New Directions’

 LETTER TO NURSING STUDENTS

ABOUT BIPOLAR DISORDER 

by Ruth Z. Deming, MGPGP 

A Talk Presented by New Directions Support Group

to the Nursing Students in Psychiatry and Community Health Rotation

at Abington (PA) Memorial Hospital’s Dixon School of Nursing

February 19, 2004.  

INTRODUCTION 

Like many little girls who grew up in the 1950s, I wanted to be a nurse when I grew up. I was reminded of this only the other day when I visited your reception room and looked at your Display Case, a museum of how things used to be:  peaked nursing caps, starched uniforms, and the classic book series: “Cherry Ames, Nurse.” There was even a navy woolen cape in the display case like Florence Nightingale may have worn.  

In that moment, I was reminded again of what healing is all about:  Women and men who put things right; people whose natural instincts drive them to reach out fearlessly to heal another’s distress. Those of you reading this have chosen as your profession the path of healing.  Is there any other profession that so matters! You are vital in the life of the world. Thousands and thousands of people will benefit from your kind and compassionate care.  

Please realize this from one of your most devoted fans! 

Two of the most vivid memories I have of nurses concerned 2 critical life events:  natural childbirth at Abington Memorial Hospital and involuntary hospitalization for mania and psychosis at Montgomery County Emergency Service in Norristown, PA.  

In each case, I was very alone. It was a nurse who personally comforted me in my hour of need, a kind soul who eased my pain – physically and emotionally – and let me know I was a human being who would prevail over adversity and get well. In the labor room and during delivery, a nurse at Abington Hospital stayed with me during the breathtakingly glorious and painful procedure of giving birth. Even though I can’t remember her name, I won’t ever forget her help.  

In the mental hospital when I was totally unaware of what was going on except for the turbulence in my own mind, the radiant face and kind personal attention of one particular nurse showed me there was hope that I would one day get out of the hospital. In my great confusion, her face shone like a star. 

So, it is with great sincerity, I tell you that nurses are very important people who do indeed change the lives of every individual they meet.  And we are grateful that you’ve chosen to remain with this profession, particularly in this new era of managed care, ridiculous amounts of paperwork and often inhuman demands on one’s time and stamina. But the true spirit of nursing can never be dampened even in this impersonal technologically-driven world of health care. There is nothing that can compare with a real human being, a “live human voice” – a “caring word” – or a supportive hand on the shoulder. Humanity at its finest. 

BIPOLAR PATIENTS:  COMPLIANT and NON-COMPLIANT 

Let me share with you a little bit of my life as a manic depressive. Or, as we now call it, a person with bipolar disorder. (I myself often cling to the old term “manic depressive” because it reminds me of the great gallery of fine minds and artists, with manic depression or depression.) Mostly, though, people in the medical community, as well as your patients, refer to the illness as “bipolar disorder.” 

You need to know there are 2 types of people with bipolar disorder:  People who are poorly medicated - or not medicated at all. They may be totally out of sync with what is going on in real life. They may have “tunnel vision” and may not realize the turmoil they cause to their families and everyone around them. This is very tragic. To a nurse on duty, these people can be the bane of the ward. Or the neighborhood. Please realize it is the “disease entity” that is making us behave this way. It is not our true selves. Many of these individuals are unable to face the truth that they suffer from an illness and refuse to receive medication unless forced by circumstances to do so. 

Then there are the many people like myself, who have been fortunate enough to recognize that we have an illness and are prepared to do everything in our power to overcome it. We realize that this is the major task in our life. To stray from this task, or to disavow it, is unthinkable. Our tools in our quest for wellness are medication and healthy lifestyle changes. I have been extremely fortunate – and eternally grateful - that both work for me. 

From the moment I wake up in the morning, until the moment I fall asleep at night, I focus on maintaining my homeostasis:  to quell my anxiety and whirring mind, and to seek serenity and joy. It’s a neverending process, and I am indeed fortunate to have succeeded. You ought to know, too, that I have experienced aplenty the true agonies of the illness.  One of my life’s goals is to help people get well and avoid suffering. I am a staunch foe of suffering. I’ve had enough of it to last a lifetime, and do everything in my power not to suffer again. And also to help others. 

One of the ways I got better is by following the Steps to Recovery that are attached separately. This includes following the advice of my incomparable psychiatrist, Dr. Laurence Schwartz, whom many of you have met, and by making healthy changes in my lifestyle. It includes embracing the light and avoiding the darkness, or, living with positive vibes around me and avoiding, as much as possible, toxic situations.  

Again, recovery from mental illness is a life’s work.  But it is achievable. For me, Medication and Lifestyle Change are the keys. 

HOW YOU CAN BE OF PERSONAL HELP TO THE BIPOLAR PATIENT 

I hope the following points will be of help to you, both in your professional situation and also in your personal life should you know anyone with bipolar disorder, or, as a nurse, are asked for information.  

