Abstract

Summary: In this first-person essay, I address the ways I deal with my physical and emotional wellbeing as someone living with bipolar disorder. I detail the strategies I utilize to counteract medication side-effects and the resulting lowered self-esteem, with the assistance of and in full participation with psychiatrists and psychotherapists.
Keywords: Mental health, bipolar disorder, medication, treatment
Citation: Flynn S. Empowered patient — empowered lifestyle. J Participat Med. 2011 May 16; 3:e23.
Published: May 16, 2011.
Competing Interests: The author has declared that no competing interests exist.

When I first was diagnosed and treated for bipolar disorder at the age of 17, I was a petite young woman weighing 110 pounds, and my defenses against my illness were just as lean and brittle as my physical appearance. Now that I have aged 26 years past that beginning point, my weight has ballooned as I’ve gained over 100 pounds, perhaps hastened by my use of psychotropic medications, essentially doubling the bulk I bore then. On the other hand, the internal and external resources I use to keep me sane have bulked up considerably as well. I’ve finally come to the realization that, although I can always complain to my mental health professionals, blaming my weight gain on my medications, this serves no purpose other than to stop me from participating in my care.

A fortuitous remark by my current counselor, whom I both like and respect, brought home the lesson: That she will work with me but that ultimately my health is in my own hands. In a recent therapy session I once again bemoaned my fate: “Everyone looks at me and sees a big fat slob, and they don’t even know that it’s not my fault, that if it weren’t for these medications I wouldn’t even be overweight.” Wisely, she responded, “Suppose we leave aside the question of fault for now, and just deal with the facts. You don’t like the way you look and you don’t like the deterioration of your physical health, and deep down, you want to change this.”

Bemused, I had to concur. “Well, in that case,” she continued, “it makes no difference how the weight got there. The salient issue is, will you change this? And it is a question of will — no one can make you decide to change.” “Yeah, but it’s so hard and it’ll take so long,” I whined. “That may be true, but you will have mine, as well as other people’s support. What I’m trying to say is that ultimately, you will need to decide that getting your health back is important not to please me, or your doctors, or your family — but you.”

With both this counselor’s and my psychiatrist’s help, I am learning that I have the power to use my progress toward stabilizing my mental health to kickstart my journey toward stable physical health. The same reasons that lead me to continue my lifelong recovery journey: A desire to stay close to my husband and family and demonstrate to them my mental health; to serve as a role model to peers with psychiatric issues; to shore up my own self-esteem through knowing I am doing the best I can with my life. All of these can help propel me toward ever greater physical health.

The parallel processes of changing and sustaining my psychological and physical health can be encapsulated in the cyclical Transtheoretical Model of Change, formulated by Stephen Prochaska and Carlo diClemente.[1] According to this model’s circular stages of change, I am likely in the “maintenance stage” in keeping my moods stable, having learned much through 26 years of “seeking euthymia” while working with my treatment professionals and making use of friends’ and family’s support.

But I can only claim to be in the “contemplation stage” of making lasting dietary and exercise changes. I have often felt resigned to the notion that I would “never” be able to make such a major and lasting shift in habits. Even as I write this, I’m caught up in weighing the pros and cons of doing so. As the transtheoretical model describes, I still often cycle to the “action stage”, begin to change my poor physical habits, and sustain my efforts for days or weeks at a time, but then “relapse” and re-enter the cycle at the “contemplation stage”. I must remind myself to work proactively with my weak will and with my treatment professionals, who consistently facilitate my power to change.

The concept of patient empowerment and patient-professional collaboration was once foreign to me, as a childlike, dysfunctional adolescent. Luckily, the doctors who cared for me then truly had my best interests at heart and did their best to provide healing intervention. They prescribed antipsychotic medication to alleviate my frequent paranoid ideation. But they didn’t appreciate the medications’ terrible side-effects played havoc on my body, leading to obesity and increased risk for heart disease and diabetes. As time passed, I matured into a person who was capable of truly participating in her care. If any “blame” is to be assigned (and I believe this word essentially misses the point), surely it falls on me as well as my treatment professionals, because I consented to the treatment prescribed for me.

I’ve been very fortunate, since all of the psychiatrists I have consulted with since the onset of my bipolar disorder have involved me wholeheartedly in the treatment decision making process. They have helped me with my health-related goals by regularly asking me to track my weight, and by keeping their own records concerning gains and losses. Another part of this participatory relationship has been the continuous fine-tuning of my medication to optimize its effectiveness. To this end, I have consistently engaged in dialogue with my doctors regarding how I’ve experienced the therapeutic effects and side effects of medications.

