- [Announcer] Major support for this program was provided by Nancy and Nyle Maxwell.

(cheerful music) Emerson.

Kathy and Charlie Izard.

Additional support was provided by Amanda Jensen and Scott Bonneau.

Amado DeHoyos.

Georgetown Health Foundation.

Kristen and John Nelson.

And by.

(cheerful music) And also by.

For more information and a full list of funders, please visit us at howarewetoday.com or APTonline.org.

The information provided in this program is for general educational purposes only and is not intended to constitute medical advice.

This is not a replacement for therapy and does not constitute therapeutic services or a therapeutic relationship.

For personalized medical guidance or in the case of an emergency, please contact a healthcare provider.

(bright music) - Yeah, I think that's it guys.

Thanks.

Hey, how are we today?

I hope you're doing okay.

I'm Tyler and welcome to my new place.

It's not too bad, yeah?

Or at least I think so.

And yes, I can see you, you can see me, and wait til you see this view.

Man.

Yeah, I just moved to a new city and that can be kind of stressful, right?

But if I'm being honest, a little bit of discomfort can help you break out of an old outlook and embrace a new one.

Super hokey, I know, but a lot of hokey things are true.

And another little hokey thing, I just wanted to be closer to family and friends.

'Cause I have found, oddly enough, that being close to the people that you love is just plain good for your mental health.

Mental health.

It's what we're here to talk about.

It's kind of what everybody's talking about nowadays, but just 'cause most of us are, doesn't make it any easier to figure out what is going on.

It can be really hard to describe what we're feeling and let alone get the help that we need.

Biggest challenge, where to start?

You know, I've often found that mental health is kind of like an invisible painting that only you can see.

All of you is on it, your thoughts, your feelings, your emotions, your personality.

You know why things go here and there.

It's a little details, but some of it, maybe a lot of it can still be really confusing.

So how could you possibly explain all of that to somebody who can't see it?

And even if you are able to communicate your feelings, your mental health journey can still be full of obstacles.

Whether it's lack of access to care, shortage of mental health professionals in your area, limited educational resources and one of the toughest, just not having a strong support system in your life.

It's not your fault, by the way.

So yeah, all of this can be really overwhelming, right?

When honestly, all we want is to have somebody untangle what is going on inside of our brains and just get the help that we need.

So if you are somebody who is struggling or if you know somebody who is, or if you just, I don't know, wanna learn a little bit more about the full spectrum, that is mental health, you're in the right place.

I'm here for you.

And together we're gonna dive into it all.

Speaking of which, I gotta dive into these boxes.

My good friend is coming by tomorrow and I need to make sure the place looks really good and clean and I need to get a jump on this.

I just don't know where to start 'cause, man, it's a lot of boxes.

Wait a second, wait a second.

Oh yeah.

This piece, this piece right here, this is one of my favorites.

This close to mastering it, by the way, before I moved and, I can take a break, right?

These boxes aren't gonna go anywhere.

I'll slap keys for like five minutes and I'm gonna get right back to it, I promise you.

Just a few little tunes.

(soft piano music) (door knocking) That's not my friend, is it?

She's not supposed to be here till tomorrow.

Come in.

(whimsical music) Not my friends.

New neighbors?

Hi, I'm, it's Tyler nice to meet you.

- I'm Barbara from next door.

- I'm Mariel from down the hall.

- Yeah, I like the pajamas, but it's a little bit early in the day for 'em, am I right?

- It's actually perfect time for pajamas because it's the middle of the night.

- Yeah, your music has been keeping us up for the past couple hours, actually.

- Wait, really?

- Yeah.

- This is a prank.

You guys are pranking me.

Do you guys do this with all your new neighbors?

Because I was unpacking today, so I'm pretty sure I would know if it was nighttime.

It's nighttime.

- Yep.

(cricketrs chirping) - (sighs) I am so, so sorry guys.

I was taking a break from unpacking and I played the piano for a little bit and I lost track of time.

I must've been having a moment of hyper fixation.

- Hyper fixation.

Like with ADHD?

'Cause our friend Barry does the same thing where he gets really focused on one task or has trouble finishing things.

- That's funny you say that 'cause yeah, hyper fixation and ADHD can overlap.

But I was having a moment of hypomania.

See, I'm somebody who suffers from bipolar disorder.

- That's also called like manic depression, right?

- Yeah.

- So are you having a manic episode?

- Well, it's cool that you know that and no, I'm not, I mean I do experience manic episodes for sure.

Depressive as well, but mainly hypomania in this exact moment.

Right, so I just threw a bunch of words and terms at you that might be a little bit hard to process all at once.

But this is a perfect example of how nuanced the mental health spectrum really is.

All right, back to my new neighbors.

- Honestly, I don't think we've ever met someone who's so, well, open about having a disorder.

And sometimes the things you hear about bipolar is- - Scary.

