Therapy Talks

When Anxiety, Depression, and Bipolar Disorder Become Chronic Mental Illnesses with Clinical Psychologist Aimee Daramus

May 09, 2022 Switch Research Season 1 Episode 15
Therapy Talks
When Anxiety, Depression, and Bipolar Disorder Become Chronic Mental Illnesses with Clinical Psychologist Aimee Daramus
Show Notes Transcript

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Aimee Daramus joins us this week to discuss chronic mental illnesses like anxiety, depression, and bipolar disorder. From early childhood experiences to epigenetic tendencies, join us as we examine the roots of mental illnesses we may face into adulthood and some steps forward.

Key Moments In This Episode:

  • What treating chronic mental illness looks like in a therapy setting.
  • How do we know we are getting better when we are being treated for chronic mental illness?
  • What steps can we take to ensure that our mental health is getting better while easing off therapy?
  • What are signs that our mental health is declining?


Aimee is a clinical psychologist specializing in chronic mental illness. She is the author of Understanding Bipolar Disorder: The Essential Family Guide a part-time co-host of the Bipolar Girl podcast. 

Website: www.audeotherapy.com 

Twitter and IG: @audeotherapy

Learn More About Switch Research:
https://switchresearch.org/

Disclaimer: Therapy Talks does NOT provide medical services or professional counseling, and it is NOT a substitute for professional medical care.

AIMEE DARAMUS

[00:00:00] Hi, everyone on this week's episode of therapy talks today, we have Amy on she's a clinical psychologist from Chicago, and we talk about chronic mental illness. We take a pretty deep dive into what chronic anxiety, depression, and bipolar disorder look like. We talk about what coping mechanisms as children and our childhood experiences, how they can correlate to our present and how some of those coping mechanisms no longer serve us, how to implement better ones with treatment plans, for those therapy, safe relationships, social support, app resources, book, resources that we mentioned as well, and also how to do it with medication and maybe without medication.

[00:00:40] And so we talked a lot about all of this information on today's show.

[00:00:52] Amy. Welcome. Thank you so much for taking time to come on the show today. I'm really excited to have you. Thanks. Thanks for inviting [00:01:00] me. Yeah. Can you tell us a little bit about yourself, you know, where you practice, what types of areas of practice you work in? So I'm from Chicago, I'm a clinical psychologist and a specialize in chronic mental illness.

[00:01:17] Yes. So, you know, depression and anxiety, but also bipolar disorders, psychotic disorders, sometimes dissociative disorders. Yeah. Great. And can you explain to our listeners a little bit more about that? I think, you know, what does that mean? Chronic mental illness when you hear that, I mean, you just said kind of those areas you work with, like yeah.

[00:01:46] Sometimes somebody has a temporary meant mental illness for different reasons. Life happens and you feel some anxiety, like there's a big change in your life, but a little work with a therapist [00:02:00] or even just a little time is going to help that to ease off or you get depressed because something happens, but that's not a core part of the way you experienced life.

[00:02:12] Chronic mental illness is when depression or anxiety or another mental illness is expected to be very long-term if not lifelong. Right? So a lot of my cases are people who have maybe like, for example, a trauma disorder, where that is going to be very lasting and often takes a lot of work and a very long time to heal that to the point where people can move on or things like schizophrenia or bipolar disorder or.

[00:02:45] Like a chronic depression that maybe has some genetic roots and family background there, um, genetically where it's not really expected to ever truly go away. And it's more about managing it, figuring out what kind of a [00:03:00] life you can have with. Yes. Wow. And so there's so much to unpack there. I mean, what amazing important work you're doing?

[00:03:11] Um, first off go Chicago, I'm American. Um, I lived outside of Chicago. So the love that area and Portillo's hot dogs.

[00:03:23] Uh, um, can you give us some examples? We'll maybe start with, you know, stuff like anxiety and depression, and then me be morphed into some of the other mental health issues that you work in, especially bipolar. I'm hearing more and more people talk about that. Um, but you, you did such a great job of kind of describing more of that chronic, like most of us go through a situation where there's anxiety is a typical response or we're feeling very down.

[00:03:49] It can work into depression, even the people that you love to work with and serve. What does that look like in terms of anxiety and depression of [00:04:00] chronic, uh, presenting issues in those forms? Yeah. So with anxiety and depression, they can be just a life experience that most of us will have at one time.

[00:04:11] Sometimes there's a strong genetic piece. There's a strong heritability, genetic hat being passed down genetically to anxiety. Um, there've been twin and adoption studies done where, um, anxiety gets passed down and the environment you're in. So for example, somebody might inherit anxiety from a biological parent or inherit a strong tendency to anxiety.

[00:04:40] Um, if they grow up in San adoptive family where it's a much safer atmosphere, um, the anxiety probably won't be as bad, but it will still manifest itself. Right. So anxiety and depression. What's called kind of epigenetic, which means you inherited genetic tendency there. You don't [00:05:00] inherit that in the strictest sense and there's nothing you can change about it.

[00:05:04] Right? You inherit a tendency and then a lot of things that happen during your life for good or bad, as well as things you might do. Um, we'll change exactly how that shows up in your life. Right. So would you say some, some people are more susceptible to anxiety or depression based on epigenetics or, you know, just hereditary passed on from family members.

[00:05:30] And sometimes you're just going to get depression because of genetics, where you're just going to get anxiety because genetics, but there's still a lot you can do to shape that. Ah, yes. So what would you say to someone who's listening to that and say, well, my mom, you know, dealt with this, or this has just been, um, in generations of my family.

[00:05:52] I don't want to be doomed. What would you say to them, or how do you help those people? So [00:06:00] it's very individual, but like some of the general ideas, um, you need to feel safe. You need to have confidence that you are basically safe. So there's so much there. We could spend an hour just in unpacking that meeting.

[00:06:15] Are you safe personally, like in the place you live in the city, you live in Chicago, um, um, based on your childhood, do you have, did you grow up in a way that causes you to develop a fundamental belief? I am probably pretty safe most of the time. Or did you grow up in such a way that there were scary things happening, setting things happening and you might have grown up with an idea.

[00:06:43] Okay. Life's not that safe. It's very unpredictable. Um, and all that, those beliefs that you're developed are stuff that you can change and grow from and heal from in therapy and develop new ways, new ways of looking at things. Um, that makes it sound [00:07:00] easy. It's actually sometimes kind of a long really grueling process, but when it's childhood beliefs or even something that a believable way of looking at the world that you acquired in adulthood, you know, that can be changed.

