On The Level: Winter 2024

ON THE

LEVEL Scotland’s e-magazine for people living with bipolar Winter 2024

EXPERT ADVICE

Menopause & Bipolar Self-management tools

for the season

Wellness Winter

bipolarscotland.org.uk

Foreword / Winter 2024 Welcome to the winter edition of On The Level!

Winter and Chirstmas can be a challenging time for those living with bipolar, which is why we’re focusing on wellness and self-management tips in this issue. Our readers, members and expert trainers share their own personal tips and tricks and discuss ways you can protect and nourish your own mental health and wellbeing over the winter months. From practicing mindfulness to establishing healthy daily habits, you have the power to find light on the darkest of days.

Someone who is experiencing the joy of wellness is our resident writer, David Carr. On page 12, David explores what it means to be well, reflects on his bipolar journey and looks to a future filled with hope and positivity. We at Bipolar Scotland are delighted for David and wish him – and every one of you – wellness this winter and beyond.

Upon reading recent findings by Cardiff University that women are more than twice as likely to develop bipolar disorder in the years leading up to their final period, we thought it was important to shine a light on women’s health. We’re discussing the challenges of menopause and bipolar and how the blurred lines between symptoms and potential introduction of Hormone Replacement Therapy (HRT), can be daunting for those who are at this stage of life. Read all about navigating bipolar and the menopause and discover expert coping tips on page 18. Meanwhile, over in Research Corner, Dr Aigli Raouna shares her research around the experience of pregnancy and being a mother with bipolar on page 14.

Our contributing professionals, doctors, professors and psychologists bring a wealth of knowledge to On The Level and we’re thankful to each and every one of them for giving up their valuable time to share their expert advice with you all. We’re also extremely grateful to our readers and members for sharing their own lived experience and creative input because without you, this magazine simply wouldn’t be possible. I’m delighted we have so much reader contribution in this issue, including a poem, movie review, self-management tips and a thoughtful essay on fatherhood.

If you have something you’d like to share with On The Level, please email editor@bipolarscotland.org.uk with the subject line ‘On The Level’. Our next edition will be out on Wednesday 29th January; we need all contributions in

by Monday 13th January.

Wishing wellness and love for you all this festive season. See you in 2025!

Sian Dolan Editor

Image: Vecteezy.com

Contents

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Winter wellness guide

13 14

RESEARCH CORNER: Pregnancy & parenting with bipolar

David Carr discovers the joys of being well Edited by Jamie Stewart and Sian Dolan.

Please note that the views and opinions expressed in On The Level are not necessarily those of Bipolar Scotland.

18

Submissions: If you would like to submit a piece of writing, a photo or an idea to be considered for future issues of On The Level, please get in touch with Sian Dolan (editor@bipolarscotland.org.uk) We would also love your feedback about On The Level.

Send us an email or reach out to us on social media.

You can find us on Instagram (@bipolar_scotland) and Facebook (@bipolarscotland) ©Bipolar Scotland 2024 T: 0141 560 2050 Scottish Charity No. SC021705 E: info@bipolarscotland.org.uk Company No. 163305 bipolarscotland.org.uk

Image: Vecteezy.com

EXPERT ADVICE: Menopause & bipolar

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Noticeboard JOURNAL GIVEAWAY!

We have 2 copies of The Bipolar Disorder Journal by Cara Lisette up for grabs!

The Bipolar Disorder Journal is designed to help you better understand and manage your bipolar disorder. Drawing on evidence-based techniques, such as CBT and mindfulness, and on the author’s own experience of bipolar, it provides journaling prompts, creative activities, colouring pages and motivational quote pages to help you stay well and keep on track.

The techniques in this journal support you in recognising and coping with episodes of depression, mania, and psychosis, understanding their triggers, and finding ways of seeking support.

To be in with a chance of winning, please send your name and address to editor@bipolarscotland.org.uk with the subject line ‘Journal Giveaway’.

Competition closes Wednesday 8th January at 5pm. Winners will be selected at random from the entries received. UK residents only.

20% DISCOUNT

Our friends at Jessica Kingsley Publishers have kindly provided a discount code, exclusively for On The Level readers. Use the code BSCOTLAND20 at the JKP checkout for 20% off The Bipolar Disorder Journal (valid from 24/10/24 for one year). Visit https:// uk.jkp.com/products/the-bipolar-disorderjournal to purchase your copy.

WE WANT TO HEAR FROM YOU! Over the next few months, we’ll be posing your questions to professionals and experts, including a professor, clinical lead and police officer, for an exciting new YouTube series!

We’ll be covering all sorts of issues that affect people living with bipolar so if you have a burning question around the topics below, please send it to info@bipolarscotland.org.uk (you can, of course, remain anonymous).

• Police involvement in a crisis • Sexual health • Diagnosis • Menopause • Anxiety • Diagnosis • Medication • Weight gain

CELEBRATING OUR FANTASTIC FUNDRAISERS!

buzz as you cross the finish line – and of course, the most rewarding of all was the number of very generous donations that we got.

We’re so grateful to Lorna Dunn who raised an amazing £1800 for Bipolar Scotland when she completed the Scottish 10k back in August!

We caught up with Lorna to ask her about her fundraising experience:

Do you have any advice you would like to share with others who are thinking about fundraising for Bipolar Scotland?

I would say to go for it and to spread the word that you are doing it. There is so much stigma around mental health – the more people who are aware of it and understand it, the more we can do to help those who suffer from mental health issues.

Why did you choose to fundraise for Bipolar Scotland?

My husband is diagnosed with bipolar and has been since his late teens. We have experienced several relapses since we have been together, however this year, we experienced a particularly difficult relapse that was completely unexpected.

With our boys at an age where they have more awareness of what was going on, it was more difficult to manage this time round. We are extremely lucky to have amazing support from family and friends and it would have been so hard to manage without that support. It hit home that not everybody who lives with bipolar has the same access to support, therefore I chose to fundraise for Bipolar Scotland in the hope it contributes towards the services they provide to help give support to those living with bipolar.

