Dr. Suzanne Simpson:
Hey, good morning, Gabe Howard. It’s afternoon for you.

Gabe Howard:
Yes, it’s just afternoon for me, by a few minutes.

Dr. Suzanne Simpson:
So you’re in Ohio, Columbus.

Gabe Howard:
Columbus, yes. Right smack in the middle of the state.

Dr. Suzanne Simpson:
Thank you so much for your time. I was looking for somebody to talk about bipolar disorder and the experience of that, and I appreciate that you’ve said I can ask you anything. My goal right now is to enlighten those of us who don’t have bipolar, or who have loved ones with bipolar, about it. What would you like to see come out of this session?

Gabe Howard:
Anything, I’m an open book. I’d really like people to know that bipolar disorder is so much more than what people think of it as. We tend to think of it as highs and lows, right? It’s right there in the name. So bipolar, either you’re manic or you’re depressed, and we tend to look at it in that really narrow window. But in actuality, it’s more of a spectrum. Suicidal depression is the lowest point, and Godlike mania is the highest point. But it’s also everything in between. So it’s very possible for people with bipolar disorder to be in the middle, stereotypical, normal, average, doing well, and then of course they can become symptomatic and become depressed or hypomanic or manic. There’s also a whole series of symptoms that can go along with it, like grandiosity, racing thoughts, and hypersexuality, and all of these things coalesce and coexist with bipolar disorder to make up a bipolar diagnosis. But in most people’s minds, either you’re manic, talking a mile a minute, the life of the party, quote unquote, but making really bad decisions, or you’re depressed, and they think those are the only two things. In some rare cases, people believe not only that those are the only two things, but that they’re somehow split equally, fifty percent of the time you’re manic and fifty percent of the time you’re depressed. That’s not even true. So there’s a lot of misunderstanding about the illness.

Dr. Suzanne Simpson:
Can you define type one and type two bipolar disorder? I only learned this because of my time on a psychiatric unit, that there is a type one and a type two.

Gabe Howard:
So bipolar one is all the way to Godlike mania, all the way down to suicidal depression. Bipolar two is all the way to hypomania, so you never make that leap into Godlike mania, hypomanic all the way down to suicidal depression. One is not more serious than the other. I’ve heard that before, well, bipolar two isn’t as serious as bipolar one. I suppose in a manner of speaking bipolar two has less severe symptoms, so I suppose maybe, but I don’t know. It’s a bit like saying to somebody with terminal cancer and six months to live, and somebody with terminal cancer and a week to live, that your cancer is less severe. It just seems like the suffering Olympics, and it rings hollow. So I don’t think it’s fair to call it less severe. It’s just different. It has different symptomology.

Dr. Suzanne Simpson:
Okay, can you tell me, do we know the cause of bipolar disorder?

Gabe Howard:
We don’t. It’s very random. We know what’s not the cause: it’s not bad parenting, it’s not any of those things. It’s just something you’re born with. For some people it’s triggered, for other people it’s not. So it’s a very complicated psychological disorder, but there’s nothing you can do to prevent it. You either have it or you don’t, and depending on how your life unfolds, that determines how it presents. It’s obviously going to present differently for different people depending on what your life is like.

Dr. Suzanne Simpson:
I did some research because I was just curious. I’m a teacher, I don’t have a psychology degree. I had read that there’s a high correlation of trauma with bipolar and schizophrenia. Do you know anything about that?

Gabe Howard:
The trauma conversation has become a real buzzword, and it’s really popular right now, and it’s difficult to say. I think people who have bipolar disorder experience a lot of trauma, I think that’s true, but the data is really mixed on trauma causing bipolar disorder. There’s a stat out there that people with schizophrenia die twenty-five years younger than the rest of the population. The stat isn’t untrue, but it’s a little incomplete. For example, if you just take all people with schizophrenia, well, people with untreated schizophrenia who aren’t getting the care they need are obviously going to die younger, so you really need to separate out people in recovery, meaning people who receive case management, treatment, supports, from people who are untreated. There’s also unfortunately a lot of comorbidity in the schizophrenia population, smoking, alcoholism, obesity, and all of those things will make your lifespan shorter too. So yes, trauma and bipolar disorder run in the same circles, absolutely, but some folks have taken that to mean trauma causes bipolar disorder. I don’t think the jury is in on that, but trauma can absolutely exacerbate bipolar disorder. And bipolar disorder itself can cause trauma. Take an example of grandiosity: if you believe you’re the greatest thing to ever live and you mortgage your house or max out your credit cards to start a once-in-a-lifetime business that you’re sure is going to be bigger than Amazon, but what you’re actually selling is painted rocks, it’s really easy to get taken advantage of, really easy to lose all your money. And if you lose all your money and end up in bankruptcy and lose your house, that causes a lot of trauma. People with bipolar disorder don’t always make the best decisions, and making bad decisions can put you front and centre for some bad times.

