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Bipolar Overview

By: Kerry Moran

According to the World Health Organization (WHO), 1 in 8 people in the world currently live with a mental health disorder. This equals out to 970 million people. As of 2019, of those 970 million people in the world, 40 million had bipolar disorder.

Bipolar disorder is a mental health disorder characterized by extreme highs and lows (it was previously known as manic-depressive disorder).  These highs and lows often come in cycles of depression or mania, though sometimes can be seen as a “mixed state” in which symptoms of both are present. Mania in adults is characterized by high, euphoric moods, increases in energy, decreases in appetite and sleep, and can sometimes also include thoughts of grandeur, delusions, and at the most extreme, hallucinations. Children are more likely to exhibit irritability and emotional outbursts than these more well-known highs. Hypomania is a less severe form of mania that can affect many people with bipolar disorder. Depression in bipolar individuals can be seen as very low mood, low energy, and feelings of hopelessness. Bipolar disorder has a high rate of suicide completion, with one in every five people with the disorder completing suicide, which highlights the importance of treatment for individuals with this disorder.

The misdiagnosis rate is unfortunately high, which delays proper treatment. Women and female presenting persons are more likely to be misdiagnosed with depression and men and male presenting persons are more likely to be misdiagnosed with schizophrenia. Bipolar affects these groups in equal rates.

Typical onset of this disorder is found in adulthood, however it can occur in adolescence and early childhood. There does seem to be a genetic component to this disorder, as it is more common in individuals who have at least one parent with unipolar depression (major depressive disorder) or bipolar disorder. Individuals with an immediate family member who has bipolar disorder are also more likely to develop it sooner in life.

Bipolar types

There are three types of bipolar disorder based on how cycles present. No type is more or less “severe” than the other in terms of the challenges someone may face and the types are not determined by impact on a person’s life but on types of symptoms.

Bipolar I typically presents with manic symptoms that last at least a week. These manic symptoms can also result in the need for emergency care depending on severity. Depression in bipolar I typically lasts at least two weeks.

Bipolar II is characterized by episodes of hypomania and depression. These hypomanic episodes can be less severe than traditional mania and usually do not require emergency medical attention. Depressive cycles tend to be more common with bipolar II.

Cyclothemia, or cyclothemic disorder, is a disorder that involves cycling between hypomania and depressive episodes. These episodes are usually shorter than in bipolar I or II.

Treatment

Typically, we see the use of mood stabilizers and anti-depressants used as the first line treatment for this disorder. Lithium is the most well-known mood stabilizer and was the first one developed as an effective treatment for bipolar. However, many more are now available. SSRI’s and SNRI’s are also commonly used in combination with mood stabilizers. Atypical antipsychotics are often used along with these other medications. According to WHO, 9 in 10 patients are happy with their treatment plan and medications.

Therapy is also part of an effective treatment plan for bipolar. Through therapy, clients are able to learn how to address troubling thoughts, identify potential triggers for cycling and signs a depressive or manic cycle may be coming, and how to change their behaviors. Therapy can also be a way of providing support and education to bipolar clients and their families.

My story

I was diagnosed with bipolar II when I was 12 years old, though it’s very likely I developed it much earlier. Bipolar is considered a progressive disorder and developing it so early meant it was likely my symptoms would be severe. Progression is associated with more frequent episodes, more difficulty in treatment, more severe episodes, and a higher likelihood of suicide attempt and completion.

Treatment was difficult at first for me. I tried many medications that did not work well for my case. My age was a complicating factor in this, of course, as many medications at the time (2002) were not approved for use in children. I reacted poorly to the medications that were available to me and eventually I stopped treatment.

My adolescence was, understandably, difficult. I often experienced rapid cycling, which is categorized as four or more cycles within a year. My depressive symptoms were very severe, resulting often in difficulty in functioning socially and in school.

According to all odds, it was likely only going to get worse. Many bipolar patients experience disability from their disorder. However, in my early 20’s, I went back to trying medications. It took a few years to find an effective treatment regimen. Some medications had side effects I couldn’t tolerate and others didn’t make a difference in my depressive symptoms. After some time I was able to find something that worked for me.

