Living with Bipolar: Doctor and patient

Today [3 December] is International Day of People with Disabilities; this year's theme is "Not all Disabilities are visible".

The focus is on spreading awareness and understanding of disabilities that are not immediately apparent, such as mental illness, chronic pain or fatigue, sight or hearing impairments, diabetes, brain injuries, neurological disorders, learning differences and cognitive dysfunctions, among others. 

Dr Nicholas Prior, a CNWL psychiatrist in Westminster, has a disability that isn't visible; he has been living with Bipolar for more than a decade.

Here is his story:

Doctor and Patient

I have lived with Bipolar for over a decade, leading to seven episodes of depression and three of hypomania. Seeing mental illness through the lens of both a patient and a Doctor has given me a rare view into the world of mental health. Having felt the nothingness and desperation of severe depression and the destructive nature of hypomania (esp. with relationships) I am passionate about helping others learn how to manage their mental illness. Using a broad, proactive and personalised approach we can reduce suffering by accelerating recoveries and preventing future illness.

One of the most significant steps in my journey was accepting that my mental illness needed active management for the rest of my life, especially when I was well. For me this has involved a combination of therapy, medication and lifestyle changes. Despite all the suffering there were some silver linings, the depressions taught me humility and that failure was just a moment in time, not permanent, it gave me perspective. Most importantly my experience with mental illness drove me towards becoming a Doctor.

As a Doctor I only bring up my lived experience if I think it will help the patient or more often than not their relatives. I feel the most value my openness can bring is to provide perspective and a clear example of how in most cases one can be really ill (the patient) and yet recover (myself). Having Bipolar makes it easier for me to emphasise with patients; I don’t have to imagine, I just have to remember. However, there is an intrinsic risk of me making it about me and transposing my experiences onto the patient, this is something I have to keep a very close eye on.

I became a dad recently and this has created a very real test of priorities. It has given me a very valuable reminder of what is really important to me. I am writing this piece halfway through my paternity leave, a time that has given me the space to support my wife and be close to our baby girl, Vita. Most of all it has made me realise how busy my mind normally is. Soothing a baby and holding them to your chest for an hour involves a repetitive movement and doesn’t allow for other distractions – a great exercise in mindfulness. I have really embraced this slower, simpler and more intimate life.

We all like to think we learn from our mistakes, and I guess most of us do – eventually! I went through many failures and setbacks before I accepted my illness but I got there in the end. With this in mind it is essential to cultivate and invest in protective factors (in particular social networks) so that we have the opportunity to make mistakes and be picked up again. I know full well that without an extremely supportive family, who understood mental illness, I would not be a Doctor today and would certainly not have earned the love and respect of my wife. My outlook would be very different.  

It took me close to a decade to learn from my mistakes, despite being medically trained. Interestingly the average time it takes from the onset of symptoms to a formal diagnosis is nine years.

Here is a typical sequence of events in my twenties (that was on repeat) –

• I’d struggle alone (both proudly and desperately) for about three months.
• Cracks would then begin to appear. My family would notice I was struggling and actively support me in getting professional help.
• I’d then begin taking antidepressants (and sometimes take part in talking therapy). It would then take me anywhere between three and nine months to recover.
• After a good spell of feeling well (which was normally during the summer), I’d stop taking medication having identified a trigger (e.g. my parents separating) for the episode that meant I created the narrative that this was a one-off and wouldn’t happen again. 4-6months later I would find myself struggling again, and so the cycle would continue…on repeat.

Accepting medication as a core element of my mental health management was huge for me. Since staying on medication I have remained mentally well for the last two years and counting. This has been the longest period of good health I’ve had since I turned 21.

My lived experience has led me towards Minderful (http://www.minderful.com). Minderful is creating a mental fitness hub, where users can identify good things to do for their mental fitness and then create a personal mental fitness routine. People need to invest in their minds and discover what makes their unique mind tick. My own mental fitness programme is made up of over 20 elements (what we term blocks).

Here is my top five:

1) Be open and frank with the person you most love.

Use the time when you’re well to create some rules and identify early signs of ill health with people close to you – write them down.

2) Accept your need for long-term medication (if necessary). 

If you have experienced severe and persistent episodes of depression, it’s really worth considering medication. It’s important to try and accept that medication can be a necessary and positive part of your journey but is also just a part of the process.

3) Consider your body temperature. 

I find both cold water swimming and hot baths have a big impact on my mood, so I’ll have a hot bath or a cold shower every day.

4) Track your mood. 

I keep a record of my mood - daily to weekly - using a platform called Moodscope. This helps me identify how my mood might be trending before anything severe happens.

5) Stretch.

For me stretching is a broad term that includes back rubs, stretching my hamstrings, or even yoga – it’s all about finding what works and embracing how good it can feel to soothe your muscles. For me, a couple of minutes three to four times a day is perfect.

By planning and building an effective mental fitness routine one creates the foundations on which a good life can be built upon. See if you can discover some new ways to improve your mental fitness at Minderful. Invest in you mind and start building your own routine that can not only prevent mental illness but also improve your overall wellbeing. Looking after the mind applies to everyone, not just the mentally ill.