Mind Dive
The Menninger Clinic’s Mind Dive podcast is a twice-monthly exploration of mental health topics from the professional’s perspective, including the dilemmas clinicians face in their practice. Hosts Dr. Bob Boland and Dr. Kerry Horrell dive into the complexities of mental health care including the latest research and other topical developments through lively discourse with distinguished colleagues from near and far.
Mind Dive
Episode 58: Better Living with Bipolar Disorder with Dr. David Miklowitz
David Miklowitz, Ph.D., has been pioneering family psychoeducational treatments for bipolar disorder by integrating psychotherapy and family therapy with medication. Dr. Miklowitz’s research emphasizes the critical role families play in identifying the early signs of bipolar disorder and how family members can help a patient implement effective strategies in managing their symptoms.
This episode of Menninger Clinic’s Mind Dive Podcast features Dr. Miklowitz, accomplished psychologist and author, joining Menninger Clinic clinicians and co-hosts Dr. Kerry Horrell and Dr. Bob Boland for a comprehensive look at bipolar disorder, its effect on family dynamics and how patients and their families can work together to better navigate life after a diagnosis.
Dr. Miklowitz is a professor of Psychiatry at the University of California, Los Angeles (UCLA) School of Medicine and a senior clinical researcher at the University of Oxford. He directs the Child and Adolescent Mood Disorders Program and the Integrative Study Center in Mood Disorders at the UCLA Semel Institute for Neuroscience and Human Behavior. Dr. Miklowitz is also a renowned author and his latest book, “Living Well with Bipolar Disorder: Practical Strategies for Improving Your Daily Life”, will be available September 16th, 2024.
“There is a grief over the lost healthy self where people start thinking of their lives as bifurcated before and after they became ill,” Dr. Miklowitz mentioned. “We try to help normalize it and help them figure out what is their personality versus their disorder.”
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Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.
any quick, any questions about it. We're just gonna. It's obviously just a conversation and sure, and you will kind of follow, even though we have some questions in front of us, we'll follow your lead. So if about anything that you'd rather talk about stuff, thanks for joining us, yeah yeah, sure, yeah, yeah, it's very interesting subject.
Speaker 1:Yeah, um, glad to be here. How what? Oh, yeah, great, maybe turn it up just a little bit On our end, sherry, yeah, on our end You're fine, but I think we need to just turn up our volume Just a little bit to the right. Maybe I can do it. Yep, there you go. Well, it's on 100, so I think that's it. That's about as much as we can do. Where'd you go? You have to click on this.
Speaker 3:Sorry, I'm not very good at doing this while you're on an angle.
Speaker 1:okay, all right, we'll manage, all right, but it's recording fine as far as you know. Yeah, okay, yeah, all right, all right. Should we get started? Sounds good, all right, then all right, great. Sounds good, all right, great, all right. So welcome back to the podcast. Today we have Dr Mikulwicz, who is a professor of psychiatry in the Division of Child and Adolescent Psychiatry at UCLA's Semmel Institute and a senior clinical research fellow in the Department of Psychiatry at Oxford University. He completed his undergraduate work at Brandeis University and his doctoral and postdoctoral work at UCLA. His research focuses on family environmental factors and family psychoeducational treatments for adult onset and child onset bipolar disorder. Welcome, dr Mikulic.
Speaker 3:Thank you, thanks for having me.
Speaker 1:Yes, it's delighted to so are you currently in LA?
Speaker 2:Is that where you?
Speaker 1:are Okay, all right, great.
Speaker 3:Well then good morning. You can tell by the guitar in the background.
Speaker 1:Well, can you just tell us a little about your career as a psychologist and how you became interested in bipolar disorders?
Speaker 3:Sure. Well, it's kind of a long story, but I got interested in bipolar disorder when I was an intern meaning I was a trainee at UCLA when I was my, in a lab that studied schizophrenia in families, how families interacted with each other and whether family therapy was a useful adjunct to medications. But I got interested when I was doing my internship. One of were people who were very articulate about their emotions, about their experiences. They had great senses of humor. There was a real sense of cohesion in this group.
