Portfolio of Hope

1. What is bipolar disorder?

Bipolar disorder, previously known as ‘manic depression’, is a mental health condition that affects your moods, which can swing from one extreme to another (https://www.nhs.uk/mental-health/conditions/bipolar-disorder/overview/.)

2. What are the possible causes of bipolar disorder?

Like all mental illnesses, bipolar disorder does not have one cause, but rather several factors that can trigger the condition to arise in someone. These factors include external factors, such as extreme stress, overwhelming problems (e.g., money, work, or relationships), and life-changing events (e.g., the breakdown of a relationship, abuse, or bereavement), as well as internal factors that are pre-determined, an example being someone’s genetics and/or chemicals in their brain.

3. What feelings might an individual experiencing bipolar disorder have?

During manic episodes of bipolar, many people living with the condition report feeling ‘on top of the world’, stating that they would like to stay feeling this way ‘forever.’ Filled with energy and optimism, a manic episode causes many people to feel extremely productive. It is a period in which they can get everything on their to do list done and more. Because they are filled with so much energy, they expend this excess energy on talking, dominating conversations, feeling a heightened sense of confidence and self-worth as a result.

In contrast, during depressive episodes of bipolar, people become very pessimistic as they are filled with an unwavering sense of hopelessness. Many people with bipolar say that ‘without the highs of mania, they wouldn’t be able to tolerate the lows of depression.’ However, crashing from such a high place to such a low place so rapidly can be extremely difficult. Gone are the feelings of wanting to do everything, instead productivity is replaced with emptiness, worthlessness, and a deep feeling of inadequacy. People no longer feel compelled to dominate conversations, they are compelled to do the opposite- wanting to distance themselves from everyone and everything.

4. How does bipolar disorder affect those diagnosed and their lives?

Bipolar disorder can have a profound impact on every area of someone’s life. One such area is relationships. People living with bipolar disorder often find it incredibly difficult to maintain friendships and relationships, whether that be in a personal sense (between partners/friends/family members), or in a work setting (between colleagues/employers), due to the complex nature of their illness. The two extremes of mood that someone with bipolar disorder experiences means that any relationship they have will be largely unstable because their mood can change so quickly. As such, people with bipolar disorder might forgo social events, making excuses as to why they are ‘unable to attend.’ Unsurprisingly, arguments and conflict are therefore all too common features found within the relationships of people living with bipolar disorder. In the context of work, this can result in long-term unemployment if the individual is considered to be ‘unreliable’, when in fact they are struggling with a mental illness.

Another way in which bipolar disorder can impact the lives of those diagnosed is due to the fact that people with the condition have a high probability of developing additional mental health problems in the future. This is because the symptoms of bipolar disorder combined with the stigma associated with it, has a significant toll on people’s emotional health. To ‘block out’ the intense feelings that they would rather not be subjected to, people with bipolar disorder might turn to addiction, drinking excessive alcohol and/or taking drugs. Other addictions, though lesser known, include shopping and exercise. Becoming addicted to an unhealthy source would have an even greater negative impact on the lives of people living with bipolar disorder. Rather than ‘blocking out’ the negative feelings, they would in fact be intensified.

As bipolar disorder can affect the sleep of those diagnosed, people with the condition might develop insomnia. Getting very little sleep, a consequence of insomnia, would have a detrimental effect on their, already faltering, concentration, making the completion of everyday tasks a struggle.

5. How might an individuals bipolar disorder affect others?

Bipolar disorder is not dissimilar to any other mental illness in that it does not just affect the individual with the diagnosis, but their family and friends as well.

The family and friends of someone living with bipolar might blame themselves for the fact that their loved one has developed the disorder. Though nonsensical to anyone ‘outside looking in’, the blame would feel very real to them. It would likely cause them to experience intense feelings of emotional distress as they would be plagued with a sense of guilt, grief, and worry. This can lead them to develop mental health problems of their own, potentially even resulting in them engaging in substance misuse, particularly if the negative emotions become ‘too much to handle.’

