Inside Bipolar Podcast: Brain Fog and How to Manage It

Meet Your Inside Bipolar Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at DrNicolePsych.com.

Episode Transcript:

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe: Welcome everyone. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: Today we’re going to be talking about brain fog with bipolar disorder. And there’s this little part of me, Dr. Nicole, that that wishes I could just do like an unedited podcast. And the reason I say that is because, you know, you hear me stumble, you hear the mistakes, you hear me start off a sentence and it goes nowhere, and you hear me try to make a point and tell the whole story of. And it just it becomes this, this, this like, nebulous concept that I’m having trouble focusing in. Now, people who know me, they’re like, okay, we get Gabe, we know what he’s trying to say, but people who don’t know me are just like, dude, what? And it’s a mess. Now we fix these in the rerecords, we fix these in the editing. And people are like, well, Gabe, you always sound so succinct. Yeah, that’s a lie. I want to be very, very clear. The reason that I sound succinct is because I cheat.

Dr. Nicole: Well, I mean, cheating is a very strong word, a very, very strong word. But do you think that stumbling or what you’re describing, do you think that is directly related to bipolar disorder, or is that just a Gabe thing? Because I know a lot of people who stumble and struggle with those kinds of things, and they don’t have bipolar disorder.

Gabe: Isn’t this the bear of bipolar disorder? Because it could be bipolar disorder. There’s well documented brain fog, cognitive deficiencies. There’s medication side effects. There’s focusing issues. All of these things are unequivocally symptoms of bipolar disorder. But you’re right. My father, who does not have bipolar disorder, he can’t speak a straight sentence to save his life. I just. So, this could be a Howard trait, I don’t know. And this makes it very, very difficult because I’ve done a lot of reading on brain fog and I definitely experience it. But at the same time, I’ve done a lot of reading on bipolar and brain fog, and I’ve done a lot of reading on aging and brain fog, and they sort of parallel each other. So, am I old or am I bipolar? Is it a combination of both? And then just when you think that you’ve got like an idea medication side effects. So, I don’t know.

Dr. Nicole: Well, I hate to tell you, none of us know. We are still trying to figure this thing out. I think we’re really just getting to a point where the research is coming into this area, and we’re seeing more articles being published. I think that we’re still going to be over the next several years and into the next couple of decades, learning how illnesses like bipolar disorder, schizophrenia, even depression, like how those things are going to affect people long term, I don’t think we have a great idea. My gut tells me that a person who’s in treatment, though, and the fewer episodes a person has, the fewer amount of medications they can be stabilized on, the better off they will be. But we don’t really I don’t think we know yet what we’re going to see down the road as far as people who have bipolar illness long term.

Gabe: People with bipolar disorder often report this concept of brain fog, or difficulty managing their thoughts or difficulty focusing. It’s not uncommon.

Dr. Nicole: Brain fog. What is that? Because it may be five different definitions to five different people. That’s the other complicated piece. When someone says, oh, I’m having cognitive impairment, or I’m having brain fog, or I feel fuzzy or I feel foggy, that may show itself in a million different ways for a million different people. So that also makes it difficult because we can’t define it. I can’t just say, oh, brain fog is this cluster of symptoms. Brain fog can really be whatever the person thinks they’re experiencing that they feel is different than kind of their typical or what they would expect cognitive functioning. So, we don’t have a good definition for it. We don’t have a good way to address it. So, this is a very, very difficult thing. And honestly, I’ll be honest with you, it makes me a little sad because patients will say, well, can you fix my fogginess? And I’m like, I don’t think so, because we don’t really have anything to fix it. So, we just have to try to dig and work through it.

Dr. Nicole: So, I am asking questions to tease that out. I’m asking about concentration. Focus. Can you can you read things? Can you retain what you read? Can you watch a TV show and remember what you just saw from episode to episode? Can you can you learn new things? Can you remember things that you need to remember? What’s your short-term memory like? What’s your immediate memory like? I can tell in a visit with somebody if they’re having more severe cognitive impairment or brain fog, because they may ask me to repeat a question multiple times because they just didn’t hold on to it. Or I may tell them something and then come back later and bring it up again and ask them, okay, can you repeat back to me what I said? And they’re not able to because they just the short-term memory is just, for lack of a better word, people will tell me my memory is shot. That’s how people describe it. I mean, those are things I’m looking for. Organization. Are you remembering to pay your bills? You know, things that you’ve done all the time? Can you always remember how to get places when you drive? Just all those little things that kind of make up our cognitive ability. Those are the questions I kind of ask to see where we are. So, when somebody says, oh, I have brain fog, then I have to go into a deeper set of questions to start teasing out things, to figure out what that specific person means when they say, I have brain fog.