Speaker 3:It wasn't a population I'd worked with before, but yet when they went into their manic and depressive phases it was almost like they became different people. There was very dramatic change that occurred. People who'd been very polite would become very angry and hostile sometimes, or people who'd been depressed would suddenly look very elated and excited. But, as an aside, one of the things they talked about was their family and how their family played a role, both positively and negatively, in how they did. Some of them had very supportive families and encouraged them to take medications, help them get medications filled, help them get to doctor appointments, and others felt that their families just didn't understand and that they thought they were faking it or felt that they could try harder, and it was all in their head.
Speaker 3:And this became what I studied. I studied what family environments are like in bipolar disorder and found out, in fact, that environments were associated with outcomes, with relapse rates, how people did over time, how they did socially. If they came from highly critical, conflictual homes, they didn't do as well, and if they came from supportive homes, needless to say, they did better. So that's how we ended up designing treatment for the family, how we ended up designing treatment for the family.
Speaker 2:That's a yeah, I want to say more about that because I'm thinking back when I did my comprehensive exams when I was doing my PhD and you go through all sorts of treatment plans for different disorders. I actually remember being struck that bipolar seemed very unique in that most disorders the gold standard treatment was psychotherapy and medication. But I remember specifically for bipolar, like the first line of treatment was medication and then family therapy and then psychotherapy, and that always stood out to me and so I wonder if you can tell us a little bit more about kind of your sense of that above.
Speaker 2:I'm glad to hear for this population and maybe especially for young people.
Speaker 3:Yeah, I'm glad to hear that they mentioned family therapy in your training. Uh, when I was, when I was coming up, they only talked about medications.
Speaker 3:The idea was like my training, yeah was uh, I did most of my graduate training in the mid 80s and basically what you heard about bipolar disorder was it was genetic and you were supposed to take lithium. And then there were a couple of alternatives to lithium antipsychotics mainly, but psychotherapy if it existed at all, was just to help people stay on their medications. There wasn't really anything about exploring or understanding stressors or coping strategies. So this became a wide open area. People were kind of. Some people tried to talk me out of studying it. When I first started out they said you know why are you so interested in that? You know what is it. Do you have it or something?
Speaker 2:Leave it to the psychiatrist.
Speaker 3:Somebody family, haven't you're trying to help them or whatever? And I said no, I thought you know it was a really uncharted territory. We knew a lot about schizophrenia and families. Why not at least look at it as a comparison group? But how about in its own right and that. But there were others working in this area that were working on individual therapies and group therapies, and now I think it's a much bigger field. Now I think there's more of a recognition that therapy is an important role, plays an important role.
Speaker 2:And what about the family component? I mean again like as far as family, family therapy kind of at this point considered sort of like part of the first line treatment of bipolar disorder.
Speaker 3:Well, I'd like to think it's part of the first line treatment. Whether everybody agrees with me or not, it's another. I think it partly depends upon how old the patient is. I think it partly depends upon how old the patient is. You mentioned the younger patients.
Speaker 3:We work a lot with teenagers who are first diagnosed, and also young adults, and there I think the family is critical because, hey, they live in a family environment. Their family tells them whether they're behaving in an appropriate way, or whether they, their families, know when they're taking medications or not. And how the family reacts plays a very big role in their, their course of illness. If they're from a family where people are saying you know, this is, you need to try harder, you're, you're being lazy, you're not, it's not, you're not depressed, you're just like sleeping late or you aren't trying hard enough, you aren't motivated, you don't know what you want to do, that kind of stuff really hurts when you have an illness. And likewise when people get manic, the family doesn't know what to do. They often respond very angrily, critically, often respond very angrily, critically or, you know, sort of shun the person for a while.
Speaker 3:And I think families need to know what to do when the person is ill. Now, some families are more natural at it. You know, I don't like to dichotomize it, as they're good and bad families, but there are families where people just seem naturally to know to give the person room, to be encouraging, to give structure in the home to, you know, encourage predictability, and those patients, I think, do much better. And so our program. I don't know if you want me to jump into talking about our program yes, I'd like to hear more about the interventions.
