How to Comfort Someone With Bipolar Disorder

Dealing with someone who has bipolar disorder requires knowledge, understanding and an extra dose of patience. People with bipolar disorder experience episodes of depression and mania that can lead to irresponsible and risky behaviors, which can be challenging to live with. Despite their best intentions, many family members and friends of people affected with this illness don't really understand the condition or how to provide much needed support, says Muffy Walker, MSN, MBA, founder and president of the International Bipolar Foundation (IBPF).

In order to increase the public's knowledgeable about bipolar disorder and dispel the stigma that exists around it, IBPF and the Depression and Bipolar Support Alliance are partnering to promote the Say it Forward campaign. This international social media effort, which runs from September 30 to October 10, 2013, provides an avenue to share key facts about mental and emotional illnesses with a broader audience via email and social media websites.

"Say it Forward allows you send a message to your friends and family that will educate them about the mental illness and hopefully diminish the devastating effects of the negativity surrounding it," Walker says. The goal for this year's effort is to reach 20,000 people around the world. The campaign takes place during International Bipolar Awareness Day (October 10, 2013), so it's also a particularly timely opportunity to reach out to people affected by the condition and encourage them to explore the array of treatment options that exist today.

Hurtful words can be painful, too and while the focus of the campaign is on what you should say to raise awareness of bipolar disorder, Walker also stresses that what you shouldn't say to people struggling with the symptoms of this condition is just as essential.

Understanding that bipolar disorder is an illness that affects the brain—and the loved one's behavior—may help you act with more compassion and patience. With that in mind, here are statements Walker suggests avoiding:

1. You must be "crazy" or "mentally ill." Blanket pronouncements or stereotypes such as these can make someone with bipolar disease feel badly about herself and frustrated, too. Referring to someone as crazy is a judgment that conveys you find her lacking as a person. Remember that bipolar disease is an actual disease just like cancer and diabetes, and the person living with it deserves the same type of compassion—not judgment—that you would offer to someone with these or other illnesses.

2. Why don't you have a more positive attitude? Such a loaded question can make a person feel as though she should be better able to control her condition and since she can't, she may feel ashamed of herself. To avoid causing this type of reaction, it's important to know that the symptoms of bipolar disease can't be "willed away" any more than you can will away the symptoms of the flu. The good news is that a combination of medication and cognitive or behavioral therapy can be effective in helping to manage the condition. And when the person feels better, her attitude will likely be better, too.

3. You need to have better control of yourself. Bipolar disease often leads to episodes of hyperactivity or mania (such as going on an excessive shopping spree or trip) that he or she isn't able to control. Therefore, if you see the person exhibiting dramatic behavior that you find very frustrating, you need to remind yourself that this is being caused by the illness and not something she deliberately set out to do. Rather than judging her, take this opportunity to encourage the person to seek professional help and/or take medication to get control of the mood swings and impulsiveness.

4. No one will ever be able to put up with you. Many people with bipolar disease have a deep-seeded fear that they won't ever sustain close friendships and relationships because of their mood swings and unpredictable behavior. However, with proper treatment, she should be able to manage her condition and develop a loving relationship and close friends. You can be there to listen to her fears and help to alleviate them by reminding her that she has people in her life that care.

5. You're just going through a bad time and it will pass soon. While bipolar disorder can be effectively managed, scientists have not yet found a cure, although more research is ongoing and this may change in the future. In the meantime, recognize that the person affected will have both good and bad periods of time. Be careful not to downplay the illness or act like it's just a temporary state, since this can leave the affected person feeling like she must have failed if she can't shake it off on her own. Walker recommends acknowledging the reality of the condition and reassuring the person that you will always be there for her when she needs you.

To learn more about bipolar disorder and the current treatment options, or to participate in the "Say it Forward" campaign, visit IBPF's website.

Muffy Walker reviewed this article.

Source:

International Bipolar Foundation
Muffy Walker, MSN, MBA, email interview 15 Sept 2013 and "Healthy Living With Bipolar Disorder," accessed 17 Sept 2013
http://www.internationalbipolarfoundation.org/‎

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Internet Quotations

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5 Ways to Turn Your Thinking Around

There's someone who talks to you all the time who has the power to change your life. She constantly gives her opinion and comments on everything you do from your job performance and parenting skills to your personal appearance and dreams for the future. If that person has supportive, positive things to say, you can achieve anything you want in life. If she is negative, nagging and critical however, she can destroy you. Who is that someone? It's you.