What was it about the 10K event that appealed to you?

I have always been a keen runner and would regularly participate in organised running events, however with managing a young family I haven’t done a 10k in several years. I thought I would challenge myself to attempt a 10k to prove I could still do it in the approach to my 40th birthday!

What did you enjoy most and what did you find challenging?

Fitting in the training could be challenging, and then there were my aching bones! However, I really enjoyed participating in an event again and the

If you’re inspired by Lorna’s amazing achievement and would like to take part in the 2025 Scottish 10k to raise funds on behalf of Bipolar Scotland, sign up at www.scottish10k.com If you’re able to pledge to fundraise three times the registration costs, we’ll cover the fee! Just choose ‘charity registration’ and select ‘Bipolar Scotland’ from the affiliate charity dropdown menu when you sign up.

12 Days of Giving

Movement for Good 2024 is giving 120 charities £1,000 each over 12 days. Please take a minute to nominate Bipolar Scotland: https://tinyurl.com/4bcdrj9d The first draw takes place on December 5th and the last on December 20th with 10 charities drawn every week day. (One nomination per charity, per person) Nominations are open until 23:59 on December 19th, 2024.

Images: Pexels/Vecteezy.com

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Winter Wellness Guide Written by Kerry Adam

Manage your mental health and wellbeing this season with tips and tricks from Bipolar Scotland’s team and members SELF-MANAGEMENT Autumn and winter can be challenging for those who struggle with mood – the darker nights and cold weather make it harder for us to get outside and many people find Christmas difficult. Self-management is particularly important at this time of year, so we’ve collated some useful tips, tricks and coping mechanisms to help you get through the season: • DAYLIGHT We all know the benefits of fresh air and daylight, but these can be harder to come by in the winter months. Getting outside for even 10 minutes at lunchtime can help enormously – not only can you top up your vitamin D but moving your body releases lots of feel-good chemicals in the brain that can help with mood. SAD lamps or alarm clocks are also a great way to get more light into your days when the Scottish winter is in full swing, and fairy lights and candles can make your home cheerful and cosy during the festive season.

• ACTIVITY Speaking of feel-good chemicals, keeping your activity levels up can really help to manage low mood. You don’t have to do any formal exercise, but housework, walking to the shops and even dancing can all make you feel better when the nights are drawing in. If you do want to exercise more vigorously, there are lots of free videos and apps that can take you through yoga or weights sessions online.

Joining a local exercise class can also bring social benefits.

• DON’T ISOLATE It’s very tempting to withdraw in the winter months, especially when you’re struggling with low mood. Feelings of isolation can be seriously detrimental to those living with bipolar, however, so make time each day to reach out to friends and family directly – not just on social media. Arrange to meet people for a walk, a coffee or a visit to a Christmas Market, or have a friend over for a cosy night in watching a movie or chatting while snuggled up under blankets. If you need to talk

to someone and don’t want to reach out to a friend, there are lots of helplines available where you can speak to someone objective.

• FOOD & MOOD We know there’s lots of evidence that gut health and the food we eat can directly affect mood, and it’s especially important to remember this in the colder months. A hearty home-made soup or stew with lots of vegetables is a great way to get the nutrients you need and is also very comforting. If you’re struggling to eat well or overeating during the Christmas period (and who doesn’t?), a probiotic can support your gut in the meantime and help to keep your mood stable.

• BE KIND TO YOURSELF Many people find the winter months – and especially Christmas – difficult. Having a simple routine can help to make things feel more manageable. But sometimes it’s important to accept that this time is going to be challenging, and you need to take extra care in looking after your wellbeing. If you need to rest, rest. If you need to withdraw a little, that’s OK too. Feelings of guilt can contribute to low mood, so try to be selfcompassionate – treat yourself as you would a good friend and accept that the season is temporary and there are brighter days ahead.

Everyone will have different coping mechanisms for winter, these are just a few.

Doing even one of these things will help you to get through the darker days until spring arrives, and if any of it becomes habit then it will only contribute to your overall wellbeing as the seasons change.

Healthy Habits Eleanor Macleod shares her thoughts on the importance of keeping a routine during the winter months – and beyond!

My name is Eleanor, and I am an online facilitator volunteer for Bipolar Scotland.

In my volunteering to date, I have noticed that members sometimes mention routine as something which is important to them.

I wanted to write about my experiences of routine so I can help others with this important topic.

Routine helps you organise your day-to-day activities – for example, when you eat meals and go to sleep. It is also important to make time for hobbies and relaxation. For those on medication, routine can help with learning to take this regularly and managing the side effects.

TIPS FOR MANAGING ROUTINE There are many helpful gems that can gleam bright for you with managing routine. I have found that having a mini whiteboard can help plan your list for the day. Include ‘to-do’ tasks for the day, as well as mealtimes, bedtime goals, med timings etc., and any relaxation activities to break the time up. Placing the whiteboard in clear view can aid memory. This helped me greatly during the lockdown period and I have used the technique since then.

Scheduling in specific times for phone calls to family and friends is also important, as is making sure you spend time outside. A few ideas on this include the following:

Winter Wellness Guide

Have fun with it!

Remember that a routine is an individual thing, and it can be fun creating yours. Grab colourful pens and paper and create a routine mind map or eye-catching to-do list. Think about all the important things to do in a day, prioritise those, and remember to make time for relaxation activities such as mindfulness.

Thank you for reading my article and I hope you will find these tips useful.

It continues to be a privilege working with those with bipolar in the groups and I am learning as much about routine from you all as from my own experience.

Shine bright with routine!