- Yeah.

- I know, I know.

But so much of what we fear comes from the things we don't understand, right?

Look, I am so sorry about waking you guys up in the middle of the night.

Why don't you come in, I'll put on some coffee, and I'll share everything I know about this.

- I mean, if there's coffee involved.

Yeah, make it strong.

- Okay, two coffees coming right up.

- Okay, so you had a hypomanic moment.

What does that mean?

- Okay, so hypomania is a milder version of a manic episode.

They can share similar symptoms, but hypomania for me feels kind of like a burst of high energy or extreme focus on an activity.

- Like your little Mozart moment.

- Like my little Mozart moment.

Yes.

Now, typically I notice pretty soon into it, instead of having a neighbor having to come in and tell me, but for a manic episode that's a little bit different because if left unchecked and untreated, it can carry some pretty heavy consequences.

- Do you have an example?

- Sure, I can tell you what one looks like for me, but keep in mind it looks different for everybody, right?

But for me usually starts off with this state of euphoria.

(lively music) I feel this incredible energy out of nowhere.

It's a feeling that I can take on the entire world.

My mind gets these endless flow of thoughts, ideas, and obsessions and even though the thoughts are intrusive and it should feel overwhelming, it doesn't.

Starts off very logical, feels incredibly productive.

Like I've found my flow, you know?

- [Mariel] So you just get obsessive, like with OCD?

- I mean everyone gets tunnel vision from time to time.

- Sure, but with bipolar disorder and the danger of it is how that behavior escalates.

'Cause even though I should be overwhelmed by all these things, it doesn't feel that way.

I feel like I can accomplish all of these tasks.

And I also feel like I need to have everything as well because by then I start taking risks, which gets real problematic really fast.

And it typically starts off with spending money.

And when I say spending money, I mean full-blown shopping sprees where I'm convinced I gotta have it all.

I need this, I need that, I need those.

(frantic music) Oh yeah, I definitely need that.

- But everyone loves a little retail therapy.

- I mean, sure, except during a manic episode, it doesn't feel like there's gonna be any of those consequences, even when spending money isn't what you really wanna be doing.

And as far as retail therapy goes, there's a big difference between treating yourself and blowing your entire savings account.

- I mean, there's a lot of people who aren't very financially responsible.

- Yeah, the problem is, is that I'm disconnected from all the negative emotions of it all.

Because typically I'm overcome by another common manic behavior, delusions of grandeur.

I get this unshakeable belief of superiority.

I'm convinced I'm the most important person in the world, the most admired and the most desired as well.

And I assume everybody wants to be with me, wishes that they could be me, that they love me.

And all of it feels so real.

It makes me feel like I'm some sort of celebrity, you know, like I only hang out with the elite, the movers and the shakers and all eyes are on me.

What's he gonna do next?

(lively music) (crowd cheers) It's a feeling that everyone just wants to bask in my glow.

And who doesn't wanna feel like that sometimes?

- So are delusions the same as hallucinations?

Because I know hallucinations are typically associated with schizophrenia.

- Well, hallucinations are more like your senses, convincing you that something's real, right?

But actually the things you're hearing or seeing aren't real at all.

With what I deal with, delusions, those are simply false beliefs.

- I'm sorry, I shouldn't have asked that.

- No, it's totally fine, Barbara.

In fact, it was a really good question.

And this just illustrates how complex and nuanced the mental health spectrum really is, right?

And why it's so important to get the right diagnosis and get on the right treatment plan because if not, with what I'm going through, the consequences can be severe.

And all of it can come to a head, because by then I feel invincible.

I see no boundaries, there is no fear, no caution tape.

So I just keep looking to push the limits.

And that's what can make a manic so dangerous.

You can't see the danger, the stop signs that should be there can become invisible.

So I feel like there is nothing that should stop me from doing what I want to do.

(lively music) And then the eventual crash, because what comes next for me is typically a depressive episode, which is far more dangerous than a manic one.

It's almost the complete inverse of what I was experiencing, the passion for the things I love to do, it's non-existent.

Just an empty void of no emotions.

There is this struggle to exist.

I stop eating, I isolate.

And probably the worst, I don't sleep.

My mind races and plays all of the hits.

Fear, anxiety, embarrassment, and self-loathing.

It all just piles up and my emotions flip.

Irritable at the slightest inconvenience, angry, cold, harsh, extremely harsh.

- Do you become violent?

- Well, that's a pretty popular misconception about bipolar people because while, yes, people with bipolar disorder can exhibit aggression, the majority are nonviolent.

And unfortunately a lot of them self-harm.

And for me, that takes form in substance abuse because I feel like that'll bury the emotions, right?

But those emotions are a lot.

That's really tough.

Because besides dealing with the underlying depression, I'm constantly wrestling with the consequences for my past behavior.