Self-talk describes the way you talk to yourself. It's that little voice inside your head that says, "You look awesome today," or "I can't believe you wore that out of the house." It's that running commentary that fuels our actions, the way we think about ourselves, how well we function and what we achieve. While many people think they have no control over their self-talk, the fact is, it's almost entirely under your control. That is, if you train your brain to "talk nice."

Follow these five tips for turning negative self-talk into powerful and positive self-talk:

Notice if you're spending most of your time saying positive, uplifting things like, "You totally rocked that," or negative, critical things like, "You are so stupid." Jot notes throughout your day on what your inner voice is saying. Then, conduct an inventory. If most of your self-talk is positive, pay attention to any areas that could be improved and keep up the good work. If your self-talk is insulting, critical and mean, it's time to ditch that bad habit.

Whenever you notice yourself engaging in negative self-talk, stop yourself mid-thought and think, "Stop!" or some other word that puts a hard stop on self-abuse. Maybe your word is, silence, kindness, or even mind your manners. The point is to stand up for yourself and call a truce with your inner-bully.

Some negative self-talk can be useful, as long as it's not self-destructive. For instance, if you realize you've made a mistake and catch yourself saying, "Dude, you blew it," grab that thought and label it "mistake." In this example, "you blew it," sends a signal that you need to amend a mistake. If you catch yourself saying, "nothing good ever happens to me," label that "pity" and ask yourself why you're feeling so sorry for yourself. Whether it's a "mistake" or "pity," find a way to amend the problem rather than let negative self-talk bring you down.

Whenever you catch yourself engaging in mean self-talk and after you've put a stop to it, turn that thought around and say something compassionate and kind. For example, when you catch yourself thinking, "You just made a fool of yourself," say, "Stop," then reframe that thought to: "Not your best moment, but you did just fine." No need to go over the top or be insincere, but you do need to be kind, compassionate, and polite. Talk to yourself the way you would your best friend. LeslieBeth Wish, psychologist and author of Smart Relationships asks, "If your friend told you she uses the same negative words about herself, how would you respond? What encouraging tips would you give her? Now use this advice to your friend for yourself!" She says this technique works because we are often blind to our own issues. We tend to see them better when they are—or appear—to be happening to someone else.

Start your day by looking in the mirror and paying yourself a compliment. Look yourself right in your eyes and say, "Looking good, my friend" or "you are so amazing, you're about to create your best day ever." Then, pepper your day with self-compliments and mini-motivational lectures that keep your spirits high.

Once you've trained your brain to be nice to yourself, go further and train yourself to dream big, think grand thoughts and provide yourself all the praise, encouragement and support you need to make those dreams come true. As Dale Carnegie once said, "It isn't what you have, or who you are, or where you are, or what you are doing that makes you happy or unhappy. It is what you think about."

LeslieBeth Wish, EDD, MSS, reviewed this article.

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Co-Counseling: A DIY Option for Psychological Help

You've been fighting with your husband, your kids are driving you crazy, and work has been stressful. You don't want to invest in long-term therapy but you wish you had someone objective you could talk to; someone who could support you as you sort out your feelings. Sound familiar? If so, co-counseling could be worth considering.

"Co-counseling is a peer group of people who offer support for personal change based on reciprocal peer counseling," explains Lisa Brateman, LCSW, a psychotherapist and relationship specialist in private practice in New York City. "The original ideas around co-counseling consisted of understanding the patterns of behavior that cause distress, and recognizing how to release suppressed feelings by emotional discharge of past traumas," Brateman says. This alternative approach began in the 1950s and unlike traditional counseling, which is led by a mental health professional, in co-counseling, participants take turns serving as the counselor and the client, listening to and helping each other process their situations and decide how to deal with them.

In a typical peer-to-peer or co-counseling session, each person takes equal time to be the counselor and the client, so both participants have a chance to listen and to be heard. "The client leads his own session, while the counselor acts as an active listener, occasionally guiding the conversation without passing judgment. As the client talks about his issues, he can gain a better understanding of himself and his situation. Many people find that serving as both the counselor and client in turn can be very rewarding and effective.

The approach used in co-counseling makes this a viable alternative for people who don't feel comfortable with psychotherapy. "Peer-to-peer can feel more like a support group, which may feel safer to them," Brateman says.

