I Still Have Bipolar Disorder

My bipolar life is a storybook success at present. I’ve just finished a period in which I received free job training and then a three-month paid internship, for which I was highly rated. I am actively involved in community theatre where I live, and I’m well-respected for it. I acted in a play recently, and now I’m directing another one that will hit the boards in November. Plus, I will be directing Shakespeare next summer, and that takes a year-long preparation. It’s a major undertaking. On top of it all, I’m writing and reading. I have dreams of a book with my name on it.

Last weekend, I went to see a play produced by the community theatre organization I work with. The play is a true smash hit. Eight of the nine performances have been totally sold out, and they are trying to figure out how to extend the run one more weekend.

My daughter and I arrived early to get good seats in the theatre. We took our programs and sat in the front row. I put on my reading glasses and buried my head in the very informative program made for the historical drama we were about to watch.

After reading the program, I put my glasses away and looked at the stage before us. Then I felt it. The theatre was nearly full, and the house manager was looking for empty seats for people waiting at the door. There was a crush of humanity around me. I didn’t have to turn around and look. I could feel them.

My stomach churned; my chest tightened. I began to squirm in my chair, and my thoughts began to race.

I was getting very near a panic attack, and I haven’t had one in ages. I thought of the Klonopin at home in my medicine chest. It was useless to me in my situation.

So, I thought of WRAP. I tried to remember what was on my Triggers Action Plan for just these situations. Crowds can cause me to panic, and they are listed as a trigger for me. Thankfully, WRAP does not stop with the knowledge of what hurts us, but we make an action plan for each item in case they arise. In the case of panic due to a crowd, I remembered to concentrate on slow breathing and to feel my body .

I took methodical breaths, and I placed my mind on exactly where my feet were and then how the chair felt and then the temperature in the room. I soothed my racing mind by giving it clear, concise things to think on.

My panic was not rising, but it was not easing either. Luckily, the play began, and the action whisked me away with its story.

I came away from the experience enriched. I survived a near panic attack.

I can see now that I have built strategies for dealing with triggers. For example, I hate large parking lots. I have an unreasonable fear of them. As a result, I learned many years ago to visualize driving into the parking lot, going down a certain row, and taking the first available space. It works for me. As a result, I am able to enter large parking lots without the unpleasant emotions.

My last post may have sounded smug. I was reminded that while things may be going well, I still have an illness. More importantly, I learned I have strategies to help today. They may not be foolproof, but they give me hope.

Life Couldn’t Be Better

My internship at my job is finished, and I am pleased to report it was a success for all involved. I received high marks on my final evaluation from my superiors at the clinic where I worked. One called me a gem. The other praised not only my ability working with a wide range of clients but also with my demeanor, too. She appreciated my work and me as a person. It was quite humbling.

I’ve gone from periods of isolation and severe depression to days of acting out improperly on all my urges. That was me not too long ago. I know mental illness. I live with it, and today, I can happily report it does not rule my life.

What changed? My medication regimen works, and I got into a job training program that gives me fulfillment. And WRAP happened. We worked our own WRAPs in the first 2 days of our job training, and my world turned over. That awful voice present for decades vanished. For me, WRAP is a miracle.

If you have mental illness and are interested in recovery, you can find a WRAP facilitator by clicking here.

In my final days of the internship, I finished working with the WRAP group and was able to hand out some Certificates of Achievement to the participants. It was quite rewarding. The smiles of all around were contagious, and the memory makes me smile now. The group came up with some great thoughts throughout the sessions. We continued with the section called “When Things Are Breaking Down” and its relevant Action Plan, and then we launched into the long Crisis Plan.

That section of WRAP is formidable. It gives the writer a chance to think deeply about how they want their care to be structured should they be in real crisis and need careful treatment by professionals. It includes pages for listing supporters and their roles and a place to write down names of people who should not be consulted for any help during a crisis. There are pages for listing doctors and other healthcare professionals and medications that one takes.

Desired treatment facilities and hospitals get their own pages, and finally there is a page for detailing when the Crisis Plan should be inactivated. After that, there is a whole section called the “Post Crisis Plan.” It is long and involved and many of the questions cannot be answered until one has been through the crisis.

The group was engaged and attentive and eager. They worked hard and earned their final certificates. I am glad to have been a part of their experience. It made me happy.

