In 1964 I was 8 years old. Back then you could take a car out of park without needing a key. I did that by mistake once and it taught me one of the most important lessons of my life. A lesson that can be easily translated to the way we treat bipolar disorder. Our family car was parked in the driveway which sloped downhill to the road. I was playing in the car by myself when I inadvertently shifted into neutral and the car started to roll downhill towards the street. I knew enough from watching my parents drive that one of the pedals would stop the car. So I pushed the brake pedal with all my might and the car stopped rolling towards what I was sure was a terrible accident. But at 8 years old I was too small to be able to both hold down the brake pedal and see over the dashboard out the window. That also meant that nobody could see me. As I got tired and I let off the break, the car started rolling downhill again. I was in a total panic and could not figure out what to do. To my luck, my mother came out looking for me and found me in the car. She reached in and put the car back where it belonged and saved the day. I learned that day that the most important thing about a car is learning how to stop it. But if that's all I ever knew about cars I would've never been able to discover how far they would take me. That is where most people are today when it comes it comes to bipolar disorder. They have learned how to put on the brakes but they have no idea how to actually function while manic or depressed. The trouble is, neither does anyone else. And so everyone assumes that the only thing you can do about bipolar disorder is put on the brakes. But, as we all know, sooner or later mania or depression comes back when the brakes stop working.
Imagine you've never seen a car before and the first one you see was involved in a fatal accident. You express how tragic that is and that you would really love to be able to help keep that from happening to others. They show you videos of all kinds of car crashes and tell you how many millions of lives are devastated by them. Since you don't understand the utility of having cars, you may suggest doing away with cars altogether. Or perhaps creating a 20 mph speed limit on all roads. Neither of these solutions would work, of course, because you wouldn't get any compliance from those who have cars. It would be far more productive to study all of the costs and benefits of having cars and use that study to determine the best desired outcomes. In this case, the premise would change from “cars are inherently bad” to recognizing that cars have value but are also dangerous. The focus of all efforts would be to maximize the usage of cars while minimizing the accident rate. Starting from such a premise would lead you to suggest that better education and training would make better drivers. In looking for people to perform that education you would be looking for the those who drove the best and not those who crash every time they take the car out. Those of us who are performance driving enthusiasts are looking to learn from the top race drivers for the ultimate education. Nobody would give a platform to those who have not developed winning skills, nor would we ever take lessons from anyone who crashes every time he/she gets behind the wheel. Their premise that we cannot drive at high speeds would keep them from ever winning. But that is exactly the premise of those who control the conversation about bipolar and you can see it even in what they call it. Always appending disorder to the word bipolar is akin to always appending accident to the end of automobile. In other words, saying “bipolar disorder” is the same as saying “car accident” every time you mention a car.
Bipolar IN Order has been an incredibly interesting journey. With each new year come new insights that build upon breakthroughs from previous years. Although it feels like each breakthrough is the furthest that we could possibly go, the next year always proves that there is more to learn about depression and mania. And this year is no exception to the rule. My breakthrough this year is that even in my deepest depression I can be just as productive as in any other state. One of the aspects of the Bipolar IN Order program is that we can find value in every moment of our lives. While that value is relatively easy to see when we are at states that are inside of our comfort zone, it is often very difficult to see any value in the more intense states. This is especially true when the intensity of the states are way outside of what is comfortable for us. But as we expand our comfort zone and learn to function in the more intense states, we learn to find value even in such intense states. Many students of the Bipolar IN Order online education program have expanded their comfort zone range to the point where, no matter what state they find themselves in, they are confident in their ability to function while the state is happening. I have long argued that we need to contrast the difference between the value of the insight found in depression and the things we can accomplish in hypomania. While low levels of mania do enable us to get more things done, the advantages in depression include that we gain tremendous insight from it even when we are not very productive at getting things done. Most people who learn to see the insights in depression can understand the contrast and value the insights over getting the dishes done, for example. It is, of course, a far more complex equation but I hope you see the point from this simplistic example. This new discovery turns that argument on its head.
