Safety, Responsibility, and Trust: Thoughts Inspired by a Drive with a Friend

I took a drive with a friend the other day. It was the first time I’d been in a private car in over a year and the first time my friend had driven me anywhere. She has yet to pass her driving test and I was there to supervise so she could gain additional practice. We had a great time and I felt completely at ease in the car with her. Thinking about it afterwards, it occurred to me how important safety, trust, and responsibility are in our lives.

Trust and Physical Safety

I was supervising but I was very much in my friend’s hands. I trusted her driving ability and sense of responsibility. If she felt confident behind the wheel, that was good enough for me. No matter how experienced we may be, every driver understands what’s at stake when we start the engine and pull out into traffic. We are responsible not only for our own safety but that of our passengers, other road users, and pedestrians. Many of us drive so frequently we take this for granted but it’s worth reminding ourselves every now and then.

We stopped for lunch, which raised further questions of safety and trust; this time from a covid perspective. Back in March as England began to emerge from lockdown I shared my fears that things would never be the same as in pre-covid days. A few months later, I was struggling mentally, in part because it seemed I had little or nothing to look forward to. I’ve taken a number of steps forward since then. I’ve met with friends a few times, including an urban ramble around Newcastle. I’ve revisited some of my favourite places and spent a day in Edinburgh.

Nevertheless, as we entered the restaurant I felt on edge. Was it covid-safe? Were the tables far enough apart? Were customers and staff wearing masks? Now that rules have been eased, safety is much more a question of responsibility and trust. My friend and I are fully vaccinated. We felt safe in the car without masks but kept the windows open. We wore our masks inside the pub until we found a table, and when ordering at the bar. The place was fairly busy but the tables weren’t too close together and we felt safe. Had we not, we would have gone elsewhere.

Later that day I called into one of my favourite bars. I expected it to be busy but it was literally heaving with people. I used to love the atmosphere but on this occasion, I was uneasy. It may not have been unsafe, but it felt so. I trusted my instinct and came away.

Safety and Challenge

There’s a flip side to all this talk of safety. Many of us deliberately put ourselves in situations where we are — or feel — unsafe or in danger. Whether it’s scary movies, roller coasters, extreme sports, or pursuits like mountaineering or skydiving, we challenge ourselves for kicks or personal growth.

Fran told me recently of a time she was on a wilderness trail and felt unsafe navigating the rocky terrain. It reminded me of the time in the early 1980s when a university friend and I ascended Snowdon, Wales’ highest mountain. Our route included Crib Goch which I’ve since learned is “an adrenaline-fuelled gut-wrenching scary arête [...] not to be undertaken lightly.” My friend was a seasoned hiker and I’d trusted him to choose our route, but I was out of my depth as we picked our way along the ridge, with mist filling the valley on one side and on the other, a clear drop to the rocks below. I’ve never felt as unsafe as I did that day.

A few years ago I did two zip wire slides for charity from Newcastle’s Tyne Bridge. Friends praised my bravery, but in truth, I felt perfectly safe. I trusted the event organisers to know what they were doing and I trusted the safety equipment and procedures. It was scary, but it was safe-scary. Challenges help us expand our horizons, as long as we choose them wisely.

Feeling Safe to Be Ourselves

Another important safety is feeling we can be open and honest without being judged or rejected. This requires trust, in other people and in ourselves, but also the responsibility not to share indiscriminately. As Brené Brown puts it in her book Daring Greatly, “Oversharing is not vulnerability. In fact, it often results in disconnection, distrust, and disengagement.” You can read more about vulnerability vs. oversharing in this excellent article by Hannah Braime.

Our ability to share appropriately can be compromised by illness. Fran experienced this during a period of mania, as we describe in our book High Tide, Low Tide:

In the grip of mania, Fran clamoured for attention, and pushed her ideas at people whether they wanted to listen or not. She was capable of presenting herself with stunning clarity, but at other times her thoughts could be hard to follow. Such behaviour disturbs, worries, and alienates people. Some approached Fran with kindness, but from others there was mistrust and misunderstanding.

