Episode #83
Bipolar Disorder & CBT - Part 1
ft. Michael Mikulski, MFT
Getting a diagnosis of Bipolar Disorder can be a shock, both to the sufferer and their family.
What is Bipolar Disorder? And what isn’t it?
How can you use CBT to manage Bipolar Disorder?
And if you’re a family member, how can you best support your loved one?
Join me, Dr Julie Osborn, and my guest, Dr Michael Mikulski, as we share the journey to diagnosis and some specific, practical ways you can use the power of CBT to help with Bipolar Disorder.
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Full Episode Transcript
Dr Julie
Hi, my name is Dr. Julie Osborn. I'm a Doctor of Psychology and a licensed clinical social worker specializing in Cognitive Behavioral Therapy. I'm here to help you bring the power of CBT into your own life. So in this podcast I'm going to answer your questions and share with you some practical ways to apply CBT principles so you can achieve a greater level of happiness and satisfaction in your life and your relationships.
So this is a really special podcast. The first time I'll be interviewing somebody who is a specialist in CBT as well. And we're going to be talking about bipolar disorder. So before we get started and I introduced my guest, I want to read an email, as I always do. And I always thank you guys for reaching out and giving me support and questions and ideas for my podcast. And I'll always respond and get back to you.
So this one says,
“Hi, Dr. Osborn. Thank you for all your podcasts. Through a wealth of knowledge, do you have any advice on when someone should see a psychiatrist versus psychologist or therapist? Thank you. I hope you're doing well.”
I will read my response to give you guys an answer.
So I said,
“Thank you for reaching out and being a listener”. I was suggesting a psychiatrist… “if your symptoms get in the way of you being able to do the therapy or if you have been in therapy for some time and are practicing the tools you are using, but it's still not making progress.
I believe if you're on meds, you should always be in therapy. Meds help, but are not a cure. I do not have any particular retreats to recommend, which she also asked about and just said she could do some research. I hope that this helps.
All my best,
Dr Julie.”
So it's interesting reading this now regarding medication. We're also going to talk about that regarding bipolar and where meds fit in with that diagnosis and how they can help as well. So let's get started. And like I said, I'm here with a friend as well as a colleague. So Michael Mikulski is with us. He's a licensed marriage & family therapist and specialized in CBT as well. So he's going to share with us the story to interrelate and again educate you on what bipolar is, what treatments with CBT, how medicine can help, and we'll go from there. So thanks for being here, Mike.
Dr Michael
Hi, Julie. It's great to be here. Great to see you again and hang out with you this morning and talk about bipolar disorder.
Dr Julie
Yes.
Dr Michael
Yeah. So I was telling you a few weeks ago that I have a personal experience with bipolar disorder. So this is not from a therapist perspective, but from a family member's perspective and how confusing it was for me and how much of a shock that I didn't really understand bipolar disorder and what it is and what it isn't and what to do. So this goes back in time in 2004, and I just graduated with my Nifty MFT degree from a school in Southern California here in a great school. And I learned a lot. But there's only so much you can learn from books. And I was recently married about a year. And my wife is from Taiwan, from Gal, Sean, Taiwan. And I knew her sister had bipolar disorder because she had a first manic episode in 2000. And what happened was they just started opening restaurants in Taiwan. This Japanese style food called Okonomiyaki, and it's really delicious. And her sister started one of the restaurants and she was managing it, and she had a manic episode. This is four years before I saw what this was. And the report is she started to greet and kiss the customers coming in and people on the sidewalk, which she wouldn't normally do.
She's a shy, respectful, very wonderful person. And she's kissing them and saying, I love you, you're my best friend, and the whole world is great. And she's started to run around in the busy streets in a very big and busy intersection in Taiwan. And it alarmed passerbys so much that five or six men went out and grabbed her. And it took that many men to hold her down because her energy level was so huge.
Dr Julie
Wow.