Gabe: Just to make sure we’re all playing with the same words. While patients often refer to it as brain fog or my memory is shot. Cognitive impairment is the actual medical definition of what we’re describing.

Dr. Nicole: Yes, cognitive impairment encompasses all of those executive functioning kind of tasks, the organization, the memory, the focus, all the all that good stuff.

Gabe: Cognitive impairment. Sounds scary. I can see why patients prefer brain fog or my memory is shot right? It. Hey, I’m having some brain fog. I mean, we’ve all seen the pictures of, like, the fog over the Golden Gate Bridge. It’s kind of pretty, right? But imagine if they said structural impairment. You know, visual impairment like that sounds dangerous, right? I just no, no, no, no, I prefer foggy day over bridge. Not visual impairment over bridge. That’s that’s frightening. But it is frightening. On one hand we are using words like that. But I got to tell you when I was untreated and I had a lot of problems when I was untreated. So please, nobody hear this is a reason to become untreated. I want to be very, very clear before I tell this story. But when I was untreated, I read a lot. I read constantly, I could read, especially during mania when I wasn’t sleeping, I could read a book a day. I loved to read, and then I got medication. You know, I was diagnosed with bipolar disorder. I was put on medication and my focus was shot. The focus was gone. I couldn’t read a book. The words became jumbled. Sitting still became problematic. I just focusing on a book and remembering what I read a hundred pages ago.

Gabe: A hundred pages later also became a problem. So, we had brain fog. We had my memory shot. We had can’t sit still. We just, we just had a plethora of problems. So, when you asked me if I thought that bipolar disorder contributed to my brain fog, not sure. When you ask me if the treatment for bipolar disorder contributed to it? I’m pretty sure. And it is a good trade, right? I’m no longer manic, suicidal, wrecking my life and on and on and on. But focusing is a bigger challenge for Gabe now that I am on medication than it was before I was on medication. Now, that said, this story that I just told is from the early days. These were some of the first medications that I was put on. I’m much, much better now, years later, dialing in the medication, lowering the doses, switching medications, getting the right stuff. But let’s talk about those strategies. Somebody comes to you and says, hey, Dr. Nicole, I’m having brain fog. Now, you’re not going to say tough. You have to keep it. You’re going, you’re going to you’re going to start, you’re going to start doing doctor stuff. What are those doctor things?

Dr. Nicole: Oh, man. Doctory things. You know, before I answer that, I will say yes. Cognitive impairment sounds a whole lot scarier than brain fog, but the feeling is the same on your end. It’s all scary. It’s going to be scary. Brain fog is scary. When you can’t remember why you walked into a room, or remember the name of somebody you’ve known your whole life. Those things are scary. So, we’re not going to focus so much on what we call it. We’re going to focus on how you feel. But you’re right. I mean, you’re going to come to me and say, I’ve started taking med A and B, and now I feel like I’m not as sharp as I used to be. I feel like I don’t think as quickly. It’s affecting me at work. I used to be an avid reader, and now I feel like I can’t retain what I just read, and I am going to make a face and go, ooh, because that’s the hard part, right? So many of the meds that we use for bipolar disorder have that sedation effect. So many of them that it becomes complicated.

Dr. Nicole: Do we take one away? Do we take both of them away and start over? Oh, that’s scary. Also giving me the twisted-up face, you know, are you able to remember how you were on the first one and then the second one was added? Was the brain fog already there? Did it get worse? Sometimes I’m asking you a lot of questions and coming at you with a whole lot of questions that you just can’t answer. So, then you’re frustrated on your end, and then I’m frustrated because I’m thinking, you want me to fix something, but then you can’t even tell me how to help fix it. I still need, you know, information. I need you to tell me these things. And I think sometimes that is where the frustration comes in. And the relationship can kind of clash between the psychiatrist and the patient. Because you’re telling me I don’t like these meds, you need to fix it. But as I’m asking questions to try to get the information, I need to try to fix it, you can’t give it to me. And so, then we’re both frustrated with each other, which makes this, you know, just super difficult to try to maneuver practically from day to day.