Once the work was finished and the internship was over, I spoke at length by phone with the head of the training I’d completed. He was complimentary, and then he dropped the bombshell. They are working on hiring me on a limited contractual basis to lead groups using various resources, until they can maneuver the state bureaucracy to hire me in a regular job.

They want me.

They like me.

I can’t begin to relate my joy knowing that I am a success. The voices in my head told me all my life I was worthless. I’m not. I have value. I had it all along. Now, I have found a place to help and to be a part of an organization whose goal is to help. I am the face of mental health recovery.

When Things Go Awry

I am teaching WRAP to a group. It’s my first time to facilitate a group instead of doing WRAP one-on-one with a client. We met for an hour last week to get started. I introduced myself, and we made a Comfort Contract for the class. A Comfort Contract is a group-directed list of guidelines to keep us all at ease talking to one another. I make these contracts with individual clients, too, but it’s vital for a group. Each member has to feel at ease.

We met again today, and we moved into the area of Triggers and a Trigger Action Plan. When a situation arises or an event occurs outside us that makes us feel particularly bad, it’s called a trigger. It may go so far as to worsen our symptoms. A very few examples of triggers include anniversary dates of losses or trauma, being overly tired, family friction, being judged or criticized, etc. The important thing to remember is that triggers are external to us.

In a WRAP class, we don’t stop at reminding us about the bad. We also gain power writing a Trigger Action Plan. An effective facilitator will reinforce this to the group. It’s easy to write a list of what makes us feel bad and have that snowball into actually experiencing the trigger. We take breaks, and we remember we are striving for recovery.

The Trigger Action Plan ideally contains some action to counter each triggering event or situation. Revisiting our Daily Maintenance List is high on the Action Plan. Are we doing everything we said that would keep us well? There are deep breathing exercises that anyone can learn to aid in getting through troubling emotions. Talking to a person we are close to is a valuable resource. Exercise cannot be underestimated in these situations either. The number of items on the Plan can go on and on.

The group went further today. We tackled the next section of WRAP, the Early Warning Signs and its accompanying E.W.S. Action Plan. While Triggers are external events that may cause us to feel bad, Early Warning Signs are internal. These signs indicate that all may not be well with us. Some examples are anxiety, forgetfulness, avoiding doing things on our Daily Maintenance List, increase in smoking, failing to buckle seat belt, etc.

The Early Warning Signs Action Plan is similar to the Trigger Action Plan. Each item relates to an Early Warning Sign. We may choose to meet anxiety with deep breathing or other relaxation exercises. Forgetfulness may cause us to renew our efforts at meditation. Avoiding doing things on our Daily Maintenance List is serious, and we may have to look deep and talk to a trusted friend about it. An increase in smoking may indicate a rise in stress, and we might decide to take extra rest and ask for assistance with responsibilities. Failing to buckle a seat belt is also serious, indicating a deeper issue that one might wish to bring up with a therapist or doctor.

Both Action Plans are important. They empower us. We don’t have to be hostage to our Triggers or to our emotions and their indicators.

It was at this point when things were winding down for the hour that something went awry for a participant. No sooner had I announced we were almost complete for the day, than she rushed from the room. Fortunately, this class took place at a center with lots of other people around, and one of the staff was soon by her side. She had not been feeling good since the morning, She bravely stated that her symptoms were worse. She was in distress, and the staff called an ambulance. I am sure she is now receiving the best care afforded by our local hospital.

I believe this incident illustrates why it is important to do WRAP with a certified facilitator and not alone. All people are vulnerable, and we with mental illness may have unique ones. A trained WRAP facilitator is often not a clinician but should have the experience to recognize a group member going off the beam, as it were.

WRAP’s Daily Maintenance List

Mary Ellen Copeland’s Wellness Recovery Action Plan (WRAP) has seven parts:

  • The Wellness Toolbox
  • The Daily Maintenance List
  • Triggers/Trigger Action Plan
  • Early Warning Signs/E.W.S. Action Plan
  • When Things Are Breaking Down and its Action Plan
  • Crisis Plan
  • Post Crisis Plan

All sections of an individual’s WRAP are vital, and the Daily Maintenance List may be the most important. It is referred to often in the action plans that accompany the other sections. When we experience a Trigger or feel an Early Warning Sign, we are reminded to check our Daily Maintenance List for ways to return to a calmer frame of mind.

