RAPID CYCLING in Bipolar Disorder | Dr Syl's Analysis
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- Опубликовано: 31 май 2024
- In this video Dr Syl reviews this viral footage from the channel of Herman H Le Roux. Dr Syl discusses Bipolar disorder, depressive episodes, manic episodes, emotional dysregulation and the terms rapid cycling and ultra rapid cycling.
Link to Channel: / @hermanhleroux
Link to video: • Bipolar Rapid Cycling....
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Timestamps
00:00 - Introduction 
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Emotional dysregulation is also common in ASD and ADHD. I wish that was talked about more. I know so many woman who were diagnosed with Bipolar or BPD because of emotional dysregulation, when they actually just had ASD and ADHD. I found the CBT and other therapy I was forced to do for emotional dysregulation incredibly harmful, and now have cPTSD from the bad treatment from medical professionals thinking I just had a personality disorder, and that I wasnt neurodivergant, nor could I have a physical illness (I have Ehlers-Danlos syndrome) as it was probably my anxiety causing all the symptoms. So much of my ASD and ADHD have been ignored (as well as my EDS), Ive regressed in my adult years, especially with the cPTSD issues.
Ehlers-danlos syndrome and ASD here too! I agree, the gas lighting trauma medical abuse and downright torture along with medical harm from drugs that have nothing to do with what EDS is! And they've never heard of it before which makes them unqualified to be treating us! They know nothing about the multiple morbidities such as pots and dysautonomia and mast cell activation and chiari and they love to throw around the psychiatric diagnosis instead of doing research or just simply googling like we do. Take care Zebra 🦓🦓🦓
This! Definitely needs more awareness
its reassuring you say you cant act out a manic episode because i have such a weird concept that i am FAKING my own illness. which im obviously not because can you fake mania? being awake for weeks, psychosis, mind on over drive, hallucinations, wild plans, genuinely believing you are better than others, with a special purpose. But oh i have the worst dsyphoric highs its like nails on a chalk board, i feel brutally suicidal my mind will not quiet down, no sleep, everything is fuzzy and ungraspable. I cannot relate to anyone else. I am in my most dangerous states when in a mixed like that. I am currently in a depression and its just not going anywhere. so hopeless and low im almost willing a high even though i hate them im just so low it would be nice for my brain to fire again. I miss being witty, and fun (even if that doesnt stay). The thing i find wild is how hard it is to imagine being in the other state. When im low, i cannot fathom how i could possibly be any other way, when im high i cannot possibly imagine how i, or ANYONE, could ever have any reason to be sad it literally takes away all my empathy.
❤❤❤ sending you good vibes and love. I understand all too well. I hope now, a month later, you've evened out. I hope your episodes are far between, and I hope you made it through your last one as smoothly as possible. Hang in there. Enjoy the even times and know the bad times won't last forever. They'll pass. ❤❤❤❤ 🫂
Yes, yes and yes. I have bipolar 2. It is extremely painful. Yes, I lost tens of thousands of dollars...maybe up to 100,000. I have to say that the people around me contributed to this: taking advantage of me, bad advice. I have had minor psychosis, it took me a while to realize that I actually had it. Now that I am taking low-dose Naltrexone I have very minimal symptoms. I have peace now.
Wahoo first! Thank you for video. As a sufferer of Bipolar II, with the main concern being moderate to severe depressive episodes, I'd love to have more videos on the distinctions between the two types of Bipolar Disorder for people who may have a limited understanding of the disorder.
Kt would be great if you could talk about differences between rapid cycling bipolar and BPD.
Kraepelin estimated rapid cycling rates at about 5%, mostly female. I think the increase in rapid cycling cases we're seeing in the modern are is due to a few factors: CTPSD and long-term exposure to cortisol is one factor as Jayashri Kulkarni has suggested, the other is declining rates of cyclothymia diagnosis and overuse of antidepressants as Nassir Ghaemi has suggested, the other theory that I know David Healy has touched on is the idea that there is some kind of adaptation occurring in response to anticonvulsants. Just like the dopamine supersensitivity first observed by Philip Seeman, the idea is that chronic anticonvulsant use may cause similar changes in the sensitivity of receptors involved with glutamate and GABA.
Aside from mixed states, another common cause of apparent treatment "resistant depression" is catatonia, specifically catatonic stupor.
Can you provide me with the David Healy source?
I also have rapid cycling bi-polar too. Also PTSD. Very difficult for me as i also have pain every moment of the day.