Combining an effective medication schedule with therapy allowed me to gain the skills I needed to achieve a normal level of functioning. These skills were recognizing when a cycle may be coming so that I could take steps to try and prevent it from being too severe, learning how to combat the thoughts and feelings that came with depression and could sometimes lengthen my depressive cycles, and learning when to reach out for more help. Learning when a medication had reached its limit to help me and I needed more support in that area was crucial for my treatment success.

Despite the odds stacked against me with my early onset and severity of symptoms, I was able to achieve a level of functioning that has allowed me to thrive as an adult. I was able to continue working and then eventually attended college and am on my way to a graduate program. Bipolar disorder can be a scary diagnosis, but with proper treatment and education on the disorder, it is possible to have a high quality of life and, more importantly, a full life that is characterized by achieving one’s goals, having good friends, and seeing one’s dreams through.

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Grieving and Relationships

By: Kerry Moran

In our previous blog post, we discussed grief more generally. This post will be dedicated to grief in relation to loss of a relationship. Many people assume grief of this type can only come when a partner dies or if we’ve left a relationship because we were broken up with or someone cheated. Often, people forget that even leaving toxic relationships can come with grief. Just because the decision that was made may have been in our best interest and for our safety doesn’t mean we don’t grieve that relationship deeply.

Ending relationships because of cheating or abuse still comes with the same elements of loss we see in other relationships ending. There is a loss of the planned future together, the loss of the life that has been built now, and the loss of the person you thought your partner was or even the person you thought you were. It is not so cut and dry as to say that just because ending a relationship was good for us that we’re going to feel good about it, at least not right away.

When thinking about grief and relationships, there is also often a time limit people expect someone to have. When grieving a death, society also places time limits on “acceptable grief” but they seem more generous than for the end of a relationship. Most people expect us to “get over it” and “move on”, especially if the end of a relationship was brought on by the other party’s infidelity or abuse. We’re lauded for leaving the relationship but not given that time and space to grieve. There is no timeline for grief and there is no right or wrong way to grieve, regardless of what brought about our grief in the first place.

Stages of grief and relationships

The stages of grief that we discussed in the previous post can also be applied to loss of a relationship. The things someone says to themselves or how they experience these stages could look a little different. It is also important to note that, again, just like when dealing with any kind of loss, these stages are not linear. Some people may skip certain stages all together or come back to a stage over and over until they’ve fully processed their grief and the mourning period is over.

Denial

In a relationship, denial can look like a rejection of acknowledging the relationship has truly ended. It can look like “They’ll come back to me once they realize they’ve made a mistake by letting me go” or it can look like “They said they’ll change so maybe they will and we can mend things”.

Anger

This is often seen as blaming someone or something else for the loss of the relationship. Sometimes it comes with not really seeing the part we play in keeping our relationships healthy and sometimes it comes from realizing how poorly treated we were and being angry at ourselves for letting it continue. It can look like “If they had just worked harder, we would still be together” or “This isn’t fair. I didn’t do anything wrong.”

Bargaining

Much like in more traditional grief, bargaining usually looks like making promises to others, the universe, or a deity in order to bring things back to normal. Sometimes it comes from a realization that we’ve had a part to play in the break up and sometimes it’s still tied to denial or anger. It can look like approaching your ex and promising “I’ll stop getting annoyed about the little things and nagging you if you just come back” or promising God that you’ll pray every night again if your ex will come back to you.

Depression

This is the sense of hopelessness as the reality of the end of the relationship hits someone. It’s what we often expect to see when someone experiences a loss. Often we see people experience feelings of not being able to accept that another relationship is possible and they’ll say things like “Who else could love me?” or “I’ll never find someone else, I’m going to be alone forever.”

Acceptance

When someone realizes the true finality of a relationship and that it is actually over, we see that as acceptance. It’s knowing that it’s time to heal and move on from the relationship, knowing that “I’m going to be okay.” Again, just like in cases of a more “traditional loss” like a death, someone can reach acceptance and then go back to another stage. This is not always the final stage. Sometimes it could even be the first and only stage! Grieving and loss are individual.

Dealing with the end of a relationship

It can be hard to lose someone you love, especially when you know it was because of a breakup and not a death. It can feel like things are more open and the hope that things can return to normal with the relationship being repaired could complicate things for some people.