Speaker 3:Yeah, Sure, so our program is called Family Focused Therapy, it's FFT we call it, and right now it is a four-month-long treatment program. It's got 12 sessions and they're divided into three modules. It's what we call psychoeducation, communication, training and problem solving psychoeducation, communication, training and problem solving. So a typical family will be coming in after a patient's had an episode of either depression or mania, and that's when the family is most motivated to figure out. You know what am I going to do? I know he needs medication or she needs medication, but what else do we do? How do we understand this? And so the first part is just talking about what has been the patient's experience. How did they know something was different? What was going on in their head? How did the family recognize something was different? And they often are very good at recognizing those changes. When the person is getting manic, they say you talk louder, you stand closer to people, there's an aggressiveness in your voice, you're talking very fast, you're loaded with all these things. You're going to do that projects that get dropped. You know, I know when you're, when you're getting that way, and the patient will often say well, I couldn't sleep, or I thought sleep was a waste of time, so I stopped sleeping or I knew all the things I wanted to do and suddenly everything was clear to me. And knowing those early warning signs is really, I think, where you have leverage to try to prevent a full episode, because even though it may feel good, it may feel wonderful to be getting manic, because even though it may feel good it may feel wonderful to be getting manic, that's when you start you need medication the most to try to stave off a more serious episode that might land you in the hospital or get you in an accident or get you hurting someone else or any number of other things.
Speaker 3:So we want the families to know what it looks like when somebody is going into mania and what to do.
Speaker 3:You know when to call the doctor, how to arrange emergency medication in advance. You know prescriptions can be written in advance for. You know rescue, so to speak, how to keep the environment structured so that person doesn't stay up all night, how to make expectations very clear and not to get riled by the person's sort of aggressive behavior, to recognize it as part of an illness, but not critical, not to say to the person. You know get up and get out of bed, because that's not going to work to be give them sort of help them shape their environment and their goals so that they can gradually reenter society which might mean maybe they have to sleep late for a while or have to sleep more than usual maybe can gradually encourage them to set the clock back a little bit each day to try to eventually get up or to have goals like today I'm going to take a walk or I'm going to call a friend or any number of other things that can gradually help them get out of a depressive episode.
Speaker 3:That's what we talk about in psychoeducation. Did you want to ask about that?
Speaker 1:Yeah, well, I also want to hear, I mean, more about the communication training. I think you've kind of touched on it a little bit already, but, yeah, maybe I'll interject here, Okay.
Speaker 2:I think I work a lot with bipolar young adults like this has been more and more common as part of the population that I've been treating and I would say, like clinically, two of the major things as a therapist that I see are grief and shame.
Speaker 2:Like just the grief of like I have this, I'm probably gonna have this my whole life. And then shame, um of like that does, even if I know this is a disorder, you know, like there's a sense like something's wrong with me, that I have this and that I experienced this and so, yeah, I'm, I'm even in this communication style. I feel like both can be so implicated of like how do you reduce shame, how do you help people even think through, like as families, like yeah, this does impact us and impacts you, and like there's grief to acknowledge. Anyways, I'm curious if that relates to the communication.
Speaker 1:Grief and shame.
Speaker 3:Definitely have seen both grief and shame operate in our family sessions and in individual work I've done with patients. I mean grief, I think you've hit it on the head. There's this. We call it grieving over the lost healthy self, which actually is Ellen Frank's term. She developed a treatment called interpersonal and social rhythm therapy Frank's term. She developed a treatment called interpersonal and social rhythm therapy where people start thinking about their lives almost as bifurcated into the periods before they got ill and after they became ill, and wishing they were the person they used to be. But often the person they think they were before was slightly hypomanic and kind of over the top and, um, you know, uh, full of full of life and in positive ways, and they kind of wish things were back to those ways and sometimes that drives medication non-adherence. They kind of say, well, maybe if I go off these stupid medications I can who I used to be. And sometimes the time yeah.
Speaker 3:And the shame I think is comes about partly because they, you know, when they recognize they've let down their parents, or parents had expectations for them they may not be able to fulfill, but also the stigma in society about having a disorder and other people being afraid or people not wanting to go out on dates with you because you have this illness, or having trouble getting jobs because people somehow figure it out or know about you. And of course that brings about quite a bit of shame and we try to help normalize it and help them know what their rights are when they go in for a job, for example.