[00:07:15] That can be made a lot easier.

[00:07:21] And those beliefs cause you're right. Like, as you're saying that, I'm like, yeah, that sounds, that sounds great. Like that could work, but I know firsthand, like just personally and then working in it too, that it's not, it's simple, but it's not easy by any means. And it can take a lot of time, especially when you're dealing with, you know, some chronic mental health.

[00:07:41] Issues here. Um, how long would you say most people attend therapy or medication, or that combination when you're working with someone with, let's say chronic anxiety or chronic depression, um, it can be anywhere from [00:08:00] months to, with most of the plants I work with. Sometimes it's going to be years. Yeah. I'm not just working on one issue necessarily, but maybe as you're exploring your anxiety, you find a little something there that you didn't expect.

[00:08:15] Maybe there's a trauma history that you kind of suppressed. Right? Um, or there are big life changes, new relationships ending of relationships, other new challenges like starting school, starting a new job and any big life event sometimes can bring up a little bit more that needs to be worked on. Um, sometimes.

[00:08:36] People just develop some really good coping skills. Um, mostly based in like cognitive behavioral, dialectical, behavioral therapy, mindfulness, or some of the more common ones. Um, and then for, again, for a lot of my clients, they'll be out of therapy for a while. They'll be in a good solid place. And then either a life event will happen or something from the past will come up and they'll come back to [00:09:00] therapy for a while.

[00:09:01] Um, or like a new challenge. My anxiety is rising again because I got this new job and I'm really excited about it, but right. So sometimes you come back for a little refresher course or just a chance to talk things over and figure out what you think about. Right. So, so it's normal then to hear, or what I'm hearing you say that it can be normal to go to therapy for a season.

[00:09:26] Feel like you have good coping skills for that particular issue or that time in your life. And then of course life happens and something else can be re-triggered and it's completely okay to come back to therapy and work through even anxiety manifesting in a different way or a similar way. Yeah, I know.

[00:09:44] Amen. I think that is so true. And so often we think, I mean, it is, um, mental health care is different than physical health care, but that can be kind of that medical model where here's the treatment plan first six to eight weeks, and then [00:10:00] we'll discharge you. And I know that those words aren't always thrown around in mental health care because while we're human, we don't always know what's going to happen or emotions or things.

[00:10:11] And like you said before, if there's some sort of trialed trauma or just parts of us are belief systems, and we finally find a safe person in that therapeutic relationship, the no wonder you want to go back to that person, or maybe someone else to find those coping skills or to work through that anxiety that's come up again or resurface trauma or anything like that.

[00:10:33] And I think that's such a beautiful picture of the ups and downs of life and therapy too, and that safe, angry, You know, therapeutic relationship that we can offer. Yeah. And sometimes it gets a lot easier if you go in with that expectation, lot of time, something's going to happen. That will push you backwards.

[00:10:51] It may or may not be anything you did. Um, but go in expecting, yeah, you're [00:11:00] gonna make the progress overall, but sometimes things will go backward a little bit for whatever reason. Right. And then sometimes things are going to be going well, something will change and you find it. You need to redo a few things relearn or.

[00:11:14] Grow to a new level, right? Yeah. Yeah. That's so true. How, if you're working with someone, let's say it is, you know, that one of those chronic presenting issues, or you've been working with someone for quite a long season, how would you know when it's time to encourage that person? Hey, maybe we elongate our time between sessions or, um, you know, that th I'm seeing these signs of improvement.

[00:11:40] Um, what does that process look like when they're doing pretty well after a period of time? And then maybe if you can speak to the signs to look out for it to return to therapy. Yeah, absolutely. So sometimes sessions will start to get a little bit repetitive or they'll be really sure, like, okay, you know, we're 35 minutes into a one-hour [00:12:00] session.

[00:12:00] We're kind of looking at each other, like, okay, what do I do now? Somebody, um, or maybe somebody will take a chance go on vacation. And be absent a couple sessions for that. And when they come back, they're completely fine. So if you've been doing weekly sessions, you're out of therapy for two, three weeks or a month and you are completely fine and didn't go backwards at all.

[00:12:23] That would be a big sign. Like the sessions that aren't really lasting or seem, they seem a little repetitive and boring lately, or that time when you're out of therapy, for whatever reason and everything stays fine. Those are some signs that it might be time to cut down a little. Oh, those are great. So if someone's experiencing that, because I know I've been in sessions and I'm like, oh wait, I think you're doing good.

[00:12:47] Like, I don't know why, why you're here. I mean, you're always welcome, but what do you, how do you suggest then that process to look like a little bit? So would you encourage someone to say let's, you know, [00:13:00] if you've now gone from weekly to bi-weekly or monthly, what, what does that process typically look like with.

[00:13:08] Um, I'll usually try to give them a little bit of notice. Like I noticed first notice things easing off. Um, Hey, no rush, but I think it might be time to maybe consider that you could do every two weeks or if they're on two, every two weeks, um, you know, let's talk about how we would know when it was time for us to go down to once a month.

[00:13:29] Yeah. And there'd be some reassurance, like that's also not set in stone. So let's say we go down to two weeks. There's a week with something ha. When something happens, you can always call me and I'll try and find some time for that. I'll try to maybe see if I get a cancellation or something. Yeah. Um, And then, like you said, also making it clear that it doesn't always have to be a one-way street.

[00:13:51] That if something happens, you can always come back or you can go from every two weeks to back to every one week for awhile, the only limitation of [00:14:00] course being my schedule. Right. Yeah. Um, sometimes that can be a little hard to schedule in, but I'm always going to do my best for that. Right. Yeah. And we would talk about all of those things as part of the decision.

[00:14:14] Yeah. Oh, that's great. So it's very, um, it just sounds like such a team approach. Like, Hey, we're having a discussion about this it's open. And like you said, I love that it's not written in stone. That takes the pressure off of, okay. I really have to do this on my own for two whole weeks or a whole month.

[00:14:29] But knowing that again, back to that safe therapeutic relationship, I have someone to go to her to call if I really need to. And I have that trust that's being rebuilt. Yeah. And like you said, you're always welcome if somebody is really resistant to. Um, like I suggest that it might be time to start cutting down and that person issues a hard, no, you know, we can talk about it, but, um, I've never like kicked anybody out and said, no, you are going down to two weeks.

