This article is excerpted from chapter 3, “The Way to Wellness: Treatments, Therapies, and Vigilance,” of our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder.
Getting Well and Staying Well
In the last chapter [The Illness Experience: Understanding Your Friend’s Diagnosis and Symptoms] we explored the symptoms Fran lives with day-to-day. Let’s turn now to how she limits their impact, so as to live as fully and richly as possible. We discuss only medications, therapies, and other treatments Fran has used personally. These may not be directly relevant to your friend’s situation. As Fran expresses it, “What works for me may not work for you, and vice versa. We need to find our own ways and make peace with them.”
It is also important to note that no strategy works forever. What we report as having worked for Fran in the past may not do so in the future. In the realm of chronic illness, wellness is a dynamic experience. We hope, nevertheless, to convey two important messages. The first is that there is no magic fix. Complex conditions such as bipolar disorder are likely to require multidisciplinary approaches including medication, therapies, and behavioural strategies. The second message is that it takes formidable commitment to stay as well as possible. It is not unreasonable to hope for dramatic improvements, but they can be a long time arriving, and may not last as long as you and your friend would hope. If so, it is not your friend’s fault — nor is it yours.
The Nature of Wellness
We all want the best for the people we care about. If they are ill or hurting, we want them to get better. But for someone with chronic illness “getting better” is not like waiting for a broken arm to mend or an infection to clear. Wellness can never be taken for granted. It is neither a prize to be won nor a place of safety to be reached. It is more like a skill that can be developed, practiced, and refined. Medication has a role to play, but there is a lot more to it than remembering to take your tablets.
For me the basics of wellness are nutrition, exercise, sleep, and hygiene. Those are non-negotiable. I start wherever I am and make the tiniest of shifts and changes, whatever I can handle at the time. It’s as if your body/mind is a spaceship and you are creating the owner’s manual. You are the only one who gets to make those choices. You can then share this manual with others who can support you in your process.
Acceptance is critical. It was only when I came to utterly accept my illnesses and myself, stopped desperately looking for fixes, and realized that there was nothing outside myself that would save me that my life began. I started being truly responsible and caring for myself.
There have been many things that have helped me and many things that have hurt me. I have also significantly hurt myself by my own thinking and actions. I learned that I could change that. I may not be able to be cured but I can stop making things worse. That was a revelation. I started being responsible for whatever I could, instead of blaming everything and everyone else for my problems: the doctor, the meds, friends, other people. I started owning my life.
Clinical Compliance
Also called adherence, compliance describes how closely a patient follows (is compliant with) medical advice. It can be tempting to stop taking medication if it causes unpleasant side effects, if it seems not to be working, or once symptoms have eased. It often takes time, however, for drugs to take effect, and it may be necessary to try several different treatments, individually or in combination, until a balance is found between the positive benefits and unwanted side effects.
It is rare for Fran to miss a dose, and she consults with her doctor before stopping a course of medication or starting something new. When traveling, or if her routine is otherwise likely to be disturbed, she asks me to remind her to take her tablets on time. There is also a social aspect to compliance. People sometimes see unstable behaviour and incorrectly assume the person has stopped doing all he or she can to stay as well as possible. This happened to Fran and it hurt her deeply.
[Many people] were mad at me for apparently going off my meds during what was the most excruciating manic experience I have ever had. I can understand how people might think that, especially if they do not have experience of friends or family with mental illness, but it simply was not true. I have been on many different medications over the years, and have always been completely compliant in taking them.
The truth is that no meds are perfect, and what I was taking simply stopped working for me. I saw my psychiatrist on a weekly basis, and kept all my other appointments. When my medication was changed by my psychiatrist my mania came back under control, though it was very difficult dealing with the transition and side effects, and the deep suicidal depression which came afterwards.
Bear this in mind if you are concerned that your friend might have stopped taking their medication, or accidentally missed a dose or two. There is a big difference between gently asking what is going on, and accusing your friend of careless or unhealthy behaviour.
Photo by Allef Vinicius on Unsplash.
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