Category: Values

Being Open about Bipolar Disorder

I’m sometimes asked how I can be so open about my bipolar disorder. I announce my diagnosis in classes. I tell strangers. I have this blog. Why?

A first reason is that I hope to combat, in my own little way, the stigma that even in 2025 attaches to mental illness. In my openness, I normalize not being normal. (Heck, someone who was “mentally normal” in every respect would be a massive outlier!) I show that I’m not ashamed of my illness, and thereby suggest that others needn’t be either. Relatedly, I serve as an instance of what may seem a surprising compatibility: success in one’s career and private life is compatible with having a severe and chronic mental illness.

Second, talking about my bipolar, and especially announcing it in the classroom, allows other sufferers – or the friends and family of sufferers – to approach me freely and without undue shyness. Because I tell pretty much anyone who’ll listen that I have bipolar, folks realize that I’ll get what they are going through; that I won’t judge them; and that they needn’t be embarrassed around me about their own mental health struggles. This has led, in particular, to many students coming to speak with me. Of course, I can’t take on the role of psychotherapist with those who approach me, lacking as I do the proper training and certification. Nonetheless, I can comfort them, reassure them, and point them in the right direction when it comes to coping with depression, anxiety, memory and concentration issues, manic symptoms, etc.

To sum up so far, my openness is partly motivated by the general public, and changing how they perceive bipolar disorder. It’s also motivated by the fact that it encourages strangers, including students, to approach me about the topic.

This makes it sound, however, as if I myself get nothing out of blogging, conversing about mental health, etc. That’s not so. To the contrary, openness benefits me in several ways. Warning people in advance of my disability sometimes makes life easier for me. Most people readily accept that I may need more patience, more reminders, more assistance than a neurotypical person might, and they treat me accordingly. I’ve frequently felt grateful for that. What’s more, if I start to cry, or shake, or… people know why. That is, it’s helpful to me to make people aware of my otherwise weird potential symptoms. I think of it this way: sharing my diagnosis is like wearing my own personal Medicalert bracelet. Besides, frankness about bipolar disorder helps me help others; and such social interactions and the pursuit of meaningful activities is essential to me keeping well. Helping you, helps me!

All that said, I completely understand why others might prefer to maintain their privacy when it comes to their mental health symptoms. For one thing, a lot of what I say above applies to a middle aged, white, professional male like me, but might not hold true for less privileged groups. Well, and not everybody is as extroverted as I can be.

The Dignity of Risk

I am part of a group preparing materials on living with chronic suicidal thoughts. We group members are made up of mental patients like me, family members of sufferers, and specialized clinicians. As I’ve written about before, as a Recovery College project, our task will be to create a “course” that interested parties can “study” online. So far, we’ve had three online meetings. I think it’s going well.

What I wanted to write about was a concept that was introduced during the second meeting. It was new to me and struck me as being of great importance. This is the notion of the dignity of risk. The idea is that, if a person’s support group (whether official, as in a clinical setting, or informal, out in the world) “rescues” a mentally ill patient from all genuine risk, the group thereby robs the patient of dignity.

A “normal” adult, in the everyday course of things, will constantly undertake tasks where they can fail; and such that they thereby suffer some bad consequences. Indeed, neurotypical folks regularly do things that could have very serious consequences – consequences such as getting hit by a car, being knocked over into traffic on one’s bike, getting serious food poisoning, etc. Living with such risk is simply part of being a grown up. In contrast, we don’t allow infants to even attempt the genuinely risky.

What’s the difference between the “normal” adult and the small child? Among other things, it’s that the former can be trusted to make reasonable choices about which risks to incur, whereas the baby can’t make wise decisions on its own. Now consider, in this context, attempts to save people like me from failure – whether that be just serious failures, or even the modestly risky. On the one hand, protecting folks like me is an understandable impulse, based in level-headed concern for the mentally ill person’s welfare. People who love me ipso facto want to protect me from harm. On the other hand, to shield a loved one from all risk, even all serious risk, is to literally infantilize them. It can be, in short, a way of robing the patient of their dignity as responsible adults.

Respecting a person’s dignity thus brings with it allowing that person to take serious risks. I have been pondering this realization for days, on two fronts.

First, there’s obviously a question of balance hereabouts. Pondering the first, part (a): there’s the dimension of how mentally ill the person is at the time. Speaking for myself, when I’m really bad, I simply can’t be trusted to make appropriate choices. In fact, my decision-making has sometimes been so irrational that it’s been necessary to lock me up. In such scenarios, maybe infantilizing is the right stance. Pondering the first, part (b): there is the dimension of how big the risk is, and how large the consequences of failing. As an example, given that an overdose of Nortriptyline would be fatal, it likely makes sense for my family and friends to dispense that medication to me only a week’s worth at a time. Arguably the resulting harm to my dignity is worth it. (It was precisely in the context of a potential for suicide that our working group touched on the dignity of risk, by the way. When should we protect a loved one who is running the risk of “failing” in the sense of killing themselves? How suicidal is too suicidal to let them be? That’s a really tough question.)