A Daily Maintenance List has three parts. First is “what I’m like when I’m well.” This part allows us to recognize we have times of stability and good mental health. It gives us the opportunity to feel good about us. We are encouraged to list our strengths, such as cheerful, bright, energetic, introverted, talkative, etc. These words become part of our WRAP’s foundation, reminding us that we can be well. It’s a great way to feel better about us, and that’s no easy task on some dark days.

“Things I do for myself daily” is the second part of the Daily Maintenance List. In this part, we are encouraged to write down actions we perform everyday to remain stable and healthy. Here, we can list activities such as the small pieces of personal hygiene, like brushing our teeth or showering. Taking our medication as prescribed might be an important part of this list. Other daily necessities might include meditation, exercise, drinking plenty of water, chatting with friends, etc. The important point here is to keep the items specific and relevant to daily life. This section needs to be read once a day. Doing the things written here will help stave off feeling poorly.

The final part of the Daily Maintenance List is “things I might do for myself daily.” In this section, we are encouraged to jot down things that aren’t absolutely necessary but may be important. The list might be made up of some of the following: make an appointment with a caregiver, call a relative, clean a part of my house, etc. These extras are important, but they might not have to be done daily to maintain stability and calmness.

Why is having a thorough Daily Maintenance List important? I believe it grounds us. It gives us a center to attempt completing every day to stay well. It’s that simple and that complex.

Staying well is not easy for us with mental illness. We need all the tools we can get, and the Daily Maintenance List in one’s WRAP is an excellent beginning.

Completing a Wellness Recovery Action Plan can be a truly life-changing experience. It changed mine for the better. Here’s a word of caution, however. It is not to be taken lightly, and it is strongly suggested that all of us seek out a knowledgeable WRAP facilitator to complete the Plan individually or in a group setting. Writing WRAP can bring up negative emotions and memories, and having a calm trained guide there to ease one through these painful moments is key.

There is much more information about WRAP on Mary Ellen Copeland’s superb website.

My Schpiel

New clients view me with a mixture of distrust and curiosity. I am usually introduced to them by a case worker who gives little information about me or about what I do. Initially, I am seen as part of the system.

I have to break through any figurative walls quickly and carefully to reach a level playing field where I can teach the skills I’ve learned. Passing along what has helped me is my whole reason for working. Giving the tools that help me stay well and not relapse into crisis is what being a Certified Peer Specialist is all about. It’s my job.

In training, I was coached on how to introduce myself. I was given the Five Key Concepts and directed to use them when I meet a new client or group. Those concepts are

  • Hope
  • Personal Responsibility
  • Education
  • Self-Advocacy
  • Support

My introductory pitch to a new person is important. It will determine how we are going to interact. Once the mood is set, it is difficult to change it. I have to be vigilant in my own recovery and follow my own WRAP daily to be ready for these precious meetings. They are precious. Each meeting and each session and each client is a gift to my recovery. I heal freely sharing what I was taught.

My schpiel or pitch is conducted completely using “I” statements. It’s my story. It’s never exactly the same, but it meanders along an outline something like what follows:

When I was diagnosed with a mental illness 12 years ago, I was devastated. I felt like I’d hit a brick wall with no possibility of going around or over it. I lost my job, the respect of my family and many friends, and my self-respect. I felt utterly worthless. My life as it had been was over, and I felt damaged. What’s worse was I felt abandoned by society as a whole. I was an outcast.

I had many dark times. There were days when I had no energy to get out of bed except for the most rudimentary needs. There was a time I wouldn’t leave my apartment for days. I despaired that things would never improve.

I had no hope. Darkness swallowed me.

Luck put a group of loving friends in my life. They listened to my complaints and distracted me with silly card games and other activities. They dragged me into the sunshine when all I wanted was to stay locked behind my door. I also had a kind prescribing psychiatric nurse practitioners and at other times good psychiatrists. I have been extremely lucky to be in therapy with a highly regarded psychologist. All these people gave me a few tools to get through each day.

They showed me that hope was possible. Trying different combinations of medicine gave me ideas that I could improve. Getting out to socialize even in simple settings like the coffee shop was a labor for me, but I did it regardless of my internal desires. I began to exercise. I clung to my friends. I renewed my interest in meditation or guided visualization. I began to see how taking care of my most basic needs was an act of self-love.