I can fixate on the shame of how I treated those I cared about.

How I must have looked, behaved, how people must have really felt about me.

(somber music) And sometimes I wonder if I just embellish the whole thing.

Did I just make all this up?

Did I let my ego distort reality?

- That must really feel awful.

But, I mean, don't we all do embarrassing things that we kind of feel stupid after?

I know I do.

- Same.

- I mean, yes, I mean, we all can except when it comes to a depressive episode, those emotions just loop in your mind.

All of those thoughts, just a gut punch again and again and again, it just never stops.

Because of that, the hope dissipates.

I submit to the emptiness and become filled with indifference.

And indifference is the most dangerous place to find myself in.

There is no empathy.

There is only nothingness.

Because if I'm nothing, then I don't matter anymore.

(somber music) If I don't matter anymore, then I tell myself, what is the point of continuing on with any of this?

- Tyler, that is awful.

I'm so sorry that you've gone through that.

- Yeah, thanks, Barb.

It's okay.

- Yeah, that's really tough.

And I mean, to be honest, I thought people with bipolar were kind of hot and cold.

Like they just kind of flipped a switch.

- Well, you know, the hot and cold thing is another common misconception, which is totally fine by the way, because most episodes typically last for longer stretches.

And depressive and manic don't always alternate, right?

Now for me, I struggle with depressive far more than I do manic.

But no matter what, it's something that I'm able to manage because no matter what you're going through, you can find the help that you need and I'm very lucky to have found a really good treatment plan.

You know, I'm on medication, I'm lucky enough to go to therapy, and probably the most important, I have a really strong network of family and friends to rely on.

And I've learned so much from my friend, Dr. Erin, who is literally gonna be here probably any second now since it's almost tomorrow.

I was supposed to have this place cleaned up and looking good when she came over.

Clearly, I'm not gonna make it.

- Sure you will, if we work together.

- Yeah, we can stay.

- Really?

You guys would help me?

- Absolutely.

- I mean, we're here.

(whimsical music) - Thanks for the help, guys.

- Yeah.

(door knocking) - Come in.

Good morning, Tyler.

- Dr. Erin.

Hey!

- I brought you a house warming gift.

- Thank you so much.

I appreciate it.

Hey, take a seat, please.

- Okay.

- Should we call you doctor Erin or just Erin?

- No, I mean, I am a doctor but I'm not your doctor.

I'm just here as me.

- Yeah, for sure.

- But the doc's right, she's just here as my friend and to help us understand things, not to offer direct therapy.

As we talked about the mental health spectrum, vast.

So make sure you check in with your personal mental health professional to get a direct treatment plan.

So yeah, Barbara and Mariel stopped by to help me unpack my boxes 'cause I had a little bit of hypomania today.

- Oh, but not a manic episode.

- That's right.

- So I get that there are differences between all of these conditions, but is the only difference between hypomania and a manic episode the length of time that it lasts?

- Good question.

The cycles and the length of cycles are important factors in diagnosing many conditions, including bipolar disorder and their important cues in how to treat those conditions.

- Hmm.

Okay.

- Can I ask you like a really basic question?

- Sure.

- I know some people have mental health issues and others don't, so is that genetics?

Is it life experiences or something else?

- That's a really, really good question.

There are all these theories behind how mental illness develops and really we know it's just a combination of these factors, your brain, or genetics, and your life, or environment, including your history, your culture, past experiences, et cetera.

And your patterns of thoughts, feelings, and actions.

The thoughts, feelings, and actions showing up is an important part.

So we have these thoughts, feelings, and action urges that show up in every situation.

And we take those combined with your genetics and informed by your environment and sometimes we get these buckets of symptoms.

- The bucket of my brain is overflowing with information right now.

- Wait though, there's even more.

So we think about those symptom buckets as diagnoses.

Each diagnosis has its own bucket and there's overlap between the symptoms, but more importantly the symptoms are gonna be different for each person.

So two people might have the same diagnosis from the same provider, but their treatment bucket might be different based on their life circumstance.

Basically what we wanna do is we wanna know exactly which buckets are showing up so we know exactly which treatments to use.

There's tons of overlap with them and that's part of where it gets really tricky to untangle is trying to figure out which symptoms are showing up, which thoughts, feelings, and actions are showing up.

And that's really the work of therapy is trying to untangle that.

And it can seem daunting, right?

Like your bucket can feel full just even thinking about it.

But sometimes in order to untangle it and figure it out, we can start really simple.

And I actually have a skill that I like to use for that if you wanna learn it.

- I'd love to.

- I love skills.

- It's one of my favorites.

It's called ice face.

Tyler, do you have any ice packs?

- You know I do.

- Can you go grab them?

- Absolutely.

Hey, so grab an ice pack out of the fridge.

If you don't have an ice pack, not a problem.

Grab peas, veggies, anything cold.