• If you can, go to your front door and take a few deep breaths • If you don’t feel like walking, simply take in some light and stretch your arms • If you do feel like it, go for a gentle stroll – sometimes just a short walk can lift the spirits • Stand at your window if you are unable to go out and appreciate what you can see outside • Practice gratitude on a daily basis and schedule this into your day • Make your bed in the morning after showering – this way, if there is a tidy bed, you may be more unlikely to jump back in

Image: Vecteezy.com

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Winter Wellness Guide

Mindfulness *TRIGGER WARNING – This article contains discussion of self-harming.*

WHAT IS MINDFULNESS? Being mindful is all about being fully present, being aware of your mind, body and surroundings, and simply appreciating the here and now. Mindfulness activities, such as gardening, meditation, colouring and baking, can all help to lower stress levels, focus the mind, and cope with negative thoughts.

On The Level reader, Susie, shares how gardening has helped her self-manage her bipolar symptoms…

“I started out with houseplants, just one or two, at first, and then it was 10, then 12 and now I’ve got about 30! I wanted more plants, but I’d run out of space in the house, so I turned my attention to outdoors and planted two pots. I started enjoying watching things grow and I thought, ‘Well, I could do more of this!’. And so, gradually, more and more pots came along, and I continued planting. Eventually, I put in two raised beds and basically it went from there until the whole front garden was absolutely crammed with flowers.

“When I feel destructive, I choose to be constructive.”

“It makes me feel like I’ve done something worthwhile.”

When I see the results of my labour or the dayto-day change in the flowers, it makes me feel like I’ve done something worthwhile. Because I once wanted to do lots of different things and haven’t ever managed. Now, however, I am managing to do one thing, and that one thing is gardening. It might not seem like a big deal to other people but, for me, it’s an achievement. I can say, ‘I made that beautiful!’ and look out my window every single day for a daily reminder of what I’ve achieved. I go outside every day to walk around, even though it’s a small space, and I can see things changing and blossoming.”

Gardening has helped Susie find a balance, but she feels it’s important to share that it doesn’t always conquer the darkness.

To Susie, and everyone who is living with bipolar, better days will come and Bipolar Scotland is here to support you.

One of the major high points for me is that gardening has helped me fight the urge to selfharm. Gardening is something tangible that I can do if I feel the urge – or I’ll go out to buy some plants. When I feel destructive, I choose to be constructive. The thing about self-harm is, you stop thinking about what you’re thinking about, and pain takes its place. Now, I focus my mind and let gardening take the place of bad thoughts. Since taking up gardening, I have not self-harmed and that’s a really big deal for me.

It helps to focus my mind in a positive way and given me something to feel good about myself.

“I’ve learned to focus.”

The most challenging aspect is being in public because it’s my front garden and I’m exposed to the street, but I’ve learned to focus. I concentrate on what I’m actually doing rather than wondering if the people walking past might be judging me while I’m messing around in my garden. It’s probably not to everybody’s taste but it’s what I like - for me, my beautifully ‘messy’ garden feels like an extension of the house and a bridge to the wider world.

Thank you to Eleanor and Susie for speaking with us. If you have a submission for On The Level or want to share your own self-management tips with our readers, please get in touch: editor@bipolarscotland.org.uk

The Outrun:

THE OUTRUN SYNOPSIS After a decade away in London, 29-year-old Rona (Saoirse Ronan) returns home to the Orkney Islands. Sober but lonely, she tries to suppress her memory of the events which set her on this journey of recovery. Slowly the beauty and lore of the land enters her inner world and – one day at a time – Rona finds hope and strength in herself among the heavy gales and the bracingly cold sea.

Adapted from the book written by Amy Liptrot.

Film Review A recent trip to the cinema inspired Bipolar Scotland online facilitator, Eleanor, to pen her thoughts…

Written by Eleanor Macleod

I was a little nervous about going to see the film, The Outrun, recently at the cinema.

I was worried that it would make me upset or anxious, or even trigger emotions for me.

However, I was surprised at my reaction – instead of feeling anxious or upset about the content (yes, some of the plot is emotionally charged), it made me feel challenged and even empowered.

Rona, the main character in the film, is played

by Saoirse Ronan who is a fantastic actress and portrays brilliantly what it must feel like to be out of control with alcohol issues. Her sheer determination and strength really shine throughout the film and it made me think how desperately hard it must be to have an alcohol issue born out of adverse childhood experiences and also have a father who is very ill with bipolar.

Not an easy mix to deal with on a daily basis.

Interestingly, we only see a small glimpse of her father’s bipolar and although brief, what is shown seems to be a fairly accurate picture of what bipolar can be like for people.

For Rona, her father’s bipolar was very difficult to manage and this film gives an insight of a carer’s view. Rona bravely confronts her alcoholism, realises that it will always be a temptation, and her rational mind wins in the end. She braves the elements and goes back to her roots in beautiful Orkney.

An amazing film of bravery, sadness and challenges, some of which none of us will experience. It will open your eyes and ignite hope that a new life is possible with courage and passion.

A must see for all!

“An amazing film of bravery, sadness and challenges.”

Images: Courtesy of STUDIOCANAL

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SPOTLIGHT ON: IMPACT & DEVELOPMENT

MANAGER Meet Maja Mitchell-Grigorjeva, our incredible Impact & Development Manager!

What brought you to Bipolar Scotland?

Before coming to Bipolar Scotland, I worked for Scottish Action for Mental Health (SAMH). I had started in an administrative role, and eventually became the Service Manager for a community-based mental health service in Aberdeenshire that included services such as counselling, resilience coaching and therapeutic horticulture. After working there for almost five years, I felt ready for a change. What excited me about coming to Bipolar Scotland was the opportunity to take on a national role, as I’d previously just been focused on Grampian. I also liked the idea of working with a much smaller charity, and I could see how much potential there was to grow Bipolar Scotland! I started in my role in November 2021.

Can you explain a little about what your role is and how you support the Bipolar Scotland team and its members?

My job title is Impact and Development Manager. Impact is in relation to the difference we make to the people we support, so I’m responsible for the delivery of our services. That includes supporting our fantastic team of staff and volunteers, and as part of this, I make sure that we are collating evidence that showcases the impact of the work we do.

The development part of my role is varied.