[00:14:59] Right. [00:15:00] It doesn't matter if you feel ready. Right. Uh, we might see, okay, what's the issue? What would you still like to work on or, um, is there a way we can ease into that or something like that? Like you said, you're always welcome. I'm not going to kick you out. Yeah. Yeah. Uh, and so let's say someone, you know, is like coming with chronic anxiety, like just for years and years, finally, in a good spot, that can be both exhilarating and scary because you're like, I'm just waiting for that other shoe to drop.

[00:15:31] When am I. How you going to have a blow up again or go in my downward spiral? What would you tell people? Hey, here are some signs, like maybe you're feeling in a good spot now. Like we've kind of identified that, um, but here would be some signs or markers to look for. Maybe your, you should come back or just to be aware of that.

[00:15:52] Maybe my mental health is declining a bit. So with anxiety specifically, um, [00:16:00] sometimes they're going to be physical signs, pen, uh, increasing panic, obviously sometimes anxiety manifest itself more physically. Are you suddenly experiencing a lot of muscle pain or unexplainable stomach aches and headaches can sometimes be the first signs, uh, especially in somebody who maybe is.

[00:16:20] Prone to expressing their emotional, that freely, right? The body does it, right. The body keeps the score as Bessel then does talking about trauma. But the same is true of anxiety very much. Um, or you'll just feel an increase in anxiety. You'll start to feel out of control or you'll. You might notice behaviors in yourself.

[00:16:39] I'm losing my temper a little more. I'm snapping on people more. I'm staying home more. Even. I want to get out. There's some part of me that isn't ready to go out and I'm isolating. So it could be just physical symptoms. Um, you might just straightforwardly notice, Hey, my anxiety is getting worse again. [00:17:00] Uh, or you might just notice yourself behaving in ways that you haven't done in a while.

[00:17:07] Hmm. Yeah, those are great points, so true. And I know, yeah, the body does keep the score that's for sure. Um, is there anything else before, maybe we switch, switch gears a bit from chronic depression or anxiety that you'd want to share with our listeners, um, you know, any, any other tips or strategies or any other insight that you have in that realm?

[00:17:34] So basically when it comes to depression and anxiety, there's a reason for it. Sometimes genetics is a big influence. Um, but the other thing is that the coping skills we have for it, and almost everybody I see comes in with some kind of dysfunctional coping skills they've developed, but the dysfunctional coping skill as an adult.

[00:17:58] This thing that isn't working for [00:18:00] you in managing the depression, the anxiety probably came from something that was a really smart idea earlier in life. So maybe you are dealing with somebody when you were a child, something, when you were a child, when you were a teenager, you didn't have a lot of options.

[00:18:14] Um, so you developed maybe a coping skill of getting angry or a coping skill of isolating. And in that situation, it kept you more safe. It kept you more comforted. Now you're an adult and that's really not working well for you, but just having a little respect for yourself and the way you got here. And even some of the things that are messing with you right now are very often signs of the way you survived something earlier.

[00:18:41] Right? That's so true. It's served a purpose maybe from a younger year that it no longer serves you now as an adult in this situation. And then they get to work with you or a therapist that's where it really is handy to have, you know, a professional or an objective lens to say, well, what about this? Or let's try [00:19:00] this.

[00:19:00] Um, just some more tools in your toolbox. Yeah. Oh, that's so true. Yes. I'd like that tools in the toolbox because it's such a nice nonjudgmental way to say it. Yeah. Yeah. And I think that's really reassuring for people to hear that, Hey, I see where this anger served a purpose and why it probably was your go-to as a child or a teenager.

[00:19:24] That makes sense in that context. Right. And when we, I mean, just to hear that would be very validating or normalizing and, and not make you feel well, why can't I deal with this or what's wrong with me? Or if, if you know, most of us, we try to keep repeating the coping skill and realize why I've just been doing the same thing.

[00:19:45] And it's not getting me anywhere. It's not working. And it takes so much bravery to seek out a different way, which is often through. And people are coming in, like, why am I like this? Why do I do this thing? And so often the answer [00:20:00] is because there was a time when it was a really smart idea and that was clever of you.

[00:20:04] And that may no longer be true. That it's the smart idea at this point in your life. So we're going to figure something else out. Yeah. I love that because that would probably be the complete opposite of what most people tell themselves when they're thinking that what's wrong with me, why am I doing this?

[00:20:21] Why can't I handle this? Why do I keep doing this? Even though I don't want to, or something along those lines, but then to hear a reassuring, even authoritarian word in a therapeutic relationship from a professional or expert to hear that was smart. I see where that comes from. I see why you did that. And that would be really powerful.

[00:20:41] Those would be really powerful healing words. Wow. So, yeah, that's awesome. Okay. You're 30 right now, and this is not working out for you, but when you were eight, that was a really clever thing to do, right? Yeah. What would be an example that you see maybe of adults [00:21:00] coming in? Yeah. At that 30 age and these presenting issues like a chronic anxiety or depression, and maybe some of our listeners can relate to a bit.

[00:21:12] So sometimes some of the things we do, um, to calm anxiety are dysfunctional ways of seeking nurturing. So for example, somebody who's a little bit hypochondriac, um, who gets really, really worried about illnesses more so than is realistic. Um, maybe for example, that was somebody who was a child who didn't get a lot of attention from their parents and the parents might not even have been super dysfunctional and they might just.

[00:21:45] Busy overwhelmed, stuff like that, but for whatever reason, or they might've been people who just didn't express emotional well, but for whatever reason, it was only when they were ill or in some other way, you know, couldn't handle something that they ever [00:22:00] got, anything that felt like nurturing or love.

[00:22:03] And those could be functional parents who like paid the bills, provided a nice home. The kids had all the clothes they needed, but there was something emotionally lacking except when somebody was taking care of them when they were sick. So as an adult, um, worrying about their illnesses, um, including the ones that, where they may be dramatically exaggerating something you don't need sometimes get that little pain in your side, like a little stitch in your side.

[00:22:30] Um, and even for PR completely normal people, part of you is going, oh my God, is that appendicitis right? But most people just kind of dismiss that. It's fine. It went away in 10 minutes, whatever. Um, but. Paying more attention to that. I'm scared. I think I might have appendicitis and you get nurturing. You care for that as an adult, it doesn't play out so well, a lot of the time.