Second, I’ve been thinking about the dignity of risk in relation to another phenomenon, namely my on-going “upwards spiral”. Part of the reason I’ve been improving, I think, is that I have felt confident enough to take on more challenging tasks; I’ve succeeded in those; and this has made me even more confident; which has encouraged me to take a still bigger risk; etc. Such a positive spiral inevitably brings along with it, however, the possibility of failure, even major-league failure.

If our little group figures out precisely how to balance autonomy versus potential failure, I’ll be sure to share the result here! Meanwhile, I’ll keep pondering the dignity of risk.

List of Good Things

One simple tool for combatting depression in general and suicidal thoughts in particular is to rehearse good things in life. Not just great big good things, like success in one’s career, but little tiny ones too.

It was homework from Mindfulness-based Cognitive Therapy weeks and weeks ago to begin my own list, but I have been super busy being back at work. Well, I’m finally getting to it. So, here’s my very partial list, and in no particular order.

Kissing Anita, my wife; or just hearing her breathing beside me

Mindfully sipping my coffee

Listening to music

Phone calls and video chats with friends and family

Reading philosophy on my front porch

Running, especially with a partner

Spotting an interesting bird at my feeders and on walks

Fishing of all sorts (Of course!)

Teaching and time with students

The cats sitting on my lap

Crawling under the covers when I’m sleepy

Travel

Eating out at restaurants

Literary fiction

Helping people

Cutting the grass

Watching TV with Anita

Grocery shopping with my daughters Saima or Moon

Hot water on my shoulders and head in the shower

Bonfires in our backyard

Trapped by Anhedonia

A recent cluster of symptoms has emerged which is very hard to endure. It’s so unbearable.

The cluster has two parts. There’s severe agitation, nervous energy – as in my toes curling up and wanting to bang my head. At the same time, I’m unable to direct it anywhere because I have no motivation to do anything. I no ability to concentrate. I can’t focus enough to read a novel or watch TV. It’s hard to make decisions and then I’m easily distracted from them when I do.

An analogy. It’s like feeling insanely, unbearably stir crazy in a room full of doors. That’s the anxiety aspect. Each door would get you out of the room, but none of the doors attracts you enough. You haven’t the drive to open that one, nor that one, nor that other one. That’s the absent “drive system”  aspect: nothing assigns a positive emotional valence to any door sufficient to get you up and out of the chair. You end up stuck in the middle of the room, at the point of screaming. Argh.

This pair also often comes along with what I call “fear blooms”, by the way. Fright starts over my heart and spreads across my chest, like the fear is blossoming and growing.

I’m experiencing this a lot because I have cleared off my calendar for ECT treatments and am on sick leave. I’m left with even more empty time to fill.

Happily, it’s really important to note that today’s ECT seemed to reduce these symptoms significantly. And they also seem to help with my fear more generally.

Values and Anhedonia

I’m continuing to do poorly. Indeed, it’s feeling like this blog is ill-named, since it’s hardly DBT recovery anymore. It’s DBT backsliding. True, my depression has improved, in the sense that I’m not crying all the time and I’m not suicidal. That really is progress and I need to remind myself of it. However, my fear levels remain very high. And I continue to suffer from anhedonia, which is a lack of interest in anything that used to give me pleasure: I don’t feel like eating, reading, watching movies, etc.

One thing that is known to help overcome anhedonia is participating in activities that connect with one’s values. E.g., as has been the case in the last ten days for me, assisting refugee families has lifted my spirits and motivated me. This realization prompted my therapist Rachel to have me do additional work on my values. I’ve explored them before, i.e., I’ve reflected on and written about the sort of person I want to be. But she thought even more “values work” might help.

My homework, then, was to mark up a list of 60 potential values as Not so important, Quite important and Very important. Then, I was to try to find a pattern by clustering the Very important ones into just a half dozen or so core values.

Here’s the result. I was able to reduce my 20 or so “Very importants” into eight categories:

1) Adventure, challenge and self-development

2) Caring, compassion, forgiveness, generosity, kindness, love, and supportiveness

3) Contribution and social connection

4) Fairness

5) Humour, fun

6) Responsibility and trust

7) Persistence, industry and courage

8) Intelligence and creativity

Family and Professional Values

I am continuing the exploration of my values. The point is to find things that can give my life the kind of meaning it once had.

Last time I came at the issue via my happiest/saddest occasions. This time I am approaching the same topic but in terms of people.

This homework is broken down into familial and professional relationships.