Gabe: So, you’re telling me that somebody was serious and persistent mental illness, who is experiencing lack of focus, who comes to you and saying

Dr. Nicole: Yes.

Gabe: That they’re having brain fog

Dr. Nicole: Yeah.

Gabe: Is not articulate about the symptoms that they’ve experienced? [Laughter]

Dr. Nicole: They can’t answer the questions. Yea yea yea yea yea. But at the same time that person expects me to be a mind reader and to have my magic wand to just wave over them and all the answers pop up on top of their head like I’m just supposed to know. So, it probably requires a little more understanding on both ends.

Gabe: So, just to make sure I understand you might be able to, quote unquote, fix it, or you might be able to lessen the symptoms of brain fog. And then with coping skills and experience, manage it the rest of the way. I don’t want the audience to hear that you can fix it, but I don’t want the audience to hear that the doctor Nicole’s of the world can do nothing about it. Having that open communication is going to get you your best outcome, but you may still be left with a little bit, or we may be able to get it to go away completely.

Dr. Nicole: Yeah, there’s a whole lot of stops between it not getting better at all and it going away. And so sometimes we do have to be open to the fact that better is our goal, not necessarily resolution.

Gabe: Here’s the good news, there are strategies that work for this. Now, they involve work. I don’t want anybody to hear it’s a quick fix. I specifically said strategy. One of the things that I think a lot of people with bipolar disorder do is they we figure out the symptom, we figure out the thing that we don’t like. That’s easy. That happens in this example, it’s brain fog. And then we think to ourselves, I need to tell my Dr. Nicole about it. So far everything is going well. But then Dr. Nicole needs specific information. And in that brain fog, we’re trying to remember backwards. This is this is the failure point. So here is the suggestion. Start keeping copious notes. Start writing things down every day. Write down, try to read a book. Got three pages in. Didn’t work out. The next day, try to follow a recipe that I followed 100 times to make dinner for my family. Got lost halfway through. Then you can start getting even more specific. What happened halfway through? Well, the words became blurred. The words became jumbled. If people give you information like, you know, as I was at work and they said that I was I was mumbling nonsense. I just write that down. These are things to do. Whether you keep it on your phone, whether you walk around with a notebook, whether you take a crayon and you put it on toilet paper,

Dr. Nicole: Yeah.

Gabe: Whatever you need to do, try to keep these notes in the moment now.

Dr. Nicole: Yeah.

Gabe: And I did say copious notes and more information is better. But even if you write down Monday, can’t read, write, or even if you get one of those little planners and just write down words on the dates, all of this stuff becomes data that your doctor Nicole can use. And this is my favorite part that you don’t have to memorize. You can just walk right in and say, I’m experiencing brain fog. What are your symptoms here? Right? And just hand it right over

Dr. Nicole: Yeah.

Gabe: And then give your Dr. Nicole a moment to go through and see these dates, and then maybe she’ll see patterns, or she can ask follow up questions from there. That’s a lot more data than trying to use our symptomatic minds

Dr. Nicole: Yeah.

Gabe: To go back one month, two months, three months and get the help that we need.

Dr. Nicole: And we do it for so many other illnesses. If you are somebody who suffers from migraines, for example, what do they have you do? Keep a headache diary. If you are, you know, a diabetic, what do they have you do? Log your blood sugars. Nobody expects you to come back a month later and say, well, on the first it was this, on the second it was this. Nobody expects you to remember that. So, I don’t know why. A lot of times it feels like my patients struggle with that whole writing things down, or tracking your moods or tracking symptoms that you want me to know about. Nobody expects you to remember those things.

