative, you have a mood.

Once you are aware of your moods and understand them, you can manage them and then as they come under control, so your moods become more stable and the diagnosis disappears.

It may not be easy. There are "brittle" diabetics who have, despite blood monitors and the latest insulin therapy unstable blood sugar levels. On the other hand, monitoring blood sugar does enable perhaps 95% or more of diabetics to lead normal healthy lives.

Support Meetings - The Tuesday Night Group

2009-08-17T04:05:00.000-07:00

The Tuesday Night Group meets on the second and fourth Tuesday each month.

This is a self management group, largely for people with bipolar disorder to meet in Fulham, London to discuss non-medical ways of managing bipolar disorder.

We believe that self management, mood management and mood mapping are the principle tools you need to improve your mental health

Open to everyone! Contact me liz at liz miller dot co dot uk if you would like to come along

www.lizmiller.co.uk
www.moodmapping.com

One in Four Magazine

2009-08-08T10:31:00.000-07:00

One in Four is a good magazine for people with an interest in their own and other peoples’ mental health. Whether you are looking because you have a mental health condition, you are involved with someone with a mental health condition, you employ people with mental health conditions, or you simply want to find out more about the rich tapestry of human existence, One in Four is a good starting place.

Demystifying mental health is one of great challenges of the twenty first century. Poor mental health is not a deficiency of fluoxetine or other medication. It is a side effect of modern lifestyles. Although people have experienced mental health problems since time immemorial, One in Four reflects the position in modern western society. By bringing together different peoples’ experiences and perspectives of mental health and society’s response, One in Four opens the door for people to become more aware of their mental lives and encourage diversity and tolerance.

One in Four is a magazine about real people, and real stories. Meeting people with mental health conditions and understanding the problems changes attitudes. And changing attitudes is the first step to making a difference to the stigma and discrimination that surrounds mental health

One in Four is free to the public, organisations need to pay but not a lot!

You can subscribe on line

www.oneinfourmag.org www.socialspider.com

or write to Social Spider CIC, 5 Hatherley Mews, London E17 4QP

29 th August 2009

2009-07-30T05:50:00.000-07:00

Roger from Stop Paddling has invited me to talk in Grantham on August 29tth - if anyone is in the area, please come along!

I will be talking about Mood Mapping and self management of bipolar disorder and it would be great to see you there.

Coming off medication

2009-04-19T23:12:00.001-07:00

This is an article I have written for Mental health today
Follow this link to find the original and feel free to place your comments below

Coming off medication

There are two main reasons for coming off medication – you no longer need it, or you are finding the side effects outweigh any benefits from taking it. In that case you are likely to be changing your medication either at the suggestion or at least with the approval of your consultant.

Coming off medication because you feel you no longer need it is trickier. And it is here the opinion of the “patient” or “service user” most often differs from that of their consultant or mental health team. “Patients” or “service users” are all too often told that he or she needs to take medication for life.

You may feel you no longer need medication because you have sorted out the difficulties that led to your mental health problems and your circumstances have changed. Nonetheless most mental health problems occur against a background of poor health in other areas.

Coming off medication safely means everything else has to be right. This includes being in the right surroundings or environment; being physically as healthy as possible, exercising, not smoking or drinking; having supportive relationships at home, and in the workplace; having good strategies to manage whatever life throws at you, having enough challenges but not excessive stress; and being able to be true to you. Under these circumstances the mind can heal, and with healing comes the possibility of a life without medication.

The nuts and bolts of coming off.

Make sure your life is as good as it can be and that your original problems have resolved.

Psychiatric medications are powerful chemicals that affect the brain. Over time the brain gets used to the presence of medication and adapts. This adaptation means that medication may become less effective and that person needs either more or a different medication to get the same benefit. Nonetheless, even if a medication no longer has an affect, it is in the clockwork and you need to take this into account.

If the supply of medications suddenly stops, the brain is affected. Therefore whatever you decide to do, do not suddenly stop your medication.

Psychiatrists and mental health teams are gradually coming round to the idea that people can come off medication. Not all of them but I am hearing of more psychiatrists who suggest people take for example, antipsychotic medication for “a couple of years” rather than lifelong. Before starting to come off your medication, it is best to talk to your psychiatrist and mental health team to see where they stand and what advice they can offer.