[00:22:57] Um, but as a child, [00:23:00] if you just, some part of you noticed, oh, that's when I get cared about. Right. So that would be one possible example. Wow. That is such a good example. That is really good. Do you have any others that you see quite frequently at all? That was a really good one. I'm like still sitting here.

[00:23:19] Wow. Like you've got somebody, who's got depression, you've got depression. And one of the most common symptoms of depression is social isolation. You stay in your room, you don't talk to people. You don't tell people what's going on with. Um, and maybe, um, lack of motivation, lack of the ability to feel pleasure.

[00:23:42] So maybe that person grew up in a situation where they felt unwanted or again, the parents were just busy and not there, um, without ever meaning anything dysfunctional by it, but it [00:24:00] became functional not to expect too much of people. Um, so there's the isolation, or maybe they grew up in a house where there was not a lot of money and presence and things that they saw other children getting weren't.

[00:24:17] Um, they didn't get that. And so one possibility for some people, is it that social isolation, there's nobody really to pay attention to me. Um, and that okay. Other kids get presents. We don't, I don't completely understand why I know it has something to do with money or for whatever reason. Um, that might be the way that a genetic tendency towards depression presents in somebody in ways that echo their childhood.

[00:24:51] Well, I was alone a lot and that's just how things were. So that's what I revert to under pressure. Right. Um, or I learned that there were certain things I couldn't [00:25:00] expect, um, in terms of like other people got to go places and do things and have things that I didn't. So it would be kind of understandable if one of their symptoms of depression was a low ability to feel pleasure.

[00:25:14] Cause during their childhood, that would have been kind of nice of eat to ease the pain of not getting to have her do these other things. A defense mechanism. Yeah, exactly. Wow. And so when someone, when you're working with someone and maybe you see these and, you know, just hearing a lot of the correlation of childhood past to the present, um, how do you gently maybe probe into that or ask questions to help connect the dots?

[00:25:49] Um, rather than saying, you know, Hey, it sounds like you were emotionally neglected as a child because no, you don't do it that way, but how do you walk with someone through that, that [00:26:00] story in that process? Well, I mean, as they get ready to tell it, um, you just listen to their stories and a lot of it is pattern recognition.

[00:26:11] Where do you see the same thing happening again and again, in different ways, them getting the same message or having the same experience. Um, and then you look and then pattern recognition you look for in their adult lives. Where are the echoes? Where are the patterns repeating themselves? Um, echos. I love that.

[00:26:30] Where are the echoes? And then you might point that out to them. Okay. So I saw this, um, so it seems like there's some similarities here, here, and here. What do you think about that? Um, and usually just probing, trying to probe a little bit gently, see how they react, give them a chance to somehow let me know, maybe by a defense mechanism, by a little bit of resistance to engaging there that [00:27:00] maybe we're not there emotionally.

[00:27:01] Yeah. And then I might back burner it. Yeah. Um, and then work on other things to build trust, like coping skills, present day problems where we don't have to explore other times. Um, but maybe come back to it later on few sessions down the road, a few weeks down the road until they kind of give me a response that says, I'm ready to go there.

[00:27:26] Right. Um, and then you can go there and even in the meantime, you can be looking at how a certain behavior or a certain symptom is playing out for them now and help them start to think about like, okay, what else might work? What's something else I could try. Or what's another way of thinking about this.

[00:27:49] Yeah. So kind of utilizing the past, but also tackling present issues at hand to not necessarily unearthing, although the past, all the time, either. [00:28:00] Right. Which can be, you know, kind of relieving to people. Cause sometimes they think, well, I don't want to go to therapy and retell my whole childhood, or they're just going to tell me something about my childhood.

[00:28:10] I just want the here and now, or this issue, which as you're describing a lot of times it can be traced back. It doesn't mean we have to camp out there forever back in childhood, but you can also kind of ping pong back into the present day of saying, you know, problem solving or more of that present day or CBT type type work.

[00:28:29] Yeah, exactly. I was that's exactly what I was thinking is like, sometimes you don't even need to go to the past. Um, they are dead set. Like I just want to stay present and focused. I've done all that. Or I don't want to do all that. Right. At CBT, you've gotten mindfulness. You've got a few different things where you don't even have to do that.

[00:28:47] And if you really, really have to go there, eventually the time will come. There's a lot that can be solved without even going into the past. Right. Yeah. That's very [00:29:00] true. Yes. And so when you're working with, let's say bipolar or schizophrenia, tell us more about those types of presenting issues that you work in.

[00:29:13] Oh, any particular place you want to start something, if you want to know. I guess just for our listeners a lot on the show, we talk about, you know, anxiety, stress, depression, ways of thinking beliefs. Um, so just a general of maybe what each of these, uh, more severe mental health issues are, what that looks like.

[00:29:32] Maybe that your kind of definition, signs, symptoms, treatment plans, or how you, how you work with people. Um, yeah, just kind of, they're really the one. Oh, that overlay of it. Yeah. So bipolar disorder is a mood disorder. Uh, depression is part of it. There are really what they call it, different kinds of mood episodes.

[00:29:53] And it's not a mood in the sense that we have modes every day. A mood episode is something that lasts like days to weeks to [00:30:00] months. And it is life-changing. So a depressive episode in bipolar is often very serious. Um, the kind where maybe you can't work, maybe it really strains your relationships and bipolar is when the mood episodes change periodically.

[00:30:19] So the other end of that is the manic episode and a manic episode is a period of very, very high energy. Like for example, an extreme version that I, I saw a lot when I was working in a psych hospital would be like somebody would be awake all night, night after night after night. And the heaviest sedatives that hospital had, wasn't touching them.

[00:30:45] Um, So lack of sleep really, really high energy, like, um, I would see people sometimes, um, and occasionally like outpatient clients still have some of these experiences too, during a [00:31:00] mania of like, they're losing a lot of weight because they can't sit down long enough to eat. Like, okay, can you wait, standing up?

[00:31:09] Yeah, that would be just a really, really basic coping skill. Yeah. We're a little bit about this weight loss. So would it be okay to eat walking or pacing just to make sure you get some food in you? Um, so part of it's the really high energy impulsiveness, and this is one of the most damaging parts for a lot of people.

[00:31:29] Uh, if you are mad at you are going to do stuff, you would not do it other times. Um, things like maybe sleeping with multiple strangers in one night would be. Extreme, but not that unusual. I'm racking up the credit cards, tens of thousands of dollars, or if you've got the credit limit for hundreds of thousands of dollars on stuff you're not going to want when you're not manic anymore.