Gabe: I always love it when we compare physical health and mental health, and how they’re not so different and how we need to treat them the same. But you know what? I don’t want to talk about this from the patient perspective. I want to flip this on all the Dr. Nicole’s of the world. Hey, hey, hey, all you patients, you ever notice that when we go in and sit down in front of our doctor Nicole’s and they open up that little folder they have on their lap, and they look down for, like, 30s 60s. You know what they’re doing? They’re reading the previous session notes. They’re reading the notes they made about their patient. They’re doing the same thing as us because they know that they can’t remember all of this stuff. They see a lot of patients just like we do a lot of things. We have a lot of hobbies. And yeah, so the exact same thing that that I am giving you to do, our doctors are doing and they’re successful. Remember, all of our doctors have tennis courts.

Dr. Nicole: [Laughter]

Gabe: They all have tennis courts and sailboats. So, this is the technique that they use to have tennis courts and sailboats. I’m obviously joking,

Dr. Nicole: Yes.

Gabe: But this is a well-respected strategy

Dr. Nicole: Yeah.

Gabe: To remember a lot of things and do well in society. It’s not something just for people with bipolar disorder. It’s something that literally doctors use to be doctors. So, look, if it’s good enough for the Dr. Nichole’s, it’s good enough for Gabe.

Dr. Nicole: Well, that is true. I mean, I, I do write all kinds of things about people in their note just to trigger those memories when I see them again. And we can have conversations and we can follow up. My patients will say, well, how do you remember that I was going on a job interview? And I very frankly tell them I did not. I wrote it in your note last time that you had an upcoming job interview. And I do try to normalize just the fact that I have to write stuff down. My memory isn’t that great. And I will be completely honest with you. When I was a brand-new doctor, when I was a medical student, when I was a doctor in training and my residency, I could see five patients and go back and do those notes right after without taking notes. And I could remember all kinds of details. Your Dr. Nicole of 2023 does not have that capability. I have to write everything down because I’ll forget. And don’t let people have similar symptoms or have same hair color. All bets are off. I just can’t. I can’t do it. So, I know for me I have to write those things down and I just encourage you to do the same.

Gabe: It was pointed out to me in preparation for this show that I don’t talk about brain fog a lot. And I was curious. I looked inward and I was like, why don’t I talk about this? Why don’t I talk about this? And it occurred to me, because my job as a public speaker, people have these ideas. They have these ideas in their head that public speakers memorize everything, right? Emcees memorize everything. The moderator memorizes everything. The first thing I want to say is, it’s not true. The majority of public speakers carry note cards, right? They have things that jog their memories. And I’m one of those people. But I never want to talk about brain fog, because I’m afraid it will impact my ability to get hired.

Dr. Nicole: Mhm. Do you think that sometimes people don’t bring it up, though, because they feel they feel like they’re whining a little bit?

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Dr. Nicole: And we’re back discussing cognitive impairment and bipolar disorder. It’s not something that patients bring up. Sometimes I ask, and that’s how I find out. Not because people come in and say, hey, I’m having brain fog. I’ve also found that some people just think it’s part of having bipolar disorder, and so they just won’t bring it up. They just think, well, it’s just inevitable. Like it’s just one of those things, I got to take these dumb meds and they’re going to make me foggy, and it is what it is. And they just kind of consider the brain fog the lesser of two evils.

Gabe: There’s so much, so much, so much that I could say to this. First off, people with bipolar disorder, we do have to make difficult decisions, right? For example, I have chronic dry mouth. I am okay with chronic dry mouth. I do have brain fog, and I’m okay with this little bit of brain fog because I have found ways to work around it. But for example, I’m not okay with any sexual dysfunction, right? Because that is a deal breaker for me. I’m not okay with lethargy. I want to be able to get out and live my life and do things right. So, when I’m looking at the symptoms, I’m comparing the will tolerate and won’t tolerate. And that’s going to be different for everybody. For example, I met a professional flutist once. It’s like, look, I can’t have dry mouth. That is unacceptable. My mouth has to be super, super wet because of my job as a concert flutist. And that’s yeah, I don’t care that my mouth is wet. I can I can carry around Diet Coke water. Et cetera. So

Dr. Nicole: Mhm.