When I started this role, my first task was to implement the Beyond Diagnosis service we had received funding for. This included everything from recruiting and training staff and volunteers, to creating processes to support the delivery of peer support and promotion of the service. I really value

being able to engage with our members and people who have used our services, to help us in the development of new services. I recently worked with a small group of staff, volunteers and members to create a funding bid for a brand-new service. My role also involves a lot of engagement with external organisations, to increase awareness of what we do and look for opportunities for partnership working. I’ve also been involved in developing training for our staff and volunteers, and I get involved in the delivery of this too, from time to time.

What does a typical working day look like for you?

I live in the North-East of Scotland, in Aberdeenshire, so I’m not often in our Paisley office! A typical day involves a lot of time in front of my laptop, responding to emails and having phone calls or video calls with others. As well as being focused on daily tasks, I’m constantly trying to look ahead and think about what needs to happen in weeks or months from now. There’s a lot of multitasking and this keeps me engaged and busy. Working from home means that if you’ve ever been on a video call with me, you’ll likely have seen one of my three cats who are usually lurking in the background!

What’s on the horizon for Bipolar Scotland?

We are planning to grow our support groups and hope to open a new group in West Dunbartonshire early next year. We’re also finalising our SelfManagement Training dates for next year and will be bringing the course to West Lothian and Inverness in early 2025! The team are busy working on some add-on modules to our core self-management course, looking at topics such as anxiety and medication in more detail and we’re also working on developing our online video content, so look out for some new videos in the not-too-distant future!

What do you enjoy most about your job and what challenges have you faced/ foresee in this role?

The part I enjoy most about my role is the people! I feel so lucky to work alongside so many knowledgeable, passionate and inspiring colleagues, volunteers and members. I’m also proud to work for an organisation like Bipolar Scotland that genuinely believes in the importance of lived experience. As someone who does not live with bipolar, I feel an important responsibility to ensure that all of the development work I do is in collaboration with others who have lived experience of bipolar. It’s a really special part of the role and something I don’t take for granted.

Maja’s adorable furry friends – Layla, Gimli and Ming Ming.

As we approach 2025, what are you most excited about for Bipolar Scotland’s future?

There’s so much to be excited about! We are really hoping to be able to secure funding to develop two big new projects – one around early intervention and young people, and one that’s focused on supporting people with bipolar in the workplace. As part of this work, I hope that next year we will be able to bring bespoke mental health training to organisations. I’m also looking forward to continuing to offer the services we know people really value, such as peer support and the support groups. We may also be planning something special for October 2025 – watch this space!

Image: Vecteezy.com

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Well On Being

by David Carr

‘Bipolar Affective Disorder (in remission)’ read the clinical letter from my psychiatrist which I had obtained in order to get some private healthcare. I have always baulked at the idea of reading my psychiatric notes. I dread the horrors within. But there it was in black and white.

I am officially well.

The well me is beginning to understand that I was ill. This should have been obvious. But I often blamed myself instead of my illness, full of self-recrimination and unable to forgive myself. Where once I would beat myself up for past behaviours, now that I have distance, I can start the process of healing.

Which I pretty much knew. I have had a lifetime of crippling and near fatal depressions and of energising but destructive highs, only marginally controlled by lithium. But, three years ago, my psychiatrist and I stumbled on a medication that works for me. I now date my life as before lamotrigine and after lamotrigine.

It’s been damned hard living with bipolar disorder. Acknowledging this has allowed me to re-evaluate memories – which have often made me cringe – and reframe them as episodes of great pain for which I deserve some self-compassion.

It was a long time coming. Lamotrigine had been on my radar for around fifteen years, as a prophylactic against the depressions that inevitably followed my highs. I don’t know why we delayed. But here we are. I find myself suddenly and unexpectedly in another life.

While I might rail against wasted years, the significant new departure to get my head around is that I am now able to glimpse normality. I am only slowly processing this.

Wellness gives me opportunities. Except it doesn’t. Although the tide has ebbed on my illness, the flotsam from my episodes lingers. My illness caused damage – to my relationships, to my finances, to my career. I have begun to get perspective on my pain.

My wellness has begun to shine in some tangible ways. I have taken up a hugely fulfilling role as a volunteer teacher of English as a second or other language – something I would have struggled with, just as I struggled with paid work. I have planned an adventurous solo trip around Morocco.

Best of all – I have exorcised a ghoul by reconnecting with a good, good friend who I lost contact with, out of embarrassment, after I had behaved inappropriately towards her during one of my wilder episodes. I had developed the misguided belief that she must be mad at me. This has turned out to be very wide of the mark. I had somehow erased from my mind how kind she had been to me.

And then there’s my teeth. Teeth have loomed large in my psyche. For years my poor mental health caused me to neglect

My wellness has begun to shine in some tangible ways

my dental health. Only now do I have the strength to look after them.

Where do I go from here? I am working on adjusting some of my thought patterns. Dealing with negative thoughts – or over-positive thoughts – is never easy. I am slowly beginning to understand those patterns and feel that I now have the presence of mind to be able to challenge them. I am no longer quite so at their mercy. Over the years, I have learned to be careful of my moods and behaviours, and this has spilled over into a mentally exhausting hypervigilance. I haven’t yet learned to relax. Is it OK to be OK? I still live with bipolar disorder.

Lamotrigine has been good – but we shouldn’t expect miracles. And note that illnesses and medications are highly individualised. Lamotrigine works for me but might or might not work for you.

I still sometimes feel down – but suicidal

ideation happens far less frequently and less intensely now. I still experience what I call mini-highs. They are less destructive – but I can get a bit more full-on than I would like.

The spectre of illness still haunts me. A bipolar lifetime has left its scars. But at least I’m in a good place from which to start to heal them. My bipolar life still takes a lot of mental energy. But it’s a more positive energy now.

If you are reading this, chances are that you are ill. You may be cursing my good fortune. Bipolar disorder is a painful illness to live with and is difficult to put into remission. But there is hope.

