Victoria, I used to be successful before I had my first episode, years later I am disillusioned and my wife has had enough. Even my teenage kids think I am a loser – they say it's not cool to have a parent on disability and maybe they are right because I am addicted to being sick and scared of trying to work – I see myself in a rooming house alone, reaching for a drink – why have I been inflicted with this plague they nicely renamed bipolar?

Dear ?

I wish I had a simple answer. I don't. And I don't want to give you one, like ‘oh, well, there's reason for everything' or ‘there's a lesson in it for you'. These flippant quips don't address the very real pain having an illness like a mood disorder involves.

At one point I needed to put the question ‘why' on the back burner, and accept my situation for what it is and where I was. I could, and did come back to the ‘why', but much later. I needed to be honest with myself and see the constant questioning, at least at that point, was not a useful step. When I forced myself to be in the present, and it wasn't easy, I could then take steps to make positive changes.

Two things pop for me when I read your message: learning cognitive reframing skills and addressing the fear of returning to work.

1. I'm concerned when I hear someone use the word ‘loser'. When I was in the depressive phase of my illness, my thoughts swarmed with self-loathing. I often called myself a ‘loser'. Others may have made critical comments, but they were nothing in comparison to what I told myself. A very large part of my treatment plan involved learning how to correct my very negative self-talk into more accurate thinking.

David Burn's book ‘The Feeling Good Handbook' is a great resource when it comes to understanding cognitive therapy and learning to shift thinking. This is not an overnight process – it takes time, diligence and practice. But it does work, especially when combined with other treatments like medication and support groups.

When I started learning to ‘refute irrational beliefs', as it is called, it was a huge eye-opener. I had no idea my inner self-talk was so negative and ‘off the mark'. I thought my ‘loser' feelings and thoughts were the truth. What I discovered? I may have felt like a loser (due in large part to self-critical beliefs and untreated depression), but that didn't mean I was loser. So the technique of challenging my ideas (the process of which is nicely outlined in Burn's book) gave me a ways to reality check.

I suggest this tool, because if your thinking is very negative, as mine was, it can significantly influence how well you become. I am NOT suggesting that ‘oh just think positively or be optimistic' as an antidote to depression. On the contrary! But I do see how my thinking was a large factor in keeping my self-esteem down which only worsened my mood disorder. I needed not a Polly Anna attitude, but perspective. Perspective gives me an accurate picture and the wherewithal to take right action and be proactive in my management of this chronic illness.

Please look at David Burn's book. I don't have the space in this column to describe proper reframing techniques. Dr. Burn's book though does, and does a very good job to boot. I should note, I needed to work with a psychiatrist or a therapy group devoted to developing this skill in order to really master it. So when your kids say you're a ‘loser', you'll have tools to effectively deal with those comments.

When you say you are ‘addicted' to being sick. I don't know exactly what you mean. When you have a chronic ailment such as a mental illness, you may have to adjust what you do in order to manage it better. This does not mean playing the ‘victim', being so wrapped up in your illness it's all you see, or being so cautious you never move out of your comfort zone to take strategic risks.

Perhaps when you say ‘addicted', you actually mean you feel immobilized by fear, see a disease and not a person and therefore refuse to believe you can take any steps to a move out of that place. Holding onto being sick, because you know little else.

It's tricky: moving too fast will only overwhelm you; on the other hand it's unhealthy, in my opinion, to remain so wary you find yourself doing nothing. Check to see if you are creating a self-fulfilling prophecy. Telling yourself, ‘since I'm sick and on disability, obviously I'm not capable of very much' (not likely very true, but very persuasive logic nonetheless) hence resulting in inaction. This line of thinking feeds the vicious fear cycle and will almost guarantee your paralysis.

Learning to reframe your thoughts can help you examine and determine what thoughts are ‘irrational' or untrue and what thoughts are accurate (addicted to being ill, for example).

2. Being ‘scared of trying to work' is natural, especially if you have been on disability for any length of time, and being diagnosed with a psychiatric disorder, doesn't exactly instill confidence in oneself. BUT…just because you have a mental illness and feel afraid, doesn't mean you can't work. What it does mean is: you have a mental illness and feel afraid.

Don't let this feeling dictate what you do. I'm not saying go out and get a full-time job, but don't let it stop you from at least exploring the many options that lie between not working at all and full on competitive employment. Look at why you are scared. Is your fear based on real evidence or is it another more common fear: fear of change?

Start very, very small. Talk to people. Be realistic. I don't know the specifics of your situation. You may well be very capable of working full-time and maybe not, but please do investigate the possibility and your fears of it with a professional, like a vocational rehab counselor or your psychiatrist. Someone who knows you well and your history will be of most benefit, but who can remain objective and emotional detached. I suggest someone other than a friend or family member. Volunteering or joining a voc rehab program can be of enormous benefit. It's your call of course.

When I pushed myself to participate in new activities with new people, I began to identify myself as more than just an illness. As my confidence improved, I grew more capable.

Lastly, if you truly fear landing in a rooming house, along and drinking to numb pain – take steps now to prevent or at least reduce the chances. You are not helpless. You may in fact find you are far more healthy than you realize and have much more potential than you can see right now. I suggest working with a therapist or psychiatrist who does psychotherapy, if you aren't already. Discuss these fears with him or her and address them directly. You will either find there is a basis to your fears and you can find help or you will find perhaps it is because you don't feel good about yourself. That too can be remedied. It is your reaching out, even while you feel disillusioned, that will make the difference. It doesn't mean you do this on your own, far from it. But you do need to reach out for help in order to recover.

I wish you all the best. Please let me know if I touched upon issues that rang true for you. You can make a difference in your own life. Not by leaps and bounds, but gentle, small step by gentle, self-loving small step.

Keep in touch.

Victoria