Dr Michael
So that's how I knew. And when I first heard the story, I had not been in school yet. So this is before I was even studying to be a therapist. And I thought, oh, that's interesting. But I had no category in my mind for what is that exactly? Was she just having a bad day? Not quite sure what that is. So fast forward to 2004. I just graduated. So her English name is Vicky. She's given me permission to share this story, and I share it in trainings. And when I'm working with people with bipolar disorder and when I'm working with their families, and I think it helps because there's a relational aspect, I can relate to what people are going through and the confusion that's going on. So I graduated, and then Vicky visits us for six months. She's going to study English, she's going to hang out with us. We're in a tiny little apartment in Pasadena. I'm starting my first job out of graduate school somewhere. We pick her up at the airport. And I remember that the first thing she showed us when we got to our apartment was this big bag of lithium pills, these white pills.
And my first mistake was thinking, oh, that's your private business, and we have nothing to do with that. I was wondering why she's showing us her lithium bills. Looking back, I realized that was an opportunity to form a team, a collaboration around this disorder. And what would have helped was to get a pill box from Sunday to Monday kind of a thing, and ask her, would it be okay if we get that? And taking up the mess is up to you. But would you want us to make sure you're taking them, because what happened was she forgot if she was taking her medics or not at some point. And I also didn't know that a change in time zones can trigger a manic episode.
Dr Julie
Excellent point. I didn't think of that either.
Dr Michael
Now, it doesn't cause bipolar disorder. Right. Millions of people cross time zones and they don't have a manic episode. But how's the story so far? We contract. You have any questions?
Dr Julie
Yes. Well, first of all, thank Vicky for allowing us to share her story because I know this is going to be so helpful. My intention with my podcast is to always educate and really give tools so all of my listeners can walk away with something or even share this if they don't have immediate maybe if they know somebody who one day will with bipolar going, oh, yeah, I thought of this. Thought of that. How can I collaborate, like you said, as a team with the person. So this is perfect.
Dr Michael
Okay, yeah, we'll get the tool. Okay, what are the tools? It's that collaboration, but it's also with respect. So we wouldn't want to be intrusive with Vicky and say, we're going to control your meds. No, it's more of a collaboration. Like, would you want some help with that? And where would you like us to be as part of your treatment team and your support? But I didn't know any of that. I just thought, well, that's your personal business. And it started off great. She was in English language school. She met some friends. She went to Magic Mountain, which is amusement park here. And everything seemed fine. We went to the 4 July down at the beach and lots of happy memories. We have pictures and all that. But the first sign that something was wrong went totally over my head because I really didn't understand bipolar disorder. Understanding from a book is often very different than really understanding with experiences. And although I had some of that book knowledge, they did not have the experience. So one Sunday, we used to go to a Chinese speaking Church for my wife and her sister. And they stayed for a Bible study.
And after the Bible study, my wife said, oh, Vicky is speaking up in class. And I just thought, well, that's good. It doesn't seem like a change, but this is a change. Her normal self is reserved and shy and she wouldn't normally speak up. So I missed an early warning sign. And one of the tools is learning how to identify early warning signs because you can help a person avoid a full blown dangerous manic episode if you understand an early warning sign.
So that was one Sunday, a whole week passed. We went to the same Church. I stay out because I don't speak Chinese. I'm reading outside somewhere and my wife and Vicky come out and we're driving home and she says, Vicky is shouting out things in class and saying weird things. Now, you would think I would get it at this point, right? Okay. Something's up here. But I have no category in my mind understanding at all what a manic episode is and how it develops. It's. Bipolar disorder is an episodic illness, so a person can feel and behave perfectly fine like anybody else. And then an episode can happen and often is triggered by intense stress or change of time zone or not taking a medication, that kind of a thing. So she says this, and I still don't understand what's going on. And a few days later, my wife tells me, Vicky's not sleeping. Now, this is a major symptom for bipolar disorder. Not sleeping. Now, just about anybody can stay up all night. But how are they going to feel the next day?
Dr Julie
Yes.
Dr Michael
Pretty tired, right? Even if I don't get a full night's sleep, I could feel it. I appreciate it, but I only have 3 hours to see if I'm feeling it, right?
Dr Julie
Yes.