I may be jinxing my wellness. Over my adult life I have lived with bipolar disorder and don’t know another way to live. I am having to remake myself anew.

Is this what wellness is like? It feels good.

Image: Pixabay

BIPOLAR SCOTLAND 13

RESEARCH CORNER ARE YOU A PARENT WITH BIPOLAR OR DO YOU HAVE A PARENT WITH BIPOLAR? One way or another, birth, parenthood and bipolar have a complex relationship that spans the whole life course. Pregnancy increases the chances of a bipolar episode, and there are many considerations around medications and lifestyle to consider for an expecting mother. After birth, there is the navigation of not just being a new parent, but being a new parent with the added layers that bipolar can bring.

“I was like; ‘I’m not sure how much is…’ you know, will they take the baby away from me if I tell them how bad I’m feeling?

All that stuff. I was very resistant then – I wanted to be a good mum and I didn’t want to be a crazy mum. So, I kind of tried to ignore that side of things.”

Our guest author Dr Aigli Raouna’s research focuses on the experience of becoming a mother for women with bipolar. Her interviews with women with bipolar explore the transition to motherhood and the vulnerability, as well as the adaptations, that occur during this time.

Adaptability as a journey: becoming a mother in the context of bipolar Dr Aigli Raouna, PsychologistPsychotherapist COMPLEX CHALLENGES Becoming vulnerable is a process; it rarely happens in just a single moment. For years, researchers have talked about how vulnerability can unfold during pregnancy, childbirth, and those intense postnatal months. And really, who would argue? Deciding to have children is challenging enough on its own. But for those living with complex mental health conditions like bipolar, the journey can come with even more layers of complexity.

Research shows that women with bipolar may face a higher risk of both mental health and physical complications during this period, including mood relapses or postpartum psychosis. But what’s often missing in these studies is the human side – the lived experience. What is it like for

o What d k? n you thyi thoughts,

ve an If you ha r want to know so question in touch! You can t more, ge r Aigli Raouna: email D 2@gmail.com na aigli.raou ber Roguski: or Dr Am ski@ed.ac.uk gu amber.ro

women with bipolar to step into the role of a mother? How do they navigate this lifechanging transition?

LIVED EXPERIENCE VOICES As part of my PhD at the University of Edinburgh, I had the privilege of interviewing ten women from across the globe, all of whom were diagnosed with bipolar before becoming mothers and had a child under five. Through their experiences – from planning to pregnancy and the early postnatal years – it became clear that vulnerability was only one aspect of their journeys. Yes, it was present, but it didn’t define them in an irreversible way.

“How much of that is just being a sensitive mom, how much is, you know, a mood disorder is hard to say. But yes, in some ways [becoming a mother made me] more resilient, in some ways more volatile. It’s different, different. But I guess the biggest change is that I’m just so conscious of how my mood affects my family, my son… I can just see that immediate feedback, like ‘Oh, I’ve got to look after myself too, to be better for him.”’

Quote from participating mother PROACTIVE ADAPTABILITY This led us to consider: what about adaptability? Much like vulnerability, becoming adaptable was not merely a reaction; it was a journey of its own. In fact, my colleagues and I argue that a key turning point in many of their experiences was their capacity to ‘project adaptability’: the ability to imagine a desirable self (in this case, an adaptable self) as an important first step toward enacting the desired change (in this case, adaptability). This forwardthinking resilience seemed to rely on three interrelated components: 1) That a mother has a level of selfawareness regarding her mental health, her weaknesses, her behaviours, and her coping mechanisms 2) That she perceives she has external support in the form of partners and/ or family members, peers, and professionals and that this support is accessible and free of judgment 3) That, ultimately, the combination of these elements enables her to take ownership of her narrative, to

proactively make choices and changes to improve outcomes.

“Before the first pregnancy [miscarriage] we talked about it a lot with my husband, I spoke to the psychiatrist about like breastfeeding on medication, taking medication at pregnancy, the pros and cons... I knew I wanted to have a baby, so I wasn’t going to sway my decision, just how to go about it in the safest way for me.”

Quote from participating mother EMPOWERED & RESILIENT So, here’s the main takeaway: neither vulnerability nor adaptability are fixed states or one-off skills that you either have or not. In this view, projecting adaptability becomes an ever-evolving capacity that can either move mothers towards vulnerability or help bolster resilience when facing life’s challenges.

Grounded in women’s lived experiences, this perspective shifts the focus away from trying to eliminate vulnerability altogether.

Rather than avoiding difficult situations, like miscarriage or relapse, which can’t always be controlled, it highlights the value of building a sustainable safety net that can buffer against the impact of these challenges. Through self-awareness, personal agency, and trust – both in oneself and in external resources – mothers can feel empowered to move beyond the stereotypes of being a “good mum” or a “crazy mum” to being their own kind of mum, complex and unique.

If you would like to find out more on this topic: • Visit Dr Raouna’s University of Edinburgh page: https://www.ed.ac.uk/profile/aigliraouna • Bipolar UK have posts covering topics of pregnancy and motherhood: https://www. bipolaruk.org/Blogs/women-and-bipolar • Disanto et al. 2021’s paper about seasonof-birth for individuals with psychiatric conditions: https://journals.plos.org/ plosone/article?id=10.1371/journal. pone.0034866 • Demers et al.’s comprehensive 2023 paper about management of bipolar during the perinatal period: https://pubmed.ncbi.nlm. nih.gov/36528074/

Image: Vecteezy.com

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Jamie’s Diary Preparing for winter I know I have spoken on this before, but it is important to be mindful that winter is upon us. I have stocked up on Vitamin D, started wearing cosy hats and taken up knitting little mittens for myself. Only kidding – of course I don’t wear hats! I am wrapping up warm and looking after myself the best I can.

My mood will dip a little, but I am doing all I can to stay well. I feel good about it; I am feeling good generally, and I am grateful for that.

