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normal human event. We all go through it.
    Or, it could be a series of events. It could be the lost of a parent, which seems like a high risk factor in developing depression. But once it’s manifested it doesn’t seems like it needs stressors. It has a life of its own. However, the better we are at copping with those stressors -- that’s something else we need to work on. The better we are able to say, “Okay, this is the stress of our life. How are we going to manage it?” And we are going to have stress in our life by definition.
    Do we take time outs? Are we getting enough sleep? Are we eating well enough? Are we taking care of ourselves in terms of meditating, giving ourselves some vacation time?
    Those sorts of things. That’s going to help our illness. That’s going to help us stay illness free.
    You mentioned working through some of the stressors. How important is it for Bipolar people to work with a therapist?
    It’s very important. From a primary level a psychiatrist might think the most important thing for a patient to do is stay on their medications, but I think in a life management way working with a good therapist is essential as well. And the therapist doesn’t have to be an expert in Bipolar disorder. It doesn’t need to be something like that. It just needs to be a therapist that can understand you and your problems, and be effective enough to recognize the disorder for what it is, the ups and downs of the illness, and the many colors of the manifestations of the illness. And to be able to work with the day to day stresses of living.
    This type of therapist would be considered a good one to have. It doesn’t have to be some specialized guru in Bipolar disorder. Just someone who is sensitive to the needs of a human being, and can help another human being cope with their stressors. I think that’s very important. There is reason to support that patients in therapy and taking their medications as well, are more apt to stay stable.
    Are there reasons for why Bipolar patients do well taking their medications and being in therapy?
    There could be a few reasons for that. First of all, the person feels connected with someone that’s listening to them. They have a disorder. The patient feels understood. They feel like they aren’t alone in the world. Sometimes patients with Bipolar disorder have an interesting way expressing themselves that might push other people away. Unless they are around other patients with Bipolar disorder, then they feel like they have a kindred spirit. But taken in isolation sometimes that’s how the patient feels, so when they are talking to a therapist that understands them, or attempts to understand them, and feels for their problems and trials and tribulations. Just like any good relationship it’s very helpful.
    Now let’s talk about communication with doctors. Thanks to HMO’s patients get 15 minutes to talk. How am I as a patient to know what I need to talk about in that 15 minutes?
    Can I make a joke? Talk fast!
    But if I talk fast then I’m hyper verbal to you!
    Well, I’ll just make a note of it. Appears to be manic!
    You know if you are doing therapy, one of the old thoughts of doing psychiatry and therapy, you wouldn’t want patients bringing in notes . You would want your patient to describe their problems so you can see the process of the person’s problems unfolding. But I think in a lot of ways when patients outline their problems, making bullet notes: I’ve had a problem sleeping ; you want to make sure you cover this with your doctor. Another example is, “it seems like I’m having a problem falling asleep and waking up in the middle of the night, and this pattern has been going on for the past two weeks. You want to make sure you cover that. Or you might note that you’re racing thoughts worse in the morning, or whatever the pattern is.
    When you do the bullet approach that’s helpful . That organizes the patient, and that organizes the doctor .