Co-counseling may also appeal to people who want to avoid the expense of more traditional therapy options. Sessions are generally free—but you will need to invest in a training course to learn both the guidelines, and how to handle both roles most effectively. The initial training usually costs no more than a few hundred dollars, though over time some people also take inexpensive workshops or other continuing education offerings to hone their skills.

Brateman says that people who have insight will be most likely to benefit the most from the co-counseling process. It's not an appropriate fit, though, for anyone

with deep psychological issues prone to high-risk behaviors grappling with addictions

In any of these situations, she stresses the need for the person to be seen by a mental health counselor.

With peer-to-peer counseling, "There can also be a risk with regards to detecting potential signs of violence," she warns. Therefore, if you have any concerns, you'll want to skip co-counseling and seek out the advice of an expert instead.

For many people, co-counseling can be a good option. To find out more and to connect with a network in your area, you can visit Co-Counseling International's website, or search online for groups that serve your region. You can also find out about upcoming trainings and learn how to connect with the peer-counseling network.

Lisa Brateman, LCSW, reviewed this article. 

Sources:

Co-Counseling International USA. "Are You Ready?" Web. 9 May 2013. Page accessed 16 July 2013.
http://cci-usa.org/what_is.htm

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Is default moral? Assorted thoughts

These guys don’t look very moral to me.

Deficits is a wonderfully crazy collection of conference papers edited by Charles Rowley, Robert Tollison and the late “Nobel” Laureate James M. Buchanan. It has been called “the Rosetta Stone of insane conservatism”, and it contains a chapter on the Ethics of Debt Default. Matt O’Brien has promised me a piece on it which hasn’t appeared yet—he assures me that he will not default on this obligation because default is immoral—but I have some thoughts in response to what I think he will write that I might forget, so here goes. Besides, it’s easier to formulate a response to something if you haven’t read it.

1. During the financial crisis there was a lot of discussion about whether it would be ethical for underwater homeowners to default and walk away from their mortgages, especially in no-recourse states. The legal scholars were generally agnostic on the ethics: from their point of view, a mortgage loan is a contract, breaching a contract is not even illegal (it would simply expose you to damages), and something that is not illegal cannot be wrong. Liberal types tended to favor this sort of strategy because it would alleviate misery.
2. Conservative and libertarian types, perhaps because it could be good for poor people, railed against any sort of effort to encourage homeowners to do default. The argument goes something like this: There is a social contract that borrowers will try to stay current on their loans and not default. This social contract cannot be enforced in a court, but if it is broken, it will inevitably lead to higher mortgage interest rates because it would change the behavioral assumptions about default that are used when interest rates are set. If borrowers start defaulting willy-nilly, they will hurt themselves in the long run.
3. I basically think that analysis is correct, even if I might disagree with the conclusions. I do, however, worry about the ethics of encouraging one group of borrowers [not] to do something for the benefit of a larger, and possibly different, group. The people we would be encouraging to default probably would not be able to borrow again for a while, no matter what they do.
4. Some (subblog!) even tried to argue that strategic default by corporations is perfectly fine. Default is only bad if individuals do it.
5. Buchanan makes a moral argument for the US defaulting on its debt, or maybe just half its debt. In my reading, he stops short of actually advocating for default, but the whole theme of the book points in that direction.
6. Matt thinks that default is immoral and Buchanan is nuts. (This is a danger of responding to something that hasn’t been written yet: maybe his views aren’t that strong.)
7. Is it moral for individual underwater homeowners to default strategically? Yes.
8. Is it moral for the United States to default to make a point about the Affordable Care Act? No.
9. Is it ever moral for the United States to default? In the present situation, default wouldn’t serve any useful fiscal purpose. Trust-with-a-capital-T is important: we should fulfill the obligations we incur. With the possible exception of the most questionable loans, we should expect borrowers to pay what they owe. But part of the implicit contract was also that they could default if they had to and were willing to suffer the consequences. There’s a reason we call it the default option. Many homeowners were (are?) in a desperate situation where they could clearly benefit from defaulting.
10. The implicit contract for US government debt is different. While a subprime or credit card lender knows that the borrower might default, the expectation on both sides of the US Treasury debt contract is that there will never be a default. In a sense, the US government has promised never to default, a promise that regular borrowers—whether they are individuals or corporations—do not and cannot make.
11. The US does not actually benefit fiscally from defaulting right now. Would default be more moral or advisable if the United States were in a situation where debt is high, interest rates are high, but deficits are low, so there would be some conceivable benefit from defaulting? I am not sure.