Dr. Suzanne Simpson:
I want to explore more of what bipolar can do to people, I have a step-cousin I’ll talk about in a sec, but I actually want to hear about you. I haven’t heard your story. I know you’re the bipolar expert, I was reading more about you to prepare for this, and I didn’t realise you’re also an advocate around substance use and have been open about the substance use that came with it. So tell me your story.

Gabe Howard:
It’s always hard to wrap up a story quickly, but the thing I like to point out is that I didn’t know I had bipolar disorder, even though I had glaring symptoms of it, and my family didn’t know either, even though the symptoms were there. They thought it was the teenage years. They thought it was boys will be boys. They thought it was hormones. They thought it was teenage angst. I was also born this way. I thought about suicide as far back as I can remember, but I thought it was normal, I thought everybody thought about suicide, I thought that was part of the human condition. That’s the problem with being born this way. This is 2024, 2025, and we still don’t have robust mental health education. It’s much better than it was, but I wouldn’t call it robust. Back in the eighties we didn’t discuss it at all, and we sure didn’t discuss it in boys. We weren’t even covering basic emotions, I grew up in the throw-like-a-girl, boys-don’t-cry generation. So I had all kinds of issues, I thought I was just weak, or a jerk, or disobedient, or a bad kid, and all of that carried into my adulthood. I didn’t know anything was wrong. To fast forward, I finally reached the point where I was going to end my own life. Before I was able to attempt, somebody noticed something was wrong and took me to the emergency room. The emergency room doctor realised I was suicidal, delusional, and depressed, and admitted me to the psychiatric ward, where I was diagnosed with bipolar disorder. That began my four-year epic journey learning to treat and manage bipolar disorder, from the time I was diagnosed to the time I reached recovery took four years. I define recovery as spending more of my life living my life than managing bipolar disorder. There’s a billion stories I could share, we’re covering decades of my life here, but the long and short of it is, I didn’t know I was sick, and that caused a lot of problems and a lot of needless suffering.

Dr. Suzanne Simpson:
How old were you when the first symptoms emerged?

Gabe Howard:
Arguably the first symptoms emerged since birth, I remember thinking about suicide at five years old, which is very abnormal. But the first real bipolar disorder symptoms that my family and I have pinpointed in hindsight are probably around eleven or twelve, maybe thirteen, it’s kind of hard to pin down. I would stay up for days at a time and then sleep for days at a time. My mother always called me her Dr. Jekyll and Mr. Hyde child, which is a direct analogy for bipolar disorder, so my mom really saw this in me even younger. But we really started to notice in earnest that things were taking a turn right around my teenage years, eleven, twelve, thirteen. It’s really difficult to pinpoint because my parents honestly thought these were behavioural problems, so they weren’t marking down, well, this is when Gabe had the following symptom. In their mind it was, Gabe is testing boundaries, Gabe is being a teenager. It didn’t help that I’m their oldest child, so they had nothing to compare it to. And whenever they reached out to their friends about the trouble they were having with me, everybody would immediately say, well, teenagers, you know teenagers. So that was really their understanding, that I was just a teenager.

Dr. Suzanne Simpson:
And back in the eighties, that would be completely off your radar.

Gabe Howard:
Completely. Mental illness was something that happened to other families, bad families, families with parents who were alcoholics, or who beat you, or were dismissive or abusive in some way. That’s just so untrue. My family was none of those things, and especially early in my public advocacy, people would ask, well, were your parents drunks, was your father absent, did your mom hit you, maybe do some drugs? None of that happened. We were a stereotypical blue-collar, middle-class family in the eighties. My mom was a stay-at-home mom, my dad was an over-the-road truck driver, a teamster. We sat down and ate dinner, we went on vacations, we lived in a house. I had all of the protective factors. What we didn’t have was education and knowledge. We thought we were safe because my parents were good, engaged people, and good, engaged families isn’t where mental illness comes from. We weren’t looking for it at all.