. It goes without saying that everyone is an individual and should be appreciated as such and not judged by their “label.” So, yes, keep in the back of your mind that we have bipolar disorder, but also realize that we have personalities, as well. Our personalities may be exuberant, joyful, funny, creative, dramatic, quiet, contemplative; we may blow off steam or get annoyed at others, exhibit normal anger. But this is our personality speaking. It’s not the illness. So we all – patients and practitioners alike – need to know what is simple personality speaking, and what is the intrusion of the illness. Wisdom and practice will help us find the difference. 

. Realize who we are:  people with mood swings are just like anyone else. Our moods are an exaggeration to the max. These many moods may include feeling overwhelmed, angry, stressed out, as well as feeling so depressed and despairing, we wish to end it all.  On the other side of the coin, our energy and confidence levels can soar to disproportionate lengths so we think we can literally conquer the world. And may be quite obnoxious about it. 

If you see us “acting out” due to our illness, talk to us tactfully about this.  

Realize, also, that we expend an extraordinary amount of energy in keeping our lives intact and from falling into disarray. Medication makes this easier than was ever possible. 

. Suggest, when we are well, that we attend a support group. One of life’s greatest pleasures is to tell Our Story to the very person(s) we need to tell it to. Support groups afford us that great opportunity. Plus learning from others in our same situation. 

. Encourage us to “reality check” or “put things in perspective.” People with bipolar disorder have “exquisitively sensitive minds.” This is a double-edged sword. It can work for us (our creativity is legion, as is our ability to listen and counsel other people) but because we’re so sensitive, we can often take things personally. We can pick up little nuances in people that other folks may not see. Sometimes these nuances may be just our imagination (“projections”) but other times, we’re often correct with our keenly intuitive, psychologically-attuned minds. Therefore, please encourage us to reality-check. 

This is a very important concept. It means checking our subjective perceptions (such as “My boss is being mean to me”) to see if they match up with the way things really are (“Your boss is actually overwhelmed with her own workload, and thus you are perceiving her to be mean, when she actually has nothing against you.”)  This is an example of how we may take things personally, when they’re not meant so. You can help us put things in perspective. 

. Gauge whether or not we need help. Many of us are unbelievably strong inside, even while rocking with the storms of the illness. Many of us prefer to keep a “stiff upper lip” rather than reach out for help. Respect this in us, but also offer us your hand anyway. Gauge our need for help. When done kindly and tactfully, we accept help, if needed. 

. Take our concerns about being overmedicated seriously and encourage us to seek help. Many of us complain about being overmedicated. This is most likely true. In a hospital setting, overmedication is probably unavoidable. When we’re discharged from the hospital – or when you meet someone who complains about being overmedicated – encourage us to earnestly discuss this with our doctor. Overmedication is a serious problem. It results in non-compliance. The goal is for medication to help our mood swings without making us feel doped up. 

. Encourage us to avoid “toxic situations.” For example, if a friend invites us to watch the Super Bowl and drink a case of Coors, advise us to drink Canada Dry instead.  

. Encourage us to utilize our creative talents. During my inpatient stay at a psychiatric hospital, an activities therapist praised a bowl I was making out of clay. That praise stuck in my mind. It wasn’t until several years later, that I became a clay artist. 

. Encourage us to help other people. We love being helpful to other people. Many of us, in fact, are in the helping professions. We may keep a low profile, however, for understandable reasons.  

. Picture us as success stories. In a hospital setting, you see us at our worst. Remember, though, how successful we can be. When our disease is controlled by medication and our symptoms held at bay, our true gifts can gracefully emerge.  Many community leaders, business people, physicians, lawyers, homemakers are extremely successful by pursuing the right medication and healthy lifestyle changes. 

. Keep these successful people in mind – they are achieving their potential – and think of them – the success stories - when you are nursing along patients in the throes of their dreadful illness. We CAN get better. Statistics show that 80 percent of us can live normal lives. 

A WORD FROM OTHER NURSING STUDENTS 

Over the years, New Directions has had a host of student nurses sit in on our support group meetings. We love having the nurses listen in, as we share the workings of our lives with them. And also so they can see the great love and caring - and “nursing” – that goes on within our support group.  

Our observing nurses have often remarked that they hadn’t realized how difficult it is to live the “bipolar life.” In other words, for some of us, it’s difficult to just get through the day. But, as the nurses witness at our meetings, our individual members become adept in putting strategies and problem-solving techniques into place. This way we can deal effectively with the universal demands of work, parenting, relationships, and utilizing our God-given talents. 

So, be our advocate. Play on our strengths. We have enormous contributions to give to the world. We never forget those people who support us and give us opportunities. You live in our minds and give us strength.