Dr told me i am strong. Have tryed killing myself many times but still here. XOXO
I have bpd and depression this describes my life so accurately. Up the crashing down violently, then agitated, then up. It is exhausting and on the overall depressing despite the up moments. Though I have bpd I take a lot of medications to help cope with all of it. I wonder if he gets anxiety? Anxiety is a huge part of it all for me
I agree sounds like BPD 100%
I can't speak on this guy's behalf, but as someone with rapid cycling and mixed eps, I can attest to anxiety being a hugely crippling feature of this disorder. The exhausting instability of rapid cycling and high physiological agitation + negative mood in mixed eps creates a hell of a lot of anxiety. I personally was treated in the Anxiety Disorders Unit years ago, and they couldn't understand why it was so severe with no response to treatment (surprise surprise, bipolar anxiety requires different medication)
I have bp 1 with rapid cycling and mixed episodes. I'm in the u.s. and here having those are just additional possible symptoms that people with bipolar can have, rather than additional diagnoses. I had it mostly managed with meds and therapy for the first 10 or so years of my diagnosis. But had a tbi in 2019 which caused me to constantly be in a rapid cycling state, pretty much. It's become largely treatment resistant, and I've been in and out of different levels of care since. Thank you for making this video!
Hi Dr Syl,new subscriber from Sydney here after recently finding your channel.I have a history of anxiety and depression and about 6 months ago I unofficially adopted the council park in my street and spent over 500 hours working on weeding the park,mowing,digging up sections of grass and laying new turf etc,to the point where I now have Carpel Tunnel in both my hands,but moderate to severe in my right hand.I was hand weeding on average anything from 6 to 12 hours a day right through summer even in 35 degree heat.I saw my GP last week and she believes this is possible mania and she has reduced my Paroxetine from 40 mg to 20mg and gave me a referral to a psychiatrist and also a referral to see hand surgeon.I love weeding and thought I was doing a good deed and being productive and serving the community etc.
I was buiying the grass,Seasol and fertiliser out of our own money which my hubby was not happy about.
My question is does this sound like possible mania to you and have you heard of this kind of presentation before and is it actually possible for someone to have mania for 6 months or longer?
I’m hoping you see this comment.
I can totally understand where this man is coming from! After 10 years of treating my bipolar 1 I’ve learned what helps my emotional dis-regulation. For me it has been intense trauma therapy, mood stabilizers, and exercise, they give me the confidence that the pain will end. Physical pain ends and emotional pain ends and it has increased my tolerance for emotional pain. It also helps when I don’t understand how I feel. That used to be infuriating, but now I know to feel it and wait it out, because it will change. My mixed states caused self harm before and now I know how to cope just enough to be in pain and be ok. Him saying he has no control feels helpless and I hope he can find solutions to help him ride out what seems impossible to overcome. Learning to no longer identify with whatever emotional state I’m in has helped me take 1 mindful step back and observe instead of being taken over my the emotions.
Hello from Uruguay! I live with Bipolar I and for me, the few mania episodes I’ve experienced have been scary as hell. Thank you for uploading this kind of content and keep going, you’re almost at 100k!
As someone with PTSD who has done 14 hours of EMDR, I can tell you that it absolutely works.
Same here. EMDR is weird, but it really helps.
Never worked for me🤷♂️🤷♂️
@@JoyfulNerd400 Am sorry to hear that. I really hope you find something that does help you.
It has also worked for me, however, it's very individual and it's not helpful for everyone. It's also important to note that some people are not good candidates for it, depending on their evaluation. I'm glad it helped you! ❤
I know lots of people who’ve said it’s been amazing for their PTSD. I’ll have to go and check out Dr Syl’s channel to see if he’s talked about this before, but a couple of friends who also have complex trauma said that things they’d repressed from childhood popped back up while doing EMDR, and they were warning me because I have complex trauma and large chunks of memories missing from childhood. I’d be curious to know if there’s anything to this or not (as in, if remembering things that had been repressed is part of the process or not)🤔
Hi Dr. Syl. I really enjoy your channel. I'm a clinical therapist (social worker) in the US, and like you, I am in training for my final credentials. I find it interesting to hear your perspective as a psychiatry "resident."
I found this client's terminology very familiar and on par with what I treat in a community mental health program here. I rarely see clients who are not already on medication, although many do not take it reliably.