Dr. Suzanne Simpson:
And you said it was four years from start to finish, from diagnosis to recovery.

Gabe Howard:
Yes, I call it my four-year epic battle against mental illness.

Dr. Suzanne Simpson:
I worked with a man, Dr. Cam Caramantini, who’s doing really amazing research on bipolar disorder, and he told me that global studies show it’s normally eight to ten years from the start of symptoms to an actual diagnosis, which is a long time if you’re struggling.

Gabe Howard:
I can really see that, especially with the intermittent nature of it. Things go poorly, you’re symptomatic, you’re having all these symptoms, but then your mood shifts and now you’re fine, and you could be fine for weeks, months, even a year, and then the symptoms come back, and you have trouble connecting those two episodes. You experienced some suicidality in January, and now it’s November and you’re experiencing some suicidality again, but you’ve already forgotten about January, it’s months later, you tend to think of each of these as an isolated incident you got through once, so you’ll get through it again. It’s not until you take a thirty-thousand-foot view of it that you realise, wait a minute, every few months I’m having these symptoms, this is a collection of symptoms, there’s a problem here.

Dr. Suzanne Simpson:
I don’t know the stats on this, do you know how often suicidal ideation coincides with untreated bipolar disorder?

Gabe Howard:
I really don’t, I’m sure there’s a stat out there, but some of these stats are difficult to get because a lot of people don’t realise what suicidal ideation actually is. In my own speeches I’ll give the definition and people will say, my God, I have that, and I’ll say, well, that’s concerning, and they’ll say, I’ve always done that, I’m just used to it, or, well, everybody does that. No, everybody doesn’t do that. And then there’s severity: if it pops into your head for a second and instantly leaves and never causes a problem, maybe it’s a weird quirk, though I’d still say you should get it checked out. But if you’re dwelling on it for minutes, hours, days, it can be really debilitating. That’s the problem, not every instance is created equal, but we tend to talk about them as if they’re all the same.

Dr. Suzanne Simpson:
I want to get into the experience of it, because I feel that when we understand it better, we respond better, with more empathy and compassion. For anybody struggling with bipolar, what’s the hardest part of it day to day?

Gabe Howard:
It’s so difficult to figure out what the hardest thing is, in some ways the hardest thing is whatever you’re faced with in the moment, because that’s the thing causing you problems. The totality of it is deeply disturbing and difficult. I really think the hardest part is that you’re not in control of your own life, your own brain. You want to be happy. I think about all the times I’m doing the thing I want, I’m at the concert, with the right people, best seats, they’re playing my favourite song, and I think, why do I feel so bad, why can I not be happy? It’s devastating, because it feels like it’s taking something from you, you’re not going to get that moment back. You can’t say, I’ll try again tomorrow, the concert isn’t tomorrow. Substitute concert for whatever you want: Christmas morning, a vacation with your family, an award ceremony for you or your kids. You intellectually acknowledge that everybody else is happy, everybody else is having fun, and you feel disconnected and alone, and you get resentful, why can’t I be happy, why do you get to be happy and I don’t. Then you start judging yourself, why can’t I get this together, why can’t I figure it out, why, even when I get exactly what I want, am I still miserable? Then you start beating yourself up, and then you start pushing people away, maybe because you don’t want to see their happiness, so now you’re losing friends, or you just stop going altogether, well, if I’m going to be miserable I might as well save the three hundred dollars on concert tickets. So now you’ve become isolated, and you don’t even have the opportunity to be happy because you’ve stopped going to things. It’s a snowball effect, death by a thousand paper cuts.

Gabe Howard:
All of that is just so difficult to wrap your brain around, when should I push myself, when should I use self-care. I pick on influencers a lot, even though I technically am one, but so often it’s, feeling down, go for a walk. Well, that’s going to help serious and persistent mental illness. But sometimes, yes, you should go for a walk. That’s the hardest part about it, the advice isn’t bad, it’s just possibly bad for the person. It’s like, stretch before you exercise, but what if you have a gunshot wound? Then don’t stretch, go to the doctor, it’s not for you. But people think the advice is for them, especially if we lump all mental health together.