In terms of my relatives, the question is about the values which my family passed on to me and those I want to pass along to my children and my nieces and nephews. I think I’d divide these into: i) warm, ii) responsible and iii) fun. My family, especially on my mother’s side, taught me the importance of being kind, compassionate, and caring. Of being tolerant and forgiving. I try hard to exemplify those gentle values and I have tried to pass them along. Then again, being kind-hearted without the ability to be supportive and generous, both materially and emotionally, must fall short. Meaning well is good, but… So, another core value is being dependable. My family also modeled a balance of all that with spontaneity and an openness to fun and adventure, including a love of the arts (e.g., music, literature, architecture and painting). This “fun” group of values shows up in my love of travel, which I learned especially from my Aunt Ruth, and have tried to pass along to the next generation.

Regarding students and professional peers, first and foremost I’d want to be remembered for those “warm” values. I try hard to be a kind, tolerant, caring, and supportive colleague/teacher. I strive to be reliable as an academic too. I would also like my Chair’s eulogy to describe me as both an academic leader – creative, innovative, knowledgeable, smart, even wise – yet also a hard-working, collaborative collegial citizen.  Also essential to my professional values is being ethical, fair, and intellectually honest.

Finally, I hope everyone, family, friends and workmates, will remember me as funny. (There’s something very important in the fact that I am never funny when I’m depressed and anxious.)

The Quest for Values: Lessons from My Saddest/Happiest Occasions

I have had a hard six weeks. Over that period, I went from one bad day a week to a couple of okay days a week. Then, following a shift in medication, I became really depressed over the last ten days. ‘Depressed’ as in asking Anita to please hide my sleeping pills. ‘Depressed’ as in If my hospital experiences hadn’t been so awful, I’d have gone to Emerg.(Thankfully, yesterday, with a new drug, saw a big turnaround.)

It’s timely, then, that my DBT homework for this week is to reflect on the connection between depressive episodes and my values, recognizing that they may be sparked by losing track of a life worth living.

Let’s go back to my last major depressive episode two years ago, for a first clue. Three big parts of what made life valuable before that were: being actively involved as a dad to two young girls; advancing in my career; and being active outdoors (fishing, skiing, running). Two years ago, the time of my hospitalizations, several things happened that conflicted with those. The girls moved out – they weren’t little anymore, needing their dad all the time. My sabbatical ended and I felt like I’d achieved everything I wanted to career-wise: Distinguished University Professor and Royal Society of Canada… There were no more academic mountains, at least none I felt interested in climbing. What’s more, I was diagnosed with both diabetes and high cholesterol, and put on meds for both. This made me acutely aware of my aging body, and of the fact that eventually I wouldn’t be able to engage in those favourite outdoor activities.

Depression resulted.

If I cling to exactly those things as what makes life worthwhile, depression will be inevitable as time passes. So, it may help to overcome this latest bout of severe depression, and to avoid potential future ones, to find other things which are valuable to me, and which I can continue working towards even as I age. Values I myself can choose going forward.

To clarify my assignment, it isn’t to identify short term goals, specific outcomes to aim for. I have plenty of those each day on my To-Do list and my Google calendar. Too many, in fact: grade that assignment, respond to those emails. My task is to find big things, about the sort of person I want to be, values to serve as a compass for choosing goals.

I’ll divide the quest in two. In the present post, I’ll try to identify my values going forward in terms of happiest/saddest occasions. The times I’ve despaired versus those when I’ve felt most intensely that life had meaning. In the follow up, I’ll write about people – those whose values I embrace, what I’d want others to remember me for, and the values I’ve wanted to share.

The saddest stages of my life were childhood and early adolescence (1960s and 70s), when my first wife Hamila died (1992), and when my mother passed away (2012). Plus, as noted, the occasion of my major depression in 2017-18. What did those have in common? Deep loneliness and low self-esteem in childhood and early adolescence – picked on and unpopular. Fear and uncertainty about the future – fear of violence as a child, anxiety about another great loss after Hamila died. Conflict with others, e.g., with my father as a child, with my brother after my mom died. Another common theme in those periods was guilt about not having done enough.

The happiest periods were my first year in Uruguay as an exchange student in the mid-80s, my time at Grad School at MIT in 88-93, when the girls first arrived early in the new Millennium, and while on sabbatical in New York, Vancouver and then London, England. What did these occasions have in common? New experiences in new places: music, art, architecture, language, outdoor activities. Success when faced with new challenges: learning Spanish, mastering extremely difficult academic material, learning to be a dad. And deep personal connections: lasting friendships, along with special family and academic relationships.

Here are some lessons I can draw about my values. When, instead of being awash in fear, I’m able to undertake challenges and succeed, I’m happy. When, instead of feeling isolated, I’m really connected to people, I’m happy. When, instead of lacking direction or being stuck in the “same-old”, I seek out new experiences, I’m happy.

The girls aren’t going to be little again; what’s more, at some point, my academic days will be over, and I won’t be young enough to fish, ski or run. Those, taken as core values, can’t last. But can I overcome new challenges; form and strengthen links to people, as I age? Yes, yes I can.