Speaker 2:uh, you know that they don't have to disclose their illness, um, and how to deal with it as a family yeah, before I jump to another kind of question, I'm curious if we did cover the different modules that you were just yeah, I want to hear more about, still want to hear more about communication well the communication we particularly target towards families that are high in conflict, where there's just been a lot sort of flinging mud back and forth and, you know, arguments that have gotten out of hand and sometimes those are related to not fully understanding the illness or what is and isn't the illness.
Speaker 3:A big question that we get is how do I know what's him and what's his disorder? You know he's always been kind of in your face and aggressive. You know this is just sort of an exaggeration of what we saw before and what communication training is. It's really a fairly old technique in the family therapy literature. It's teaching people how to listen and how to make requests of each other and how to balance positive and negative feedback. So a typical exercise and these are more like role play exercises we'll say to two people who are fighting a lot we'll say, okay, I want one of you to be the speaker and the other one be the listener, and what the listener has to do is paraphrase, ask questions, clarify, not interrupt, and just let them say their piece.
Speaker 3:So then we run. You know a little role play like that ask everyone how did it feel to be in that spot? And you get a person saying, well, I could listen, but he didn't mention what he did the other day. And so we say, hold on that, we'll get to your point of view in just a minute. But how did it feel to be a listener? And then to the patient how did it feel to be listened to? Now, let's switch. Now you be listener and listen, you, mom, you tell patient how it felt. You know, the other day, when he was up late at night selling things on the internet or, you know, speaking to people all over the country on on the phone.
Speaker 3:So, and then you, when there are like I want you to get out of bed earlier or you're being lazy, we get them to phrase that as a request rather than something negative, to say, okay, what do you want the person to do? Explain specifically how you think they could get out of bed earlier and how it would make you feel if they did, and have them role play that and that might lead into problem solving. What could the family do to this person get out of bed? What could they do to help them take their medications, help them find a job, help them, you know, deal with their day-to-day requirements. You know, if they're taking care of children how they're going to continue doing that even though they're depressed. Various problems arise in the aftermath of an episode, and the family can really help, you know, generate solutions and evaluate which ones are going to work or not.
Speaker 1:Yeah, and it sounds very practically based. Yes, it is.
Speaker 2:I am going back to that question because I think I hear that too from a lot of our patients which is is this me or is this bipolar? And is that a distinction that matters to look at and some of the I think very painful trying to like open that up of? Was that really me? Is that me? Who am I in this kind of mess of these episodes? Um, I wonder how you counsel patients and families on that.
Speaker 3:I think it's a very first. I think it's very important because it's it's up with whether the person is going to take treatment or not. If they think this is just me uh, me being me and I happen to be a my personality is to be aggressive or hyper or whatever they, you know, whatever they describe it as, yeah, they'll be less likely to take medication. So we try to first there are concrete things you can do, like, and one can think of a patient where I asked them to make a list of your personality as you understand it. What are the features of your personality, like? Are you intellectual, are you a good friend? Are you dependable, are you easily angered or impulsive or conscientious? And how are you different when you're in your manic states or in your depressive states? That tells you something about whether this is you or your personality.
Speaker 3:Um, it gets even trickier in kids well, adolescents really where the question is what's being a teenager and what's being a bipolar teenager? Right and that's, and, uh, yeah, that there's one way to think about it which is, you know, typical in teenage years is three things Family conflict, risk taking and instability. Those are features of just being an adolescent, and those things all get exaggerated in bipolar disorder. Yeah, unfortunately it all overlaps right. So yeah, of just being an adolescent and those things all get exaggerated in bipolar disorder.
Speaker 2:Yeah, unfortunately it all overlaps, right, so yeah and you kind of think of in this question too, like identity development yeah yes yeah, exactly what that means.
Speaker 1:Yeah, yeah, it's interesting too, like because, uh, it sounds like some of the strategies I could call early on, I think, still as a trainee, having a patient who is a businessman and he would always, he would come in every now and then and say those kinds of things like okay, I know you're going to say, I know you're going to say I'm manic, but I've got this great opportunity. So I'm like selling everything here and I'm going down to Florida and I'm going to, like, you know, throw everything into this, like particular real estate development or something like that, and it's really going to take and it's a great idea, that kind of thing, you know, and you'd be like, well, you're right about one thing. Like I do think you're manic, but it's like. But then it just became like a back and forth where, like no, I'm not.