Dr. Suzanne Simpson:
It feels like we’re trivialising it. That’s my response, the go-for-a-walk advice: we all think we have the answers and we have no idea what it’s like, and it trivialises that person’s experience when I say go for a walk, when you’re barely able to get up in the morning.

Gabe Howard:
One of the biggest problems is that we treat mental health as one-size-fits-all. We take the person with schizophrenia, the person with bipolar disorder, the person with suicidal depression, and the person who’s feeling disconnected or down or anxious, and we lump them all in the same category and give them all the same advice. Could you imagine if hospitals did that, if you stub your toe or have a heart attack and they give you the same treatment and the same advice? That would be terrible, and the stubbed-toe people would be fine, because they need the least, and chances are we default to the lowest common denominator. But for the heart-attack people, they’re out there saying, you’re not helping us, and this is leading to pain and suffering needlessly, this is leading to death. And the problem is the stubbed-your-toe people say, well, it worked for me, so you’re just a complainer, it worked for me, so you’re not trying, it worked for me, you’re just not compliant. We find ways to blame people with mental illness for their own suffering, because after all, we told you to take a walk, or do yoga, or use fish oil, or CBD oil, or essential oils, or a nature bath, and all of that will absolutely help the blues, or feeling down, or low-level anxiety, which are all normal human emotions. Going for a walk and connecting with people will absolutely alleviate basic anxiety and basic blues, but it’s not going to do anything for bipolar disorder, unless you’re already healthy, meaning already in recovery and well managed, because people with bipolar disorder have normal moods too. We can have our bipolar disorder perfectly in control and still be anxious, not clinically anxious, just nervous. We can still have the blues, feel down, it’s raining, our friend cancelled, this is a lackluster day, that’s not mental illness, that’s the kind of thing self-care was designed for. But we lump it all together: you’re having suicidal depression, go for a walk. Your baseball game got rained out, go for a walk. Those need two wildly different approaches, but we’ve got this one-size-fits-all mentality.

Dr. Suzanne Simpson:
Good for everybody to hear that. Can you tell me about the psychosis part of bipolar? Not everybody goes into psychosis, I had a lot of students in psychosis from bipolar disorder. Can you speak to that?

Gabe Howard:
One of the potential symptoms of bipolar disorder is psychosis, you can experience hallucinations, delusions, visual or audio. I had delusions, that was my experience with it. Delusion, for people who don’t know, is being positive something is there even though you can’t see it. I could not see or hear the demons under my bed, but I knew they were there, I was positive of it. Another example I use: if the refrigerator door is closed you can’t see the food that’s in there, but you know it’s in there, you have zero doubt, so you make decisions based on food you can’t see. The difference is, if you open the door, you can see the food. If you look under the bed, the demons won’t be there, but you’ve convinced yourself they ran away because they knew you were looking.

Dr. Suzanne Simpson:
So let’s talk about treatment and recovery, because I think it’s so important for people to understand what it takes and what works. Is it also universal for an adolescent versus an adult, versus older adults, that the steps are going to be the same for every age group?

Gabe Howard:
I don’t know that the steps are exact, they’re kind of the same, depending on how far you pull out. For everybody it’s going to be medication, therapy, coping skills, and support, so it’s completely the same there, but the closer you look, the more it dials in. It’s like cars: all cars are the same in that they have a gas pedal, a brake pedal, and a steering wheel, but there’s a lot of difference between a Ferrari and a twenty-year-old beater you bought off the street, in terms of the specifics. But in general there’s a lot of overlap.

Dr. Suzanne Simpson:
For example, medications: here in Canada, Health Canada has medications approved up to eighteen, and there’s different rules for younger versus older, you’ll look at a different medication for a forty-year-old than a seventeen-year-old. Medications are pretty much required, right?