Dr Michael
But people with bipolar disorder and a manic episode, they're just as up and energetic as if they did have a full night sleep. Anyway, she's telling me she's not sleeping. And this is now the third warning sign that I'm not getting. So it's going to be embarrassing to share this story because I'm going to share with you. I don't know what word you use. How I didn't know what was going on. So my wife told me she's wandering around the apartment all night. And we have a small apartment. So I said to my wife, you know, why is she wandering around the apartment all night long? I just couldn't get it. And then the next night, my wife didn't sleep because she was trying to keep Vicki calm, sitting with her on the bed singing like childhood songs, trying to keep her calm.
Dr Julie
Wow.
Dr Michael
And the next day, I was home from work and I was watching TV, and Vicky comes over and kisses me on the mouth.
Dr Julie
Wow.
Dr Michael
And that shocked me. And I turned around and looked at my wife, and I raised my hand. I'm like, what's going on? And my wife looked at me with terror now in her eyes and said, she thinks she's your wife. And I'm the sisterinlaw.
Dr Julie
Oh, my goodness.
Dr Michael
And then Vicky goes to the front door and she opens it, closes it, opens it, closes it with this wild look in her head. Then the light went on in my mind. I suddenly realized we have a problem telling Houston, I think we have a problem. It was one of those moments that it finally fully registered that there was something extremely unusual going on here. And I panicked. And I told my wife, keep her here. And I got my car and I drove 45 minutes to West La, where a previous therapist that I used to see as a psychiatrist. So he's an MD.
Dr Julie
Yes.
Dr Michael
Great guy, but I wasn't seeing anymore. But I panicked. I didn't even know if he was working.
Dr Julie
Oh, my goodness.
Dr Michael
That day or even if he was still there. So I drove, like, an hour, and I pressed the silver button in the office, hoping that he's there. And after five or ten minutes, he comes out.
Dr Julie
Wow.
Dr Michael
And I'm like, Tim, can I see you for a few minutes? He's like, sure, come on in. And I told him what was going on. He said, well, it sounds like she's having a major episode. You need to get her to the hospital. And he was considering taking her himself, but we decided the best thing was for me to take her to the hospital.
Dr Julie
Yeah.
Dr Michael
So it's a great hospital down the street from where we were like 5 miles. So I Tracel home, and I said, get her in the car. And we had trouble getting her in the car. And a couple of other warning signs that I didn't know about at the time. But she would tell my wife during this period leading up to this wild, manic episode is that English was so easy, and she could speak English now. Right. So she had this grandiosity. And of course, she said it all in Mandarin, not in English. Then she said, oh, I can play the piano. And she went to our piano with banging on the keys. It didn't sound like music, but she claimed she could play piano perfectly. Anyway, we get her in the car, and she tried to jump out of the car. We're going down the Llama Boulevard in Pasadena or Del Mar Boulevard. She's trying to jump out, yelling at my wife. Keep running the car. She's in the back seat. I was pretty sure I shouldn't do this, but I drove into where the ambulances go? Because I was still in a panic. I didn't know what to do.
Dr Julie
Sure.
Dr Michael
And I kind of don't want her in the waiting room.
Dr Julie
Yes.
Dr Michael
Because she had no insurance and I had no insurance for her.
Dr Julie
And she's acting.
Dr Michael
Yeah, she's full blown. And she hadn't slept for a week at this time.
Dr Julie
Oh, my God.
Dr Michael
Yes, a whole week. And she was out of her mind, and she's delusional. She thinks I'm her husband. So I Park. And I said, Get her out of that car. And I get out. And the nurse comes out wagging her finger at me and saying, you can't park here. I said, you're right. And I closed the doors with my wife and Vicky out of the car, and I drove to the parking lot. And out of the rear view mirror, I saw the nurse pointing to the waiting room. And then her jaw dropped and lead them right into the hospital.
Dr Julie
Wow.
Dr Michael
And as soon as she led her into the hospital, a wave of relief washed over me because I felt like maybe now we could get her some help.
Dr Julie
Yes. And she's safe.
Dr Michael
And she's safe.
Dr Julie
Yeah. And she's with people that know what to do.
Dr Michael
Yeah. But the drama didn't end there.
