How a Regular Schedule Can Keep You Sane

Keeping Bipolar Disorder At Bay, Naturally

Today's The Frontier Psychiatrists article is a guest post from our wonderful Nurse and Author, Courtny Hopen BSN, HNB-BC, CRRN.

She's previously written this fabulous article about overcoming bipolar disorder, and today she describes how living well-patterned life can be protective against relapse. Thanks for reading, and supporting the work. Take it away, Courtny…

While medical interventions such as medication, magnetic brain stimulation, and evidence-based therapy are often important parts of managing mental illness, these interventions do not take up the majority of time during the day.

What choices a person makes on a day-to-day basis about “activities of daily living,” such as eating meals, doing chores, getting exercise, and structuring their work and social life, have as much, if not more, of an effect on mental health. In my experience, the best outcome occurred when viewing things “holistically.” Once we have a sense of the whole picture, we can use all tools available to maximize functioning and enjoyment of life. The medical interventions need to be actually effective and tailored to the person. The person, in turn, needs to maintain a structure of their days that is sustainable and healing.

I’m writing this not only from my experience as a Registered Nurse with a Holistic certification. I am also writing from the lived experience of learning to manage my mental illness—Bipolar Disorder. Yes, Bipolar I, thanks for asking. When I was first diagnosed, my psychiatrist emphasized the importance of taking medications as prescribed and encouraged me to go to therapy. I did both things as recommended but still had trouble doing basic tasks at home and organizing my days. On the medications he prescribed, I slept for fourteen hours a day and had trouble collecting my thoughts. I couldn’t even do laundry without losing focus—my thoughts were so clouded that I ended up leaving the local laundromat with a strange man’s clothing instead of my own, which languished soddenly in a washing machine. It was a bitter pill to swallow, going from an Ivy League graduate to a mental patient who couldn’t even do her own laundry. 

Rather than give up and accept a new normal where my psychiatrist told me to apply for disability and give up a career in nursing, I began my own science experiment. For over a year, I tracked thirty variables in my life, including sleep, exercise, individual medications, alcohol use, hours of sunlight, and social interaction. Inspired by the work of Dr. Ellen Frank and her interventions described in Interpersonal Social Rhythm Therapy (Amazon Affiliate link), I considered multiple factors affecting my moods. Week by week, I tweaked different variables to see which would improve my functioning. With this quantified self type tracking, I set up a routine that worked for me and could return to fully functional. I returned to school to become a Registered Nurse and graduated from the Sigma Theta Tau nursing honor society. 

As part of that tracking process, I also tapered myself off all of my psychiatric medications (without the approval of my psychiatrist). This allowed me to go back to fully functional once more, as it was poor medication management decisions from the psychiatrist that had made me so dysfunctional after my bipolar episode. I’m not recommending this exact approach, but keep reading!

The crippling nature of the medications that I’d been initially taking made me very wary of all psychiatry and psychiatric medications.

However, it was not psychiatry itself that was at fault—as I was to discover, psychiatry could be very helpful—it was just that I received poor care. While I was initially able to manage my mental health using only holistic methods, I threw out the baby with the bathwater and rejected the bipolar diagnosis entirely. This led me to taking risks such as working the night shift as a new nurse. This, in turn, ultimately triggered another bipolar episode. Luckily, I’d met a young doctor who also had bipolar disorder named Owen Muir. He was able to direct me to a competent psychiatrist who offered me medical management that improved my functioning rather than destroyed it.

There was a vast difference between competent psychiatric care and poor medical management. However, I couldn’t simply take medication and expect my life to be turned around. In order to maintain my mental health, I needed to practice holistic self care in the form of a stable routine, regular exercise, a yoga practice, enough sleep, and healthy meals. I also got a little dog who needed me to wake up and take care of him at regular hours, keeping me on my schedule even when I was so depressed that I didn’t want to get out of bed. Medical interventions may make symptoms better, but they can’t always eliminate them. The combination of competent care and holistic interventions allowed me to return to my nursing practice and thrive once more. The personalized and nuanced psychiatric approach allowed me to tailor a medication regimen to my life goals (including planning for a pregnancy), while the holistic methods allowed me to maintain my functioning on a day to day basis. It is this winning combination that has helped me to thrive and enjoy life.

—CH

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I swear I didn't put Courtny up to that. I also don't micromanage my authors! Having a regular cycle in your life makes it easier to get through every day, not just the bad ones.

—OM