I’m fortunate to have friends with whom I feel completely safe, and trust implicitly. I wrote about some of these recently in a post I titled Team Marty because that’s how it feels to have them on my side.

Safety and Trust in Professionals

We have a responsibility to look after ourselves, but our health also depends on our doctors and other professionals. Trust is essential. If we trust the people involved in our care we’re more likely to follow their guidance. That doesn’t mean we should accept things naively or uncritically. As in any profession, mistakes can and do happen and need to be challenged.

When we met in 2011, Fran’s mania was poorly controlled by her prescribed medication. No one was necessarily to blame. Symptoms of bipolar disorder are prone to change over time, requiring adjustments in treatment. Despite all she’s been through, Fran has never lost trust in her clinicians. This is nowhere better expressed than in the open letter she wrote to her psychiatrist when he retired.

Not everyone’s had a positive experience with the medical profession, of course. Chris Good shared his experience with us in a guest post titled Twenty-Plus Years of Misdiagnosis and Incorrect Treatment. Another friend suffered due to a serious dispensing error, as I’ve described previously:

[The] pharmacy stopped dispensing one medication altogether. This wasn’t spotted for some weeks, during which my friend’s stability and safety were severely compromised. It was an error with potentially serious repercussions. Even after the mistake was corrected it took time to restore the full protective benefits of the medication. It’s fair to say my friend will pay very close attention from now on to what is dispensed.

You can read my friend’s account of the incident here.

Safety, Suicide, and Self-Harm

The final aspect of safety, trust, and responsibility I want to discuss is safety from self-harm and suicide. It’s a subject close to my heart. Fran and I devote an entire chapter of our book to it (“The ‘S’ Word: Being There When Your Friend Is Suicidal”). Suicidal ideation is less present for Fran than it used to be, but we remain vigilant. Suicidality and the urge to self-harm are an ongoing or recurrent reality for many, including several of my friends. Information, support lines, and training courses are widely available. I’ve previously pulled together a list of suicide awareness and prevention courses, and you can find further information on our resources page.

Strategies for staying safe are necessarily personal but may include a Wellness Recovery Action Plan (WRAP), Dialectical Behavioural Therapy (DBT), or other techniques. Fran has a personal care manual and travel wellness plan. My friend and fellow mental health blogger Aimee Wilson has written extensively on her use of DBT, including this detailed guide.

What matters most is that the strategies work for the person concerned. For many years, Fran kept a stash of medication. Others might disapprove, but she considered it protective because it filled a need that might otherwise have found expression in more dangerous ways. In her words, “I needed the insurance to escape. Perhaps because this was the only thing in my life I had control over and I needed to do it my way, not everyone else’s way.” As I trusted she would, Fran voluntarily relinquished her stash when the time felt right.

Trust distinguishes caring about someone from worrying about them. These terms are often used interchangeably but there are important differences between them:

When we care about a friend we are expressing our trust in their abilities, strengths, and resilience. We trust ourselves to support them as best we can, and others to contribute as they are able. We don’t feel we have to do it on our own, fix everything, or find all the answers.

When we worry about a friend we express fear that they lack the resources to meet whatever challenges they are facing. We fear we don’t know what we are doing, that we will be found lacking, or not up to the task. We fear others won’t be around to contribute, and we will be left doing everything ourselves.

There Are No Guarantees

It’s worth reminding ourselves that trust and responsibility are no guarantee of safety. All we can do is our best, and all we can expect of others is that they do their best. For me, the clearest example of this is my relationship with Fran. She trusts me to be there for her, to be on her side, to fight her corner, and to always have her best interests at heart. For my part, I trust that I will handle whatever might come up. That doesn’t mean I can or have to handle everything on my own. I’m one member of a team of people — professionals and other friends — Fran trusts to help her stay as safe and as well as possible. I nevertheless accept that no one and nothing can guarantee Fran’s safety. This is nowhere better expressed than in this excerpt from our book:

Fran has told me many times I help keep her alive. There is no objective way to know if that is true, but I take her words at face value. I cannot explain my lack of fear when she is suicidal, but trust is fundamental. [...] It is not that I trust Fran never to try to harm herself, or imagine our friendship guarantees her safety. She has never attempted suicide, but she knows what to do, and I take very seriously any hint she is thinking about hurting herself or ending her life. But I trust her to not hide her suicidal feelings from me, and to be honest with me about them. Ultimately, I trust Fran to allow me to help her stay alive.