I am well acquainted with the DSM5. I've wondered, though, because I don't see many people presenting with the severity of symptoms it lays out. This man describes his "mania" but he also said it was a breakthrough symptom. Is it possible that it presents differently because he is already on treatment medications? Also, I have the same question about the concept of "ultra-rapid-cycling" bipolar disorder. Clients seem to be trying to tell us something about their experience, and while I've certainly seen emotional dysregulation, I've also seen rapid shifts that don't seem to be simple dysregulation. My goodness the mind is a fascinating thing, isn't it?
Again, thanks for doing these videos. I enjoy learning from your perspective, and I recognize and appreciate your compassion and skills as a clinician. The world needs more good people like you!
I was diagnosed with Bipolar I in 2002 and, in November 2023, my husband died and two of my dogs died. The first died one month before my husband died the second died a month after my husband.
2/3rds of our household died and an uncle and a very close friend died in close proximity to the other three.
My husband was a narcissist and a hoarder.
I’ve been cleaning and purging things from the house. I’ve also had two manic episodes since November that I became very aware of within the initial onset and a few days after.
Have you heard of that happening?
I am engaged in grief counseling using ACT therapy which seems to be helping and is likely why I was able to recognize that I was considering risky behavior but I did not act upon it, outside of my home. 4 March 2024.
What I read is that stress can sometimes trigger Bipolar episodes. Extreme or chronic stress can trigger all sorts of medical conditions; i.e. autoimmune disorders.
@@Hollyucinogen like Multi-Focal Motor Neuropathy, which I have.
@@timhuffmaster3588 There's a girl named Sarah who used to live with the narcissistic RUclipsr Onision off and on for about 4 years who developed an autoimmune disorder, too.
My Mom is also a narcissist, and I also went on to develop an autoimmune disorder (Hashimoto's Thyroiditis).
I'm pretty sure that severe stress is the trigger for autoimmune disorders.
@@timhuffmaster3588 I also have an autoimmune disorder from narcissistic abuse (Hashimoto's Thyroiditis). I know of a girl online who developed an autoimmune disorder from living with the narcissistic RUclipsr Onision (Sarah).
This is just my own pet theory, I'm not a doctor or anything; but I suspect that the root of autoimmune disorders is chronic inflammation, which is triggered by stress. 🧐
@@timhuffmaster3588 My "Mother" is also a narcissist, and I went on to develop an autoimmune disorder as well (Hashimoto's Thyroiditis). I suspect that chronic inflammation triggered by stress is at the root of autoimmune disorders (this is just my own pet theory, please don't go too hard on me. 😩) I also know of a girl who developed an autoimmune disorder from living with the narcissistic RUclipsr, Onision (Sarah).
Nine and a half minutes in and I've been told I (and my father and sister) don't have my illness on two occasions (bipolar 2 with ultra-rapid cycling) but rather I have a disorder where I am unable to regulate my emotions. According to my wife the medicine I have taken for bipolar, lamotrigine, has been effective without any other therapy.. It's obviously disappointing to be told you don't have what you have.
I really hope that in the nearest future will have amazing dedicated knowledgeable great doctors who will help people with bipolar and other disabilities not mostly based on the books like the author says here that he has just he the other keeps saying that this is what the book say or I started for the exams so I really hope we get more videos from people who have worked with hundreds and hundreds of patients so they are able to analyse based on that experience on real life experience not the books and not laugh at the colour of the wall because a real professional wouldn’t even notice or think or that with the colour of the wall wouldn’t even matter Because all that would matter is the person in front of him you are analysing a human being and you were laughing at the colour of his wall and telling us that there is a towel hanging on the door. What does that have to do with all that the person is saying, this unreal this is incredible
You absolutely must read "Mania: A Short History of Bipolar Disorder". Honestly, it's incredible, after you've read it you then have go and read Kraepelin's "Lehrbuch der Psychiatrie". The biggest mistake I made was burying my head in scientific literature instead of history books. The sheer amount of information and research that has just been forgotten about is staggering.
Ugh, I have had so many mixed episodes. I have bipolar 2, so they weren’t as intense as full blown mania, but it’s awful. It’s also hard to get admitted to the hospital because they see me having energy and don’t seem to get how suicidal I am feeling.
Hello Dr. Syl, I really appreciate your videos. I was wondering if you might at some point talk a bit about the effect on a child to have a parent with mental illness. It can deeply impact a family, as well as the fact that some mental illnesses appear to be heritable, i.e. schizophrenia. One of my parents had schizophrenia and I fear the presentation of it in myself when I grow older, and my parent's lack of grasp on reality at times was frightening and difficult to understand as a child.