Dr Julie
I'm sure not. I want to ask you this before we move on. Do you think part of not recognizing it is family? I think when people are that close to us, we can see it in strangers. What's she thinking? That's weird behavior when it's family. Okay. So maybe she felt a little more comfortable with this particular Church. Right. Like, we rationalize the behavior sometimes when it's not like until she kissed you on the lips. Right. And then you're like, well, before it's like, okay, that's a little odd, but we don't put a lot of thought into it sometimes when it's close to us.
Dr Michael
I think that's true. This is certainly true for me. Yeah.
Dr Julie
And I shared earlier in the episode before this with my one daughter that has ADHD that I didn't get diagnosed until later. And I regret that because of different symptoms. And I talked about it in the podcast, but I look back on like, okay, I'm in the field, but it's my own kid and I don't see it exactly because it was just too close for me.
Dr Michael
Yeah, right.
Dr Julie
So I was just thinking about this as you were sharing that she's your sister in law, but a little bit of like, okay, so she spoke up in group. That's not something to jump on normally, right?
Dr Michael
Yeah. I think that played a part in it. And also my ignorance, quite frankly, of what this diagnosis really is.
Dr Julie
Yes.
Dr Michael
My wife said that at the time she wasn't afraid because it was her sister.
Dr Julie
Okay.
Dr Michael
But looking back, it was very serious.
Dr Julie
Oh, yes. And that's another reason why I'm so happy we're doing this together, because for you to help us understand what is bipolar, because I meet people so and so is bipolar. And I'm like, slow down, like it's a big diagnosis. Yeah, right. And just because someone's moods change doesn't mean they're bipolar. There's a lot more to that which we'll get to. So that's why. Another reason I'm really glad we're talking about this.
Dr Michael
Okay. Yeah. Well, this I'll get into the next drama scene, but this experience propelled me to study bipolar disorder. And then I became a director of adult services at a community mental health in Southern California for five and a half years. And we had like 800 patients under us and about a third have bipolar disorder. So I began studying it and learning and working with families and people with bipolar disorder and training staff because largely people aren't really trained in this. And I would go to Nami. So Nami is the National Association of Mentally Ill People, and it's family to family. It's a really important resource for families. So they're not alone with what's going on. I learned a tremendous amount from the families who came there, and their families run it and they welcome new members, and they come in with like a deer in headlights. And they welcome them so much. And they feel for the first time, somebody understands what they're going through.
Dr Julie
Exactly.
Dr Michael
Because your neighbor isn't going to understand.
Dr Julie
Right.
Dr Michael
So Naomi is really important. Anyway, I Park the car, and I go in to where my wife and sister in law is right there in the emergency section. And they had to restrain Vicki. And she was in a room. And they said to me, they don't have any rooms at the hospital. We have to take her to the county hospital. Now, I've been to the county hospital, and I think they probably do a great job. But you wait a long time in a pretty sterile waiting room. And the thought of putting in a car where she could jump out again was pretty frightening to me.
Dr Julie
Sure.
Dr Michael
So I said, if you're willing to transport her, we'll follow and we'll go wherever you want. They said they weren't willing to do that. And I said, I just don't know what to do then, because it would be dangerous, actually to take her back home.
Dr Julie
Or do you put her in the car?
Dr Michael
Yeah, absolutely. Because from four years earlier, she was running around in traffic without any concerns for own safety, right to the point of alarms just complete strangers to get her to safety. So they didn't seem very happy with me that I said I was unwilling to drive her to another hospital. And then they brought a clipboard with some papers to sign. And they wanted me to sign some papers. And I didn't have any money. I just graduated. I'm not making but I'm not going to sign anything. I can't have financial responsibility this hospital. I'm so grateful to them because I put them in a bad spot. But they said that they have to keep her there in that kind of holding bin overnight because they really had no room. And I said, well, that's the best that we can do then. And we drove home, and the next day we got a call that they found a bed for her.
Dr Julie
Oh, great.
Dr Michael
And it took her a week on medication before she recognized my wife.
Dr Julie
Wow.