The social pressures of this time of year and the expectation can be way too much. I am either going to try and keep up with everyone (and have a breakdown) or try to be realistic and enjoy being social when I am able. I don’t want to sound like a sassy Simon here, but it is my life, and I have to make it work for me.

Image: Vecteezy.com

A huge part of my healthy routine is walking the Tay Road Bridge every morning – I know I have mentioned this before, but it really keeps me well. These photos are some highlights of my walk to work in 2024.

I hope everyone is well and if you are not right now, you will be again!

Big love to everyone, and a very happy christmas!

Jamie xx

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Navigating Bipolar A Many people with bipolar find managing the menopause and perimenopause to be a challenging time. The blurred lines between bipolar and menopausal symptoms, combined with the potential introduction of new treatments such as Hormone Replacement Therapy (HRT), can be daunting for many people in this phase of life.

In a 2022 survey conducted by Bipolar UK and Cardiff University, more than 55% of respondents aged over 40 found that the perimenopause or menopause had impacted their bipolar symptoms, with 28% stating that the impact was ‘significant’.

WHAT IS THE MENOPAUSE? The menopause usually begins around the age of 47, beginning with changes in the menstrual cycle, and ending with the final menstrual period. Perimenopause refers to the transitional phase and hormonal changes before the onset of the menopause as the body prepares to stop the process of ovulation.

WHAT ARE THE SYMPTOMS? Menopause symptoms vary from person to person. Recognising the difference between your bipolar symptoms and menopausal symptoms can be difficult to pinpoint, but some common symptoms include: • Headaches • Night sweats • Changes in your periods, e.g., frequency or level of bleeding • Fatigue • Vaginal dryness

HOW CAN MENOPAUSE IMPACT BIPOLAR SYMPTOMS? For many people managing bipolar, the perimenopause and menopause phase can be a confusing time. Many of the symptoms can be similar or can overlap with existing bipolar symptoms. One of the key indicators is changes to your periods, particularly in their timings and level of bleeding that you normally experience.

Take the time to consider what is ‘usual’ for you and talk to your doctor about any changes you are experiencing – both physically and mentally.

HOW CAN YOU EFFECTIVELY MANAGE BIPOLAR AND THE MENOPAUSE? Balancing bipolar medication and possible use of Hormone Replacement Therapy (HRT), along with lifestyle changes, can be effective in managing the hormonal changes occurring during this period. HRT is not suitable for everyone – it can have an impact on bipolar medication and the benefits and risks should be discussed with your doctor. However, it can relieve many symptoms, as well as providing other health benefits, such as reducing osteoporosis and cardiovascular disease.

The same 2022 Bipolar UK study found that 64% of people taking HRT found it helped them, with 21% stating that it was ‘extremely effective’.

And The Menopause REASSESS YOUR LIFESTYLE HABITS Prioritising healthy habits and an active lifestyle has also been found to significantly help with menopausal symptoms. As you move into this phase, many find it useful to reassess their lifestyle choices and find opportunities for positive change. This could include: • Prioritising sleep when possible • Taking regular exercise • Eating a healthy and varied diet • Drinking plenty of water • Dedicating time to relax and unwind • Connecting with friends, family and your community

able to take it. There are non-hormonal medications available which may help some people and there is a little evidence for some natural preparations.

4. HRT isn’t one size fits all and can take some tweaking to find what works for you as an individual. Don’t give up hope if the first prescription doesn’t seem life changing.

5. Don’t forget about contraception – we don’t assume fertility is lost until age 55 (unless there are other reasons to believe so).

Written by Gillian Sheriff

It’s important to remember that you can ask your GP for a specialist referral to a menopause clinic if you feel like you need additional support.

EXPERT OPINION:

Dr Jocelyn Skaaning, clinical lead for primary care BBV and specialty doctor in sexual health, shares her top tips for managing bipolar and the menopause: 1. There can be a lot of crossover between symptoms of bipolar and peri/post menopause which can cause uncertainty and distress. If in doubt, speak with a clinician in your GP practice. Ideally, this would be someone with a special interest in menopause.

2. Like so many things to do with health, menopause changes are multi-factorial and what you eat and drink, how active you are and how you sleep play a huge part in maintaining a good quality of life. Increasing protein in the diet and introducing or continuing strength-based exercise can help with aches and pains, support bone health and might help with the shift in fat distribution to the stomach area.

3. HRT can be extremely effective in symptom control and helps reduce risk of heart disease and osteoporosis, but not everyone needs it, wants it or is

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YOU: Your space to share your creative writing. If you’d like to submit a poem, story or piece of writing, please email us on info@bipolarscotland.org.uk with the subject line ‘On The Level Submission’.

Moods

By Colette MacFadyen

My moods can be dark And all seems bleak.

I want to hide away For the darkness to go For the light mood to come To brighten me To lift my soul To give me hope and life.

No more darkness But I have to accept Both the dark and the light They are both part of me It is who I am.

Image: Vecteezy.com

Early Intervention in Bipolar Conference In September, Kerry, one of our staff with lived experience of bipolar, attended a two-day conference in Reykjavik run by The Daymark Foundation. The aims of the conference were primarily to discuss internationally standardised diagnostic criteria for young people and create an umbrella organisation providing resources for early intervention in bipolar. Kerry shares her experience here: “On the Friday evening, after arriving in Reykjavik, we enjoyed a yacht cruise from the harbour, where there was lots of excited chatter from those who know each other from their field of study, and where new participants were warmly welcomed. Several delegates had travelled from Australia – it had taken some three days to get to Iceland(!) – but the bracing sea air soon put paid to jetlag!

We enjoyed a lovely meal at Kopar, a beautiful restaurant at the harbour, before returning to the hotel to rest before the main part of the conference the next day.”

Saturday was incredibly productive with lots of group work and discussion. We had a fascinating presentation on behavioural science delivered by a doctor who studied in Glasgow (we had a great laugh with lots of Scottish in-jokes), and another on The Daymark Foundation’s work in early intervention to date. It was great to hear about some of the practical work being done with young people living with bipolar, and ‘nothing about me without me’ was a strong theme, particularly at The University of Manchester, where young people with lived experience are heavily involved not only in studies, but in informing mental-health policy suggestions in NHS England.