Just a thought, thank you for your thoughtful analysis and perspective.
^^^I second this comment. Now that you're working in a lower security/outpatient/long-term care facility, it would be good to hear how family/support-people therapy contributes to the management of the person's illness
I have been diagnosed with BP 2 which cycled every 6 weeks or so. 2022 I was diagnosed as BP 1 after a trauma event and I haven’t had highs since but still having lows while medicated. 2023 after 51 years it seems I have DID, so I have a part with bipolar or a depressive part? My psychiatrist and C/psychologist not sure.
The point of this post is I know I need intensive support but I can’t afford it. I only get 10 subsidised sessions a year, my psychologist is $280 an hour, my mental health care plan cost $190 from my GP. My psychiatrist is $650 for 1/2 an hour and the cost of meds. I had to retire 2 years ago because of my illnesses and cut my private health insurance because I can afford it. Now I can’t go to a private clinic to rest and get more support. Therapy is helpful if you can afford it.
You are right when you say that mixed episodes are awful. I have schizoeffective disorder bipolar type. Two years ago I had been experiencing depression for about six months when it got worse. I am talking being hospitalized for suicidal ideation. The doctors changed my meds, but the depression got worse, not better. Then without warning one Friday night at the end of August I couldn't sleep all night. I knew it was the beginning of a manic episode. So, now, all of a sudden, I am in a mixed episode of mania and depression which is way worse than experiencing them separately. It took a while for my doctor to figure out the meds so I was in the mixed state for about three months, but it felt like three years. I kept track of my sleep every night. Based on an average night's sleep of 8 hr a night. Averaging the sleep I got during that time, in three months I lost one month of sleep. It was awful. I managed to keep my full-time job with a few days off here and there and sometimes a week off. I was doing much better by the end of December.
Wow. This chap's experience of "rapid cycling" bipolar is so very different from my own experience of bipolar. But then again, I don't think I ever experienced 'rapid cycling' bipolar - just bipolar I. My deep depressions lasted months (if not years), whilst the manic episodes (which came much later after the diagnosis) were relatively short lived, and very intense. (I read about 10 different newspapers a day, and fully absorbed and discussed them - or so I thought - but I also thought that the presenters reading the news on the television were talking directly at me, I talked one hundred to the dozen (most unlike me) and went on spending sprees (which thankfully didn't culminate in huge debts). I was very sick, and was hospitalised on more than one occasion. What really flummoxed me was the more recent progression from bipolar disorder to Schizoaffective disorder (a combination of a major mood disorder - or bipolar - with Schizophrenia). I would be very appreciative if you could explain such a progression from one major disorder to one one that is (arguably) even more serious?? I am currently being successfully treated for Schizoaffective Disorder with medication (as I was formerly with Bipolar disorder) but I cannot understand the major blips in these diseases and the progression. It seems to me that stress (following a life time of abuse, and complex PTSD) acts as a major trigger. I don't know what you think about this?
I always learn a lot from you. I am in school to be a Psychiatric Mental Health Nurse Practitioner (PMNP).
I wonder if he ever experienced rapid cycling before being put on meds?
I don't have bipolar disorder, but have major depression. One problem I tried to address was my insomnia, as I believe it adversely affects my life. Some genius decided to prescribe to me a bipolar med (despite me never having a maniac episode). What this medication did instead was to worsen my insomnia dramatically. What happened was I went 9 days with only 16-17 hours of sleep. I felt fairly functional, but was deeply concerned what this would do to my health. I tried pretty much everything I could think of to help me sleep during this nine days. I guess that eventually the drug left my system, and I went back to my "normal" 5 hrs a night sleep.
Thank you. These vids are helpful. I'd love to see your input on Chris Palmer videos.
putting your things in order is key
Emotional regulation - this is not a rapid cycling bipolar disorder (28 years ex-mental health social worker - ex ASW as well in UK). Great channel and commentary....Eye Movement desensitization & re-processing doc. By the way - the history of the originator of this method is - lets state is enough to create some scepticism of this method. It could merely be a different way exposure and nothing to do with bi-lateral stimulation. Her early history up to the "walking through the woods" miraculous discovery is not easy to discover. If I can I will find where I read it and post...it makes interesting reading.