Responsibility and Self-care

We all need a hand to hold and people to trust, but it’s important not to rely on the same people all the time. Fran is happy I have others in my life I can turn to because meeting all my needs would be too much. There are times when she needs all her focus and energy to take care of herself, or is simply unable to help me deal with what’s going on for me. She trusts me to do whatever I need to keep myself safe.

Afterword

This discussion might appear to have come a long way from its inspiration in the passenger seat of my friend’s car, but I believe it shows how important safety, trust, and responsibility are. How do these themes play out in your life? Do you have any safety strategies you would like to share? Who do you trust most, and why? We’d love to hear from you.

 

Photo by takahiro taguchi on Unsplash.

 

Ten Ways to Turn a Bad Day Around

There’s nothing inherently wrong with having a bad day. It’s natural, I would even say healthy, for our mood to fluctuate in response to whatever is going on around us. On the other hand, no one wants to stay stuck in a rut.

Here are ten techniques I use when I’m having a rough day. Several of them feature in my Wellness Recovery Action Plan (WRAP).

It’s worth saying these are not fixes or solutions for anxiety, depression, or other mental health conditions although they might form part of a person’s wellness toolbox. They help me weather the ups and downs of life and I offer them on that basis.

1. Go for a Walk

I’ve written elsewhere about how important walking is to my wellbeing. It’s my go-to strategy when things are getting me down. Walking allows me to acknowledge whatever feelings are present for me, experience them, and then let them go. I sometimes use the “hot coals” technique I learned from Fran. I close my hand at my chest, taking hold of whatever feeling I wish to release. I extend my hand to the side and open it, palm down as I walk on. As silly as it might sound, it works. Try it next time you are feeling stuck.

2. Talk with a Friend

I’m fortunate to have a small number of friends I can turn to if I need to share what’s going on for me. I don’t find it easy to be vulnerable but with these few people I feel safe enough to be myself, knowing they will listen without judgement. There are few personal skills more important and healthy than the art of listening.

3. Write It Out

Writing features prominently in my Wellness Recovery Action Plan (WRAP). Apart from our two books and my blogging I’ve kept a daily journal since I was fourteen years old. For most of that time I wrote my diary each evening for the previous day. More recently I’ve started capturing my thoughts in the morning and at various times throughout the day. This means my diary is more of an in-the-moment account of how I’m feeling than an historic account of “how I felt yesterday.” Although journaling is an important part of my wellness regime I occasionally find myself trapped in an unhealthy cycle of introspection. To break the pattern I might challenge myself not to write any more about a certain person or situation until something specific changes.

4. Distract Yourself

Distraction is a core strategy of Dialectical behaviour therapy (DBT); others are self-soothing, improving the moment, and pros and cons. My friend and fellow mental health blogger Aimee Wilson has written extensively about distraction in a DBT context on her blog I’m NOT Disordered. According to Aimee,

Distraction can include writing and other creative activities, reading, beauty treatments, really anything that can take your attention away from what is bothering you. It is important not to overuse this or it can become avoidance.

I find distraction techniques help when I’m feeling stuck or overwhelmed, especially if other approaches aren’t working. Recently I’ve distracted myself by listening to the BBC News channel when I’m at work or at home in the evening. I can understand that for many people the barrage of world affairs might be upsetting or triggering but it stops me obsessing about things that are troubling me. Music can have a similar effect although I’m careful what I choose to listen to in case it exacerbates how I’m feeling rather than providing relief.

5. Escape for a Bit

Escape is similar to distraction except that the intention is to consciously set the difficult situation aside and find comfort and solace elsewhere for a while. Movies and television shows work well for me, especially when Fran and I watch DVDs or Netflix together online. For an hour or two we can put everything on hold and immerse ourselves in whatever we are watching. This doesn’t fix things but it allows time for my emotions and thoughts to settle and for fresh ideas to emerge. Taking a break from social media can have the same effect.