I'll explain why in a second.

Ah, there they're.

Here you go.

- Thank you.

- One for you.

One for you.

- Okay, thank you.

- All right, doc, let's do this.

- So it might sound really simple, but sometimes just noticing what's showing up, what thoughts, feelings, and action urges you're having and what the patterns are can be actually really difficult.

Really facing what's showing up in the moment.

Really what we're talking about is mindfulness, which I know has been overused in the media a lot, but it's all just about noticing.

- Yeah, I feel like I see people talking about mindfulness all the time and it's annoying.

- [Erin] Yeah.

- Yeah.

I've tried mindfulness before, but I always feel kind of awkward following along to some weird TikTok and then I just give up.

- Mindfulness is all about awareness.

Anytime you're purposefully paying attention to something you're being mindful.

The idea with this is noticing what your brains and bodies are doing so that we can figure out what to do with them, what to do next.

Which can give you back some of the power and control rather than your thoughts or feelings having it.

But it can be so tricky or it can bring up all kinds of thoughts and feelings like the ones you two just had.

So having a tangible skill like ice face to help can make it a little bit easier.

Ice face is one of those things that's rooted in DBT distress tolerance and lots of different providers have different versions of this.

This is just the Dr. Erin flavor.

- Ooh, fancy.

- What is DBT?

- Dialectical Behavior Therapy.

Good question.

It's just a type of evidence-based treatment that we use a lot of times.

It has tons of skills in it, like emotion regulation skills or distress tolerance skills like ice face.

Your job while you're doing this is just pay attention to which thoughts and feelings might show up.

Whether they're judgment thoughts like, this is really weird, I don't wanna do this anymore.

Or feelings that might come up.

Just practice pausing and noticing them so that we can figure out what we wanna do with them next.

While you're noticing, go ahead and just put this on your face.

Take a deep breath.

Notice what the cold feels like.

- Cold.

I notice that all my thoughts are going to the ice pack.

- That's the mindfulness part.

I always catch myself taking deep breaths as I do it, probably because it's cold, but also because I've done this so many times that I've trained my body to really regulate through.

The cold will literally cool you down.

While the mindfulness and regulation part will increase your ability to think, which in turn increases your capacity to tolerate distress.

Hence the name, distress tolerance.

- You know, I'm feeling pretty regulated right now and kind of forgetting about that 3:00 AM concert.

- And I am realizing that I should slow down sometimes and take stock.

Doc, I appreciate it as always and I'm glad you guys got to stop by too.

We learned so much today.

- I know it's been such a great day.

- Yeah.

You know the best part?

We got to chill out.

(group laughs) - I like you already.

- [Tyler] Thanks for coming over everybody, I appreciate it.

- It's good meeting you.

- Yeah.

- Maybe a little less music tonight.

- [Tyler] Yes ma'am.

- I'm so glad you live here now.

- [Tyler] Me too.

I'll see you soon, okay?

- Bye.

- See ya.

Man, what a day.

Made new friends, had an old one stop by, and I got a plant.

who doesn't like a plant?

I know the perfect place to put it too.

And actually, the best thing about today, we did a lot of unpacking.

And we unpacked a lot of my boxes.

That's terrible.

I know.

Stick with me, 'cause that's why I'm here.

I'm here to let you know that you are allowed to have fun when it comes to your mental health.

'Cause yes, this is very complex and it's heavy and it's personal and it can be unbelievably cringey when somebody asks you to get in touch with your inner child.

But, this conversation, and whatever it is you're going through, does not have to feel like the death sentence it's made out to be.

'Cause if you feel trapped, if you feel like you're in the bottom of a prison, just know that so many of us have been down there.

And we know a few ways out.

Now, I'm no medical expert, but one thing I can 100% guarantee is that if you are brave enough to ask for help, those that can will find you.

As a very wise mind once said, look for the helpers.

You'll always find people who are helping.

And now that we have found each other, let's help each other out.

Do you think I have all this figured out?

Heck no.

I have so much further to go as a person.

Some days I feel like I'm just beginning my mental health journey.

But that's okay, because we're gonna do this together.

We're gonna figure out what works for us and we're gonna do it on our own time.

So until then, take heart and take care.

Now, I need to figure out where the girls put my laptop because I need to Google how to take care of a plant.

I don't think I know how to take care of a plant.

How much do you water a plant?

Is this plant fake?

(cheerful music) - [Announcer] Major support for this program was provided by Nancy and Nyle Maxwell.

(cheerful music) Emerson.

Kathy and Charlie Izard.

Additional support was provided by Amanda Jensen and Scott Bonneau.

Amado DeHoyos.

Georgetown Health Foundation.

Kristen and John Nelson.

And by.

(cheerful music) And also by.

For more information and a full list of funders, please visit us at howarewetoday.com or APTonline.org.

(logo whooshing) (cheerful music)