From what I know some consider it as a mixed episode if you're cycling in just one day and that quickly. If I can describe it in one word it would be HELL.
Very interesting. We appreciate your analysis! Thank you
I would like to see a video about treatment of bipolar and/or schizophrenia 🙏
Thank you Dr Syl for all the information, this is very insightful :)) i just discovered your channel, i think it's a great content! thank you keep it up.
More volumen please on your videos, gracias!
@DrSyl Hello 👋 Dr Syl ,Thanks again for good video 🙏as I wrote before that , I have bipolar and now feel that I am on my way into my low episode right now..
For me when I go down in my lows, then I get like a roller blind coming down and everything turns gray, I wonder if you have met others who might explain it that way??
Then comes like you said, sleep bad, eat bad, and right now I'm just lying in my bed so tired after the manic weeks 😮💨
Maybe you can talk about how people can be during certain seasons, like spring or summer? how that affects mental health.
thank you so much for your channel it gives hope to try to move forward even when it feels dark , regards // J 🇸🇪
im not sure and i cant diagnose but i wouldnt be surprised if my neighbour might have something like this going on, ive been living in the apartment for almost 3y already and my partner dont want us to move no matter how much it destroys my mental wellbeing to live there, my neighbour have seasonal tendency to come to our door on full rage complaining how we are noisy even tho we are not, she also hits the wall often, first i really thought we were the problem but eventually i realized that wasnt the case when example she started to hit the wall because i went to shower on my own home at afternoon when theres no silence, now i dont care anymore but it still bothers me but theres nothing i can do because my partner dont want us to move, but good side of this is that her behavior seems to be seasonal, ofc it can be something else than bipolar(example substance abuse) and im not diagnosing her but its just makes it easier to think she might have some personal challenges causing the behavior than thinking she is terrorizing my life out of being evil
Tengo trastorno bipolar tipo 2 desde más de 30 años y TDH, con la menopausia se me han agudizado los síntomas. Tengo ciclos ultrapidos durante el día. Pero mis estados en comparación con este chico, son el triple de exagerados. Cuando estoy depresiva, lloro sin consuelo, no tengo fuerzas para nada. Cuando se me pasa, empiezo a entrenar, limpiar, salir a hacer cosas, hablo super rápido, mis pensamientos me atropellan, no dejo hablar a los demás... El único estado de ánimo que me anula la impulsividad y la irritabilidad, ansiedad, es el Rubifen que me dan para el TDH. Es agotador, también pienso en suicidarme a diario. Es una tortura tanto cambio en tan poco tiempo 😢
Dr Syl, are you at any time going to examine the ketognic diet as a treatment for bipolar illness and schizophrenia? I've been listening to interviews from several people who had had great success with this for years, and the outcome is not only greatly improved symptoms, but much better physical health.
I seen a video of myself after about a week ½ of mania and it's scary because I didn't even recognize myself. I was crawling on all fours and trying to shapeshift. Trying to smoke whole cigarettes in one hit etc I genuinely believed I was in contact with aliens etc. But the energy was great I did love how it felt physically it felt magical.
Hello Dr Syl, thank you for your informative content. It has really helped me to understand my own mental illness. I have two questions. What the difference between schizoaffective disorder and having dual diagnosis both schizophrenia and depression? Second one is that is it possible to have first bipolar disorder and later on develope this "schizophrenic pattern" (I don't know a better way to describe it) and get diagnosed with schizoaffective disorder? So is it something you can develope later on your age or you've got it in the first place but have been missdiagnosed for example as bipolar disorder?
Hi Dr Syl. Thanks for the video. I was diagnosed with Bipolar 6 years ago. I'm a new mum. I find that the balance I have to keep between family time, work time, social time and me time is quite a challenge. I find keeping time/routine is helpful to me. The only problem I face is if I deviate from the time slots, the more I become dysregulated. Do you have any tips on this?
I am a human with bipolar 2. I have experienced mixed episodes and it is the worst thing ever. 0 out of 10 do not recommend. From the depression side I continually cut my work hours back and ended up losing my apartment. I was also super irritable and made a few peoples lives miserable.
Hey Dr Syl! Could you do a video about a psychiatrist's view on romantic relationships? I would be really interested in what your psychiatry training has taught you about choosing romantic partners and maintaining successful romantic relationships. I love your content so much, it really inspires my interest as a medical student in psychiatry training :)
My daughter is schizoaffective and rapid cycles. Iv see her on the same day go from skipping round the sitting room to rocking and crying
Yea disorganised thinking and problems with speech evident
Hi Doc!!! Love your channel!! Can BiPolar patients hide their illness from physicians?
if a person has bipolar 2 it is easy for doctors to misdiagnose.