Gabe Howard:
There’s controversy there, and I want to make sure we’re telling your audience the truth. In my opinion, and the opinion of most experts, people with bipolar disorder will do best on medication. They’ll thrive on it, manage it on it, and managing it without medication is nearly impossible. Now, there’s always somebody out there who swears they’re managing bipolar disorder with zero medication, and maybe they’ll be able to manage it for their lifetime, but for my money, if you have an accurate diagnosis of bipolar disorder, if you’re truly living with it and weren’t misdiagnosed for something else, the chances of managing it without medication are so remote that I’m confident saying you need it. We have ways to forcibly medicate people in crisis, and it would be easy to think, just round everybody up and give them a shot, and everybody lives happily ever after. It doesn’t work like that. It takes time for medication to work, it takes time to see a doctor, there are so many barriers to finding the right medication. What’s always left out is that it’s not actually med-compliance we need, it’s the correct medication that you’re compliant on, and that takes time. We have this general belief that if you follow your doctor’s orders you’ll live happily ever after, and it’s not even that simple to see a doctor, let alone have doctors divine the perfect medicine cocktail for you and get it right instantly. That’s not how any illness works, and certainly not complicated illnesses like severe and persistent mental illness. It puts people with bipolar disorder, and people experiencing homelessness, in such harm’s way, because we’re so comfortable blaming them for their own problem.

Dr. Suzanne Simpson:
It’s such a quandary, such a sad state of affairs of what we don’t have for support and what we need. I want to get into treatment, but first I want to talk about substance use, since we know there’s such a high correlation between mental health disorders and substance use. What did taking substances do for you?

Gabe Howard:
They did a couple of things, and in some ways I don’t think I’m unique, though in other ways I do think I’m unique in how I think about my own substance abuse. I always say I abused drugs and alcohol, I never say I was addicted, because I’m not sure what the mechanism was there, but once I got treated for bipolar disorder, the substance abuse cleared up relatively easily. I don’t have the same stories as people who fought addiction and would relapse. I really believe I was using drugs and alcohol for two primary reasons. The first is more understood, self-medication: drinking slowed my brain down, doing drugs slowed my brain down, especially when I was manic, I needed anything to distract me from the racing thoughts and everything going through my head. During depression, certain drugs could elevate my mood even momentarily, and that was worth it. There was this idea of, if I did X, Y would follow, and Y was more desirable than the mood state I was currently in, and that led to a lot of drug and alcohol abuse for me. The second thing is, I was up for days at a time, and you have to go back twenty, twenty-five years, if you wanted to be in the company of people at two a.m. there weren’t a lot of options, and the majority of those options involved drugs and alcohol. I remind people, especially the younger generation, that back in the nineties and early two-thousands, if you were around a bunch of people doing drugs and wanted to stay, you had to do drugs too, because they didn’t want somebody around who wasn’t doing drugs, they’d think maybe you were a cop, a narc, up to no good. So in many ways I had to do drugs just to fit in with people who were up at that hour or had a place to go for days at a time. Unfortunately addiction, substance abuse, and alcoholism followed people who partied for days at a time, there really was no healthy, safe place to be around people for two, three, four, five days in a stretch that didn’t involve a lot of illicit and debaucherous activity, and I joined into all of it because I was there and I wanted to fit in.

Dr. Suzanne Simpson:
That makes so much sense as a reason to get into substances, if you’re up at two in the morning, where are you going to go, what are you going to do? I hadn’t considered that.

Gabe Howard:
Exactly, it’s part of the process, honestly. I don’t want to say it’s better now, though in some ways it is, certain drugs are legal, we have a different view of alcohol, now if you say I’m sober, or I’m not drinking, people say, no problem. Back in my day, especially as a young man, if you said I’m not drinking, it was, what, are you a wuss, can’t hold your liquor? There was much more of an expectation, at least in the circles I was in. I talk to many people my age, and they say, yeah, in my early days alcohol and cigarettes were everywhere, this is back when you could smoke in a bar at eighteen, now in many states you have to be twenty-one and indoor smoking bans are pretty much everywhere.

Dr. Suzanne Simpson:
Let’s go to recovery, I think it’s so important for people to understand what it takes and what works now.

Gabe Howard:
So there’s controversy there, but in general, recovery for everyone comes down to medication, therapy, coping skills, and support.

Dr. Suzanne Simpson:
For example, medications, so here in Canada, Health Canada has medications up to eighteen, and there’s different rules agreed on for younger versus older, medications are pretty much required, right?

Gabe Howard:
In my opinion, and the opinion of most experts, people with bipolar disorder will do best on medication, and managing it without medication is nearly impossible for most people who are accurately diagnosed.

Dr. Suzanne Simpson:
You brought up earlier what the effects can be for somebody with bipolar, getting a mortgage, and so on. I told you about my step-cousin, who, until just this last year, we had no understanding of the effects he could have when he wasn’t well from bipolar. He was in psychosis, diagnosed after that with bipolar, and he spent all of his money.