Hope rekindled in me. It was slow, and over the course of years, I realized that I had a stake in making me feel better. I was miserable, and I wanted not to be. Those little daily tasks like taking my medicine, socializing, exercising, and meditating became a mantra of sorts. I saw that I had to take some responsibility if I wanted to feel good.

I also had a lot to learn. I was fortunate growing up to have an older sister who worked in the mental health field. I knew a lot about the importance of taking medicine each day. I heard about her experiences with patients, and I knew I did not want to be sick. I wanted good mental health, and I had to educate myself on my illness. Living with the Internet, this process was much easier than just a few years ago. I had a wealth of information at my fingertips, and I used it.

I began using the new information I’d gleaned from the Internet and books and sundry other resources to talk to my healthcare providers about my treatment. I became an active participant. Looking my psychiatrist in the face and stating plainly that I wanted help with a particular problem altered my life. I was a force in my own decision making. I was not a pawn of any system.

Finally, I permitted myself to have a group of supporters who have my best needs at heart. Today, I have an excellent prescribing nurse practitioner, and we work closely together on my medication needs and talk openly about events in my life. I have a top-notch therapist that I’ve known for over twenty years. I have a case worker who is one of my greatest cheerleaders. I have loving children. I have friends who truly love and support me in my endeavors.

I have a new lease on life.

The above is a broad example of my schpiel or introduction. It’s tailored for each setting and each new client, but it’s my joyous responsibility to follow the Five Key Concepts and model them in my life.

If there is anything I would like to emphasize it is regaining hope. Without it, I was lost. I cannot say enough how thrilled I am to do the work I do, to live the life I have, and to practice my own recovery. Today, I am hope-full.

A Wide-Ranging Session

One client during my internship has grown into a really interesting case. Readers will remember him as the combative one. He has returned several times since that appointment, and his attitude has always been good. He enjoys lively conversation, but he’s never returned to the highly argumentative tone.

Today, he arrived and sat down and informed me he’d almost taken the bus to a town about two hours away. Taking this trip is his way of saying he wants to kill himself. He’s taken the trip many times in the past decade, but he’s thankfully never followed through. His routine there is always the same. He drinks rum on the bus ride and then continues to drink the first day there. He also smokes cigars that first day. He sleeps outdoors and awakens with the intention of killing himself the second day. Instead, he takes the two-hour bus ride back to the care home where he has a bed.

I knew about this habit of his, and I’ve known about his chronic suicidality since I first met him. My response to him this morning was to thank him for telling me about his plans. Then I said that I was glad he hadn’t gone on the trip, because it would have left me without a client and I would have been bored.

He quickly said, “That’s not a good enough reason for me not to go.”

I responded that I completely understood, but that I still didn’t want to be bored. He was really interested in my seemingly nonchalant answer.

My real answer was to then launch into continuing to fill out his WRAP folder. We approached the section entitled Crisis Plan, which requires a lot of writing by the client. They have to think thoroughly about how they want their care to be conducted in case they fall into crisis. My client mentioned simply that he didn’t want to do it. I agreed that we should stop since I’ve been trained that WRAP is self-directed. He did say he wasn’t ready to completely give up on the Plan. He wants a hook. He’s looking for something that will give him a lease on life.

I told him again of my own WRAP and how it changed my life. I went from having chronic negative self-talk to none. I talked about the dark times I’d seen, and I called them that: the dark times. I kept it general. Using “I” statements, I mentioned that since writing my WRAP, I had not relapsed into dark times, and I had not required a stay in the hospital. My WRAP has kept them at bay.

His reaction was to announce that dark times are the natural state of mankind, and they shouldn’t be fought. I thank him for telling me his ideas, and then I surprised him. I agreed with him. Dark times may be the natural state for many, but I don’t have to stay stuck there. I was careful to mention that I was speaking for me.

This client has a set of interesting ideas that he regularly says for all to hear. “Man is a primate.” “Man is alienated from life.” “Life is meaningless.” “God is dead.”

I surprised him again today. I agreed with him once more. I told him I thought it was indeed difficult for people to find an ultimate meaning in life. He smiled and said he had nothing to say in response. I continued with my story and how important WRAP was to helping me out of the dark times and into a state of serenity. That piqued his interest. I explained how the Daily Maintenance List kept me on an even keel so I wouldn’t fall back into a crisis.

