In this article Lara interviews her friend diagnosed with Bipolar Disorder who gives us a candid view of what it is to live with this mental health condition; and how we can be better as healthcare professionals when coming across it.

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The CSP recently published a guide for physios who come across patients with mental health conditions in their practice but are not specialised in mental health. It's called "So your next patient has a mental health condition".

It's a very useful resource (you can read it here) and it's interesting to think of the variety there is in mental health conditions and how our response should vary accordingly. I think as healthcare professionals, as often when we're not specialised or familiar in an area, we can indeed be guilty of thinking of mental illness as one broad condition, and approach patients in a similar way.

The main take away messages I took from this guide were:

• Inform yourself beforehand and do not be afraid to ask for guidance to more specialised professionals if needed.
• Communication is key. Get to know your patient - everyone is different even if they suffer from the same condition. 

This publication made me reflect on previous experiences with patients with mental health conditions. I remember specifically a lady who came to see me for a musculoskeletal problem and who had Bipolar Disorder. Luckily I was not unfamiliar with the condition so I did not have to do much research about it, and although the treatment went well I still think my dialogue with her could have been better. Seeing the CSP guide and reflecting on this past story encouraged me to take action and find answers to some of my questions about mental health.

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I am familiar with Bipolar Disorder because one of my husband’s best friends, Bernardo, has been diagnosed with this condition. I have known him for 8 years which is around the same time he was diagnosed. Bernardo is 30, he works in a night-bar and has a degree in law. I met with him recently and asked him if he would like to give me his perspective on a few things. We had a great chat about his condition, about general life experiences, about healthcare... And he has been kind enough to allow me to share it with you guys.

You'll find below some of the questions I asked him and I will try my best to share his very enlightening answers. Some of them I have tweaked for the sake of translation (our conversation was in Spanish), but I can assure you this post is as true to my friend’s perspective as it can be.

With regards to Bipolar Disorder, most people think that you change from one state to another very quickly and this is not true. In some cases like subtype Cyclothymia this might happen quicker, but in my case, each phase, whether is depression or mania lasts longer and it also takes longer to reach each point. It can actually last months or even years.

I have found that friends and relatives are cautious about my emotions, and tend to confuse these with symptoms. Sometimes they forget I am still able to get excited about things, get angry or even feel low without it necessarily meaning that I am about to get depressive or manic. These are just normal feelings!

 

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Do you think it is important to increase awareness of mental health issues in society? To reduce stereotypes for instance.

Definitely. Mental health is still a taboo and unfamiliar to many. Nowadays however, some mental health conditions like depression are getting more awareness brought to them, and this helps.

In my case, I feel more comfortable around people that have a bit more knowledge of the condition. It is easier to be honest with them and you can tell they don’t need to be cautious with their words, which is what happens, unnecessarily, with people that have no a little experience with it.

When it comes to new relationships I tend to wait for the right moment to tell them. Like everything in an relationship you start little by little. I normally explain it through my experiences with depression, as this is more accepted and is easier to introduce the topic that way. I am not afraid of the reaction people might have, it has been fine so far. 

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What do you think health professionals (such as GPs and physios) should know before treating someone with a mental health condition?

It is important that they have basic knowledge and do not assume we are all the same. Not all mental health illnesses are the same and not every person deals with it the same way. Moreover, within the same disorder you might experience different phases or symptoms, therefore the approach will be different depending on the phase the patient is in that moment. 

My experience with my GP has been good, he always asks how I am feeling, what medication I am taking… However, I had a bad experience with one of my Psychiatrists. They would only focus on my blood tests and wouldn't bother asking me anything beyond that, not even when they knew I was changing jobs (changes in routine can potentially trigger a new phase in people with Bipolar Disorder). 

In terms exercise in general, I know that it can be beneficial, but sometimes I see more as a need than a therapy. When you are in a manic phase you have a lot of energy that needs to come out somehow. This often translates into a higher sexual drive and increased activity in general. Those are the signs that tell me I am entering a manic phase and that I might need a medication review.

During this phase you don’t really have a measure of your own limits. For instance, I used to take my bike and cycle really fast. It did help me to relax and free all that energy accumulated, but I used to put myself at risk by cycling everywhere at speed without thinking of the potential danger around me… Exercise prescription needs to be personalised and regularly reviewed, especially in this phase.

 

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Do you think it is important that healthcare professionals know how to give advice about support tools and support groups?

I think it is important that these tools exist but as I said before they need to be tailored and personalised. In Bipolar cases, you cannot send someone in a manic phase to a depression group, they will end up unhinged, like it happened to me once. I was sent to a support group when I was in a manic phase and I didn’t last long. I was so fast-paced that sitting and listening to everyone wasn’t helpful at the time.

I think there is a lack of knowledge within the healthcare system regarding what to advise or how to refer someone to those services. We need to ensuring frontline professionals are aware of them, or at least know where to find the information.

 

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You were diagnosed 8 years ago. Do you think you can talk about how you feel with the people around you? How do you see us (closer friends and relatives) in this aspect?

In general there is still a lack of awareness. Most people associate Bipolar with Schizophrenia. I feel my family has not changed. There is a bit of overprotection and misinterpretation of feelings with symptoms. I feel  my mom in particular is constantly worried and every time I express an emotion she is alert as thinks this might be a sign or symptom - which is often not the case, I am just being sincere about my normal emotions and feelings. 

In my group of friends I feel mostly at ease, but sometimes it still feels strange as certain words and topics that have become taboo. Some people will be different but I find it funny when one of our friends used to joke and say things like ‘do not let the crazy one do this, it will not work!’. It was obviously very friendly and made me feel normal. I can take a joke, it's okay!

The thing that helps me the most is when a friend takes the time to listen. To just let me say everything I have to say and let it all out. Whether it's in depression or in a manic phase, it helps me to have someone sat next to me listening patiently.

 

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What would you tell people that have just being diagnosed or are in a similar situation to you?

I feel that this process is like the 5 stages of grieving: denial - anger - bargaining - depression and acceptance. I have gone through all of them. I am not sure I am still fully in acceptance but definitely this perspective has helped me.

The key is to be patient with yourself. There will be bad experiences… In my case I had a degrading treatment from nurses and I realise know that psychiatry is still a science in diapers. Many treatments are still experimental and there is a huge complexity within this speciality and within each condition. To this you have to add that everyone is different and unfortunately, now you're also getting information overload. It is difficult to filter what information is reliable or applicable to your case. But it's important is to remember that you have same rights to privacy and dignity than anyone else. 

My current approach is that I am not living with it, I am working to control it. I am the owner of my life.

 

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What about the future, your future? How do you see it?

One step at a time. For the first time I am feeling good, I am happy with my situation but I am very aware of my limitations. I still have projects and goals in life but I know my approach to them will have to be different to what others do.

I would like to go travelling and do a big trip like you have done, but I know it cannot bit as long as yours, perhaps only a couple of months… I still would love to live some time in Scotland and to have a different job, but as I said, one challenge at a time.

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What are your thoughts on the topic? Do you work with or treat people with mental health issues on a regular basis? Have you been diagnosed or know someone who suffers from a mental health condition? Don't hesitate to share your story or experience with us in the comments below.

 

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About the author

Lara Garzón

Lara is a Spanish physiotherapist who has been working in the UK for the past 5 years. Having worked as a rotational Band 5 physiotherapist over here and now works as a Band 6 Physiotherapist, she's had experience in a wide range of specialities. However, it hasn't always been easy finding her way and adjusting to the UK system. She's been sharing her experience and helping other foreign-trained physios to come and settle here; firstly through her own blog, and now as part of the QP team!

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