[00:31:52] Um,

[00:31:56] so different kinds of impulsivity, big shopping [00:32:00] sprees. Um, sometimes for a lot, for a lot of people, part of managing a manic episode is figuring out who's going to take control of your money when you feel it starting to come on. So you can't run up $30,000 on cute clothes. Right. Right. Um, and then grandiosity, um, mania tends to come with incredible confidence.

[00:32:23] And a lot of times, that's really hard on people around you who are maybe trying to help you manage the manic episode, like family, friends, because we're are so confident that you will do anything because it really, really seems like you can do that. And sometimes that grandiosity, he can range anywhere from just really being kind of a pain and being a little bit demanding in a way that's not typical of you, right.

[00:32:46] To having delusions, you can be completely psychotic. Um, and believe it, you're a celebrity married to a celebrity, um, the hospital CEO. [00:33:00] Great. Which is surprisingly not surprisingly common as a delusion, or maybe not when you spend your whole lifetime in a hospital. Right. Um, so not everyone with bipolar disorder has delusions.

[00:33:15] Some do. So you're with the main mania you're looking at wildly high energy impulsiveness, um, the grandiosity. And so you've got this time when you feel really, really out of control that, uh, you might have be, uh, be having a great time. Everybody else realizes they're completely out of control, right?

[00:33:37] That's the thing too. So there's also a third episode, call a hypomania and that's a somewhat milder form of mania. So instead of going days and days without sleep, you might only need 2, 3, 4 hours of sleep and you can go like that for weeks and not feel it during the day. The impulsiveness will be, you know, [00:34:00] a little less, you might dance and drink a little too wild at a company party, as opposed to kind of a mania level, sleeping with multiple people or racking up huge credit card bill.

[00:34:15] So you'll strike people as a little impulsive, right. But not that much, um, as, as contrasting or striking, right. Um, that confidence that grandiosity actually going to be pretty functional in hypomania, uh, you just feel absolutely superb. And for some people, hypomania is still a very, very painful time. Um, maybe most of all, because unlike mania, you can sense that you're out of control.

[00:34:43] You know, things are not as they should be. They're still kind of fun sometimes. Um, but you're scared. You're upset. Like you said earlier, you're wondering what's wrong with you because you're doing these things and you can't [00:35:00] seem to stop yourself doing these things. Um, other people love their hypomanic episodes or at least, you know, can cope with them.

[00:35:10] And. A lot of people with bipolar, choose not to Medicaid. Maybe they'll put in a lot of very complex system of coping skills to make sure they get through the depression. Okay. But especially the hypomanic time, some people are like, it's not that destructive for me. I've never, you know, especially with the help of friends and family, I've never done anything.

[00:35:32] I can't really come back from. Um, and th the bipolar meds can be rough, so there's a genuine calculation to do there of risk versus reward. Yeah. Um, how long do you do on average? I know everyone's different, but the episodes last, like the manic episodes are hypomanic. Um, you know, the depressive episodes, how long roughly do each of those last four, typically weeks or months?

[00:35:59] Um, [00:36:00] there's a type of bipolar called cyclothymia. And with that one. The mood episodes tend to be less severe, and they also tend to cycle faster days to weeks instead of weeks to months, even then there's going to be exceptions. Some people can have like a full on mania, but they tend to switch within the same week.

[00:36:21] Um, and so when you're working within bipolar, what do you do? How do you help someone, uh, getting the bio rhythms? Right. It's usually first thing we do sleep as essential. Um, bipolar disorder is really tied to circadian rhythms. In fact, although I don't think this is a particularly official part of treatment.

[00:36:45] Just word of mouth. I've known a few people with bipolar disorder who found sunlight lamps, like the type used for seasonal depression, useful. That's their perception. They've tried it and they feel like it's worked for. Yeah. Um, but definitely getting enough sleep, making [00:37:00] sure you get a little sunlight, making sure you're eating well.

[00:37:03] You want your body to be as stable as possible. So that, that creates a basis for the mental stability. Um, sense. You also want to look at family support. So for a lot of chronic mental illnesses, especially bipolar and schizophrenia, living in an unsupportive emotional environment is every bit as strong a predictor of hospitalization as not taking your meds.

[00:37:36] So that stress of living with people who won't, or can't be supportive, negative emotional environment, um, it's called expressed emotion, but negative expressed emotion would be a better term. That is very, very dangerous just to build. So if their living environment isn't good. You definitely want to take a look at that.

[00:37:58] See what can be [00:38:00] changed, improved if anything, and if not, try and strengthen their emotional coping skills for dealing with it. Um, so you're, yeah, you're getting those basic bio rhythms, right? You're doing what you can to get the social support. Right. Um, many person these days has found their first true social, um, support on like Twitter or Reddit if they don't have it available to them in real time.

[00:38:28] And there are both big, big advantages and obviously big, big, dangerous to that. Right. So, and then once you've got the basic bio rhythms, right, you can start, um, you want to start charting a lot of things and there are apps for this. So. For the people who are taking medications, you want to create a chart of some kind, whether it's in an app in Excel, notebook and pen, doesn't matter how you do it.

[00:38:55] Um, but you want to chart your medication, make, make a [00:39:00] note that you took your medication on a certain day. And then especially if they're changes in medication or the medication is still taking effect. You want to chart that against your major symptoms to see how changes in the meds are affecting symptoms.

[00:39:17] And you want to continue that for awhile until you've had a very long period of stability, at least a few months, um, because that's also a really, really good way to tell. When a new episode is coming on await, you know, I didn't really see this in real life, but now I'm noticing that my chart is trending downwards towards depression a little bit.

[00:39:39] It might be time to call the doctor and see if I need a med adjustment or all my therapist and see what we can figure out there. And it really helps people learn their first signs that a new episode is coming on. Like for a lot of people, if they're tracking their sleep changes in sleep or the first sign that they're about to turn that.

[00:39:59] [00:40:00] Right. Which I could see that being very empowering because if these episodes are prolonged, like days, weeks, months, then that almost feels like you're being hijacked. Like you're do you're out of control, but here you are with some tangible tools that bring some controller order back or trying to bring some understanding back of, you know, kind of being a scientist in your own world of your sleep of your mood in charting those different things.