“The whole meaning of WRAP is to keep us out of crisis,” I said.

He looked at me quizzically and muttered something about the meaninglessness of life.

I answered him by describing the meaning I find in a string of small things. I love my job. I love my family. I enjoy reading and writing for myself and others to read. Finally, I have a passion for theater. While I reserved my speech to “I” statements, I tried to steer the conversation to his enjoyments. He loves classical music and speaks about it with fervor.

Then I mentioned the word “pleasure,” and we started a tangential discussion of how a meaningless life could or couldn’t possibly have any. The talk was fascinating. We spoke about hedonism, and yes, we used that word. He’s a smart man and has read a good deal of philosophy. I threw Epicurus into the mix, and he was impressed when I mentioned that Epicurus was a champion of the middle path rather than what Epicurean philosophy has come to represent, namely hedonism. My client said he preferred a more stoical way.

We ended our time together with a talk about Shakespeare’s sonnets and specifically, the unknown lady mentioned therein. My client called Mozart and Beethoven eternal, and I said the lady of the sonnets was, too. Shakespeare even tells the lady she will be eternal in his words. My client appreciates the beauty of those words. He was surprised at me again that I seemed so enthusiastic about the Bard. For our session next week, I’m going to take a few of the sonnets for us to study, I think.

It was indeed a great session. I am blessed to know this man. He touches me with his candor. He honestly appears to be searching for something that he can’t or is afraid to grasp. I’m not so presumptuous to imagine I will help him find it, but I truly hope I can demonstrate that reaching out doesn’t have to be painful. A desire can sometimes lead to pleasant surprises.

Work and Life Continue

Work and life go hand in hand. Humans are constantly engaged in something. Simple activities like watching television keep us occupied. Harder ones require more energy to perform. Humans do things; we don’t simply exist.

I’m thrilled to say that two months of my three-month internship are winding down. I have spent a great deal of time teaching the Wellness Recovery Action Plan (WRAP), and it has reinforced to me its value. I had a disappointing romantic experience recently, and negative thoughts started barreling inside my head. I talked it over thoroughly with a close friend. I checked my WRAP. I forced myself to accomplish some tasks around my house that I didn’t want to do. In the end, the thoughts subsided, and I felt calm.

The client I mentioned previously who had a combative session with me keeps returning to his appointments. I am really happy about that. He’s finding some value in our time and work together. He’s reaching out. I would like to think he’s expanding his ideas of what might work in his own life. He still likes to debate, but the combative tone was limited to the one time only.

I continually mention to all my clients that I’m a person with a mental illness, too. I’m not a doctor or any other kind of clinician.

Recently, I drove thirty minutes to a rural clinic to meet with a young man and do WRAP with him. He entered the room and sat stiffly with his arms crossed tightly guarding his chest. He was uncomfortable. I have to add I was just as nervous.

Why? Traveling gives me anxiety. Driving worries me. I have a real phobia of parking lots. The morning of my thirty-minute trip, I was simply scared. I spoke long and honestly about my fears to a close friend, and she asked what my WRAP would have me do? I thought about the Daily Maintenance List in the front of my WRAP, and I determined that I had not meditated that morning or for many days actually.

I went to my room and moved my meditation stool into the place I like. I sat and closed my eyes and concentrated on getting to my happy place. There I released my worry. I breathed deeply and calmly. It was not a long time nor did I reach any epiphanies, but I came out of the meditation with my spirits restored. It worked. I felt better.

My job at the rural clinic was to teach WRAP to this one young man who was obviously as fearful as I had been earlier. I did not let his emotions distract me. I launched into my opening introduction about me and the Plan. His arms dropped, and his face relaxed. When he knew I was there for his benefit without an agenda, he became an eager participant. Lo and behold, we finished his WRAP in one sitting. It was amazing and energized me. His case worker was similarly astounded.

I have finished Plans with three individuals now. One woman was so grateful to get her Certificate of Achievement after finishing she nearly cried. It was the only such certificate she had ever received. It is a privilege for me to work with these peers. I grow, too.

I have only about one more month before my internship is finished, and then I will be a fully certified Peer Specialist. My life is utterly different than three years ago when I wrote about my pain. I am working, and I’m happy about that. What a change!

Recovery works. It really works.