A common refrain in the bipolar disorder community is "I'm doing the best I can.” Every time I hear this or a similar phrase my heart weeps. I know all too well the feeling of despair and hopelessness that comes with it. There were so many times, while in tears, I used the exact same phrase. Whenever I hear it now, I want to reach out and empathize with the person so she does not feel alone. But at the same time I find myself conflicted. I know from my own experience, and from helping so many others, that the results we based the statement on was not the best we could do. Not by a long shot. That part of me wants to say, "you are stigmatizing yourself into accepting a life that is far less fulfilling than what you're capable of." I have struggled with this conflict for many years and I'm finally ready to go public with it. Allowing such statements to go unchallenged not only harms the person saying them but also stigmatizes everyone else into believing that the best we can do is to continue to suffer with a dis-ordered relationship to the bipolar condition. I wonder if my first compassionate inclination is not really compassionate at all when we consider it prolongs suffering in anyone who buys into the sentiment. The most compassionate thing is to help everyone create better outcomes so that bipolar is no longer a disordered condition and instead becomes an advantage in their lives. It is especially disconcerting when I hear such statements from people claiming to be "experts" who are giving advice about how to deal with bipolar disorder. I know it gets them sympathetic comments and the feeling that they are relating to their audience, but aren't they just telling their audience to accept the same limitations that they have accepted?
I know depression. It destroyed my life in my thirties and almost killed me in my early fifties. Back then, had anyone dared to tell me what I am about to say to you, I would have gotten very upset. I could not imagine that there was anything good about depression. Can you? What you are about to learn could change your mind. By using a new approach to working with depression, I had prepared myself for probably the most extreme crisis our family has ever faced. When I was first diagnosed with bipolar disorder, I wholeheartedly bought into the idea that depression is a dark hole from which the only hope is to escape. It was certainly impossible to function well during deep depression. To function while deeply depressed meant to stay alive and minimize the harm it was clearly causing in my life and in the lives of those around me. High-functioning as related to depression meant that I needed to find ways to get out of it and back to a state where functioning in any productive way was possible. Finding agreement for such beliefs is easy. Finding someone who challenges those beliefs is difficult. Even more difficult is letting go of society's belief that it is impossible to function while in manic or depressed states. But once you become open to the possibility that you can learn to function during manic or depressive states, your life will change in ways that you cannot imagine. You will come to understand something that few people do. You may well consider it the most important lesson of your life.
I recently watched a movie about the life of Jackson Pollock. (Sony Pictures, Ed Harris, 2000) It left me thinking about how a generation of young artists were taught the mythology of the Abstract Expressionist painters, not just the concepts of their work. What got passed down along with the art history was the Modern American version of the myth of the tormented artist. The same mythology has been used in mental health. "At the mercy of her moods" was a very 19th century expression. That phrase along the the term "hysteric" was often used as justification for why a woman could not achieve or do certain things. Emotion and mood were used to keep women from equal status with men as they were portrayed as weaknesses instead of the strength that they actually are. The expressions were also applied to 20th century artists. The implication in all cases remained that the person was somehow taken over; that mood was stronger than their ability to handle it. It was someone of a sensitive, delicate, and susceptible personality who was prone to these episodes, illnesses, or disorders. The literature about artists in the 19th and 20th century is replete with these concepts.
Bipolar disorder is an incredibly complex condition. It can be approached from so many angles that you might specialize in any one of them. Unfortunately, most of the specialized approaches will do you no good when in the throes of an intense mania or depression. The only thing that matters at that point is whether your specialty is knowing how to function during the state. I find many of the points of view about bipolar disorder to be immensely interesting. The biological aspects are fascinating; the research that has looked at the inner workings of the brain, the electrical and chemical reactions within it, and the influence of external substances is fascinating. Researchers have found some truly amazing things through that approach and it has made a huge difference in many peoples lives. But there are so many other approaches that I find just as interesting and have proven equally fruitful.
I have been trying to let everyone know that it is possible to find value in all states, including depression. The following was written by Margaret Miller and it so captured what I have been trying to say that I asked her if I could share it. I hope you love it as much as I do. Manic-depression left a decisive scar across generations of my family. For each of us who bears that mark, moods have conferred advantage, as well as disability. I don’t mean the energy of hypomania. That’s a fun enough ride, while it lasts. But it’s nothing compared to the unexpected and enriching gifts of depression, like patience, humility, insight, and empathy.