There are three main ways medication affects people
Drugs that are addictive. These cause cravings and severe difficulties when you come off them. These include benzodiazepines, such as Valium (diazepam), lorezepam, zopilclone, and most sleeping medications. They also include barbiturates and heroin or morphine based drugs such as pethidine, codeine and tramadol. Also in this group are for heavy drinkers, alcohol.

The choice with addictive drugs is whether to stop suddenly going “cold turkey” or gradually the dose over time. If you want to go “cold turkey” it is best if you do this under medical supervision because “cold turkey” can cause significant medical problems.
The alternative is to reduce the drug gradually. The difficulty with this approach is the cravings continue as long as you are taking the medication and for some time afterwards. Physically, gradually reducing the dose, is less demanding.

Drugs may have a “Withdrawal Syndrome”. This is less severe than for an addictive drug but is nonetheless unpleasant. Drugs with “Withdrawal Syndromes” include antidepressants, such as fluoxetine, paroxetine, cipramil and venlaflaxine, as well as atypical antipsychotics such as quetiapine. In these cases, it is best to reduce the dose slowly, over a few weeks and again, you are best to do this with the help of your psychiatrist

Finally there are drugs that do not fall into either group, yet still need to be treated with respect. Lithium is the most widely used example. No one craves lithium! But stopping lithium suddenly is dangerous. Up to 80% of people will have a sudden relapse within three months. The pioneering work on this subject was done by Balderassini in the 1980s where he showed that people who came of lithium suddenly were at greater risk of relapse than those who came off gradually. The difference in relapse rate between those who stopped suddenly and those who tailed off over six weeks were still there three years later.

Personally, I believe that if you want to come off lithium you must prepare to do so over at least three months, and ideally a year. Lithium more than any other drug gets into the clockwork and has its effect on the RNA of the cell (that is almost at the level of the DNA). Such a drug needs to be treated with respect and under almost no circumstances should you stop it suddenly.

In conclusion, brains have been around for millions of years, very few mental health conditions are due to of a lack of medication. Nonetheless, medication can help get us through bad times. If you want to come off medication, everything else in your life needs to be right from your physical health to being happy within yourself. Ideally, the more people you have to help you the better, and listen to their advice. Talk to your psychiatrist about it and whatever you do, take it slowly and carefully.

www.lizmiller.co.uk
www.moodmapping.com

Recovery

2008-09-13T00:00:00.001-07:00

Every now and again, I get asked to write articles or give talks. This is in response to a request for a short description of my own recovery.

For me, recovery means “never being ill again”, for others it might be “living well with symptoms” or “getting back to where I was before I was ill”

I was first sectioned at the age of 29. There was no mental illness in the family. If there was a cause, it was the stress of applying for jobs. Jobs that would have left me in the wrong career for the rest of my life, as a woman neurosurgeon. Not an impossible goal, even in the UK. After that, I had ten years of bipolar disorder, three sections and much misery, drugs and side effects. I now live drug free, work at jobs I enjoy and know I will never be ill again, at least not with bipolar disorder. My life has never been happier, more fulfilled, healthier or more secure. This for me is recovery. I have been lucky. Not lucky with my "illness", not lucky with my “outcome” but lucky that I have had access to information, support and the money I needed to find my answer …. eventually.

My luck depended on being a doctor. This meant I could access research on bipolar disorder, psychology, and nutrition. I was lucky with having some true friends and lucky to earn enough from a few hours work each week. I also had a string of bad psychiatrists and therapists, with an occasional enlightened beacon, which made me realise that psychiatry and therapy would not give me the answer. Instead I found my answer in a healthy lifestyle. This consists of fresh fruit, fresh vegetables, omega 3 fish oils, daily exercise and a ban on junk food and alcohol. In self-management; not blaming my “illness” and personal development. And equally important, in a reasonable and rational set of beliefs and values, writing, being heard and learning to listen. And best of all, with a few good and honest friends.

This makes me privileged.

My recovery took me nearly twenty years. My next question is “What would I have needed to know, to have reached this point more quickly?” And “Can it be done more cheaply?” Finding that out is now my life’s work. The Internet helps enormously. Self-management groups, providing security, support, wisdom and experience of the illness, help. Promoting a healthy lifestyle and writing blogs are some of the answers. Finding good and honest friends is the tricky one. Many people, especially those with bipolar disorder, find themselves failed by their friends just when they need them most. Learning social skills, developing appropriate social expectations and fine-tuning social judgements to help find those elusive good and honest friends is hardest.

www.lizmiller.co.uk
www.moodmapping.com

For those who are living at home

2008-09-09T20:54:00.000-07:00

Last night was R's first night at the group.