  1. If you or someone you care about is experiencing grief, a great resource is counseling. It can help people work through their feelings, especially when done with a neutral party who is less likely to push for us to feel a certain way or the other. Therapists often know of resources and skills we can use in order to try and heal a little bit faster. Resources in the community are especially important for someone who has left an abusive relationship and therapists can often help people with finding those.
  2. It’s important to take extra time to be compassionate and gentle with yourself. Regardless of why the relationship has ended, these events tend to come with a lot of difficult and sometimes overwhelming feelings. It’s not easy to say goodbye to something that meant so much to you and so it’s important to be kind to yourself through this process.
  3. Don’t force yourself to meet society’s timetables for what an “acceptable” mourning period looks like. We all take our time in processing these events and it’s normal for yours to look different from someone else’s. Trying to force ourselves to fit a grieving mold can make things harder and can leave things unresolved for us, emotionally.
  4. Look for support from those you love who are in your life. Those people who are still there for you are going to be important anchors throughout this process. It’s especially important to try and avoid social withdrawal or isolation during grieving as that can sometimes make things worse for us.
  5. Seek out support groups catered to your loss, such as for divorce, domestic violence, or the death of a partner. Many support groups exist and this is something a therapist can help you find. It can be helpful to hear that you’re not alone in this and that someone else has experienced a similar loss and is coming out on the other side of it.
  6. The most important thing to remember is that you don’t have to grieve alone.
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The Subjective Grief Experience

By: Kerry Moran

Everyone will experience grief and loss at some point in their lives. Grief can impact people in many different ways and can look very different from person to person. It also doesn’t just come from the death of a loved one. People can experience grief that can be brought on by loss of a job, a housing move, loss of a friendship, opportunities, a relationship, and any number of things. It can also be brought on by a loss of a social role, such as the role of a worker when someone retires or the loss of parenting role once children become adults and start their own lives away from home.

Grief can be about mourning the actual, physical loss of a person but it can also be about mourning the future and dreams involved with that person. Any joint plans, expectations, or hopes for the future that can no longer happen because of someone not being in our lives anymore can all come with an experience of grief and a feeling of loss and mourning.

There is no one way to grieve and there is no one definitive list of what can cause a grief response for someone.

The Five Stages of Grief

Elizabeth Kubler-Ross was the first to detail what many of us know as the “five stages of grief”. While she initially developed these to explain the process those with life-threatening illnesses go through once they receive a terminal diagnosis, it can also be applied to many other forms of grief. These stages are not linear. What this means is that someone can go through them in any order, may never experience certain stages, or may go back to stages even after “resolving” them. For example, someone may reach acceptance, but may then experience anger or denial again.

Denial

This stage is defined as not being able to accept or understand that someone or something is truly gone. People can experience this as an expectation that things will go back to normal and that this is temporary. When dealing with illness, for example, it is a denial that the diagnosis is terminal and that you or someone you love will find an effective treatment that will not result in death.

Anger

When talking about the stages of grief, anger can be seen as a desire to blame someone or something else. Often this is seen as an expression of things not being fair or just. “Why is this happening to me?” “Why would God do this to me?”

Bargaining

With grief, bargaining often looks like trying to make promises to the universe, a deity, or someone in our lives in order to make things go back to normal. This is different from denial because the person accepts that the loss is happening but not accepting that nothing can be done to change it. Sometimes this can look like “I promise I’ll go to church again if you save my mother from dying” or “I promise I’ll take my medication and go to the doctor if I can just get better.” It’s an attempt at gaining control over a situation in which someone feels helpless in the face of their loss.

Depression

This is a realization of the loss, and the fact there isn’t anything that can be done about it, which often brings upon strong feelings of despair and hopelessness. Often people withdraw from their families or loved ones as a result of this. It can be seen as “What’s the point?” or “Why should I even bother?”

Acceptance

This should not be seen as the end of the grief experience or cycle. People do not always reach “acceptance” about their loss and then stop there. Sometimes someone can accept their loss but then go back to anger or denial, for example. This stage involves accepting the reality of their loss and no longer trying to change it but moving forward. There is an acceptance that things cannot go back to the way they were before the diagnosis, the housing move, or the job loss.