Gabe: It’s going to be different for every person. But when it comes to brain fog as well, you know, some people just hear stupid, I’m having brain fog because you’re dumb. I’m having trouble focusing because you’re dumb. I think slower than I think maybe my peers do. Right? Because you’re dumb and just on and on and on and on and on. So, people don’t want to bring it up because they’re like, no, I’m not dumb. I’m smart. I’m really, really smart. This

Dr. Nicole: Mhm.

Gabe: Was the issue for me all the way back in the early days. I don’t want anyone to think I’m dumb. I don’t want anybody to think I’m slow. I don’t want anybody to think that they can take advantage of me. I don’t want anybody to think I’m less than. And here’s the kicker. They already do. Because of the bipolar diagnosis. They already think less of me because of the stigma of bipolar disorder. And then I tell them I give them a hard core

Dr. Nicole: Yeah.

Gabe: Reason. Hi, I have brain fog, but I’m up for this promotion. Well, I don’t know that we want someone with brain fog in charge of the Richardson account. And then what do you say? Right? They’re already thinking, do we want somebody with bipolar disorder in charge of the Richardson account? It’s tough for people like us. Now,

Dr. Nicole: Yes.

Gabe: This doesn’t necessarily answer the question of why we don’t bring it up with our doctors, but we come in with all of that baggage

Dr. Nicole: Yes.

Gabe: So, you can see where it becomes super difficult.

Dr. Nicole: I get you? Because my first thought was, that has nothing to do with why you don’t tell me. Because you’re not telling your boss, or the people at work, or the people who are going to pay you has nothing to do with me. I need to know. There’s all kinds of things that can cause somebody to have cognitive impairment. Chronic substance use can cause people to have cognitive impairment. So, there are lots of reasons that we can kind of tease out. And there may be things that we can remove that may help with the fog. We may not lift it completely. But man, if we can increase your visibility, that would be very nice, right? If we can treat your anxiety, if we can work and help you through the chronic alcohol use, if we can do all those things, we can make those things better. And for my ladies out there.

Dr. Nicole: I want you to hear me. Getting older just sometimes really sucks for us because that whole perimenopausal phase, that’s a big complaint that people tell me is that they feel foggy in that phase. So here, if you are somebody who is living with bipolar illness, you’re taking medications that can add to your fogginess, and then all of a sudden you get north of 40 and you feel like it’s getting worse, but nothing else has changed. It could be that you’re just in that perimenopausal phase where that cognitive impairment, that brain fog is a real, real thing. And we and we often don’t know what to do about that to help you. So that I guess I say all that to say, there’s a whole lot of reasons why you could be experiencing cognitive impairment or that fogginess. So yeah, tell me, because I may be able to help you clear it up a little bit, even if I can’t get rid of it all together. And you just may not know how I can help you if you never bring it up. So, tell me, tell me, tell me.

Gabe: I’m so glad that you brought up aging because first and foremost, again, away from bipolar disorder, I think the aging process shocks everybody. There are just some factors that happen when you age, and I think that maybe people with bipolar disorder, we are so used to blaming everything on bipolar disorder, or at the very least, considering that it’s a symptom of bipolar disorder first, that maybe we don’t see the forest through the trees, maybe the cognitive decline, the scary word, or maybe just not having as good a memory at 46 as we did at 25, has nothing to do with medication. It has nothing to do with bipolar disorder, and it has everything to do with. Hey, welcome to your mid-forties. It only gets worse from here.

Dr. Nicole: Man, that that’s depressing. But you’re absolutely right. Sometimes we, I just see people who attribute everything to their bipolar disorder. And I know we’ve talked about this a lot. There are a whole lot more things going on within your body than the fact that you have bipolar disorder. You still have to be concerned about your physical health. There are physical health disorders that can affect your cognition or your mental clarity. And we know that sometimes when people have disorders like bipolar disorder, they may not have the resources, they may not put as much effort into taking care of those physical health things. So those things can come back to kind of bite you in the butt, so to speak, and lead to some more of that cognitive impairment over time, too, which is why it’s important to have the whole team, to have your primary care doctor, to have your psychiatrist, to have your, the whole team, you’re a whole person. Bipolar disorder is not the only illness you may have that you need to be addressing.

