I was diagnosed with bipolar disorder, also known as manic depression, thirteen years ago when I was eighteen. I was lucky, though I didn't think so at the time...most people who suffer from this illness aren't diagnosed until they are much older and the illness has slashed and burned their personal lives beyond recognition.

I went through all of the requisite stages of grief - anger and self-pity took an exceptionally long time to ride out - and I've endured three hospitalizations since 1988. Without medication, I am what's known as a "rapid cycler" with a diagnosis of type 1. There are plenty of great medical sites and books out there that will give you all the information you could ever want on the biological facts of the illness, but when I was first diagnosed (and for years into wrestling with this illness) there was precious little anecdotal information on how to deal with such a tricky disease. I thought I'd compile some of the things I've learned over the past few years that have helped me survive, function, and sometimes just get through the damn day.

Note: This is a subjective list of things that have worked for me in my own little life. It is not - I repeat, NOT - a substitute for medical care. That said:

1. Become an informed patient. With so much good information about bipolar disorder out there, it only makes sense to spend a good bit of time studying your diagnosis. I highly recommend two books by Kay Redfield Jamison, Touched With Fire and particularly An Unquiet Mind. (Jamison is the leading expert in the field of bipolar treatment and research, and as an added bonus she herself struggles with the illness. Her writings are immensely readable, marvelously informative, and blessedly compassionate. An Unquiet Mind is her autobiography, and a book that I keep copies of to give to friends and relatives who want to understand me a little better.)

2. Don't let the damn illness define you. This is an epiphany I had several years ago when a boyfriend left me. He was a great guy, very honest and patient, and when he gave his reasons for leaving the top one was that I had become boringly obsessed with being sick. Nothing alienates people quite like a steady stream of information about your mental illness, particularly if you're still in the self-pity stage of grieving. Bite your tongue and save it for your shrink. Above all, remember and repeat after me: I am not my illness. Repeat as often as necessary. Silently, please.

3. Don't expect everyone, or even most people, to understand what you are going through. Even though this disorder strikes about two percent of the general populace (which means that you most likely love, know, or work with someone with bipolar disorder), there is still a strong stigma associated with mental illness. I am not advocating a "closeted" existence - on the contrary, I look forward to the day that mental illness is as discussed and accepted as, for instance, diabetes is - just a little common sense about who you let into your inner circle. Remember that not everyone needs to know about your troubles, particularly acquaintances and ignorant bosses.

4. Find a creative outlet for your pain and frustration. This does not mean kicking your cat, lover, or best friend. Write it out, paint through it, sculpt it into oblivion. Some of the best art has come from ordinary people wrestling with extraordinary pressures.

5. Count your blessings. This is not pretending that nothing is wrong or that pain is not involved. Far from it. It is training yourself to remember that a scant 30 years ago there was no treatment for this illness short of permanent hospitalization or arbitrary electroconvulsive therapy. You are living in a time where hundreds of the best scientific minds of our generation are pouring themselves into research on the treatment and possible cure of this illness. You are capable of living a relatively normal life with the help of medicines that weren't even around 15 years ago. You are not your illness, but 35 years ago that's precisely what you would be.

6. Exercise. I know you hear this everywhere and from every media source, but if you have bipolar disorder it can mean the difference between years of remission and years of rapid mood cycling. Between the ages of 20 and 24 I worked as a fitness consultant. My job required me to exercise almost daily. During those years I went through a nasty divorce, dealt with crushing financial setbacks, and suffered through the deaths of two dear friends. I am convinced that the only reason that I stayed well - and I mean totally asymptomatic - was the fact that I was taking care of my body. Often, the regular life stress that "normal" people seem to deal with so handily can be crippling to someone with bipolar disorder. Every time you work out (especially outdoors...it feeds the spirit), marvelously beneficial neurotransmitters bathe your nervous system in hot, buttery goodness. As an added benefit, your sex life will improve...I guarantee it!

7. Find something, someplace, or someone that feeds your spirit. For me, He's God. For someone else, it may be the beach at dawn or the grandmother who never judged you even when your whole family considered you to be the resident fuckup. One of the most insidious things about this illness is that though it is a biological disease of the brain that affects the functioning of the mind, what it can really do is destroy one's will to live, love, and carry on. Tend to your spirit. Feed it, care for it, pamper and spoil it, and do not ever surround yourself with people who treat it with contempt.