[00:40:25] Right. And sometimes making all those charts can be a pain. So we make them as simple as possible. Uh, put a.here. When you take your meds today, uh, rate these symptoms on a one to 10 scale. I try to keep it. So to once they've got their system down, um, unless they want to do something more complex, it takes less than a minute every day for people.

[00:40:48] And then, and you do that with them, or do you use the app for that? Um, whatever they prefer, like I'll help them set it up, figure out what they want to track. Sometimes they've got good ideas [00:41:00] for things they want to track that I didn't realize like, oh, I noticed it. This other part of my life, um, is strongly affected by some of my bipolar symptoms.

[00:41:11] So I'm going to add that to my chart. Yeah. What are some apps that you would recommend for charting or tracking? Let's see which of the ones I've got. I usually let the clients choose them. And then, uh, the nice thing about the apps is they can send stuff to me or to their other doctors. So, um, I've then iPhone.

[00:41:33] So right now I'm looking at the app store. So just put medication tracker into your app store.

[00:41:46] Sorry. I know exactly which ones I want. I just can't remember the names of them. I know where I can like see the icons of them. Um, my therapy medication is a good one. Icon [00:42:00] is kind of turquoise with a microphone or light bulb. Can't tell which in the middle. Um, there's one called Medisafe that a couple of my clients have used and that's kind of blue with a white design in the middle for the icon.

[00:42:15] Um,

[00:42:23] um, and then care clinic is pretty popular. And then there are a couple of them that are specific for bipolar disorder. Those are just general medication tractors,

[00:42:42] uh, IE moods, bipolar disorder. It's a white icon with a lines and different shades of kind of turquoise. Oh, neat. And so that would check some of the moods or symptoms. And then, um, if this is a risk, uh, there are [00:43:00] also a couple of really, really good, uh, suicide prevention apps where you can sit down with your therapist, fill out a plan and, um, you can send your plan to your therapist, your family, your other doctors.

[00:43:14] Um, there are, some of them have like, um, hotlines, or you can put people's phone numbers in there on your emergency plan. And so.

[00:43:30] There's one called safety plan. That's a favorite of mine for that. And that's a blue icon with a white across in the middle and then a Samsung, the, um, drug and alcohol addictions organization has a really good one called suicide safe. And it's kind, it looks sort of like a stylized version of, um, two people drawn in white with a background of different colors of yellow and teal.

[00:43:56] Okay. No idea. Why allow the medical hat apps had like turquoise [00:44:00] and teal

[00:44:05] Chicago? Do you mind if I give a quick shout out? Yes. Yeah. Here in Chicago, we've got something really cool, which is there to actual like mental health and suicide prevention, coffee shops in town. They're basic Hangouts and community organization spots around treating mental illness and there's one in Logan square.

[00:44:25] Um, And there's another one called a coffee, mental health, coffee, hip hop, and mental health. That's awesome. That's actually really cool to have. So what are, what are the, what's the premise of those basically, um, step it's a coffee shop and they used the coffee shop to raise money for different things, as well as having staff that are trained in mental health.

[00:44:54] First aid, they have, they have staff right there that know how to handle psych emergencies. [00:45:00] Wow. A lot them, of course, who've dealt with mental health problems themselves. So it's kind of peer to peer. Oh, that's amazing. We have. Okay. So Chicago Colona, which is like 120,000 people in British Columbia, we're trying to follow that.

[00:45:16] So we started third space cafe that emulates that, um, about seven years ago, which is really fun. And so I get to supervise the graduate students who provide the free counseling, but in our cafe, all the proceeds of that go into mental health care to make that counseling free for the community. And then our stuff goes through mental health first aid, which is amazing because I'm going to tell those names to my family and friends in Chicago.

[00:45:43] And next time I'm there. I totally want to go there. That's amazing. That's coffee, hip hop, and mental health. And then, um, Sip of hope. Oh, I love that. And I like hip hop, so that's pretty cool too. Oh, that's awesome. So when I know you [00:46:00] alluded to medication before, especially with bipolar and how tricky that can be.

[00:46:03] And I know that's true for every, um, presenting issue because everybody's different and we all respond a little bit different to medication, but specific to bipolar. Can you tell us about that with the medication and how that just impacts everything too, or just how that can be difficult, you know, finding the right one for you or what that looks like.

[00:46:24] So with bipolar disorder, there are the mood stabilizer meds. Well, first of all, um, a lot of people get their first bipolar disorder diagnosis because they show up in therapy or to psychiatrist's office for depression. Um, they get antidepressants. Now the thing about antidepressants is that they, if you have bipolar disorder, they'll push you into a mania.

[00:46:50] So maybe they didn't realize that some of these times of like impulsivity or going out all night or [00:47:00] however their mania presented itself or hypomania, they might've just thought that was being done, being incredibly messed up. Yeah. And they go through these periods where they're just not acting right.

[00:47:10] But it turns out it was a manic episode or hypomanic episode. And when you try to address your depression with an antidepressant, you find that out, right. And maybe your therapist or your psychiatrist realizes, or somebody else around you familiar with bipolar disorder realizes no, that's not you being messed up.

[00:47:31] Right. I think that's bipolar disorder. And then, um, you've got the mood stabilizers, which are the main bipolar meds and they are really pretty effective at controlling bipolar. Mo, it takes a little experimenting, like psych drugs often. Do you play with the med, you play with the dosage to see what's right for you.

[00:47:52] Sometimes the first medication you try, isn't the right one. In fact, it's not that uncommon, to be honest for finding the right [00:48:00] medication to take anywhere from six months to a year and a half, right. And I've known people who've taken longer than that. The thing about the mood stabilizer meds, they are effective, but there are dangers that other segments don't have even above and beyond the usual side effects.

[00:48:16] So if the mood stabilizers get to a toxic level in your blood, that can be really, really dangerous to your liver, kidneys, and thyroid. So you have to take regular blood tests. And when you're first trying the meds, it might be once a week or a little bit more just to make sure that you're not being given too big a dose.

[00:48:38] And then eventually it will be like once a week, once a month. Um, once every few months, once you get stable on a med, you find what's right for you, but they're always going to be checking to make sure that medication is not at a level that's going to injure your internal organs. Right?

[00:48:58] So when [00:49:00] somebody with bipolar disorder has real doubts about taking their meds, that's not them being difficult. That is them having to make a very important calculation. Great. Yeah. It's a very, um, there's a lot to it. Yeah. What's the danger from my manic episodes versus what's the danger from, uh, the potential organ damage from taking these medications.