Speaker 3:Yes, I am, which wasn't terribly helpful to either of us. I was frustrated and he still went down to Florida. Yeah, i'll'll tell you what I wouldn't say.
Speaker 3:We have a great solution to that, but I can tell you what we do in those circumstances is, um, somebody's saying, yeah, I'm going to throw everything away, I'm going to leave my wife, I'm going to go, you know, become a rock musician, and you know selling all my stuff, and so on. We we sit, tell them two things. Can you wait till Thursday to do that? Negotiate, negotiate. I mean, if it's a good idea now, it'll be a good idea on Thursday too, won't it?
Speaker 3:And the other is name two people you know whose judgment you trust, outside your family preferably. Well, my uncle, my former roommate, all right. So would you be willing to call them and ask them what their opinion is? You know and that doesn't mean you have to do what they say, but would you at least find out what they think about this plan? And sometimes you know there's still a part of them that's logical enough to hear that. You know, everyone else thinks this is a crazy idea and maybe I shouldn't jump in. Maybe I can do part of it and not the whole thing. Maybe I don't have to move, maybe I can take guitar lessons if I want to become a musician or something like that. So you know, partly it's just.
Speaker 2:But if you know, if they're in a psychotic mania, all that's going to fall flat, which is why you have to really try to get before it's out of hand, I will say, just to pick your brain on this a little bit more, because I again this is a bit anecdotal, but it's what I've seen, especially again for some reason, over the last few years I've I've worked with a lot of young adults who come in like after a manic episode and I think they really are like genuinely very creative, very talented, very smart, and they describe again like across multiple patients I've heard them describe something akin to when I'm manic I can sort of access some level of my mind, thinking, creativity, that I can't access otherwise, and I certainly don't think I can't access otherwise and I certainly don't think I can access when I'm on medication.
Speaker 2:And it's one of the huge, I wouldn't even say conflict points, because I, as a therapist, I'm not trying to argue with them about like, yeah, you should do this. I'm trying to be like what's the pros and cons? You know like what? Let's look at like what you, what really aligns with your values, because when you become manic you become oftentimes pretty destructive, it's traumatizing to your family, it's not good for you and it is getting in the way of your success. And, like I'm hearing you say, I make better music when I'm manic and I feel like I have more of a chance to really make it when I'm manic. And so this is the conflict. I feel like I'm seeing the most that these people do seem like they can access something in their mind. They're really quite I agree with you.
Speaker 3:I have a couple of responses. First, I think it's great that you develop a relationship with your patients and sort of take them through that Is this good for you? Pro and con type of thinking, because if they have a good relationship with you they're going to listen, even if they're combating you for what you're saying. Uh. Now, first thing is you know creativity. There is no question that there's a link between bipolar disorder and creativity and you know just k jameson has written uh dozens of books about this maybe not dozens, but uh quite a few books on bipolar disorder and and uh artistic creativity and the various people in history who've had bipolar disorder. You know tchaikovsky um strauss. Uh, you know dancer nijinsky, the dancer um very power amy winehouse yeah in the winehouse.
Speaker 3:Uh, lots of um kurt cobain, I think. Uh, now the thing is, uh, people really are most creative when they're hypomanic, not when they're manic. That's a really important distinction to tell patients that when you're a I I think your mind does expand a bit. You do are able to grab onto your creative instinct and probably think outside the box and be able to paint or write music in ways you couldn't before. But when you're manic, what's going to happen is your mind is going so fast You're going to produce a lot of things, but then you're going to throw them all out when you feel well. So, if anything, you want to harvest the creativity when you're hypomanic.
Speaker 3:But how do you do that without going off your medications? Well, sometimes you can make a deal essentially with your doctor that if, say, you're on lithium, can you be maintained at a lower lithium level and still have protection, like some people, particularly those with bipolar two, may be able to get away with a lower lithium level and during hypomania they still experience that burst of creativity. It's not, the medication takes it all away. So make those kinds of arrangements with their doc and recognize the importance of playing music or doing their art, they may be able to have both Right.