I had some free time on the Saturday night and spent a lovely couple of hours exploring the capital on foot. I’m a huge fan of Icelandic fiction, so was absolutely thrilled to recognise street names and locations mentioned in books I’ve enjoyed.

My favourite place was Bokabud Mals Og Menningar, which is a bar, bookstore and live music venue all in one. As a musician, I would LOVE to play in such a unique venue!

I also found Te & Kaffi, the go-to place for my favourite Icelandic detectives to grab a hot drink, and I treated myself to one of their famous cakes, which was £22! The prices were wild, but it was a great experience.

It was a real privilege to represent Bipolar Scotland at such an important event, and I’ve been lucky enough to make some lovely friends and contacts from all over the world.

I’m really looking forward to seeing how the plans discussed and suggestions made will have an impact on early intervention in bipolar going forward. It’s great to know that The Daymark Foundation are having such a valuable impact on a vital area of study.”

Images: Kerry Adam

What relationship do we want from professional staff?

I’m Graham Morgan, an Engagement Worker at the Mental Welfare Commission and over the last few months I have been speaking with some groups about the relationships we have with professionals. We chose to talk about relationships because, when asked what they most want to talk about, people with lived experience voiced three top priorities: • Help and support on discharge from hospital • Things to do in hospital and in the community • The relationships we have with professionals WHAT WE NEED FROM PROFESSIONALS With regards to relationships, people wanted: continuity, people who knew them, people who treated them with humanity, compassion and empathy, and who did what they promised they would do. They did not want to be seen as a case but as a person deserving of respect and dignity. They wanted connection and welcome, and a sense that a person had enough authority for them to trust them, as well as enough humanity to be someone they also felt comfortable with: “If you really listen and hold space with them, it can be possible to love in mental health care. Someone who listens and puts you at ease and understands what you are going through. Last time, it was, ‘Do your meds work and do you want to come off them?’ and then I was referred back to my GP. [I need] someone who is not dismissive like that.”

People said that when they sought help or saw professionals, they could struggle to say how they were feeling and could worry a great deal about staff perceptions.

Trust could be a big issue too as could the power dynamics between professionals and people with lived experience. Some people said that their carers could be a

very important bridge at these times; both with communication and information: “We can disguise how we are feeling and presenting. We can avoid talking about how we actually feel.”

RELATIONSHIPS IN HOSPITAL Some people did have good relationships and were grateful for the support they received. They talked of arriving at hospital in huge distress, with behaviour that was hard to deal with and found staff who saw them and were able to reach out without judgement. They found staff who spent time with them and got to know them, and this made a huge difference. They also talked about times when staff confessed their ignorance on some issues and worked in partnership with them to find solutions: “My treatment was fantastic – wonderful! They got me back on a level.

I got to know them; they would tell me about their world. They made me feel like a person who is ill, rather than some kind of stigma…”

However, people had some issues, saying that, in hospital, staff can be so under pressure and the physical environment itself so unpleasant that it is impossible to feel a sense of compassion from staff and that it is instead easier to feel resentment and anger: “When I was sectioned, there was no love and no emotion, and no one explained it to me, which had a lasting effect…”

Some people felt that if they stepped ‘out of line’ then some staff would treat them more negatively, while others reported threats of the police being called when they were distressed. Some talked about how traumatic and stressful compulsory or forcible treatment can be and said that could alienate them.

RELATIONSHIPS IN THE COMMUNITY In the community, people often said that, in the past, they had had good relationships with nurses and doctors but increasingly they were discharged from services or that there were no permanent doctors to see. In some areas, there were many locums in operation, which led to less well-informed and helpful treatment.

Some people said they got little support and therefore relationships were less relevant.

People mentioned doctors who suddenly re-diagnosed large numbers of people in their caseload, leading to confusion and bewilderment and the need to adjust to new treatment regimes. They found this extremely upsetting and concerning.

They also talked about how sometimes, when the police were involved, that they provided more sensitive and helpful support than NHS staff appeared to do, and that A&E could be a hostile place to deal with people in crisis.

THE TROUBLE WITH TECHNOLOGY Although some people preferred phone calls with staff, the majority saw remote and digital technology as a barrier to therapeutic relationships. They were worried that interactions were getting increasingly cold and that clinicians had fewer and fewer opportunities to pick up on the issues they were really facing, rather

than just those they spoke about: “The drive to go online is intensely worrying. We do not want a robotic non-human, non-relational approach to our therapy and treatment.”

A MORE POSITIVE FUTURE People also mentioned that staff could also have lived experience and praised the support and atmosphere of the bipolar groups which sometimes provided all their support. They suggested that training in developing positive relationships would be very useful for all staff and should be incorporated into the culture of the NHS. They also suggested that the ability to develop therapeutic relationships should be reflected in staff appraisal and that people with lived experience should be asked their opinions of staff.

If any of you would like an Engagement Worker from the Mental Welfare Commission to visit you, either online or at an in-person support group, please do let me know.

CONTACTING MWCFS: Advice line – 0800 389 6809 Email – enquiries@mwcscot.org.uk Website – www.mwcscot.org.uk BIPOLAR SCOTLAND 23

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YOU: Your space to share your creative writing. If you’d like to submit a poem, story or piece of writing, please email us on info@bipolarscotland.org.uk with the subject line ‘On The Level Submission’.

‘Ups and Downs – More to Follow…’

By John James

I write anonymously for now, but I am confident that one day I will share more openly. I believe it is important that we disclose our stories and share our lessons learned with others.

