IN A RELATED PIECE, we discussed personal support. Part of the conversation involved support groups. For three years, back in the early 2000s, I attended a support group in Connecticut run by Mental Health America (MHA). Then I spent another three years facilitating a Depression and Bipolar Support Alliance (DBSA) support group in Princeton, New Jersey. I also sporadically attended two DBSA groups in the San Diego area for a couple of years.
In my other piece, I described some of my personal experiences. Here, we get into the nitty-gritty ...
Mutual support is basic to human nature, from two people informally sharing their experiences to larger groups in more structured settings. In DBSA groups, there is no hierarchy as such, other than an implicit understanding to let the facilitator guide the meeting. The facilitator is a volunteer drawn from the ranks. No know-it-all professionals imposing their clinical perspectives. This is the beauty of support. It's about us, just us.
Back when I was facilitating, I liked to joke we had only two rules: 1) No dancing on tables. 2) Check knives and guns at the door.
Our local group did run meetings according to a commonly accepted procedure: First, I welcomed new members, and told them what they could expect from the meeting. Then we went around the table for a check-in. A laminated card with five or six prompts got passed around. What we were looking for - very briefly - was how people were feeling right now, how their week went, any changes in their situation regarding meds and lifestyle, and what they wanted to talk about.
If we had a large crowd, we would split the group in two after the check-in. In my experience 10 or 12 people is the ideal number - enough to provide diversity of viewpoints, but sufficiently small to afford people ample time to speak.
From my time with support groups, the major thing I came away with was the profound wisdom and insight displayed by those who attended. In many cases, these were people marginalized to the fringes of society. Yet, around the table, they came across as wise elders. Typically, it was a team effort: Someone would share what happened to them. Inevitably three people at the table would have experienced something similar. Inevitably, each had a slightly different take on the situation. Inevitably, one of them was going to connect with the perfect insight.
Often, the person with the penetrating insight may have only ventured in from the cold the week before. At that meeting, she may have felt ignorant and helpless, at wit's end, in need of help. Now we see her jumping in and contributing to the discussion. She spots nodding heads, validating her wisdom. I ask you, what is that going to do for her confidence and self-worth?
Thus, the helpless become the helpers. "We've been there, we can help." That's the guiding philosophy of DBSA.
Support groups may not be for everyone, but I do urge everyone to give it a try. Each meeting is different, so you need to attend at least three before you make up your mind.
A few understandings ...
Support groups are not therapy. There are no rule books, no assignments, no goals. Rather, they are structured conversations where people feel safe to talk. Some people may come away from a meeting with a few practical tips, others may experience major revelations. How you apply them to your life is up to you.
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There is no agenda. AA, for instance, has an agenda, a big book, a series of steps you need to follow. DBSA does not. For instance, DBSA does not urge you to be on your meds, or to get off your meds. Or to engage in a particular spiritual or recovery practice. Those discussions inevitably come up, but always in the context of people sharing their experiences or points of view.
For instance, a newcomer who has just been put on meds may state that he is thinking of going off his meds. Here, you can count on at least three people jumping to explain why this isn't such a good idea. In a different context, though, expect to encounter learned conversations on the pros and cons of staying on meds over the long term.
Individuals, of course, are free to promote whatever has worked for them. Thus, you will be privy to discussions on mindfulness, meditation, diet and exercise, cognitive behavioral therapy, getting out in nature, and so on. Plus books to read, websites, videos, organizations to contact, and so on.
Support groups are not workshops. You are not there to learn a specific technique, such a developing a wellness recovery action plan. Mary Ellen Copeland's WRAP program does an excellent job with that. Inevitably, at least three members of any support group will be intimately familiar with WRAP and will fill you in, complete with contact info.
Support groups don't have the answers. They are not going to get you out of your bad living situation or make your symptoms go away. But never underestimate the power of emotional support or the wisdom of the crowd.
Support groups don't handle psychiatric emergencies. If you are feeling suicidal or are bouncing off of walls and ceilings, you need to be in the ER or in a safe place, not a support group. Just about every support group has a procedure for handling these situations, including assuring the person that their cat will be taken care of should they find themselves admitted to a hospital.
The guideline is "danger to self or others." In my six years of support groups, this has only happened once. This took place in my group in Connecticut, where we met in a room at a hospital with a psychiatric unit. I suspect the person turned up looking for confirmation that she was suicidal. You could see the relief on her face when the room acknowledged her suffering. She willingly allowed someone in the group to accompany her to the psychiatric unit.
Having said that, groups do get faced with close calls. Generally, it takes about 20 minutes for the facilitator and others in the group to determine if the person is a danger to herself or others and to handle her concerns and make her feel safe. But then we have to move on. The person we haven't heard from yet may also be in a state of extreme distress. Someone else may have just lost their job or is facing eviction. In a room of 20 people, at least three are going to have a major concern and another three are on their way to one. And the rest are there for a reason, as well. Everyone needs to be heard.
In cases of individuals needing further attention but not emergency care, with the person's consent, a couple of individuals may accompany that person to another room. But this is not to be confused with therapy. Sometimes, people simply need to talk, for an hour or more, with a sympatheric person or two in attendance.
One more thing to add: All meetings are confidential, but all bets are off when the "danger to self or others" criteria is met. In no way, for instance, should a person experiencing mania be driving. No way, as a facilitator, was I going to allow this to happen.
When a support group works right, a community develops around it. Members start seeing each other socially. Friendships form. An occasional romance. People may come and go, but every functional group has a core, a group of people who generate a positive dynamic that creates a welcoming atmosphere for newcomers.
But sometimes things don't go right. The core may become a clique. Or people with a strong sense of victimhood begin to dominate. If it is your misfortune to walk into one of these groups, my advice is to see if there is another group in your area.
One concern of mine is that you find more men in attendance than women. My guess is three men to two women. This stands in complete reverse to my readership, which I estimate is three-quarters women. Women are far more willing to talk about their personal issues than men. They are also more inclined to take the initiative in educating themselves and taking an active role in their own recovery. It stands to reason we should be seeing three women to one man in every group.
My guess is that women have major safety concerns. Venturing out alone in the dark to face a room full of stangers is intimidating for all of us, regardless of gender. On top of that, women experience more trauma and abuse than men.
To the women out there: Although support groups are extremely safe places, I share your concerns. My suggestion is to ask a friend or family member to accompany you to your first few meetings. After that, you will find yourself bonding with certain members of the group.
Another concern is lack of attendance from immigrant communities. Members from these communities have their own unique concerns to deal with, not to mention major trust issues seeking out support. There are no easy answers, here.
As to how long you should attend: Three months may be too long for some people, three years too short for others. Whatever the case, I strongly believe there is a time to move on. This is completely different than the AA mindset. Bipolar may stalk us all our lives, but it doesn't have to determine our identity or the people we should be hanging around with.
Walking in the door to your first meeting may be the bravest thing you've ever done. Walking out that door for the very last time - to a new life - may be the second-bravest.
For a list of DBSA groups in your area, please check out the DBSA website.
Jan 10, 2017.
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