8. A corollary to 7.: Don't let someone else become your entire world. This is a recipie for the worst kind of disaster there is. Period. You will be tempted, when that amazing, caring, perfectly understanding man/woman comes into your life, to set up a shrine to them and never again leave the house. DO NOT DO THIS. Pray for such a person, and when he or she arrives, bless the one who sent them, but don't let other friendships, projects, and goals fall by the wayside. They will feel strangled, and you will become desperate, and things will get ugly fast.

9. This may seem like common sense, but here goes: see a good doctor, a board certified psychiatrist, regularly. I am stabilized on Depakote right now, so for me regular visits mean once a month. There have been times in the past thirteen years, however, when regular visits meant once a day with phone calls in between. Know your illness (see 1.), respect its power, and find an excellent shrink who can help you with it. Remember, the first doctor you meet with may not be the one for you. It's sort of like dating through the classifieds. Keep looking, get recommendations from people you trust, and interview your doctor. After all, she'll be working for you. Ask her what her credentials are, whether she specializes in mood disorders, about some examples of successful treatment she has under her belt. She won't be offended; she went to school for about 14 years for the privilege of treating you. Ask, ask, ask. When you find the right one, don't skip appointments just because the meds she put you on are making you feel better. She'll have lots of practical tips on how to live with the effects of this illness that I couldn't even dream of. That's why she makes the big bucks.

10. I wish I could say that this, too, is common sense, but statistics say it isn't: Do Not Ever For Any Reason Stop Taking Your Medicine. Ever ever ever. Unless you have express permission from your doctor, stay on the exact prescribed dosage of whatever she has you on. If the meds make you feel muddy or less creative, for god's sake TELL HER and let her decide how to correct any side effects. She went to school for this, not you. Be compliant. I cannot stress this enough. I am not exaggerating when I say that your life may depend on taking the medicine your doctor has prescribed. Sixty percent of untreated people with bipolar disorder attempt suicide. Twenty percent succeed. (Incidentally, that makes bipolar disorder more lethal than many forms of cancer.) Do not be one of these. We would all miss you.

11. Don't isolate yourself. Think of gazelles in The Discovery Channel videos who lag behind the herd. Presumeably they are just taking some time to regroup or are indulging in some melancholy nostalgia. Whatever their reasons for isolating themselves, it's always these guys who get picked off by the hungry cheetahs. This is your life. Don't be cheetah bait.

12. Don't indulge in self-pity. It is the equivalent of psychic B.O. and will drive potential friends far away from you.

13. On the other hand, go easy on yourself. You have an illness that makes you a little more susceptible to the slings and arrows life tosses at us all. It is a real condition...it is in your brain chemistry, like epilepsy or Parkinson's disease. (For a really cool picture of what your brain looks like compared to your lucky big sister who missed the bipolar gene, go to http://www.brainplace.com/bp/atlas/ch8.asp) Ease up on you. It may take you a little longer to hit your stride in life than some other people, but once you hit it you'll savor every damn step, I promise.

14. For god's sake, get enough sleep! (If you are reading this at four AM, this means you!) Sleep rejuvenates the brain, refreshes brain function, and is about 100 times more important for bipolars to get enough of than the general populace. Take naps. Make bedtime a set, fabulous ritual involving hot baths, snuggling (with a cat, a blankie, or a lover), and fresh linens. Train yourself to not be quite so nocturnal (this is one of my greatest challenges). Know that sleep deprivation can trigger psychotic manic episodes quite easily, and be very afraid. You do not want to have a psychotic manic episode. Trust me on this one.

15. Surround yourself with beauty. This doesn't necessarily mean spending a lot of money, either. Make your personal environment inviting. Let it serve to remind you of the people who love you, of all the things you want to do but haven't yet done, of all the far-off places to which you want to travel one day, of all the reasons you have to get through the pain of today and press through to tomorrow. A friend of mine who was also bipolar once wrote a heartbreakingly beautiful poem about her struggle. She wrote: "...at dawn, I found emeralds/ Where at midnight I stumbled and fell."

Look for your emeralds. When you find them, share them.

By all means, if anyone out there has more suggestions of this nature, please write them up! And if any new wisdom comes to me, I'll most certainly share with the group.

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