Furthermore, the fact that bipolar disorder is a mental illness means that no matter how keen the family and friends of someone with bipolar is to understand what their loved one is going through, they cannot go inside their loved one’s head, and therefore they will never know the full extent of their struggles. This might lead them to experience feelings of powerlessness, as they want to help but have no idea how they can do so. Again, this would contribute to the decline in their own mental health. It could even lead to physical health problems developing as a direct result of stress.

A final way in which bipolar disorder can affect others, is by putting a strain on relationships. This can make maintaining said relationships a challenge, and could, in extreme circumstances, lead to divorce, job loss, or the breakdown of friendships if the tension becomes ‘too much.’ Not only would this affect the individual with bipolar, as they will have essentially lost a loved one, but it would also affect the loved one in question, who might feel as though they have ‘failed’ them.

6. What demands of daily life might influence symptoms of bipolar disorder?

Bipolar disorder can be triggered by certain lifestyle and environmental factors that occur in our daily life.

One major demand of daily life that can have a profound influence on one developing symptoms of bipolar disorder, is work. In today’s society where we are obsessed with productivity, many of us are ‘burning ourselves into the ground’ trying to work longer hours to achieve financial security so that we can support ourselves and our families. This can cause stress as everything feels overwhelming, hence why it can lead to some people developing bipolar disorder.

Our quest to ‘do more’ means that many of us suffer from reduced sleeping hours, as we sacrifice sleep to do more work. 

Combined with the reduced hours we are sleeping, our quest for doing more therefore not only results in stress, but also worsens the symptoms of bipolar disorder, triggering the occurrence of intense mood swings.

After a long day at work, it has become accepted and normalised that people go home to have a glass of wine, or two. It is sold under the guise of helping us all to ‘relax’ when it in fact does the opposite. The consumption of addictive substances, whether that be drugs, alcohol or even caffeine, all causes the mood swings in people with bipolar disorder to intensify.

7. How might these demands (as identified above) influence symptoms of bipolar disorder?

Spending increased hours working and reduced hours relaxing contributes to feelings of stress, a major trigger for symptoms of bipolar disorder. People might feel torn between wanting to do less to reduce their feelings of stress, whilst at the same time, feeling compelled to do more to increase their sense of financial security because, ultimately, it is their sense of financial insecurity that is their main source of stress.

Using drugs and/or alcohol to ‘unwind’ after a hard day has become a largely normalised, expected even, thing to do in today’s society. The issue with this, however, is that substance use can, and does, cause symptoms attributed to bipolar disorder, including agitation, anxiety, and paranoia, to worsen.

Caffeine, though considered to be less harmful than drugs and alcohol, is in fact one of the biggest triggers of manic episodes in individuals with bipolar disorder. It is therefore unsurprising that the symptoms of bipolar disorder are worsening when we consider the fact that more of us than ever are drinking excessive amounts of coffee, using it as an unhealthy substitute for water.

The demands of our hectic working life in which we feel under pressure to be constantly achieving more and constantly ‘bettering’ ourselves means that we sacrifice our mental health. It is for this reason, the fact that we are overworking ourselves, that symptoms of bipolar disorder are on the rise.

8. What symptoms may occur in a manic and depressive episode?

Manic symptoms:

A manic episode is characterised by the experience of extreme highs, with many people reporting to feel very happy, elated or overjoyed when they are having such an episode.

They are likely to feel ‘full of energy’, portraying this by talking very quickly as they may feel ‘full of great new ideas’ and ‘important plans.’ This can lead to people experiencing a sense of self-importance, whereby they may be prone to making decisions or saying things that are perhaps out of character for them.

The sudden burst of energy many people have when going through a manic episode can make seemingly simple things such as sleeping and eating difficult, as their brain is likely to be distracted by all the thoughts and new ideas they have going round in their head.