Grieving

The process of grieving and going through these stages is incredibly personal and individualized. No two people will experience grief or mourning in the same way, even if they are responding to the same loss. Two siblings going through the loss of a parent will experience this loss in different ways, going through different stages at different times, and reconciling with their own personal experiences with this parent and the impact of the parent’s loss on their lives.

It is normal to compare your experiences with grief and loss to how others are experiencing it or how society tells us we should. Our perceptions of how others are experiencing a similar grief can also impact how we should or should not be behaving or reacting to grief. There is no timeframe for grief and there is no normal way to grieve. Our personal way of grieving is not wrong just because it doesn’t look like someone else’s.

Help and support

There are many different resources out there for people who are grieving. Getting support and care from those we love is certainly a first step. We can also take extra steps to be gentle with ourselves and prioritize self-care. Bereavement therapy is an option for those who feel grief is impacting their lives in a way they need extra support with and there are many grief counseling groups revolving around different forms of grief, such as child loss or parent loss.

Additional resources

https://www.grief.com

https://optionb.org/

About the Author

Kerry Moran is an intern at CCC who is currently enrolled in the undergraduate psychology program at the University of Massachusetts Dartmouth. She is currently applying to graduate programs for her master’s in counseling with the goal of becoming a Licensed Mental Health Counselor. Grief is a topic that is close to her heart and something she feels passionately about, especially since so many people grieve alone as a result of societal pressures. Grief and grieving are important parts of the human experience and her hope is to be able to one day work with many different types of clients, but especially those experiencing grief and loss.

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Why I Decided to Run a Postpartum Group

By April Lacey, LICSW

How it Started

I thought it might be beneficial to share why I decided to run a postpartum support group. Initially another clinician decided they wanted to facilitate a Postpartum Depression Group due to the lack of resources and support in the area. Once I heard the idea, I was immediately on board with becoming a co-facilitator. Circumstances changed and I became the one to move forward with facilitating the group.

The Structure

This group was designed to benefit mother’s with infants ranging from birth to age one. The group was initially scheduled as a 6 week series. I felt like 6 weeks wasn’t enough time to really gain those meaningful connections and process through all the struggles of being a parent. I decided to switch it to an ongoing group and change the name from Postpartum Depression Support Group to Postpartum Stress Support Group. My reason was to make the group all encompassing to anyone experience postpartum struggles. Since then I have decided switching to a 10 week group as that sweet spot to meet the need. I plan to run it in a cycle of 10 week series all year round.

Topics covered are the following:

Self-care

Family Support

Attachment

Boundaries

Baby Blues

Perinatal Mood and Anxiety Disorders

Breastfeeding

Mom guilt

Expectations

Motherhood Myths

Milestones

My Why

So why did I jump at the chance to facilitate this group?

First and foremost I am a mother. As a parent we all have our own idea of what having a baby might look like. We set these expectations and make plans in our mind. You might think you are prepared because you already have kids, worked with kids, watched kids, or have kids in your family. The one thing I learned from becoming a mother is “I was not.” All babies are different. Yes, I was prepared for the basic things in order to keep my child alive but there are plenty of things that happened that I wasn’t prepared for. Parents are going most likely feel challenged. They are going to have moments when they may feel like a complete failure. They are going to experience an array of emotions. But remember, that’s okay. There is no certain way you should feel or act. We all going on instinct and doing what is best for our child.

Experiencing postpartum struggles does not always mean that something went “wrong”  or was “different”. Even having what society might consider a “normal experience” can still lead to parents developing feelings of sadness and anxiety. Many mothers and even fathers will experience the “baby blues” the first few weeks after giving birth.

For me there were some complications and my daughter was born 6 weeks premature in January 2020. None of what I planned for happened. And just two short months later COVID happened. I had to not only adjust to all of the emotions of being a new mom with a premature baby, but also the isolation of quarantine.

I wanted parents to know they are not alone. There is support and others who can empathize and understand what you are experiencing.

My next Postpartum Stress Support Group starts Monday January 9 at 7pm.