Update: Read this, this and this from Matt Bruenig.

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Of Course Monetary Policy is an Asset Swap -- But that Doesn't Make it Any Less Useful

Nobel Laureate Eugene Fama made waves in the past few days when he called QE a "neutral event". Fama argued that because QE was just the exchange of one kind of interest bearing asset (money that collects IOER) for another (long term treasuries and agency MBS), the policy could have no effect. In my view, his comments were mistaken because they focused on microeconomic intuition and thus ignored the macroeconomic effects of monetary policy.

Fama's main argument was that monetary policy changed character at the zero lower bound. Starting in 2008, the Federal Reserve started paying interest on excess reserves. Once the Fed started to pay IOER, excess reserves held by banks became interest bearing assets. As a result, now when the Fed conducts QE, all it is really doing is taking the private sector's long term bonds and assets and exchanging them for short term (interest bearing) cash. So no new currency makes it into the economy, and as such QE can have no effect.

The set up is correct, but not the conclusion. By ignoring the role of expectations at the zero lower bound, Fama glosses over the real reason why QE matters. Scott Sumner explained this a few weeks ago:

So QE works for very simple reasons. Permanent monetary injections are effective even at the zero bound. QE programs are a signal that central banks would prefer at least slightly faster nominal GDP growth. Slightly faster nominal GDP growth requires that at least a small portion of the currency injection be permanent. So by signaling a preference for slightly faster nominal GDP growth, central banks are implicitly signaling a preference to have at least a small portion of the QE program be permanent (for any given IOR rate). Markets believe the central banks (and why shouldn’t they?) And hence asset prices react to the QE program.

In short, QE is effective because it changes expectations about the future monetary base. Since QE signals an increase in the monetary base in this period and all future periods, it raises expectations about future nominal income and therefore boosts the economy now. Since the short term rate will not be below the interest paid on reserves forever, then the injection of currency has a positive effect on the future price level. This is not a story of wealth effects from appreciating financial assets or a reach for yield due to lower average bond duration. It's not a story of people borrowing as the result of lower interest rates. It's just a simple tale of price expectations and forward looking monetary policy.

Another peculiar argument Fama made was that the Fed's current policy should actually be raising short term interest rates. Because the Fed is introducing more short term debt (in the form of cash) on the market, then short term rates should rise. Analogously, because the Fed is buying up so much long term debt, then the long term rates should fall.

But this misses the underlying macro context. Because the purchase of assets represents a signal about a desired monetary outcome, the result of this "asset swap" is not as neutral as Fama would believe. Moreover, because the Fed has made a commitment to keeping the Fed Funds rate low for an extended period of time, the short rate will not rise. Instead, by expanding the money supply, the Fed keeps short rate low.

Now, if I were a single market participant, the situation would be different. If I individually decided to sell short term debt to buy long term debt, then with sufficiently large quantities I could raise the short term rate and lower the long term rate. But since the Fed controls the printing presses and has the power to pin down the short term rate, this logic does not apply. Instead, if rates did rise, the Fed could just purchase more T-Bills. Even though QE introduces more short term assets into the system, it does not raise the short end of the yield curve.

Furthermore, Fed's purchases of long term treasuries are supposed to raise long rates, not lower them. Since the the long term rate goes up with higher NGDP expectations, then Fed purchases of long term bonds should raise long term rates. And as Michael Darda has repeatedly shown, rates rose during every period of QE. This is just another example of how microeconomic intuition can fail catastrophically in the world of macro. Because Fed purchases have macro level effects on inflation and economic growth, the Fed can actually buy more of an asset and have the price of it go down.

Source: FRED, MKM Partners

If all this seems counter-intuitive, do not blame yourself. Instead, the blame should go to our obsession with interest rates in models of monetary policy. Because monetary policy has historically been implemented through changes in the Fed Funds rate, people have equated monetary policy with interest rate policy. But in truth, interest rates should be seen as reflections of the money supply. So when we say that the Fed is cutting short term rates, what we really mean is that the Fed is expanding the money supply, and as a result, short term rates are falling.

