Let's assume for a moment that tomorrow you start feeling really, really lousy. So much so that you decide to go and see your doctor. After examining you and running a battery of tests, he tells you that you have diabetes - a very common disease and one we know a great deal about. The doctor writes you a prescription, gives you a few brief instructions on diet and exercise, and tells you to make a follow-up appointment.

If you're like many people, when you go in for that follow-up appointment, your diabetes is still not well under control. You tell the doctor that you've been taking your medication religiously, but when he checks your blood sugar, it's still above normal range. After some discussion, your doctor begins to detect the problem.

While you've been taking the medication faithfully, you haven't exactly stuck to any reasonable plans for diet and exercise. Having spent several years in the health care field, I can honestly say this happens very frequently. It takes much more willpower and determination to change our eating habits. It's hard to change habits which have been developed over decades. It's also hard to make ourselves set aside time for proper exercise.

We're a convenience-seeking society. Downright spoiled, perhaps. We live in a society where people will pay for tanning bed visits and pay someone else to mow the lawn, when they could save money AND get a tan at the same time by putting on some shorts and mowing their own lawn.

Watch a couple of hours of television or thumb through one copy of a popular magazine. What will you find? An abundance of advertisements for drugs that are supposed to do everything from lowering blood pressure or cholesterol to preventing heart attacks. These advertisements should be required - by law - to include a large, bold print disclaimer that they aren't worth the money you'll spend on them if you don't also make whatever lifestyle and habit changes are necessary to accomplish the intended goal. The same holds true for medications intended to treat mood disorders such as depression and bipolar disorder.

I stand firm on my opinion that mood disorders are inside-out, outside-in illnesses. Inside-out in the sense that the illness itself can affect how we perceive and react to the things happening around us. Ever have "a bad day" and find yourself overreacting to someone else's criticisms or rude comments only to regret it later? Our internal state of mind - call it our "mood" to be simple - controls how we see, feel, and react to the world around us. It does not make the world intentionally cruel to us. Admittedly, our state of mind, by controlling how we react to our world, can shape that world through our actions and reactions over time. But in the beginning, things are what they are and we act and react according to our internal workings.

As for outside-in, what happens around us does affect our moods. It's only human to start feeling stressed and maybe even depressed if we get bombarded with enough bad news, pressures, failures, etc. If such things don't have at least some effect on you, odds are you may be doing some drugs that aren't exactly prescription, if you catch my drift. That, or you're already dead and just haven't checked the obituaries yet. Let the stressors keep pouring in and a sort of domino effect occurs. Your mood gets worse, you perceive a stressor as being a little worse than you ordinarily would, which lowers your mood even more, then more bad news, the mood declines more... you get the picture. It's a vicious and often dangerous spiral.

So how can we stop this vicious chain-reaction?

Medications can help to some degree. By keeping our moods from artificially bottoming-out or going sky-high, antidepressants and mood stabilizers (respectively) help to control our reactions to the world. They are designed to temporarily enable us to act and react on a more rational and appropriate level. Instead of feeling like a piece of bad news is the end of the world and crawling in the proverbial hole of depression, we (hopefully) deal with the problem at hand and simply move on. That's about the extent of what these medications are good for. The medications themselves don't fix all the negative things going on around us. That's where we, ourselves, have to step in and take an outside-in approach. Let's take a look at some examples.

Perhaps your job is very stressful. Your boss is not a kind person and has unrealistic expectations much of the time. Can you make your boss change? Probably not. But a pill can't do that for you either. It's up to you to decide whether to stick around or go out and find a job that's less stressful. Or perhaps you can simply ask to be transferred to a different position with a different supervisor. You just have to explore the possibilities and make a choice. The key is to seek out a positive way to alter this aspect of your environment.

Maybe you're under tremendous financial strain. It might take a different, higher paying job to resolve this situation. Or perhaps you could go to school part-time and earn a degree as a means of getting a promotion or higher paying job. It could be that you need to look more closely at your budget and make some changes in spending habits, or seek financial counseling. Again, there are usually many possibilities for changing your little part of the world, you just need to analyze the problem, think of ways of to solve it, choose the course of action you think best, and get started. A medication which helps you think more clearly and act more rationally can definitely make a difference in your ability to do this. It might be absolutely necessary. But it won't do the hard work for you.

Which brings us back to the original question at hand: why do I so strongly promote therapy, counseling, and support groups? Because they can often be very instrumental in our outside-in approach. To put it another way, they can help us to reshape our environment and make life at least a little easier to deal with. Mood disorder support groups are great sounding-boards and idea generators. Someone shares a problem they're dealing with, and other group members in return share ideas or even personal experiences in dealing with such a situation. Support groups are great, especially for newly diagnosed people, because they can benefit from the experiences of other people - people who have indeed walked in the same moccasins, so to speak. Plus, people feel more positively about their own illness when they can turn their experiences into something positive and help out others.

As for therapists and counselors, they are also key components in the wellness equation. True, they might not by sympathetic in the sense that they, themselves, have never personally experienced what it's like to have the illness. But they are especially trained to help a patient sort through the maze of thoughts and emotions and discover the roots of problems. As an example, someone with children might think that the kids are getting progressively worse in terms of their behavior when they get home from school. Every day they seem to get worse. But it could be that stress at work is making mom or dad a little more "on edge" every day. In other words, the kids aren't the problem - the problem is really how mom or day perceives the kids' behavior. A really good therapist or counselor will help uncover this and perhaps help brainstorm some possible solutions to the work issues. If all goes well, everybody wins.

There is no "magic bullet" or pill that will fix the world. It is what it is. Stephen Covey, an author I have had the fortune to talk with and highly respect, shared something he once read and I would like to shamelessly share it with you now.

"Between stimulus and response there is a space. In that space lies our freedom and power to choose our response. In those choices lie our growth and happiness."

Choices. Plural. Rarely is there only one possible reaction to something that happens to us. It might be that we respond out of habit and THINK there is only one choice. In the throes of an out-of-control mood disorder, our reactions often turn out to be the worst possible choice. For some, it is literally fatal, as in suicide. But as we with DBSA say, "Suicide is a permanent solution to a temporary problem." Get the mood illness under better control and it becomes possible to seek realistic, positive solutions. Medications can sometimes help make this more likely, but they can take us just so far. No type or amount of medication will ever solve all our problems for us.

Support groups, therapists, and counselors are also very important in times of crisis. That might seem like an unnecessary statement, but in the deep darkness of depression or the multi-colored highs of mania, we are often unable to think this rationally. That's why it's a good idea to keep phone numbers of fellow support group members, therapists, counselors, nearby family members, etc. posted where they can be seen easily and often. This helps remind us regularly of those we can call on when things seem really out of control. It's also important to attend support groups and keep appointments - regularly. It's better to be proactive and nip seemingly little problems in the bud before they grow or combine to become huge problems.

As always, I hope that this article leaves you thinking seriously about how you choose to manage your mood disorder. Moreover, I hope it stirs some thinking about how you choose to manage your life.

May your choices lead to greater and greater growth and happiness.