The result of a lack of sleep and poor diet often leads to many people who are in a manic episode becoming easily irritated/agitated, and in extreme cases, it can even lead to one experiencing hallucinations, or being delusional, showing signs of disturbed/illogical thinking. This means that rash decisions are at risk of being made, with people reportedly being tempted to do things that often have disastrous consequences, one example being spending large sums of money that is not really ‘there’ to be spent.

These symptoms associated with mania can last up to 6 months, therefore it is essential that help and support is sought immediately in order to give people the best chance of recovery.

Depressive symptoms:

A depressive episode is the exact opposite of a manic episode, this time being characterised, not by feelings of extreme highs, but of extreme lows.

As is the case with clinical depression, someone going through a depressive episode is likely to feel very sad, hopeless and/or irritable most of the time. They are likely to lose interest in the things they previously enjoyed doing, which often leads to feelings of emptiness or worthlessness arising.

The persistent feelings of sadness that someone in a depressive episode experiences means that they feel largely pessimistic, about everything. Such negative feelings can lead to people in this situation having suicidal thoughts which, can in turn, affect their sleep, appetite, thinking, and energy levels. People might also experience delusions and hallucinations during an episode of this nature.  

The symptoms associated with depression, as described above, typically last somewhere between 6-12 months, though with adequate help and support in the form of professional treatment, episodes usually improve in an average of 3 months. Therefore, it is so important that professional help is sought as soon as possible, ideally as soon as the symptoms are identified.

9. What are some examples of medical intervention for bipolar disorder?

Many people with bipolar disorder will be offered mood stabilisers (anticonvulsant or antipsychotic medicines), medication that is prescribed in tablet form, to help individuals with bipolar to manage their illness in a safe and controlled way. Such medication works to prevent episodes of mania and depression, and they are to be taken every day, on a long-term basis. The most widely used medication for bipolar disorder in the UK is Lithium, which is used to treat episodes of both mania and depression.

Aside from being prescribed tablets to manage the symptoms associated with bipolar disorder, most people with the condition are also encouraged to sign up to some form of talking therapy, with CBT being the recommended course to go down. Psychological treatment such as this allows one to explain how they are feeling to someone who will listen and whom they can trust. Therapy also allows people to gain advice regarding how they can better cope with their illness in productive rather than destructive ways.

Typically consisting of around 16 sessions over a 6–9-month period, with each session being an hour long, CBT is an effective way to treat bipolar disorder, however, it is not the only way. Family therapy and psychoeducation are also recommended for anyone showing symptoms of bipolar disorder.

10. How can someone with bipolar disorder help to manage their illness when entering a manic and depressive episode?

It is important for people living with bipolar disorder to be able to recognise their own early warning signs which suggest that an episode, whether that be manic or depressive, is ‘on the horizon.’ If any of these early warning signs are identified; needing less sleep, being more active, feeling unusually happy, making unrealistic plans, being easily distracted, or becoming more talkative, then it is appropriate to expect a manic episode.

To avoid manic and depressive episodes, or at least, manage them to reduce their severity, people must ensure that they are getting an adequate amount of sleep every night (7-9 hours.) People should stick to a stable sleep pattern whereby they go to bed at the same time every night and get up at the same time every morning. ‘What is the benefit of doing this?’, you may wonder. Well, as sleep is known to have an influence over chemicals in the brain, by ensuring that they get enough of it, the symptoms of bipolar are more likely to remain dormant. People should also stick to a routine in other areas of their life, including their diet and exercise.

Another way in which one can manage their bipolar disorder is by setting realistic goals. A major indicator of a manic episode is the setting of farfetched goals and the creation of ‘wild plans.’ By ensuring that any goals that are set are achievable and realistic ones, a trigger that could potentially cause a manic episode, is removed. People will not feel disappointed and frustrated for not reaching their goals, they will instead feel empowered with the knowledge that setbacks are to be expected, but they do not define who we are.

To manage bipolar disorder, people should distance themselves from addictive substances, such as drugs and alcohol. It is not uncommon for people with bipolar disorder to turn to substance misuse as a form of ‘escapism’, but the fact is that it does not really allow one to escape, it simply intensifies their problem(s) in the long run. By staying away from such substances, people will not be at risk of developing further mental health problems that would in turn worsen the symptoms of their bipolar disorder.