R is back living with her parents, not uncommon for "bipolar" children of "normal" parents to have a second childhood, and a third and sometimes a fourth childhood. A moment of thanks to parents all over the world who put up with their adult children returning to the nest in a state of complete incapacity. Your sacrifice is appreciated and we are duly grateful.

Living at home maybe better than being homeless, sometimes. But please note you drive us CRAZY!!!!!! Being a kid is bad enough first time round but to repeat it, three and four times, is worse.

Sorting out our problems seems to be a national pasttime and a Parental Right. Of course is we did what you said, we'd be fine. But we can't, so stop telling us. I am sure it is great advice, but it doesn't work. If your advice was so great, how comes we turned out the way we have - incapable of looking after ourselves in our mid thirties?????

And why, why, why and this this is one of the worst bits; everytime we get annoyed, show a bit of life, do too much, do anything, get irritated, do you tell us we are going high? I appreciate that if you have middle aged offspring living at home, you want them to sit quietly in a corner. Anything else is a nuisance. I understand that you had not planned to have your retirement blighted by your ageing infants. I understand this and am grateful you put up with us..... but it is just like being a kid again. Too much energy for the status quo.

We have real feelings, real moods and real emotions. Showing them does not mean we are about to go mad. No one likes being told that they can't have emotions. Dont tell us we can't get angry!!! We are angry, furious to be exact. And yes, it is your fault, for not preparing us for life better. Get over it and accept the blame. It is not our fault, so it must be your fault. There are times when we want to kill you for what you have done to us, but we don't. Be grateful you have a retirement

Sometimes it must be worse being a parent and watching your child thrashing around, seemingly unable to help themselves when life seems so clear to you. Sometimes it is worse being the child.

In reality, neither side are managing their moods or emotions. Adult children are worse than their tiny counterparts, a hundred times more annoying and the hope that they will leave home and start their own families has gone. Now you, the parent, can only worry what will happen when you, the parent, are not there to pick up the pieces.

The key to peaceful co existence is calm, tolerance and joy, concentrating on the good bits. Maybe second or third time round, we can all learn to do it differently. Same ingredients, same recipe, same cake. If you want people to behave differently, you have to change what you put into the relationship.

This time round, raise your parents differently, Encourage them when they do something well and patiently explain when they are not doing it right. Help them express their feelings, and encourage them to negotiate their emotions. Read books and talk to people who have well brought up, easy to get on with parents. Even if you feel powerless in the relationship, remain calm and assertive. Ask your friends how they handle their parents. Criticise the behaviour, not the parent. They are doing their best to help. You may have to explain things more than once and in different ways. They are getting old, and you have to make allowances for their age.

And finally remember

You are never too old to have a happy childhood
.

www.lizmiller.co.uk
www.moodmapping.com

Triggers, Warnings and Ghosts in the Machine

2008-04-19T23:40:00.000-07:00

As much as anything, this is meant to be an online diary of "bipolar like" experiences. I can no longer claim to have bipolar disorder, as I have been off medication and well for the last seven years. Nonetheless, there are still some ghosts in the machine.

I recently refurbished a flat. And I have been totally incompetent. I have refurbished places before, for my own use, but this was meant to be an investment. And I have been worse at it than anyone you have ever seen on day time TV. Finally the penny has dropped. My difficulties are about jobs and money and what is right to do. I am paralysed by fear. Refurbishing a flat is not a "proper job"! All my major episodes of bipolar disorder have been about a job coming to an end as the contract finished and my fears about getting the next "proper" job.

Identifying Triggers and Warnings is an essential part of managing bipolar disorder. You have to know what Triggers an episode and be able to pick up Warning signs. Triggers, in my case are around jobs, job insecurity and hence money. My Warning signs are spending money, not sleeping, trying to do too much, and in the past, alcohol. At that stage I know that if I cannot get my mood under control, I need to take medication.

If you have bipolar disorder, and you want to keep it under control, you need to know what Triggers an episode. It helps to know why those Triggers cause such massive stress. I come from a medical family yet I did not want to be a doctor. Family life was revolved around medicine, from spending most of Christmas Day visiting the wards where my father was consultant, never seeing him because he was always working, to my choice of A'Levels. The only way to gain respect in our family was to be a successful doctor. A friend of mine plays the piano (beautifully) when she is going high. For her, it is in part about her parents not letting her be a musician and insisting she take a "useful" degree at University.