Gabe Howard:
It makes people feel better to think it was an accident rather than something they did on purpose, but you’re absolutely right, the reality is many people become homeless because they run out of money and there are no resources to support them, no case management, they need a higher level of care than can be provided. We have this general idea that if people would just take their meds they’d be fine, I wish that were the case, we have long-lasting injectables now, but it’s not that simple.

Dr. Suzanne Simpson:
And history, and the observation of history: what were they like a year ago, five years ago, what were the circumstances that led up to this moment? Okay, thank you. Wrap-up question, last question.

Gabe Howard:
Thank you, last question, all right.

Dr. Suzanne Simpson:
This could be a one-sentence answer. If you could have a big massive speaker in your car and drive around the streets, what’s the one thing you’d want society to know about bipolar disorder, so society becomes more understanding, more empathetic, and more supportive?

Gabe Howard:
Bipolar disorder is absolutely treatable, and people with bipolar disorder thrive and accomplish all the time, you just don’t see them, because they have to hide, due to stigma and discrimination. I’d want to explain so much more, there are so many people with bipolar disorder contributing at such a high level, and they’re able to do that because they got treatment, because they got therapy, because they learned coping skills, because they’re managing their illness, but nobody sees them, because they’re smart to hide. Unfortunately, they’re smart to hide.

Dr. Suzanne Simpson:
I think also creating boundaries, I have a good friend who has bipolar and has completely changed her life, she said, I can’t do this anymore, it was too stressful before, and she totally revamped, and you can thrive. I think that’s the big hope, that you don’t have to live like this, and you can thrive.

Gabe Howard:
Yes, everybody wants to thrive. People don’t just want to get by, don’t just want to live, they want to live their best life.

Dr. Suzanne Simpson:
What did you need, as a child, ten or eleven years old, as this emerged throughout adolescence, from the adults around you?

Gabe Howard:
What I needed from them was more understanding, more knowledge of the illness, because they had none, they were in the dark just like I was, so they reacted to everything incorrectly. I’m fond of the grease-fire analogy: people who know what to do when a grease fire breaks out on the stove simply get a lid and put it on. I’ve seen my mother not even hang up the phone, she just goes and gets the lid and sits it on the pan, and the fire goes out. But my parents didn’t know what to do with me, so the fire burst out, which is a symptom of bipolar disorder, and they sprayed it with water and it spread everywhere. It wasn’t because they were bad, or uncaring, or wanted to hurt their son, it’s because they didn’t know. So I really needed the adults to understand that just because they didn’t have any mental health issues themselves, and didn’t think mental illness was going to touch them, that doesn’t mean it won’t. I wish they would have taken a moment to be preventative, to learn about it just in case, and if they never needed it, that’s great, but they did need it, and they didn’t have it.

Dr. Suzanne Simpson:
Gabe, you’re kind of a segue into my research findings, because you’re saying exactly what the kids in my research at the psych unit said, it’s one of the things they desperately wanted. I wrote about this and use it in presentations: they know they’re not perfect, but they want the adults to have a general understanding, and to go pursue it. They said that across the board, they want the adults to know, to understand.

Gabe Howard:
Yes, we just want them to know things. We’re learning this in other areas too, the big example I use is fathers finally starting to learn about the menstrual cycle and the facts of life for young women, after decades of what can only be seen as underlying misogyny. This was avoided like the plague, and it left daughters in a difficult position, it led to fathers saying ignorant things, it led to shame, to misunderstanding, and in the rare case of divorce or death where a father is raising a daughter alone, he didn’t know what to do because he’d never learned it. We finally realised this was a problem, and I use this example because many people hearing this, especially of a certain age, think, that’s disgusting, they don’t need to know that, it’s private, but now we’re starting to see people say, no, you need to know this, this is important, you want to be there for your child. We can see how that’s evolved across generations, and I think it’s a really powerful thing, because I don’t think fathers of previous generations were trying to be dismissive, it was an unfortunate byproduct of misinformation and misunderstanding. I want to see that same shift in mental illness, in mental health, and I think it will save a lot of lives.