[00:49:24] Right. And so that's one of the reasons that a lot of people with, uh, the hypomania type, the bipolar two. I just decide, I don't think I'm going to take medications. It's too big, a risk for the game that I'm going to get out of it. I will cope with the depression and the hypomania some other way. What do you find, let's say someone does choose that path of maybe not wanting medication or, or even with medication in particularly, um, around the depressive episodes.

[00:49:56] What are some treatments or strategies that you find [00:50:00] work well for people in those episodes? One of the most important things is to have social support because yeah, for somebody with bipolar too, a lot of times the depression is by far the more dangerous part. Right. Um, self-harm, um, attempting to kill yourself, which unfortunately is really quite common.

[00:50:24] So you need people, you can go to somewhere, you can go day or night. And not everybody's going to be willing to go to the hospital if they don't absolutely have to. So you need people who are willing to keep checking in on you. People who are willing to, um, stay with you if necessary for awhile. And a lot of times you're going to find that in the community of mental illness, because these are people who are going to need the same from you someday, right?

[00:50:52] For mutual support. How do people find those groups supports with those connections? [00:51:00] Sometimes it's the support groups that are provided by like a local hospital. One of the major mental health agencies, like on NAMI or the depression and bipolar support Alliance. Uh, sometimes it's like, like I said, the local coffee shops, sometimes we're just gets around.

[00:51:15] You're in school, the quote messed up. Kids tends to hang out together and support each other. And then as you get older, you find out a little bit more about mental health and what's really going on there. If you didn't already know. Wow. That's so true. Yes. Social support is so critical. Yeah. Um, and we touched on epigenetics earlier of maybe it, especially in anxiety and depression and tracing it from the correlation of a childhood event or some childhood interactions to the present day.

[00:51:48] What do you notice with bipolar disorder of, you know, we, when I work with people, a common question is where did this come from? Oh, here's what you're saying. There [00:52:00] are accurate descriptions of bipolar disorder going back to ancient Egyptian medical texts. Wow. So it's been around for quite a while. Um, so it seems to be largely genetic, but there's cross and genetic inheritance.

[00:52:19] I don't even know if I'm using the right term there, but you get what I mean? I think between bipolar and other disorders, so bipolar and schizophrenia. Um, epilepsy, I believe autism. When you have one of those in your background, you have slightly greater risks of the others as well. So they run in a family somehow, and we just don't understand completely how, but we know that if you have this disorder over here, you've got a greater chance of this disorder, but also these two or three other disorders.

[00:52:52] So the epigenetics and bipolar is complicated. Um, so family stress plays a very big role. You [00:53:00] grow up in a basically safe, supportive family. You're going to have a very different experience of that disorder than, um, somebody who does not right in this case, drugs, even drugs that are not considered all that harmful outside of that, um, can play a very important role.

[00:53:19] So for example, with bipolar and schizophrenia, Um, there are many, many studies supporting the idea that, uh, cannabis, especially if it's used regularly and heavily in the teenage years can bring these disorders on sooner or be that stress or that kind of tips you over the edge one day into the full-blown disorder.

[00:53:41] Uh, so if you have a strong family history of that, you can't always take the same chances or develop the same habits that are honestly sometimes pretty innocent in other heat. Right. Um,

[00:53:58] and then we talked a little bit about [00:54:00] circadian rhythms, bipolar and sunlight areas with more sunlight tends to bring bipolar on earlier in life. For some reason, sunlight sleep, circadian rhythms, the body's basic rhythms. Um, so even if two places are kind of. On a line, like, is that longitude the same amount north of the same?

[00:54:29] Oh boy. Now I'm confused. It's been awhile since geography, the same amount north or the same amount south of the equator. And one city is really sunny and one city is really cloudy. Like I've lived in both Minnesota and upstate New York. And that's pretty similar geographically as far as how north is, but upstate New York is really cloudy, like five days of sunlight a year or something like that [00:55:00] live there.

[00:55:00] Um, but Minnesota was freezing cold. There are parts of it. They're like really, really sunny. Yeah. There's some studies suggesting that the sunnier places it's going to come on earlier and that there are slightly more cases of bipolar disorder within the general population. That's closer to the equator you get.

[00:55:17] Wow. Which is an interesting detail. Yeah. Um, I don't know if the effect is strong enough that it would be worth moving to try and prevent it. Right. That would work. Cause if it's a clear effect it's repeated over and over, but it's not that strong in effect. Right. As far as like, would this be the deciding factor?

[00:55:34] Probably not. Yeah. Um, so things like family stress, uh, stress from any kind of drugs, even when it might not be a big stress on somebody else's body, um, even sunlight levels, uh, all can play a role. And at what age often is, let's say bipolar disorder diagnosed or even, you [00:56:00] know, suspected. Um, a lot of times first diagnosis is somewhere in the college years, too early to late twenties.

[00:56:08] Yeah. Why do you think that is? Um, nobody really knows for sure. Uh, some of it could have to do with like the physical maturity of the body and brain. Um, other theories think that it's more like this person is more independent of their family now. Um, so maybe they are seeking treatment as an adult. Um, or now that they're in college, in the working world, they're just noticing this, the symptoms messing with their life in a very different way.

[00:56:45] And that makes them decide, okay. Now's the time to get checked out. Yeah. It could be a variety of reasons. We know. And then as you're describing, you know, the risky behavior, um, the spending, you know, [00:57:00] what, a 15 year old doesn't have too much money to spend, but I would have spent it on when I was 15. Yeah.

[00:57:10] Shoes and clothes get bedroom with their own. Yeah. So tell us, how did you get into working in these areas? I mean, such important work that you do, how did you get into it? And honestly, it wasn't a super deep, like I was in college and I was looking at different majors, loved my psychology course. There were a couple of courses I loved, um, I was considering history for awhile, like a museum studies major.

[00:57:36] Um, that would have been really fascinating too, but I knew that like I wanted something that would keep me interested and excited, like lifelong. Yeah. Nothing. I would not get bored with. Um, So I really wasn't cut out for like the regular day office job. Um, so it was going to be history or psychology. And honestly, I looked up the career [00:58:00] prospects and psychology was looking a lot better history, still a big hobby.

[00:58:07] I still volunteer at a couple of museums here in Chicago, and I spend a time for fun. Um, but psychology, I have never looked back or regretted it for a second. Even the parts that are kind of like frustrating or heavy are fascinating and exciting. And I like the people I work with and I feel genuinely invested in what's happening here.