I am a dad of three young children. I am fairly certain there is a strong genetic link between us. They have my hair, and I didn’t look too dissimilar to them at their age. From studying Kay Redfield Jamison’s work, I am also confident that there is a slim chance – yet a chance nonetheless – due to genetics, that they too may one day be diagnosed with bipolar disorder. And perhaps they will have to face some of the challenges that I did: some unnecessary wrong turns, a racing mind, irrational thoughts, hyper-

manic and ill-considered decisions, a lot of wasted energy and momentum, anxiety and depression. But also, a lot of fun and valuable life lessons and, in my opinion, a life well spent.

Understanding and mastering oneself is ancient wisdom we should all follow.

It becomes increasingly difficult when you have a mood disorder like bipolar. It shouldn’t be an excuse for not striving to be your best self. I am delighted to feel that I have come closer to that having received my diagnosis at 35, four years ago. It’s a constant battle to keep myself healthy and in the best of spirits. I try to do it for the people around me, as it is evident that mood, whether good or bad, is highly contagious.

Image: Vecteezy.com

A festive message to all our members from our CEO… The season of goodwill is almost upon us, where we express gratitude for the people or good causes we love and care about. We might do this by sending gifts, preparing special food, performing acts of kindness, or simply embracing the precious joy of spending quality time together.

For some, this is a season of quiet solitude and hibernation, and it’s important not to get swept along in the merry throng of cultural expectation to connect with others if the thought fills us with dread.

Paying attention to our own needs is an important part of wellbeing, and sometimes that means staying curled up on the couch eating chocolates and listening to music without the company of others.

This year, I’m aiming for a good mixed bag of seasonal activities and downtime. I’d like to start with a lie in until at least lunchtime one day, and progress to a woodland walk with my pal and her three dogs. I’ll make a conscious effort to avoid the nightmare of last-minute shopping and ease myself gently into dutiful visits to relatives for mince pies and an overdue blether before Christmas Eve. My one-year-old granddaughter will descend at some point to play with wrapping paper no doubt, and later I’ll collapse in front of the telly to watch ‘The Holiday’ and update my journal with all the things I’m grateful for.

At Bipolar Scotland, I’m especially grateful for our wonderful team of volunteers, trustees and staff, working diligently alongside me to serve the charity and the thousands of people from all over Scotland we’ve supported this year. I’ll think of them in quiet moments of reflection amid the seasonal celebrations, and wish each of them and each of you, peace, joy and good tidings.

With love, Jayne Image: Vecteezy.com

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BIPOLAR SUPPORT GROUPS ACROSS SCOTLAND We run online and in-person peer support groups across Scotland – friendly, safe spaces for anyone living with or affected by bipolar.

Here’s a full list of all our groups running during October and November. Why not talk to people who get it?

To access and online support group, please visit https:// bipolarscotland.org.uk/supportgroups/ , click on the relevant calendar entry to RSVP, and you’ll be emailed a link you can use to join the group at the appointed meeting time.

SCOTLAND-WIDE (all online) BIPOLAR BLETHER: For anyone living with or affected by bipolar in Scotland. Sunday 1 December, 3-4pm.

18-30: For anyone aged 18-30 affected by bipolar in Scotland.

Wednesday 11 December and Wednesday 8 & 22 January, 7-8pm.

FRIENDS AND FAMILY: For carers and loved ones. Monday 16 December & Monday 20 January, 7-8pm.

REGIONAL AYRSHIRE & DUNDEE • Ayrshire & Dundee online group: Tuesday 3 December & Tuesday 7 January, 7-8pm.

• Dundee in-person (Dundee Volunteer and Voluntary Action, 10 Constitution Rd, Dundee, SS1 1LL): Thursday 5 December, 7-9pm.

BORDERS • Borders online group: Wednesday 4 & 18 December and Wednesday 15 January, 7-8pm.

FIFE & FORTH VALLEY • Fife & Forth Valley online group: Tuesday 10 December and Tuesday 14 & 28 January, 7-8pm.

GLASGOW • Glasgow City online group: Sunday 22 December & Sunday 26 January, 7-8pm.

• Glasgow City in-person (Premier Inn, Glasgow City, 187 George St, Glasgow, G1 1YU): Wednesday 11 December & Wednesday 8 January, 7-9pm.

PAISLEY • Paisley online group: Monday 9 December & Monday 13 January, 6-7pm.

• Paisley in-person (Methodist Central Hall, 2 Gauze St, Paisley, PA1 1EP): Monday 23 December & Monday 27 January, 6-7.30pm.

WEST LOTHIAN • West Lothian in-person (Bathgate Community Centre, Lindsay House, South Bridge St, Bathgate, West Lothian, EH48 1TS): Thursday 12 December & Thursday 9 January, 7-9pm.

HIGHLANDS & ISLANDS • Highlands & Islands online group: Thursday 19 December & Thursday 16 January, 7-8pm.

• Highlands & Islands in-person (Café 1668, 86 Church St, Inverness, IV1 1EP): Thursday 5 December, 7-9pm.

Please note: dates may be subject to change during the festive period.

• Glasgow West online group: Sunday 8 December & Sunday 12 January, 7-8pm.

• Glasgow West in-person (Partick Trinity Church, 20 Lawrence St, Partick, Glasgow, G11 5HG): Wednesday 22 January, 7-9pm.

NORTH LANARKSHIRE North Lanarkshire in-person (Coatbridge Community Centre, 9 Old Monkland Rd, Coatbridge, ML5 5EA): Monday 9 December & Monday 13 January, 7-9pm.

Image: Vecteezy.com

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Want to get in touch with us?

Bipolar Scotland is based at: Studio 40, Sir James Clark Building Abbey Mill Business Centre Seedhill Road Paisley, PA1 1TJ You can contact us by phone between 9.30am – 3:30 pm, Monday to Thursday, on: 0141 560 2050, or by email on info@bipolarscotland.org.uk We’re also on Instagram: (@bipolar_scotland), Facebook: (bipolarscotland1) and X/Twitter: (BipolarScotland).

Charity Number: SC021705 Company Number: 163306 bipolarscotland.org.uk Image: Vecteezy.com