Gabe: So, in that same vein, I found a whole bunch of strategies on the internet for people who are experiencing memory issues, brain fog. And I got to tell you, I was really shocked at how easy many of these strategies were. And the very, very, very first strategy that comes up on pretty much every podcast, every blog, everywhere for how to work through brain fog or memory loss or short-term memory issues or cognitive impairment is use your phone, use technology, set a reminder on your phone and have it ding you. Have it remind you to take your pills in the morning. Have it, have it send you a text message an hour before all of your meetings. Use the calendar app to organize your day so that you don’t have to worry about it. Look the day before to figure it out. You don’t have to remember that you have an appointment in two weeks. The app will do it for you. I live by my calendar, Dr. Nicole. You and I would not be here recording right now

Dr. Nicole: Mhm mhm. Mhhm.

Gabe: If I didn’t get a calendar reminder, and I didn’t check the day before as a habit. Right where I look at my next day and I’m like, all right, this is the time I meet Dr. Nicole. And just I’m going to give you a behind the scenes of the podcast listeners in the invitation that Dr. Nicole and I use, along with our producer, Lisa, want to give her a shout out, is the topic. I don’t even have to remember the topic and get this. Are you ready? It gets even better. In the calendar notes are talking points and links of things that we discussed when we came up with this. We’re. You think Dr. Nicole and I are remembering this stuff from the time that we schedule the appointment, come up with the topic until now? Nope. We’re just doing it. And I think anyone listening is like, well, duh, why wouldn’t you do it that way? That’s just, business is run off calendaring.

Dr. Nicole: Uh-huh.

Gabe: Yeah. And you can run your life and interference for bipolar disorder off of calendaring as well.

Dr. Nicole: And you sure can. My whole life is surrounding a calendar. Everybody in my house has a different color on my calendar. I have my business calendar, my personal calendar. And I’ll be totally honest with you. And sometimes patients look at me a little crazy. They tilt their head and give me that RCA dog look like, huh? You do that sometimes. It’s how I keep up with people I care about. Birthdays. It’s how I remember to call, you know, my godmother or my aunt regularly so that they know I still love them. I love them, but sometimes I just can’t remember that kind of stuff. It’s not something I’m really good at. So, I have no problem telling people to put everything on there. If you want to do something special for your, for your wife or your husband, and you know that you’re not the kind of person who’s going to effectively remember to do those things randomly, put it on the calendar every other month, pick a random date, send flowers. There is literally nothing that you want to do on a regular basis that you cannot put on your calendar.

Gabe: I love that you brought up birthdays, because we all know that we got better at our friends’ birthdays because of Facebook.

Dr. Nicole: Absolutely.

Gabe: I don’t care what anybody says. All right. I

Dr. Nicole: Absolutely.

Gabe: Started to get so many birthday cards and messages and phone calls after I got on social media. Before social media, my mom and my grandma remembered. After social media, everybody out of the woodwork. We’re so glad you’re born. We love you. I’m

Dr. Nicole: Right.

Gabe: Like, I didn’t even know it was my birthday. How did you.

Dr. Nicole: Right.

Gabe: Yeah, yeah. Facebook changed the birthday landscape.

Dr. Nicole: And that is a great point, because when you get those happy birthdays, even if you know those people only remembered because Facebook told them, it still feels nice to have people remember you on your birthday. So, a lot of times people will give me pushback about putting too many things on their calendar if they’re having cognitive symptoms because they say, well, that doesn’t feel genuine. I have to put on the calendar, call my grandma. That does not feel very genuine. Do you think your grandma knows that? Like, do you think that when you call grandma, she’s going to ask you, did you only call me because I was on your calendar? Now I recommend you not start the conversation off with, hey grandma, I called you because it was on my calendar. My reminder popped up and I said, oh, let me call grandma. Don’t do that. Just call and say hello. But I can guarantee you her feeling on the other end, which is what you really care about when you’re calling somebody to check in, is going to be no different whether it’s planned or not.