Speaker 1:So you know, speaking of books and stuff, I know you have a new book out it's Living Well with Bipolar Disorder Practical Strategies for Improving your Daily Life, and you know it's really an update. You know on what we know about bipolar treatments and you know. So can you say a little bit about what you know, your decision to write a book and why you felt there's a need for it?
Speaker 3:Right. Sure, I've been writing books about bipolar disorder for quite a while. I wrote that really, I think had the biggest mark was the Bipolar Disorder Survival Guide, which was about the early 2000s. That was a more informational book. What should families know about bipolar disorder? What should the patient know about depression and mania and suicide prevention, or if you have a bipolar disorder in a child? The new book is really oriented specifically towards the patient. And how do you deal with the crises that occur or even the minor changes that occur on a day-to-day basis to cope with this disorder? So what do you do if, during the day, you feel your anger rising Because maybe your hypomania isn't completely under control, but there's still the question what do you do?
Speaker 3:You don't just keep taking more and more pills. There have to be strategies. You use Meditation, perhaps, might be a way to calm yourself down. Distraction, walking away from a conflict that you know is likely to occur and dealing with it later. Likewise, suicidal ideation when it comes up on a daily basis. How do you distract yourself? What are the things you can do internally or with the help of your family? What do you do when your family is telling you things that make you feel bad and that you find difficult to come home as a result? How do you talk to them in a way that they're going to be able to hear you and acknowledges your illness? And, for example, people often complain.
Speaker 3:My parents are constantly reminding me to take my medications, every day it's did you take your medication? Have you taken your? Did you sleep? Have you you know? Have you had any symptoms? And to be able to tell them. You know, I want to have a relationship with you that's not just about my illness. How do you, you and I find a way to talk about this stuff in a very contained way, maybe only on sunday, or maybe only once a day and for five minutes, and I'll give you a brief update, rather than this being the centerpiece of our relationship.
Speaker 3:Uh, getting a job, how do you? Uh, what are the challenges you run into in the workplace and how do you cope with those? So the book really takes, topic by topic, different ways you can manage your disorder in the face of challenges. Diet there's a chapter on diet. There's a chapter on exercise, on dealing with substance abuse. So what do you say to therapy? What do you say to your therapist? What, why should you go to therapy? And what are you going to say to the person? How you know it's, if it's the wrong person you're seeing.
Speaker 2:All those things are in the book it sounds incredibly practical and in that way, it also sounds very hopeful, like you know. Like you know, people can have and we've seen this like beautiful, fulfilling, healthy life.
Speaker 1:And some agency Alfred, as opposed to feeling helpless, which a lot of people do yeah.
Speaker 3:Especially when it comes to the family. There's every chapter has a section that says you know what's the role of the family here and how can you respond to them. But instead of talking to the family, I talk to the patient and say or the person who has a disorder and say you know, if your parents are saying this, here's how you can respond. Or if your spouse says this, here are good ways to talk to them without alien, and yes, it it tries to be very hopeful but also realistic about what you can and can't do.
Speaker 2:And uh, I don't think there's anything you can't do with bipolar disorder, but you may have to set your expectations accordingly I wonder kind of as we begin to wrap up, if you have kind of any future directions or areas of research that are really exciting to you for this field yeah, um, we are.
Speaker 3:We're starting to do some research on diets, about whether certain you're about to start a study on ketogenic diets uh that there's some beginning evidence that they may be effective in bipolar disorder. A colleague of mine is studying psilocybin for depression. That's, although it used to be an abuse, well still a drug of abuse, but now it's also got a therapeutic value as well. If it's done under very controlled circumstances, people are seeing real improvements in depression, kind of like what they're seeing with ketamine and other drugs. So I'm kind of interested in how that's going to come out. But for the family, one thing we found and I'm really excited about this is the idea that you may be able to prevent episodes of bipolar disorder that occur in kids by working with the family early on. We did a study of kids who were at risk for bipolar disorder because they had early mood instability. They had a family history of the disorder and they were only, say, 13, 14 years old. We were able to show we could prevent episodes of depression in those kids with family therapy. So I'd like to see that go a lot further the prevention of at least the hurts of the illness.