Dr Michael
So my wife went to visit her every day. I went when I could because I was still working, and she was very stiff in her body language. She looked like a zombie. And I think because of the bipolar disorder, the manic episode, but also because of the meds, they had to stabilize her. So I feel grateful that they did that. And then I let my wife know. I said, tell the hospital, get her stable. And we'll put her on the next plane back with my wife is accompanying her to Taiwan to see her psychiatrist. Okay. And they got her stable for two weeks. We picked her up from the hospital and took her directly to lax. And my wife, who I think was pregnant at the time with her, firstborn took her to Taiwan, to her psychiatrist. And then I began to learn about this experience. There's actually a little bit more drama later, but that's the first full kind of thing. And then I'd like to share with you what I've learned for sure. Since then, as I discovered let me.
Dr Julie
Just say, in our field, a lot of people wonder, like, why are you a therapist? I'm not saying it was. I mean, you already graduated, but our interests, our specialties a lot of times derive from our own personal experiences. Right. And then we feel like, I want to help people. I can understand. I've been there. So you having this experience is even in addition to being able to help people because you can really empathize.
Dr Michael
Well, it certainly was a whole education in and of itself.
Dr Julie
Yes.
Dr Michael
And then studying it and then working with people and their families has been such an honor and a privilege. And bipolar disorder is a very treatable illness. There's lots of hope. And CBT does come into play, and we'll get to that in just a minute. But it's just an episodic illness that needs to be understood and treated. I talked to families, and I say it's like diabetes. Right. That's not a death sentence. It's just an illness that once you get it, I think it's lifelong. And you just have to understand, oh, I have diabetes. Oh. I need to check my blood sugar level. I need to watch what I eat. And I need periodic labs.
Dr Julie
Yes. And the hope is to let people know they're listening. You can have very full lives.
Dr Michael
Absolutely. With bipolar, Vicki is very successful restaurant owner and manager. She does all the inventory, she trains staff. She has a beautiful three bedroom condo that she bought with her own money in Taiwan. It's in a beautiful complex, and she's very successful.
Dr Julie
That's excellent to hear.
Dr Michael
Yeah. And she hasn't had since then a full blown manic episode. She's started to have episodes. So this is one of the main points I want to talk about is when you understand the warning signs and she gets back to the psychiatrist, he can adjust or she can adjust the medication and avoid a manic episode.
And manic episodes are dangerous because she could have gotten killed running into the street. People I've worked with have done all kinds of things, like driving down the freeway at 90 miles an hour.
Dr Julie
Yes.
Dr Michael
Or convincing a whole bunch of 20 year olds that they're hanging out with to drop everything and go to Vegas. And they're still going 100 miles an hour in Vegas and everybody else instead.
Dr Julie
My experience also just like yours. But then when I used to work at UCI, I'll never forget this one client that became manic. When she would become manic, she was suicidal, like, immediately. So I think really for movies and TV, people see the mania as this elevated mood, and you always feel good. But there's the other mania.
Dr Michael
So glad you're saying that.
Dr Julie
Yeah. Where you're also very agitated and depressed. I have two that I can think of off the top of my head that became suicidal, just like with the man, just like that. And she had to be hospitalized over and over and finally became stable. But it was a long and I didn't know back then, like you didn't know that the mania could be more negative feelings and not just, quote, happy feelings.
Dr Michael
I just love what you're saying. There's kind of a way of understanding a person's warning signs as their own signature. You know how we all have our own signature and it's different than mine always changes, but people have their own distinct signature. And although the symptoms are kind of clumped together in, like eight or so kind of core symptoms for bipolar disorder, everybody is a different person, and they might present these symptoms differently. So this is one of the most important things I learned as I'm studying this and working with my wife and Vicki. Vicki is now in Taiwan, and she was in Taiwan. And as I'm studying, I'm starting to understand what our role is the family. And I would hear my wife talking to her sister on the phone. And although I don't speak any Mandarin or just a few words, the tone would change. Something was different. And I would say to her, my wife, while she's on the phone, what's going on? And she would say, oh, my brother is saying that Vicki is starting to talk weird.
So that's how they for them. Like you said, they're family, so they're too close to see it. But that's a warning sign: talking weird.