My current medications, consisting “” of an atypical antipsychotic, an anticonvulsant mood stabilizer, a tricyclic antidepressant, and an anti-parkinsonian (side-effect controlling) medicine are required for me to maintain my stability and mental health. I, most likely, will have to continue these, given the failures of alternate medication trials over the years. In the words of a former, very caring psychiatrist, I am “exquisitely sensitive” to the medications I must take, such that one missed dose can spin me off-kilter for days at a time, mood-wise. But I feel empowered to have played a vital role in arriving at the most effective cocktail for me.

Early on, for example, one doctor remarked, “You’ve been on lithium for a year now, and it’s been great for keeping suicidal thoughts at bay. However, you seem to have turned into a rapid cycler; would you like to try Depakote instead?” After careful consideration I opted in, and have taken Depakote for the past 20 years. A later example: “We’ve had you on Risperdal for 10 years and while you’ve regained so much functionality, it has certainly led to weight gain,”(earning a nod, sigh, and eye-rolling from me). So I decided to switch to the weight-neutral Geodon and then Abilify, but both resulted in a dysphoric mania that I had no desire to revisit. Recently, my new psychiatrist asked, “You say the only true psychotic symptom you experience is the ‘paranoia’ in the form of fearing people are talking about you?Not as disabling as having the conviction that the CIA is stalking you. How about slowly attempting to decrease your dosage of Risperdal?” I was enthusiastic, until we found that I could not manage the hypervigilance and anxiety I experienced after lowering the dose.

There still is much that I can do to compensate for my poor health, physically sedentary lifestyle, and obesity. Although it is rather difficult to get off my duff and exercise when I feel like eating a doughnut instead, and look like one as well, it is not impossible. Since the weight started piling on and it became easier and more tempting to eat unhealthily and stop exercising, my doctors have taken notice and urged me to be more proactive about my health. Each one has counseled me on proper nutrition, given me suggestions for exercise that will strengthen my heart and increase my stamina without overly taxing my physical system, and encouraged me to view my health as vitally important, and worth making the necessary lifestyle changes to improve it. “” My therapists have been able to help me explore why I sabotage my own efforts; why I believe I am unworthy of a healthier, happier life, and how to move toward self-love. This can, in turn, lead to greater health and an outward appearance I am not ashamed of viewing in my mirror, as well as the inward appearance of psychic health.

My therapies have included modified cognitive-behavioral therapy, motivational interviewing, dream symbolism exploration, simple coaching-based encouragement. My therapists have cheered me on when I’ve succeeded in making a behavioral change, have helped me to not berate myself too harshly when I’ve fallen down on the job, and have kept me accountable to a commitment to changing my lifestyle for the long term.

“Come on, Shannon, get back on that bike,” one might say, or another, “You may be surprised at the progress you can make just by leaving a little bit on your plate at each meal.” In a more analytical vein, another therapist remarked, “Yes, you are used to seeing yourself as a dumpy loser but in your heart you know you are so much more than that and you deserve self-love.” Or, “What makes you so special that there are idiosyncratic rules governing punishment to be meted out only to you for your mistakes when you would never judge a friend or for that matter a stranger, as harshly as you judge yourself?”

The problem that keeps recurring has nothing to do with their wise counsel and everything to do with my own self-sabotage.”” I often wonder why I did not take my health issues more seriously years ago when I only carried twenty extra pounds rather than 100-plus. How much more swiftly could I have reversed the damages then, rather than my attempts now, which surely will require several years of attention to eating and moving healthfully to drop the weight and then maintain my healthier self?

Some of the self-hatred and feelings of worthlessness I thought I had discarded following my recovery from the initial episode of suicidal depression may have surfaced and fueled my half-hearted attempts to better my health. The feelings of self-stigma I drag behind along with my fat bulges seem to justify the alacrity with which I give up and slacken off.

Still, their efforts at steering me toward self-growth, alternately gentle and emphatic as needed, have helped me only in so far as I have been willing to myself! My therapists have the ability to empower me only to the degree that I have empowered myself. And guess what? I only just recently, after all these years, made that connection. The light bulb finally lit up and now I understand and accept what I never could before.

That is the essence of empowerment, isn’t it? In becoming an empowered patient, I discovered the beauty of the interchange between two equals, patient and professional, both focused on the patient’s goals, both committed to helping the patient achieve the lifestyle changes that bring about lasting health.

References

1. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change, 2nd ed. New York: The Guilford Press; 2002. ↩

Copyright: © 2011 Shannon Flynn. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.