Speaker 3:Some of this, I think, may end up having to be digitized because, by the way, are we running out of time? Do I need to kind of wrap this up? We have a couple minutes. Keep going and then they'll edit accordingly, but they'll edit us, not you. I think basic information can be delivered that way, and maybe some interactive tools like sleep-wake cycle management perhaps, or, you know, tracking your medication compliance. But there's a whole set of emotional issues that come up with this disorder that I don't think are going to be amenable to digital mental health as we have it now, to digital mental health as we have it now. I'm looking forward to being challenged on that, but I think we're not there yet in terms of what we can offer.
Speaker 2:That is our field man we are.
Speaker 1:yeah, the digital wave is continuing to come, continues to come, but I think we still have a role, yeah.
Speaker 2:Josh again, I want to just say again in September, your book Living Well with Bipolar Disorder Practical Strategies for Improving your Daily Life comes out, and it sounds again just like an incredible resource for clinicians and families and patients alike. So thank you so much for giving us this sneak preview and talking with us today.
Speaker 1:Absolutely so. Once again you've been, yeah, once again we've been listening to Dr David Mikulowicz and I'm your host, bob Bowen.
Speaker 2:I'm Keri Harrell.
Speaker 1:And thanks for diving in Great Thank you, thanks a lot.
Speaker 2:Thanks, david, again super helpful. I've had a couple of patients recently who they really feel like bipolar is their superpower and the idea of being on medications and giving it up is so painful. But it's like we're just having these tough conversations, that you can still have this beautiful life, but it doesn't have to be so destructive.
Speaker 1:Yeah.
Speaker 2:You know I've had multiple patients be like I don't mind if I joined the 27 club. You know I don't mind if I die young, if I make something really spectacular and I'm like doesn't it have to be that.
Speaker 1:Couldn't we have it? Look different? No gosh so exciting. That's the work you're doing. Yeah, I do appreciate that. All right, well, thanks a lot and thanks for being part. So it's gonna take.
Speaker 2:Uh, usually takes about about a month or so for the turnaround send you an email when it's coming out in advance, and also I I don't know if you're active on social media, but we'll um send you some information about how you can post and tag us and we'll tell lucy, too.
Speaker 1:Yeah, yes, god's in contact yeah, wonderful sounds great thank you very much, nice great conversation, yeah, nice to meet you Absolutely. Thank you, bye, bye now.
Speaker 2:Okay.
Speaker 1:Okay, so it's still recording, but yeah. Oh, I thought we already did.
Speaker 2:Well, it didn't work out by monthly, and now we're going to monthly. So all right, here we are. We're resuming our recording.
Speaker 1:All right, here we go with the modified script.
Speaker 2:There are no mistakes here.
Speaker 1:Except, you know, except really bad ones.
Speaker 2:Yeah, okay, ready. I'm going to give you three, two, one, and we'll do the first, take All right ready Three, two, one.
Speaker 1:Welcome to the Mind Dive podcast brought to you by the Mendinger Clinic, a national leader in mental health care. We're your hosts, Dr Bob Boland and Dr Keri Harrell.
Speaker 2:Monthly we explore intriguing topics from across the mental health field and dive into hidden realities of patient treatment.
Speaker 1:We also discuss the latest research and perspectives from the minds of distinguished colleagues near and far so thanks for joining us. Let's dive in.
Speaker 2:Should we do one more just to be safe?
Speaker 1:Okay, I try to keep a smile on my face.
Speaker 2:Thanks for joining us.
Speaker 1:Yeah, that's great.
Speaker 2:Okay, I'm in.
Speaker 1:All right, and I'm sticking with you.
Speaker 2:Do you want to do one more, Bob? Sure All right, you ready? Yeah, I'm going to give you the three, two, one.
Speaker 1:Welcome to the Mind Dive podcast brought to you by the Menninger Clinic, a national leader in mental health care.
Speaker 2:We're your hosts, Dr Bob Boland and Dr Keri Harrell Monthly, we explore intriguing topics from across the mental health field and dive into hidden realities of patient treatment.
Speaker 1:We also discuss the latest research and perspectives from the minds of distinguished colleagues near and far.
Speaker 2:So thanks for joining us.
Speaker 1:Let's dive in.
Speaker 2:Yay, I'm glad, because I didn't like the way I sounded in the last one. I sounded sadder. I was like I sounded so happy in the first one.
Speaker 1:Yeah, originally you sounded so excited.