[00:58:32] And I feel genuinely confident that I am helping to change things maybe on the small level of the few number of people that you can really work with in a career, but things are changing and I'm there. Yeah. And you're changing real people's real lives. And that's huge. What an honor, how did you get in, in your career as a clinical psychologist?

[00:58:54] How did you get into working into more of these, you know, more intense issues, really like [00:59:00] more chronic anxiety or depression or bipolar disorders schizophrenia. So funny story actually, um, it was my junior year of college and we had to do a one semester internship and my friends were coming back from theirs saying stuff like, okay, it was kind of boring or like, I was just, somebody's unpaid secretary for a semester and I'm looking back now like, well, yeah, they're not going to take a junior in college and let them do much most of the time.

[00:59:25] Um, so I went to my advisor and I'm like, I'm thinking about grad school for this. You know, I'm starting to pick out grad schools I might want to apply to, but before I do that, I really want to know whether I want this. And so can you, is there anything you can do to get me an internship where I can work with actual people with mental illness?

[00:59:44] Or, you know, with some kind of a psychological problem. So I know if I really want this and he was like, it's going to be hard. Cause nobody's going to, you know, let a junior in college do therapy or anything like that. But if you're just talking about being around them so you can get an idea, I might be able to do something.

[00:59:59] So a [01:00:00] few days later he calls me to his office and he says, um, I got violent criminal fenders you want? And he had just given me, um, like all the teachers at my college had a mini fridge full of diet Coke. And you knew you were okay with them. If they offered you one, he had just given me a diet Coke. He said that I choked him, stopped the diet Coke.

[01:00:22] Um, I ended up taking the internship. I ended up really liking it. Um, and then I worked there, like after my internship, they offered me a job. So I ended up working there for the rest of college until I moved to Chicago for grad school. So I already had some really interesting and intense experience. And, you know, in grad school I got to experiment with other kinds of therapy.

[01:00:48] Uh, what would it be like to do relationship therapy, family therapy, um, to focus more on people who just kind of like come to therapy for a while, once in their lives to sort out a problem. [01:01:00] But like, it shifted eventually from like forensics from criminal psychology to major mental illness. But I definitely ended up finding that the more intense and complex parts of it were what I was most drawn to.

[01:01:20] Wow. Wow. That's amazing. And so how do you manage, I guess, your own self care in working major, you work in major mental illness. Um, how do you manage your own self-care that you don't take on people's stuff or on those really heavier dark days? Um, one of the most important things I started calling it, flipping the switch when work is over work is over and I need some kind of a specific moment to say, this is what I'm done.

[01:01:51] And so for me, like before the pandemic, that was leaving work, but like the second I was out the door I'd [01:02:00] have like my, um, your phone's in my ear blasting some music. I'm definitely sacrificing my future hearing to my current. Um, and then, um, during the pandemic, like that would be just like, um, hitting the treadmill.

[01:02:16] Like I bought an inexpensive treadmill so I could get some exercise. So, Hey, not immediately after work, but not even so much for the exercise, but for just movement and use it to move my commute that way, or to find some other way of saying I am going to do something totally different. Right. And then also, honestly, unless.

[01:02:35] Reading up on something professionally on purpose. Like I'm a complete nerd. I'm always in some other world watching like a Marvel movie or star wars or something else, like really nerdy, really unrealistic and really fun. Yeah. That kind of healthy escapism. Right. People seem so disappointed in me when I'm like, no, I don't want to watch ordinary people or anything like that.

[01:02:58] That's too much like being [01:03:00] at work. Right. Yeah. One more socializing and being with people where we can talk about all kinds of things. Yeah. Yeah. Oh, that's great. And so Amy, where can we find you? Where can our listeners find you? I know you're in Chicago, but you know, physical location, but also social media location, all of that.

[01:03:23] So, um, I work for a private practice called urban balance. Uh, my office is at, um, on north Michigan right now. I'm still only doing telehealth, but if things stay pretty chill here, I'm hoping to open up the office. Um, at least to people who want to be seen in person in may awesome at Twitter and Instagram, I'm at, it's like at our day therapy, AUD E O therapy it's Latin for, I dare just because it's, it takes such stone-cold nerve to start therapy.

[01:03:57] Like it's really scary too. [01:04:00] So, um, and then my website is www audio therapy.com and that's where they find more about me as a therapist. So that's pretty much it. And then if you don't mind, if I click one more thing. Yes, please. Um, actually in 2020, wrote a book for mostly for the families of people with bipolar, and that was with, uh, colostomy.

[01:04:29] Um, had a great experience with them because they let me do stuff like add things in about diversity. In fact, they were actively encouraging it and asking for that. So although it's not the biggest focus of the book, there's things like, you know, stories of like how bipolar shows up differently in say somebody who's trans, uh, how people react to a manic episode differently.

[01:04:50] If you're a black male than if you're white or female, stuff like that. But mostly it's just focused on information and coping skills for families [01:05:00] to help them understand really what's going on with their family member, with bipolar and how they can cope, how they can caretake and get support for that caretaker role.

[01:05:11] Wow. Oh, that's great. And so where can I, where can we find that as a resource? I mean, that's a very valuable when. Most bookstores, Amazon Barnes, noble bookshop.com. Okay, awesome. Can you repeat the name of that? Yeah. Understanding bipolar disorder, the essential family guide. Wonderful. It's got this cute kind of again, the teal.

[01:05:35] Yeah. Always find a mental health stuff. I don't know why it's like purple and teal and white and black and kind of looks like an eighties, Jim. Awesome. In the color scheme. Yeah. Yeah. Oh, wonderful. Well, Amy, is there any thing else you want to share from today's episode or anything else that you want to share with our listeners?

[01:05:55] We so appreciate you coming on. Oh, I really appreciate the [01:06:00] chance just to there as with the coffee shops. And when I talked about with people supporting each other, there's a big, big movement towards mental health community, towards people with different mental health disorders. You know, coming together to create their communities online and off.

[01:06:17] And that I think is an essential part of treatment. There's a whole level of care and recovery going on in those situations that is very, very different, but at least as important as what goes on with therapy or meds, right? Yes. Yes. That's so true. Well, Amy, thank you so much. Thank you for coming on and sharing your wisdom and expertise.

[01:06:39] We really appreciate you and thank you again. Thank you for the invitation. I had a great time. Uh, retail.