Because Vicky does it talk weird. She's having an impending manic episode. You could look at it like a slope that gradually goes down and then dives into a cliff. So the warning sign is the slope beginning to go down and going toward this cliff. And a certain point, there's no stopping the manic episode. So the person just goes full into it. What you want to do is catch them on that slope and bring them back up to safety.
So when I heard that Vicky is talking weird, I said to my wife, please ask her brother to take her to the psychiatrist right away. And my wife said, oh, she has an appointment on Friday. Well, that's three days away. I said, no. Actually, I had to almost beg my wife, please just do this, because it.
Dr Julie
Can happen that quickly.
Dr Michael
It can happen quickly.
Dr Julie
Yeah.
Dr Michael
No, it might have been okay. Maybe not. So her brother Graciously did that, right. He stopped what he was doing. And it's kind of an inconvenience. But that's why you need to understand this ahead of time. So you're ready to take action if you need to, because it's going to.
Dr Julie
Be even more of an inconvenience if she goes into full mania. And then they have to deal with all of that. That is true. That is an extra responsibility with family. But the sooner you catch it, the better it is for everybody.
Dr Michael
The sooner you catch it, the better it is for everybody. Absolutely. That's why that's the role family has is to be the eyes and ears for the warning signs, not in an intrusive way. Right. So part of the kind of what I do with families is I ask the client who is in control of the treatment.
We say, what would you like your family to do if they see warning signs? And what would you like your family not to do if they see warning signs? And we get that all on paper and have a shared understanding? Because family can be very meaning. Well meaning, but say the wrong thing. And it might have the opposite effect. It might upset the person who's bipolar disorder, and they might refuse to take meds or not see it because denial is pretty easy to do. It's hard to recognize this illness for what it is anyway. So that happened several times where she was beginning to have symptoms, not sleeping and whatnot. And she would go see her psychiatrist and they would adjust the meds and she would not have a manic episode. She would get the baseline the depression part has happened with her. She was six months in bed one time. And this is where the CBT can be really powerful. Before 2004, when I saw this between her first episode and that she had severe depression, but she hasn't had much depression. So the meds have really kept her stable. I'm wondering where we're at.
Dr Julie
Yeah. Let me ask you this before we finish up today's episode, and for all of you hanging on for more information, we are going to have a second episode with Mike for sure, because all this is just fascinating.
Dr Michael
Right.
Dr Julie
And there's so much to share. But just for at least today, where would you recommend people that want to maybe do more reading or start learning more on their own if they're wanting to know or if they're thinking, oh, maybe this is my cousin that we never figured out what was going on or she was so much fun to hang out with. She's always so happy. Right. That we never really like there's something else. And then she had the depression or things like that. So Where's a good resource for them to start? Would you say.
Dr Michael
They could start on YouTube and try to find some stuff or TikTok might have some good things. I've seen some really good. You can tell if somebody's really sincere and they share their stories. Kay Jaminson wrote a great book on her own experience with bipolar disorder. I can't think of the name. I don't remember the name of the book.
Dr Julie
Okay. Our next episode you guys will have a couple of books for you because I have one also that I had a client actually bring me that he thought was super helpful when he found out he had bipolar.
Dr Michael
That's good.
Dr Julie
And I would say another resource I just thought of as we're talking is you can just go to a therapist. You don't have to be the patient. Right. You can find a therapist that specializes in bipolar. If you look up people's websites and things like that they'll share what they specialize in and you can just go get educated through a therapist. So that's also a resource.
Dr Michael
Yes. They really understand bipolar.
Dr Julie
Exactly. Yes.
Dr Michael
And for people with bipolar disorder the DBSA groups are excellent. It's depression bipolar support association. I just had somebody called me last week asking if I did groups and I don't do groups but this is a group excellent and it is an excellent place safe place for people to go with a bipolar disorder and connect with others and learn a lot about it.
Dr Julie
Okay. All right. So we're finished for today. I hope that this was helpful.
And if you have any specific questions that you love us to answer, you can always email me at mycbtpodcast@gmail.com. Please continue to send in your email, sending me questions and recommendations for further podcasts.
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