6. Reward Yourself

I’ve written elsewhere how important it is to recognise and celebrate our successes. That said, when I’m low or upset it’s hard to believe I’m worthy of reward because my default is to blame myself for whatever’s gone wrong. My friend Jen reminded me that no matter what’s happening I can take responsibility and reward myself for that.

What about playdates, Marty? Do you have playdates with yourself? Take yourself to a movie, or to dinner, or to a good bookstore?

This doesn’t work too well if my underlying mood is very low; rather than celebrate I’m likely to spend the time brooding. But if I’ve begun to shift things using some of the other techniques, treating myself can help move me forward.

7. Find Solid Ground

When I’m overwhelmed it can be hard to find a stable point of reference. Paying attention to my day-to-day routine helps but it’s not always enough to get me to a place where I feel grounded and secure. When other techniques fail I sometimes attempt to “jolt myself” back to a time or place when I felt more stable. Music from a particular period in my life can work, as can looking through old photographs or reading my journal from years ago. The aim is to get my feet under me again and then return to the present to face whatever is going on from that place of stability and safety.

8. Change Something

Changing even one small aspect of your situation can affect how you feel. When I’m low or stressed I take less interest in my appearance. Sorting out a nice shirt and my favourite tweed jacket in the morning can be all it takes to shift my mood in a positive direction. Get out of the house if you’ve been stuck inside. Try a different café or even a different table at your regular place. Drive or walk an alternate route to work or to the store. Talk to someone other than the people you usually turn to.

9. Accept How It Is

Despite having all the techniques at your fingertips, sometimes nothing can turn the day around. Processing, talking, escaping, distracting, rewarding — they all take time, energy, and focus and sometimes you just can’t. All you can do is accept you’re having a rubbish day and handle it as safely as you can. Cry, scream, grumble, isolate — whatever it takes to get you through. The very act of “giving up” can help shift your mood. It may not, but it’s worth a try.

10. Go to Bed!

If you’ve made it to the evening — or even the middle of the afternoon — and things are still looking grim, sometimes the best option is to turn your back on the rest of the day and turn in. Tomorrow is a new day and maybe things will look different in the morning.

I’ve shared some of the techniques I use to turn the day around. What works for you? I’d love to hear your thoughts, experiences and ideas!

 

Seeing Red: A Look at Bipolar Anger

Anyone can get angry but bipolar disorder can take rage to unprecedented extremes. What is bipolar anger, what triggers it, and how can it be managed?

In this article we’re going to explore bipolar anger. Examples are drawn from my experience as caregiver to my best friend Fran, and others happy to share their stories.

What Does Bipolar Anger Feel Like?

It would be hard to improve on this description:

“Bipolar anger is impulsive, intense, erratic, and explosive. It is being asked a simple question and responding with irrational anger and/or irritation. It is lashing out, for no logical reason, on those that love and care for you. It’s driving down the road and whetting the blade of your pocket knife on the side mirror because someone is driving too close to you. It is the inability to listen to rational behavior and even answering the question ‘why?’” (Mariah)

Others also talked about its explosive nature:

“I can ignore issues for only so long then my anger towards another person spikes. I have been known to yell really really hard, say extremely mean things and sometimes throw things but I wouldn’t physically hurt someone.” (Susan)

“Bipolar rage is very real and it can be very, very violent. I will chase people and pick a fight.” (Julie)

The anger is mostly directed towards others but it can turn inward, manifesting as self-harm:

“I said very mean things in texts to my now ex-boyfriend. Basically I am on the attack personally without direct provocation. Then I get back in the mode of attacking myself … biting myself, pulling my hair, and hitting myself.” (Susan)

Mariah shared that anger comes easier to her than addressing what is actually happening in her life:

“It is easy for me to tell those that I love to leave me and never come back, even offering to help them pack. It is easy for me to say ‘Fuck it!’ and let people go, rather than admit that I am the one hurting inside. It is easy to push all other emotions aside and let the rage erupt inside of me until it spills out into the household, creating chaos all around me.” (Mariah)

In a similar vein Vikki describes anger as “bipolar’s go-to emotion.” This might sound like taking the easy way out but to me it reinforces how desperately hard it can be to engage more “reasonable” responses when anger takes hold.