Dr. Suzanne Simpson:
I worked with a lot of parents on that psych unit, with their kids and my students, and what I always said is, you have to become your child’s advocate, whether it’s a younger child or a fifty-year-old child and you’re eighty, but you become that advocate, and part of that is knowledge. With my daughter, I knew at three years old that something was going on, and I was up researching medication until four in the morning, because we’re the advocate, and that’s for any age. Here’s wrap-up question number two, continuing that parenting thread: I want to know your top three steps. For a parent who has a child of any age, or a close relative or friend, what do you do if you’re concerned, if you’re watching emerging symptoms? What do you do in our system to access appropriate care, to help our loved ones with bipolar?

Gabe Howard:
First and foremost, if you suspect anything, get medical attention. For some reason in mental health we believe we have to be sure something is wrong before we seek out a medical professional. Could you imagine that in physical health? I think there’s something wrong with my child, well, what is it, I don’t know, I’m going to keep observing until I figure it out, and the rash keeps spreading, but I won’t take him to the doctor until I can identify the rash. No. Suspecting something is physically wrong is enough to get you to take your child to a pediatrician or general practitioner, so I want to see the same thing in mental health. If you suspect something is wrong, make an appointment. You can start with your pediatrician or general practitioner, and if you suspect it’s more serious, or you have the insurance and the access, go straight to a psychologist, psychiatrist, therapist, or psychiatric nurse practitioner. Make whatever introduction into the medical field you feel most comfortable with, and understand, that’s number one, don’t try to handle it on your own. There are so many advocates out there giving advice to manage your child’s mental health by yourself, and I think that’s bad. You need to engage a professional immediately, at the highest level you have the means and access to. I do acknowledge that somebody with great insurance is going to have an easier time accessing care than somebody with none, but access the highest level of care you can, write everything down, and go in. Next, make sure you understand: if you think something is wrong with your child and you go in and they say, they’re fine, that’s just normal teenage stuff, ask them to explain why it’s normal teenage stuff, and also, it’s not normal teenage stuff if it’s causing them distress. Be open to the idea that your kid might just need boundaries, we’ve got to stop over-pathologising everything, but don’t just take their word for it either, make sure you understand. Be open to the idea that nothing is wrong, just because you suspect it doesn’t make it true, I’m not saying only accept a diagnosis, but also don’t accept just being told it’s fine without understanding why, because this is serious, this can lead to suicidality, to issues later in life, to eating disorders, to all kinds of things. And last, understand going in that you’re probably going to have to be tenacious, persistent, and patient, this is not a quick fix. So many people say, I made an appointment with a psychiatrist, talked to him for five minutes, and it’s fine now, and I’m always suspect of that no matter the outcome, whether that’s, we talked for five minutes and they prescribed my daughter medication, or, we talked for five minutes and I realised my son’s just a brat. No, that’s too quick either way, this is complicated, this is nuanced, this is serious, and mental health issues are diagnosed by observation, so if somebody’s only looking at your kid for five minutes, they’re not observing much.

Dr. Suzanne Simpson:
And history, the observation of history, what were they like a year ago, five years ago, what were the circumstances that led up to this moment right now.

Dr. Suzanne Simpson:
This could be a one-sentence answer. What’s the one thing, if you had a big massive blaring speaker in your car and drove around the streets, you’d want society to know about bipolar disorder, so society becomes more understanding, more empathetic, more supportive?

Gabe Howard:
Bipolar disorder is absolutely treatable, and people with bipolar disorder thrive and accomplish all the time. You just don’t see them, because they have to hide, due to stigma and discrimination. There are so many people with bipolar disorder contributing at such a high level, and they’re able to do that because they got treatment, got therapy, learned coping skills, are managing their illness, but nobody sees them, because they’re smart to hide. Unfortunately, they are smart to hide.

Dr. Suzanne Simpson:
And I think also creating boundaries, I’ve got a really good friend who has bipolar, and she completely changed her life, she said, I can’t do this anymore, too stressful before, and totally revamped, and you can thrive. I think that’s the big hope, that you don’t have to live like this, and thrive.

Gabe Howard:
Yes, everybody wants to thrive, people don’t want to just get by, they want to live their best life.

Dr. Suzanne Simpson:
Gabe Howard, thank you so much for taking on little old, just-starting-out me, with your time about this. Your expertise is fantastic. Thank you.

Gabe Howard:
Thank you so much, thank you, it was so great talking to you. Thank you.

Dr. Suzanne Simpson:
Thanks, Gabe.