Gabe: Building off of that, it’s the same thing with these strategies. You don’t need to tell people that the reason you’re adding all of this to the calendar is because you have brain fog. Just say this is the process. This is how you do things. In fact, I’ve made it work to my advantage. Whenever I book a speech or anything. Right? I’ve got to get a lot of information. Phone numbers, contact names, what they want me to talk about, what they booked, contract rates, etcetera. That’s a lot of stuff to remember. And I don’t say, hey, listen, I have brain fog. I have trouble focusing. My short-term memory is not great. So, it’s really important I write all this down. Of course, I don’t say that, but here’s what I do say. I say, hey, I’m going to give a lot of speeches between now and your speech. So, I want to make sure that nothing gets missed in that process or that I don’t conflate anything. So, and notice I get in there that, hey, I’m going to do a lot of work. I’m in high demand. I’m right. And these are not managing bipolar techniques. These are just sales techniques. I learned these in sales classes. I did not learn these in therapy.

Gabe: You know what? No car is used. It’s pre owned. No house is small. It’s cozy. All right. It’s that kind of logic. Figure out another reason that you’re doing what you’re doing. And honestly, I don’t know that people care at all. We probably give too much information to try to hide the thing. What is it? Doth protest too much. We could probably just go with, hey, I need this information. And most people are just going to give you the information. I want to switch gears to another coping strategy that is, that is kind of along the same lines, but slightly different. It’s when you’re in a meeting, so many people are like in a meeting and you’re like, look, I’m having I’m having trouble focusing on what everybody’s saying. I don’t know what’s going on. There’s a few things that I want to say about meetings that I think a lot of people miss. One, if you are in a big meeting and someone’s keeping minutes, that’s a hallelujah moment right there. Somebody else is keeping notes to jog your memory for you. So go ahead and just find those minutes. So many people attend all of these meetings and they don’t realize that minutes are being kept. If minutes are being kept, find them. But if they’re not being kept, you need to keep your own minutes.

Gabe: I bring up minutes for another reason. There’s all kinds of podcasts, articles, writings, trainings on how to keep minutes. And the specific thing about minutes is they’re designed to quickly jog your memory. Right. And what are we talking about? Quickly jog your memory. They’re also designed to be kept quickly. Right. So, during the meeting, as the meeting is going on so nothing gets missed, you’re not writing a novel here. Go ahead and Google how to keep minutes. That is not a skill for people with bipolar disorder. That is a skill for the secretary of the board. That is a skill for the administrative executive assistant. That is a skill for whoever raises their hand too slow and gets stuck keeping the minutes for that meeting. But it absolutely will help you. A person experiencing brain fog, a person living with bipolar disorder. Keep quick notes, pay attention and be able to jog your memory later. And if anybody asks you what you’re doing one why are they asking you that? Like, that’s weird. You know, they’re ultra focused on you. That’s just that’s just a little extra tip. But if anybody asks you what you’re doing, say, look, this is very important, and I want to make sure that I don’t miss anything.

Dr. Nicole: Yeah, that’s also not a Dr. Nicole skill either. I should share I am also not a minute taker in in meetings. So not just not just a job that maybe someone with bipolar disorder struggles with. There are a lot of us who might struggle with those kind of memories and those kind of tasks. What else is on your list? What else you got there?

Gabe: This next one. I think that people with bipolar disorder and people in general are naturally doing but one, it’s to break up a big task into smaller parts. I am really guilty of this grandiose thinking, right? So, brain fog and grandiosity merge where I think to myself, all right, I want to do something gigantic and I only focus on the gigantic thing. So, for example, we’ll use this podcast. I say, I want to put out a podcast episode, and I become ultra focused on the podcast episode coming out. But that doesn’t serve me what I need to do. And what I do is break it down into smaller tasks. Step one, come up with a topic. Step two, schedule the topic. The recording. Step three, research the topic. Step four, record the topic.

Gabe: Step five, edit the show and on and on and on until you end up where you want to be. By breaking the podcast down into what actually comes out to about 15 different steps for just the show you’re listening to right now. There’s 15 separate steps, give or take, that I need to do. If I just said, hey, I’m going to release a podcast, that becomes this overwhelming thing. But if I just say, hey, my goal is to schedule a doctor Nicole boom, done. Hey, my goal is to pick a topic. Boom, done. And then all of these things add up to the big thing. And here’s the beautiful part. Eventually it does add up to the giant part. The podcast does come out. You graduate from college, you get the job, you achieve the goal. And that feels, it’s so empowering and it’s so beautiful and it’s so wonderful. And again, I’d like to remind the audience, I don’t think this is a brain fog bipolar skill.