Bipolar 2 is very easy to mask, either from denial or on purpose. You have to confide about your symptoms or else it's easily missed even by your own family. Most people will think you're the depressive type at worst...
Have you ever diagnosed symptoms with hypersexual mania in patient dependency on dating apps? I have to assume Bipolar people usually live alone. With the internet, we live in a time where dating is very accessible and overstimulating. Friends vs partnership, love vs lust are getting confused frequently while I look at pictures of other attractive people of the opposite sex. It seems very real to me after I spend hours not getting a conversation with someone. Is the internet "gaming" love. I don't know the right way to approach a relatively addictive thought process. If my brain thinks about sex and nudity, I don't know how to get away from it. I am not acting it out that much. I am just thinking about desires (genital pleasures) constantly and am lonely at the same time.
How would someone react to ECT with rapid cycling depression
A comment from a person that have Bipolar 1:
About your comment on ultra rapid cycling at about 11:34; Ultra Rapid Cycling as well as Ultradian Cycling do in fact exist in some people with bipolar affective disorder:
ruclips.net/video/Bb2i35Y9J9k/видео.htmlsi=ldh-khpL9zYCwjdu
and ruclips.net/video/ly5DEEw5CrQ/видео.htmlsi=5_SYYz-sEBMs9aMU
That said, from what I've seen and heard from this man, he doesn´t seem to be experiencing neither a major depressive staste or a manic state in the clinical sense.
Is rapid cycling something that happens if you don't treat your bipolar? I'm BP2 and my first episodes lasted months. I was untreated at the time, so the episodes kept getting shorter, more intense and more frequent until I realized I needed help. After I got started on lithium, the episodes went back to being more scarced. They're still relatively short, though (hypomoania 3-5 days and depressions 10-15 days).
if your depressions are between 10-15 days and that's scarced then that's incredibly short!
@@zoeyelh They used to be about 3 months. Then they kept getting shorter (1 month, a couple weeks…). Now I only have about 5 per year, but they’re worse than ever. I can barely move or speak. I’m currently trying a new antidepressant.
Not going to make a Tour de France joke... not going to make a Tour de France joke... not going to make a Tour de France joke...
For what it's worth, I've had mood cycling at the "flipping a few times a day" rate. Luckily that wasn't a long-term state, lasted maybe a couple of months. Not pleasant.
I did wonder at the time if it was some kind of very rapid-cycling bipolar thing. Pretty sure it wasn't. No professional diagnosis-and couldn't have been, really, there's no way in the US to see a psychiatrist within six months...
You are adorable!
After watching a certain number of personal videos about mental health I'm getting a bit cynical. Some people seem to be personality disorders or normal moods misdiagnosed as bipolar etc. Having a mental illness is becoming a brand. I hate the word 'neurotypical' which implies anyone who isnt ill is boring or less. Some accounts are promoting the sense that even though you are ill you still have to be perfect. I find more honesty on Redditt where its anonymous and people aren't trying to build an identity or brand around their condition. It makes me realise how many people must be misdiagnosed. Like someone on reddit said, when you have bipolar you know what's going on.
What about calling bipolar a Metabolic Disorder?
This loose definition of mania is one of my pet peeves, herman is clearly not manic in this video and i think people really dont get the level of what mania really is.
I’ve always described bipolar as being on a rollercoaster 🎢 with high ups and low hills but the car your sitting in of the coaster is one from those spin rides. So your constantly spinning sometimes slow other times fast on a track that you can’t see. You don’t know when a high on the track will come or when the track will plunge you into a down hill. There the very rare and all to scary loop ➰ that turns you upside down. There’s also the spiral 🌀track that goes up or down. All this while constantly spinning 😵💫 trying to figure out where the brake is to stop or at the very least slow it down. Meds are like the electricity of the rollercoaster 🎢 they help in making a steady ride out of the speed to coasters going. They help keep the power on when your body would shut it down into a deep low track or up a high speed hill. They slow down the spinning and allow you get your bearings easier. The manual break is the counselling and therapy’s you do. You have control over how much you using the skills you learn and when you want to or need to use them. When all is working and you can control you coaster you can then direct the track construction.
(I like metaphors 😊and rollercoasters 🎢)