I did a NHS psychoeducation course about bipolar disorder a few years ago. It was surprisingly informative. I thought I was pretty well read already but I learnt some useful things. I also met some people who I am good friends with now.
A lot of the information about bipolar disorder was relatively basic and would not have been out of place on a standard educational website for people newly diagnosed. The interesting bits were two metaphors that they used to ilustrate this information.
The first was the concept of a stress bucket. Everyone has a unique capacity for stress (the size of the bucket) and has different stressors in their life (fluid filling the bucket) and different stress relieving techiniques (a tap or holes emptying the bucket at the bottom). How much stress you can take before you develop symptoms (the bucket overflowing) is mostly genetically determined, so the theory goes. To stop the bucket overflowing, some people need to work harder than others to bring their stress levels down and to reduce the amount of stress coming into their life. I think I liked this metaphor so much as it made me think that I wasn’t to blame for how little stress it takes to destabilise me. I just have a small bucket in my head. Also, it made sense to me to link reducing incoming stress to increasing stress relieving activities. I can adapt to having a small bucket filling up quickly by putting in lots of taps.
Secondly, the psychoeducation course used the metaphor of a mood thermostat. Just like the thermostat for your central heating, a ‘normal’ brain tries to keep your mood within a certain range from sad at the bottom to happy at the top. It has mechanisms to lift up your mood (such as drives to do things that bring you pleasure or make you happy like seeking social contact, eating, sex, etc) and mechanisms to dampen down your mood (such as making you feel tired so you sleep or rest). A bipolar brain isn’t very good at keeping your mood in this normal range and veers up from happy to mania and crashes down from sad to depression. The psychoeducation course talked a fair bit about things that we could do to help regulate this mood thermostat. These days, this is called self-care. The strategies that I use are eating regularly and nutritiously, getting enough but not too much sleep (it took me years to fully apply sleep hygiene but it has worked very well for me), exercising, taking medication as prescribed and avoiding alcohol (nine years) and recreational drugs (sixteen years, yes, I am bragging now). I don’t think there is any actual clinical evidence for the recommendation to try and have routine for your daily activies but it seems to be common advice from healthcare professionals. The psychoeducation course’s wording was “routine is king” which has stuck with me because it’s such an odd way of putting it.
For many years in my twenties and the first half of my thirties, I had no routine at all. I got up when I couldn’t make myself sleep anymore (I would have preferred to have been dead but sleeping as much as possible was close as I could get) which could be any time of day. I went to bed when it finally occurred to me and that could be anytime from 9pm to 7am. I didn’t eat at particular times. I didn’t exercise at all. I certainly wasn’t taking my medication regularly and several times got scunnered of it and stopped it all entirely. The only thing I was doing ‘right’ was that I wasn’t drinking or taking recreational drugs.
Now, I have somewhat swung the other way and have a very scheduled routine. I get up at 5am and go to the gym or for a run at 7:30am except for one, or sometimes two, rest day a week when I sleep in and get up around 9am (that is a very much against sleep hygiene but hasn’t, so far, disrupted my sleep). I have breakfast when I get up and a snack/second breakfast when I get home around 10am. I eat lunch around 1:30pm and dinner around 6pm and have snacks in between. In the afternoon, I try to get out the house and see a friend or at least walk around other people. I am an extrovert and I get lonely if I don’t talk to other people for more than a couple of days. Something happens in my brain and I get this numb, stretched feeling like everything is wrong. Took me a long time to connect that feeling to not having social contact. Phone calls help so sometimes I phone family instead. I try and read a book and play the guitar every evening. It doesn’t sound like much when it’s written down. I imagine the ‘normal’ people are wondering what I do all day. Manage fucking symptoms, of course. But that’s another post.
I have definitely taken the advice of getting and maintaining a routine to heart. I think it has improved my quality of life but maybe things would have improved anyway. The disadvantage is that I have become a bit rigid in when I am comfortable doing things during the day. I feel unsettled when I can’t eat or go for a run at my usual times. If my mood is already bad then I don’t just feel unsettled and uncomfortable, the change can totally derail me and my entire routine breaks down for a few days or sometimes longer. Now that I am using intuitive eating, I hope that I will learn some flexibility with my eating at least as you eat when you are hungry and not according to the clock. I have been more flexible with my exercise routine over the last few months too.
So routine might be king in my life now but it wasn’t always. On the whole, things have improved but it is not the silver bullet that some people have suggested.