Thinking in these terms will make sure you don't forget about the macroeconomic side of monetary policy. If Fama had said, "IOER means the Fed's printing of money to buy long term bonds has no effect on long term rates and actually raises short term rates", it would have been immediately clear something was off. Why would printing money have an effect on short term rates given that new mass of money can be used to buy T-Bills? Money immediately evokes macro intuition, whereas interest rates focus on micro intuition. As such, focusing on money allows you to guard against simple mistakes.

Thinking in terms of money also makes sure you don't mix causality. Ronald McKinnon argued in a recent WSJ opinion piece that the Fed should raise interest rates will stimulate banks to start lending. If you translate his statement about interest rates into money, it would read "contract the money supply so banks start lending". The first statement appeals to microeconomics, and seems sensible. But even a little thought about the second statement in terms of money immediately reveals the mistake. To stimulate lending, rates will need to fall as the money supply expands. But over time, when interest rates rise, it will be because of the monetary expansion boosting inflation.

Monetary theory is peculiar because it contradicts a lot of basic microeconomic and intuitions. As such, you often see very smart people (Nobel prize winners included) make smart-sounding arguments that are ultimately false. So for as much as I respect the work Professor Fama has done in the field of empirical finance, I disagree with his description of QE. It's not some neutral event, and to think so distracts from the urgent task of monetary reform.
---
DeLong offers his comments here.

Edit: 10/31 -- Added QE and long term rates graph from Michael Darda

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Did nominal interest rates fail to spike during the run on the Franc?

Paul Krugman has a new paper investigating the role of currency regimes on the nature of sudden stops, where he argues that a sudden stop would not be contractionary for a country that has a floating exchange rate. The big chunk of the paper is theoretical, but towards the end of the paper, Krugman digs out an interesting case study – France in the 1920s – that helps put his argument into historical perspective.

“The closest one can come to historical situations at all resembling the situation of today’s floating-rate debtors is that of France in the 1920s, which emerged from World War I with a large debt burden that it had great political difficulty dealing with, and did in fact experience a run on the franc.”

“The basic insight is that France grew quite strongly as the franc slid due to loss of confidence […] What actually happened was a sharp fall in the franc, substantial inflation, but no interest rate spike and a quite good performance in terms of real output. Nothing in that story validates the conventional wisdom [about the vulnerability of the United States and other nations to a loss of capital inflows].”

I happened to be particularly interested in that part of the paper, as I’ve recently been trying to understand why nominal interest rates did not spike following the election of the Popular Front in 1936 and the country’s departure from the Gold Standard a few months after. Krugman seemed to point to a similar situation: despite the Franc losing two thirds of its value between 1922 and 1926, he notes that there was “no spike in interest rates”.

Source: Paul Krugman

In fact, Krugman’s diagram shows that “rates actually fell during the first leg of franc depreciation”, which is even more puzzling. After a bit of research, I figured out that Krugman is using the average yield for a portfolio of 180 securities of varying returns from the NBER macro history database (series 13027). One would have to turn to the original sources to understand exactly how that series was constructed, but it strikes me as a choice that would warrant a bit of discussion.

As I show below, the more standard measure of nominal interest rates for that period – the rates of returns calculated on the French consols or rentes – gives a different picture. According to this series, nominal interest rates did increase over this time period. The spike, although seemingly not huge, is an understatement of the increase in nominal interest rates as these returns “are averages of the rates during these troubled times and of the rates that were expected to prevail afterwards, once stability was reached again” (Hautcoeur and Sicsic (1999)).  Assuming a long-term interest rate of 3.75 per cent, Hautcoeur and Sicsic (1999) show that the 2 percentage point spike in the nominal interest rates of the consols that I document in the diagram below correspond to an increase in medium-term nominal interest rates of about 8 percentage points.

Note: Note: The first vertical line indicates the start of the depreciation according to NBER series 14004b. The second vertical line indicates the Poincare stabilization

So nominal interest rates did spike, although clearly not enough to make real interest rates increase. Overall, the Krugman story holds, since he only needs a decrease in real interest rates for the sudden stop to be expansionary. But unless I missed something, that small part of his paper on nominal interest rates needs to be revised.

Jeremie Cohen-Setton (@JCSBruegel) is a PhD candidate in economics at UC Berkeley and an Affiliate Fellow at Bruegel. He specializes in Macroeconomic Policies and Macroeconomic History and worked previously as an economist at HM Treasury and at Goldman Sachs. Jeremie blogs at ecbwatchers.org and is the main author of the blogs review at bruegel.org.

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