Dr. Nicole: No.

Gabe: I think this is a life skill.

Dr. Nicole: Yes, yes. And I will add, I think a potential strategy could also be to figure out how to decrease fog from other reasons. So, make sure you’re sleeping well, because not getting adequate sleep will completely derail your ability to be sharp and focused and kind of with it like you’d like to be and present. Making sure if there are any substances involved, you know, alcohol, illicit drugs, whatever it is, you know, do those things, add to it? So, I think a great strategy is to just take a step back from your lifestyle and figure out what other things that are going on with you, whether it’s activities or lack of activities, are adding to the fog.

Gabe: First off, I want to remind our audience that you can Google this stuff. Google routines, Google accomplishing goals, Google fighting through. There’s so much more than we can give you on the podcast. And I want to make sure that, you know, that I just I just kind of pick some ones that that were meaningful to me or that would help me.

Dr. Nicole: So, if you Google it, there’s a ton of examples online. But what did you personally do to deal with your brain fog?

Gabe: The biggest, biggest, biggest thing that works for me is keeping notes on everything. I write down everything that listen back in my dating days. All right, I would I would write in my phone the woman’s name I was dating, and then I would put in parentheses what dating site we met on. So, for example, when I first met my wife, she was Kendall parentheses, OkCupid and years later we are now married. We own a house together, we own a dog, and we’re, like, testing our new phones. And she calls me to make sure the phone works and it pops up. Kendall. Okcupid. And she looked at it and she goes, what the hell is this? What is this, Kendall? Okcupid? I said, well, yeah, it’s how I know you. And she just glared at me. Now listen, you’re in my phone as Dr. Nicole podcast. I’ve got my I’ve got the vice president of Healthline is, you know, Brendan comma, Healthline vice president. And just on and on and on and on and on. Even my mother-in-law is in there as Pam, mother-in-law. So, when I say that, I take notes on everything, there is nothing that I won’t write down and I do it with my phone. I have found sincerely so much benefit from making technology work for me. And not to belabor a point, I want to say another thing. I know that social media is evil. I’m not saying that it’s not evil, it’s evil. But you can make social media work for you.

Gabe: When the Timehop app came out, it was the best thing that ever happened to me because I would take pictures of vacations and family events and movies and date night with my wife. And then a year later, Timehop would be like, remember last year when you did this? And I was like, no, no, I didn’t because of short term memory issues, because of brain fog, because of bipolar disorder, because of aging, because of life, because of my pessimistic nature. No, I forgot about the time that my wife and I dressed up and went to see a Broadway play. You know, when Broadway toured through central Ohio. I forgot about that. I forgot about that. That nice lady who agreed to take our picture because we were struggling to take the selfie. And Timehop reminded me of that. So, when I say find a way to write this stuff down and make it work for you, use everything at your disposal. Because the one thing that I’ve noticed about brain fog is it never has a problem remembering the shitty things that happened to me, but brain fog has a real problem reminding Gabe of all the good things.

Dr. Nicole: Regardless of what stage you are in your bipolar disorder, the honest to God truth is you will always be evolving. You will always see changes. We talked about changes as you age, changes as your medications change. There are constant changes so you being able to adapt and change along with those changes that are happening within you. It’s the only way that you’re going to be able to manage your bipolar disorder in a way that you feel good about, and that you can feel proud about.

Gabe: With that we will head out. My name is Gabe Howard and I’m an award-winning public speaker and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon. However, you can grab a signed copy with free show swag or learn more about me just by heading over to my website, gabehoward.com.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych or on my website, DrNicolePsych.com.

Gabe: And, hey, do us a favor. Wherever you downloaded this episode, please follow. Subscribe to the show. You don’t want to miss anything that Dr. Nicole and I are going to talk about. And hey, do us another favor. Recommend the show, bring it up in a support group, bring it up in an online forum. Bring it up on social media. Hell, send somebody a text because sharing the show is how we grow. We will see everybody next time on Inside Bipolar.

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