April graduated from Boston College in 2012 with her Masters in Social Work and is a Licensed Independent Clinical Social Worker. She is in the process of working towards her Perinatal Mental Health Certification and currently runs the Postpartum Sress Support Group here at Compassionate Counseling Company.
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Navigating LGBTQIA Family Holidays

By Aden Meiselbach, LICSW

Growing up did you receive negative messages from your family and friends about sexual and gender identities they deemed to be outside the social norm?

After you moved away from your family home did you finally feel safe to identify with your true self and now you want to make sure your confidence in your identity doesn’t become diminished?

If either of these ring true to you, the following tips might be helpful for you navigating the holidays with family and friends.

Patience and Understanding

First, think about how much time it took you to decide and accept who you are as a person. Likely, expressing your true sexuality or gender identity took some time and consideration on your part. Remember how much time it took you to process who you were and come out to family and friends? Family and friends that have known you for a long time might need some time as well to process and accept your newly disclosed identity, as it may be brand-new information for them.

I came out as Transgender to my family around the age of 21 and unfortunately received less than supportive reactions from the majority of my family. However, about 8 years later, I finally found myself in a place where I felt accepted by most of my family and comfortable returning home for the holidays. Without the patience and understanding that I forced myself to practice throughout this transitional time, I wonder if I would still have a relationship with them right now. After all, it is important that as individuals we role model the actions and words that we expect from others. However, practicing patience and understanding is no easy feat, and should not be confused with allowance for disrespect. So then you ask what do I then do to ensure I receive respect from those around me? The answer is to set boundaries!

Setting Boundaries

So what are boundaries or what do boundaries look like? Boundaries are imaginary property lines set between you and others you interact with. It gives you the ability to separate your physical, mental, and emotional space from others, with the imaginary property line. Setting boundaries also give others around you a clear expectation of appropriate and inappropriate ways of interacting with you and defining what respecting you might look like.

So what do boundaries look like? This is a difficult question to answer as everyone’s boundaries look different. However, when deciding what boundaries you want to set you start by prioritize your needs and comfortability over those of others. It’s also important to determine within yourself what rigid boundaries (those you will not allow anyone to cross at any time for any reason) and those which we identify as soft boundaries (setting expectations for how others interact with you but leaving room for exceptions to the rule).

One boundary you might think about the setting is that you disclose your sexual or gender identity to whomever you choose, not who your family chooses. Early in my transition, I had a girlfriend, with whom I finally felt comfortable disclosing my gender identity. While processing this information she choose to disclose my gender identity to people in our lives. I was not ready to disclose that information. While I understand where she was coming from, this was very hurtful and difficult early on as I was in my most vulnerable state at the time.

That being said, it is important to consider what boundaries you might want to set prior to seeing family and friends during the holidays. However, these are important conversations prior to the day of, so they have time for processing and to be held accountable. This is not to say even the most accepting of friends are family might “slip up,” every now and again. However, you will quickly learn what are honest mistakes and what mistakes are intentional!

Self Care and Positive Affirmations

Holidays can be one of the most difficult times of the year for people who are part of the LGBTQIA community for a multitude of reasons. Although the holidays are been advertised as a time of being thankful and giving back to others, it’s important to give to yourself as well. Make sure that during the holiday season you are giving more to yourself as well. This might mean prioritizing your own self-care, (ie taking a nice bath, getting your hair done, seeing your therapist more frequently, or joining a local support group). Also, be mindful that self-care can look different for each person and does not have to look any particular way. Think about what makes you happy, what fuels your heart and soul, and what healthy thing makes it just that much easier when you have a bad day. Whatever your answer might be, that is your self-care! Self-care is always best coupled with positive affirmations. It can be difficult to be kind to yourself when the world can be an unkind place. Positive daily affirmations, although an awkward feeling at times, can definitely increase a person’s self-worth. By simply writing, saying, or acknowledging a positive quality about yourself daily, you will equip yourself with a little more armor to battle the world!

For me, some days self-care looks like a nap on the weekend, and for others, it’s taking an overnight trip to the mountains. And positive affirmations are an ongoing list on my phone to remind me of the qualities I like in myself.  So what fuels your soul? What makes you who you are? What qualities are you proud of?

