Getting support in bereavement

Grief in those with pre-existing bipolar disorder is an area which is poorly addressed in terms of literature, understanding and practical support. Grief counselling for bipolar disorder should be provided by someone not only trained in grief counselling, but also someone who has a good knowledge of the condition. These people are hard to find and often sufferers are referred to standard bereavement services and it is pot luck who they are assigned if they get any help at all.

You will hear in my story how much of a trigger grief became for me. It is widely stated and obvious that “grief is a trigger” with bereavement being such a stressful and traumatic event but the impact of it and medium-long term effects on the illness has not been explored in detail in the mainstream. This prompted my own analysis and I have come up with a theory.

I will be interested to find if this resonates with any other users as they examine their own journeys. I appreciate everyone is different even within their bipolar disorder so am sure there will be many stories but I believe my simple proposition makes obvious sense.

If you find, particularly with reference to bipolar depression that the ideas make sense to you, please email me  as I am collecting a list of future interest for sharing thoughts on it with a view to possible workshops on self managing this area. This is simply as an expression of interest or to share your thoughts. It is completely confidential.

In 2015, I was living with my soulmate, a happy somewhat insular life with our beautiful then 6 year old daughter. I was working 16 hours as a Speech & Language Therapist and after a somewhat yo yo pattern of sickness, had achieved some stability and was in work regularly and working hard.

In 2015, after prolonged pains in his bones and back, my husband received a cancer diagnosis with months to live. Within 10 weeks he had a basilar artery stroke as a treatment complication, went into a coma. After a week we were told he would never wake up and the life support was withdrawn. I became a lone parent widow.

My initial response, was typical, survival instincts, organising, getting things done, attending to my daughter. Shortly after this the grief came. I attended counselling for 12 sessions and felt things were resolved. Then I almost felt cured and left with a sense of elation and gratitude. I carried this gratitude for the next couple of years, rarely revisiting grief. Making trips round the world, Barbados, New York, Florida. Paul would have wanted us to be doing this I would say. Everyone I met I had a gratitude speech ready about my life with Paul. I started taking my daughter to festivals and gigs. Let’s live for today, let’s enjoy now. We barely had a moment to breathe I was always booking something. I never felt any bitterness or anger only thanks for what we had.

Grief as a trigger for bipolar

But there was also the reality of my illness. These euphoric jaunts were punctuated with frequent crippling depressions. I’ve never had obvious triggers so initially I just accepted them as part of my rapid cycling. Finally I had to see that the frequency had increased and despite optimum medication intervention they were continuing to arise. Grief was a trigger, grief was triggering episodes. But what grief? Where was it?

This was answered when my husband’s mum died. I had an excessive response and was dissolved into a state of grief that wasn’t moving after the funeral and beyond. It was classic delayed grief. I returned to grief counselling. It was my gift that the counsellor was a trained psychologist with good knowledge on bipolar disorder as well as an excellent grief therapist. I saw him for 4 months and whilst I was doing this my theory on grief and bipolar disorder emerged.

I believe bipolar disorder itself delays grief. Due to the emotional extremes we experience there is little space for grieving to take place. This would be especially true for someone who rapid cycles or suffers repeated episodes across the year. There is a clear and distinct difference between grief and depression. When we are in a state of depression we are out of touch with grief. It is not accessible due to numbness and disconnection from feelings. When our mood is elevated we are so concerned with euphoric, happy or creative goal driven distractions, it is also nigh impossible to access grief. We may only see glimpses of grief in either of these states and then it disappears. Or more likely may not notice the presence of grief at all but it is likely that it is there.

Then in the periods of remission I am usually slightly above normal mood and full of gratitude to be back to health, recovering, catching up etc, there is not room for grief there either. So when do people with bipolar disorder go through a grief process? Particularly those who have rapid cycling. We need to find a way to override the mood symptoms so we can grieve properly. Find simple techniques to observe and process the grief despite the mood symptoms so we can move on and avoid being stuck in a never-ending cycle of hidden grief triggered episodes. In my case I have done that whilst writing my book with live examples during illness. It is an ongoing process but now I have the simple strategy underway I believe I can reduce the number of grief triggered episodes as I am working through my grief. It is not sitting under the illness anymore. I have brought it into the present.

Becoming grief aware

The bare bones of the strategy is simply coming to the awareness. Not just intellectually but on a practical, psychological and physiological level. grief needs space. You need to train yourself despite manic symptoms, despite depressive symptoms, to notice where grief is trying to break through. For example that sense of unease in your stomach like something is wrong. I find I experience anxiety which if I stop and employ certain strategies like stopping and sitting and checking in with myself and trying to identify the source, if it is grief related which it usually is, I may start crying and become aware of my thoughts around my loss. Whereas the typical response I might normally have is to keep moving.

When feeling depressed, just forcing a 5 minute check in many of the days on a week as I can manage, writing at the top of the page “How am I” can have a profound effect at connecting me with my feelings. The other thing with depression is the tendency to curl up and roll over and ignore any discomfort of feeling. Just focusing on it for 5 minutes can help to connect with reality and see if there is a grief component. The manic response is to be constantly moving onto something, something that needs doing and something more interesting. But again it is possible to ground and find your grief by making some space.

Simple things to alleviate grief

Activity 1 – When anxious/when depressed/when manic/just because! Making a focused time. Sit and do nothing but be present. Stay exactly where you are for 5 minutes, see what comes. It’s very simple. It’s all about making space. I would bet it will be tears. We have a lot of unspent tears and need to allow them to come out in the spaces we will make for them in order to override the effects of bipolar on grief and allow that grief to be released.

Activity 2 – for daily practice 5 minutes journal time “How am I?” check in with yourself. As little or as much as you want to write. But make that check-in.

These are not rocket science. But actually when you are in a state of bipolar illness do you need rocket science? These simple strategies work and have facilitated my grief process enormously. These are the main two strategies I am using. When you are in an episode of illness you might not be able to do a whole mindfulness activity but you can just sit and notice for 5 minutes. You might not be able to do free journaling, but you can answer the question “How am I?”. These are all the things that I have needed to do. Cultivate some discipline around these very simple things.

You might be surprised at the things it triggers and be prepared that sometimes it may be an intense emotional experience. But at the end of it you will feel better and you will have found some of your sorrow and processed it. I used to like writing about it afterwards but I like writing and I was writing the book to share. But if you think that would help do that. Look after yourself, wrap up in a blanket. Sleep. Sometimes a sugary tea will be enough. When I first started with these techniques I had some strong reactions. These days I may only spill a few tears for 5 minutes and move on.

I have processed a lot of my grief now. It will always be with me but that is OK, you can’t keep hold of all the happy memories without being aware of the loss.

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