Timing and Triggers

Jen traces her anger back to childhood and the suppression of emotions from an early age:

“I think for me, it comes from childhood trauma. I learned too soon in life that life is not always fair. I was taught that feelings should be stuffed down and I became angry about that in later life. I’m still angry about that.” (Jen)

Most contributors said that anger is more of an issue during mania, especially dysphoric mania, but it can appear at any time:

“For me mania anger was more because others thought I was on drugs when I wasn’t. When I’m depressed it’s more anger at me or the world.” (Vikki)

Fran becomes frustrated when people fail to understand or challenge her reality. When Fran was manic she was falsely accused of being drunk or of not taking her medication, which hurt and angered her greatly. Several people mentioned driving as a specific trigger:

“My bipolar anger is very unreasonable. I get angry at things that I normally don’t even notice. My worst anger is in traffic. I have absolute road rage when an episode is in full force. I have to be very, very careful when driving.” (Julie)

Other people’s anger is likely to add fuel to the fire and once the line has been crossed it can be hard to pull back:

“When others are angry I take it as a challenge. I push back and fight back until I feel as though I have ‘won.’ When I am in the cycle of my own anger I do not consider possible consequences and at those moments I do not care.” (Mariah)

Healthy Anger

As unlikely as it might seem anger can be healthy:

“We were reminded in dialectical behaviour therapy (DBT) that anger is a motivator for change. We do not like something or it irritates us, so we work to change it. Without irritation and anger we would be a pretty lazy species.” (Roiben)

Anger drives Fran forward when she would otherwise become mired in self-doubt. It can also help get her message across. She once became furious when I failed to recognise how desperate things were for her. Within moments she had my full attention! We can also think of anger in the face of injustice:

“When things in my life don’t seem fair, or if I see that things are unfair for my friends, or even my country, I get angry. But maybe it’s okay to be a little angry.” (Jen)

What Helps?

There are several approaches to managing bipolar anger. It can help to avoid triggers and stressful situations. Fran’s life has become much calmer since she withdrew from social media. As she puts it, “There were plenty of good things but also plenty that pissed me off.” Calming activities such as art, listening to music, taking a bath, and meditation can help as can medication, talking therapies, prayer, and positive affirmations.

“I am trying to improve by positive self-talk in the mirror and with drawing. Self-talk is really helping!” (Susan)

It is worth remembering that the underlying reason or trigger for the anger is very often real and needs addressing. It can help to explore what is going on, either alone or with a trusted friend:

“It is not until much later, sometimes days later, that I am able to analyze my behavior.” (Mariah)

“I get so frustrated with a few of the people in my world, not so much with what they say but how they say it, and I have to ruminate for days and talk it over with Marty until I can let it go.” (Fran)

Beth describes a different approach:

“I feel I know the receiving end of the anger that came come with bi-polar. I have several friends who get angry with me on occasion, enough to tell me they want to end our friendship. I no longer try to ferret out what I did. I have come to understand that it is not based on anything I did most of the time. Talking it through can be incredibly counter-productive. Waiting it out, letting them know I am around if and when they are ready, and giving them space is about all I can do. I have been told by more than one that part of my getting the brunt end of anger is because the person knows I will not give up on them.” (Beth)

Jen finds insight in a quote from the movie Excalibur:

“Lancelot says to King Arthur ‘Your rage has unbalanced you.’ This is an amazing metaphor because I battle myself internally, like these men are doing externally and I can get unbalanced quickly.” (Jen)

Being honest about how you are feeling helps. (“A heads up. Just so you know I’m in a bad mood.”) And there is always humour.

Fran: I’m going to keep getting mad at you, Marty, because that’s the only way you’re going to learn.

Marty: You’re going to keep getting mad at me because I’m writing an article on bipolar anger!

What are your experiences with bipolar anger in yourself and in others? What works for you? What doesn’t?