Refurbishing the flat has triggered ghosts of "you must be a doctor" and "medicine is the only proper job". These are unhealthy beliefs, and I thought I had dealt with them. However my difficulty in finishing this flat is at least partly related to doing something that is not "medical".

Having again dragged this Trigger into the open, I can see how damaging this belief is and am consciously determined once and for all to get rid of it. Unhealthy beliefs are like weeds, if you do not constantly check them, they grow back and start taking over the garden.

Because the subconscious mind only responds to positive commands, I have written in large letters on my noticeboard "EARN MONEY".
I have to FACE THE FEAR and do it anyway. I accept my anxiety around the project is not real fear, I am not going to be killed by an unpainted wall. It is only anxiety. Yes I feel anxious, anxiety is not pleasant but it is only a feeling, an unpleasant mood and it will pass.

If you have a spider phobia and you want to live at peace in a world infested by spiders (the UK has over 600 different types of spider), you have to learn to ignore the anxiety and love spiders. Equally, to EARN MONEY, I have to learn to love the anxiety that goes with not doing a "proper job". There is nothing wrong with feeling frightened, but if you let it frighten you then it will paralyse you. The feeling is there, yet you do not need to indulge it.

~~~~~~~~~~~~~~~~

One evening an old Cherokee told his grandson about a battle that goes on inside people. He said, "My son, the battle is between two wolves" inside us all.

One is Evil. It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.

The other is Good. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith." The grandson thought about it for a minute and then asked his grandfather: "Which wolf wins?"

The old Cherokee simply replied, "The one you feed."

Spirituality and Bipolar disorder

2008-03-10T23:47:00.000-07:00

Many people have "spiritual experiences" with bipolar disorder. These experiences include feelings of being special, of people recognising who you are, of "knowing", of being different, of being the descendant of Jesus or other prophet. These spiritual experiences are delusions, regardless of how good and exciting they feel, and regardless of whether they resemble the description of biblical spiritual experiences, the bipolar experience of spirituality is not real. It is a delusion fuelled by adrenaline and noradrenaline that pours out of the sympathetic nervous system during a manic high of bipolar disorder.

True spiritual experiences come from the experience of a deep peace, certainty and calm. This calmness is a parasympathetic nervous system experience, not a race for the finish. False delusions of a manic high and true spiritual experiences are incompatible. It is not possible to experience the deep calm and peace of true spirituality at the same time as the delightful delusions of hypomania.

There are plenty of stories in the bible describing these delusions. The most famous is Jesus' forty days in the wilderness where he was tempted by demons. These demons were not necessarily nasty scary demons, - they were delightful tempting demons. No one is tempted by terror, well no one apart from a few House of Horror freaks. The temptation was in the feelings of power and specialness that these demons offered. "Demons" also "tempt" people with bipolar disorder and make you think you are special. "Those whom the Gods would destroy, they first make mad" Hanging onto hypomanic spiritual delusions that you developed when you were high, is true madness.

The key to sanity is in being ordinary. While you harbour the delusions of specialness that come from bipolar highs, you will be insane on the inside, regardless of how sanely you behave towards the outside world. If you are looking for a true spiritual path, the first step is accepting humility and ordinariness, that is accepting that are an ordinary human being. I have a couple of friends who insist of hanging on their "specialness", because they enjoy the feeling of power that comes from secretly believing they are a Messiah. Unfortunately, refusing to acknowledge that they are ordinary people means their belief system is "unstable" and consequently, they are both at risk of getting ill again.

Bipolar spiritual delusions are dangerous and deceiving. Delusions reflect a massive overactivity of the sympathetic nervous system which leaves a person in a high state of arousal which, not unsurprisingly, distorts their ability to think clearly. These beliefs make a person feel special but they are not backed up in the real world, even if they do result in an almost irresistably seductive feeling of power.

Sanity and saintliness are real and deeply connected. Saints are not mad. An adrenaline soaked vision of being "special" is not saintly, nor humble nor realistic. Only calm rationality leads to the true spirituality of people like Mother Theresa, Ghandi, or the Dalai Lama.

www.lizmiller.co.uk
www.moodmapping.com