Mindfulness - Part I

Patient Expert

Rewind the clock to early 1999. I was two or three weeks into my diagnosis. My meds were doing their job. I was stabilizing, with very few side effects. If this were a clinical drug trial, I would be classified as a responder and deemed a success.

Now what?

My emergency psychiatrist indicated that I would benefit from cognitive behavioral therapy.

Not so fast, I cut in. I'm not partial to strangers getting inside my head.

No, this wasn't like that, she explained. This was all about watching our erroneous thoughts and taking appropriate action.

A lightbulb went off. "Ah, mindfulness," I shot back.

She gave me a blank stare. "The mind watching the mind," I explained. "The Buddha talked about this 2,600 years ago."

Whatever, said the look in her eyes. Two or three weeks into my diagnosis, I was not exactly looking like a poster boy for mindfulness. Maybe the Buddha was a non-starter with this illness.

Despite my initial skepticism, I found cognitive behavioral therapy extremely useful. The therapy was strongly derivative of mindfulness, though its practitioners refrain from acknowledging the Buddha. (By contrast, dialectical behavioral therapy explicitly highlights mindfulness and gives credit where credit is due.)

These days, mindfulness is the new recovery buzzword. There is even something called "mindfulness-based cognitive therapy" (which is something of a redundancy).

In between, my writings on talking therapy and coping kept coming back to mindfulness, but it was only in 2005 that I began connecting the dots. That is when I came across a study by Melbourne researcher Sarah Russell PhD.

Dr. Russell surveyed 100 "successful" bipolar patients, and asked what they did to stay well. Seventy-six percent of the participants were in paid employment, 38 percent were parents.

What Dr. Russell discovered boiled down to mindfulness, though she didn't use that term. Rather, she talked about "moving swiftly to intercept a mood swing." This had to do with how patients "were responding to their mental, emotional, social, and physical environment."

Dr. Russell observed that these patients were adept at identifying their mood triggers. These needed to be picked up much earlier, they reported, than what their doctors recommended. Once depression or hypomania picked up a full head of steam, it was already way too late. Instead, these patients were microscopically attuned to such things as subtle changes in sleep, mood, thoughts, and energy levels.

By quickly responding, successful patients could nip an episode in the bud. Sometimes it was as simple as getting a good night's sleep or stopping to smell the roses.

At around the same time, I received in the mail a manuscript copy of "The Bipolar Workbook: Tools for Controlling Your Moodswings" by Monica Basco PhD of the University of Texas, Dallas, now a very successful book. "See It Coming," said the heading of the first section.

Dr. Basco is a leading proponent of cognitive behavioral therapy. In her book, she gave the example of a person with a great idea who stays up all night following up on it. The problem is not the great idea, Dr Basco notes. The problem was staying up all night. Now, thanks to a lack of sleep, there is all hell to pay.

Dr. Basco points out that emotions change our thinking, which affects behavior. We need to learn to take stock, spot patterns, and recognize triggers.

In other words, we need to be exceptionally mindful about how we conduct our lives, even if we are on meds.

Meanwhile, I was engaging in a series of conversations with John Gartner, PhD of Johns Hopkins, author of "The Hypomanic Edge." Hypomania can be a very scary proposition for many, but for a lot of us, Dr Gartner pointed out, it can also be a very positive personality trait. I long held the belief that psychiatrists tended to err on the side of overmedicating us. Now a clinician was validating my suspicion.

I had been on the same (recommended minimum) dose of a mood stabilizer since 1999. My business was picking up traction, I was receiving recognition for my writing, I had broken out of my social isolation, and I was into my second year of my second marriage. Moreover, I rested secure in the knowledge that my behavior, after all these years, was fairly predictable. As long as I remained on my meds and stuck to my various lifestyle and coping regimens, I was never going to embarrass myself in public.

But was that the goal of my recovery? To simply avoid making a spectacle of myself? A certain sense of exuberance - my vital oomph factor - was missing. I didn't trust myself to experience unreserved joy, and neither, apparently, did the psychiatric profession.

Would I be playing with fire if I tried to get it back?

Fortunately, I never had to make the decision. Due to various reasons, I lost my medical coverage and went from a name brand extended release mood stabilizer to the generic version. Whereas I only had to take the name brand drug each morning, now I had to remember to swallow four pills at various times of the day. Inevitably, I would miss a dose, perhaps even two.

A funny thing happened. Over the weeks, I noticed I was actually feeling better, more clear-headed and alert, with a certain spring to my step. But at what price? I could only wonder. Would there be a reckoning?

Or could I manage? By now, I had a full array of coping skills, and I was becoming fairly adept at mindfulness. Could mindfulness, in effect, augment my lowered meds doses?

Warning: There may be various reasons for lowering your meds doses, but please do not experiment on your own. Always consult your psychiatrist. My actions were unintentional, and fortunately, in my case, serendipitous.

To be continued...