It can also be incredibly useful to keep a mood diary so that mood swings can be easily identified, therefore suggesting when an episode is due. Knowing when to expect either a manic or a depressive episode means that people can prepare in advance, ensuring that they have their coping mechanisms ‘on hand’ to get them through the episode, and giving them an opportunity to make their loved ones aware.

11. How can others help an individual with bipolar disorder to manage their illness?

You do not have to be a therapist to help someone with bipolar disorder to manage their illness, for the simple things that most of us do anyway, can be of enormous help to individuals living with bipolar disorder. Small actions such as being patient and showing love and understanding can go such a long way in helping people with bipolar feel less alone, and like less of a burden. By showing that you are there with a shoulder to cry on and ears to listen, you will unknowingly be making all the difference, prompting them to take positive steps towards recovery.

In order to really have a level of understanding regarding what bipolar disorder is and how it feels to live with it, people should educate themselves about the condition, using the internet to research everything they can about the symptoms and treatment options. This will equip you with greater knowledge that you can present to your loved one when you recommend a next course of action.

An open dialogue should also be encouraged, whereby the individual with bipolar disorder is prompted to communicate about how they are feeling. By knowing the early warning signs that may, for example, suggest that a relapse is imminent, they can be there to support their loved one in their time of need. This may include doing more around the house or reducing their workload, to remove stress at home and at work.

12. What are some local resources and treatments available to people experiencing bipolar disorder?

Local Resources:

• ‘The Social Inclusion Team’ is a subgroup within RDASH (Doncaster and the surrounding areas community mental health service.) Specialising in helping people who are either experiencing or recovering from bipolar disorder or psychosis, the team consists of nurses, doctors, social workers, support workers, psychological therapists, and occupational therapists, all of whom work together to offer referrals the help and support they need. A care plan tailored to everyone’s needs is created in the early stages of one contacting the social inclusion team. This plan will ultimately help people to manage their bipolar disorder as they embark on their journey to recovery. A care plan typically includes the following things: education and information on bipolar disorder, family/carer/significant other support, details of community groups, support with housing and finances, and education/training/employment/voluntary opportunities, support with increasing motivation and structuring every day, and support to develop a plan to cope with setbacks and staying well (relapse prevention strategy.)

• ‘Rethink Mental Illness’ is a national charity with several branches across the UK. The free 24/7 helpline offers emotional support and information to anyone over the age of 16 who is affected by mental illness living in Doncaster. Not only do Rethink provide support to people at a time when they are struggling, they also help individuals by ‘signposting’ them to additional sources of information and/or services that may be of help.

Treatment:

• ‘Doncaster IAPT’ is a mental health service made up of wellbeing practitioners, cognitive behavioural therapists, and counsellors. They provide everyone over the age of 18 who have been diagnosed with a mental illness in Doncaster, with an opportunity to access a range of different talking therapies on the NHS. CBT is the most widely used type of therapy accessed by people with bipolar disorder, as it is proven to help with depression, therefore reducing the intensity of subsequent depressive episodes that may arise.

• Psychiatric Medication is often advised to be considered for people with bipolar disorder, with one type of the medication being antipsychotics. Antipsychotics reduce the symptoms of psychosis and severe anxiety, two symptoms that one may experience in a manic episode. The most prescribed medication for bipolar disorder, however, is lithium. Lithium is a mood stabilising drug; therefore, it is well equipped to help manage the extreme highs and lows that someone with bipolar disorder will experience in both manic and depressive episodes. Medication is rarely taken on its own, instead being offered alongside talking therapy such as CBT. This is because bipolar disorder is known to have several different potential causes, some of which are biological factors such as one’s brain chemicals, and others which are social factors that therapy can investigate. A combination of both psychological therapy and psychiatric medication will therefore be the most effective route to go down when deciding how to treat individuals presenting with the mixed symptoms of bipolar disorder.