You have the Right to Celebrate the Holidays the Way in Which You Choose

Above all else, you choose where, when, and how you celebrate. If you don’t want to celebrate with this person or that person it is okay! You have a right to your own autonomy and to make your own choices. You are under no obligation to explain yourself to others either. Most importantly you have the right to enjoy your holiday the way you choose to! Happy Holiday Season!

Aden is a Licensed Independent Clinical Social Worker. He has over 10 years of experience treating co-occurring disorders. He is a Certified Trauma Professional and specializes in the LGBTQA population. He currently facilitates our Gender Spectrum Support Group.
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Baby Blues or Postpartum Depression?

By: April Lacey

First and foremost, congratulations on having a new baby! Entering parenthood has the potential to give rise to many unanticipated emotions and expectations for yourself. Some people will have feelings of excitement and/or happiness while others might experience feelings of being overwhelmed, sad, and/or anxious. You might also have a mixture of both. Generally, society presents the former as the norm and you might feel as though you are expected to just know what to do. As a result of these expectations you may be under the impression that something is “wrong”  or that you are a “failure” if you have difficulty meeting society’s expectations of immediate connection and happiness. However, experts report that an estimated 80% of all new mothers will experience mood swings and/or weeping that starts a few days after following the birth of a new child. These are symptoms of what we refer to as “Baby Blues”.  Symptoms of baby blues typically only last for a few weeks and do not require medical intervention nor do they interfere with your ability to care for your infant.

Symptoms of Baby Blues include:

Mood swings

The other side of motherhood. At times, the responsibilities of motherhood can be exhausting.

Anxiety

Sadness 

Irritability

Feeling Overwhelmed 

Crying

Reduced concentration

Appetite problems

Trouble sleeping

Now that we’ve highlighted the symptoms that are characteristic of the Baby Blues; I believe that it is equally important to highlight the symptoms that are characteristic of Postpartum Depression as well so that you might be better able to to distinguish the differences between the two. It is important to note that if you observe that your symptoms of Baby Blues does not resolve or even start to increase after a few weeks, then it may be a possibility that you are experiencing symptoms of Postpartum Depression or another perinatal mood disorder. Please know that you are not alone! Postpartum Depression affects approximately 15% of women and it even affects 10% of dads. It is also important to note that symptoms of Postpartum Depression are very much similar to those of Major Depressive Disorder although symptoms of Postpartum Depression tend to occur after pregnancy and can last up to one year postpartum. If left untreated, Postpartum Depression can potentially develop into Major Depressive Disorder.

Symptoms of Postpartum Depression include:   

Severe mood swings

Symptoms of Postpartum Depression and the Baby Blues can be debilitating, leading us to question our parenting skills.

Excessive crying

Difficulty bonding

Insomnia

Intense irritability and anger

Hopelessness

Feelings of worthlessness

Inability to concentrate

Thoughts of harming self or baby

Please remember that if you are experiencing symptoms of either of these disorders; early identification leads to early treatment and relief. Postpartum depression is temporary and treatable with professional help. However, it is important to note there is no universally defined time frame to feel better and each person is unique with different needs. If you feel that you may be suffering from Postpartum Depression, please reach out for support. A few possible treatment options include connecting with your social circle (family or friends), connecting with a therapist, joining a support group, and/or consulting with your primary care physician, OBGYN, or a psychiatrist for medication if necessary. As a new parent, it is important for you to take time to engage in self-care activities including but not limited to getting rest and recuperating, eating well, and taking breaks to prevent burnout. No one is perfect and each of us could use a helping hand at times. Never be afraid to ask for help.

At Compassionate Counseling Company, we are offering an ongoing weekly Postpartum Stress Support Group that begins virtually on Monday August 8th at 7 PM. You do not need to have a formal diagnosis in order to attend the group. Come meet and be supported by other parents with shared experiences by taking advantage of the opportunity to process the stressors and emotions that come along with having a new baby. If you are interested, sign up here.

April graduated from Boston College in 2012 with her Masters in Social Work and is a Licensed Independent Clinical Social Worker. April enjoys working with children, adolescents, adults, and families and she currently runs the Postpartum Stress Support Group here at Compassionate Counseling Company.
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