Do you suffer from bipolar disorder or know someone who does? If you want to end all suffering you need to understand the difference between why and how. The reason so many people are still suffering is because this difference has not been made clear enough. Why do people go to a psychiatrist? To end the suffering. Why do they go to a therapist? To end the suffering. Why do they engage in any treatment regimen? To end the suffering. We don't go there for medicine, for therapy, or for any of the other tools that we are given. We go there in hopes that they can help us remove the suffering. And we didn't go there seeking remission for mania or depression. We went there to remove the suffering. We were told, though, that remission and the tools that aim to produce remission is the way to do it. Does remission work? Perhaps temporarily. But in the end we must admit that the answer is no. And that is the conclusion of the biggest research on bipolar disorder ever conducted by the National Institute Of Mental Health. The research is called STEP-BD and this is what they say: "According to the researchers, these results indicate that in spite of modern, evidence-based treatment, bipolar disorder remains a highly recurrent, predominantly depressive illness.” In other words, even if remission did end suffering temporarily it will not remove it permanently.
Do you have bipolar disorder or know somebody who does? What would change if you could learn how to turn depression and mania on and off whenever you wanted to? The entire way we look at bipolar disorder would change in profound ways. Some of them are beyond most people’s imagination, but a simple illustration will help you to see why some of us say bipolar is an advantage that we do not want to give up. Please understand that I am not talking about people who do not know how yet say “snap out of it” or any other offensive phrase, but the actual ability to do it which is an incredibly advanced skill. I have been openly sharing my journey and exploration of the possibilities with bipolar for over 10 years now. It seems that sometimes I push the boundaries a bit too far and am met with pretty hostile pushback. This is a dilemma for me because I want to help others but I am afraid that this time it may be perceived once again as going too far. Nonetheless I have been thinking about and working on this idea for the better part of this year and I feel it is the most significant breakthrough that I have made so far in my understanding of bipolar.
Robin Williams killed himself yesterday. I tried to kill myself August 8th of 2005 so I know perhaps a little bit about how he felt. My best friend Santiago killed himself in November 2005 so I also know what it feels like for those who are left behind to sort it out. I have been contacted by several people since the news of Robin Williams' suicide. His action has brought up a lot of painful memories and they wanted to reach out and talk about it. I read this morning that Robin hung himself and that's the same thing Santiago did, so I feel compelled to reach out too. I have often heard that we should process the pain so that it eventually goes away. But I don't think it actually works that way. I think we become comfortable with the pain while it gets covered over by recent experiences, yet it remains for the rest of our lives.
I have long argued that the X-Men movies are a great metaphor for bipolar disorder. When X-Men: The Last Stand came out I wrote an article about how the X-Men’s struggle to control their “super powers” are analogous to our struggles with mania and depression. When the newest movie came out I was hoping to see further evidence in support of my ideas and was not disappointed. There are so many parallels between X-Men: Days of Future Past and bipolar conditions that I could write several articles about them, but I want to just briefly mention a few and then focus in on the one that I find the most meaning in. The movie mentions meds, genetics, and mental difficulties, but the parallels to my own views on depression is uncanny. Meds Medication plays a central role in the movie. Hank uses a special formula to control his tendency to turn into “the beast.” Based on that formula, Hank creates a different version for the young Charles Xavier to use to control his condition. Young Charles takes too much and loses his ability to function at all. The parallel to common experience with psych meds is pretty obvious. Later in the movie, young Charles tells Eric that the meds help him to walk. Eric mocks him for trading his power for the ability to walk and young Charles responds that he takes meds because it helps him sleep. The way he says it indicates that without the meds his life is unbearable. Genetics
There is a new effort to promote complete remission as the goal of treatment for people with bipolar in disorder and I am fundamentaly opposed to it. I have written about the topic many times, so I will repost the article that had the...
Bipolar in disorder combined with anger is a very dangerous mix. The disordered person tends to become very volatile and can explode into a rage with little provocation. It is best for the person to avoid anything that might trigger anger until the disorder is in remission, but even then an angering stimulus can trigger another manic or depressive episode with anger as one of the troubling elements. Bipolar people who have their condition in order have learned important lessons that can be applied to most of our experiences. For example, since we understand bipolar so well that we can function highly during depression and mania, we can also handle more intense states of anger without losing control. As with every experience, most people can usually function fine when anger is at a very low intensity, but when the intensity of anger increases beyond their comfort zone they begin to lose the ability to choose their response to it. They act in ways that are less than optimal. They may even become a danger to themselves and others if the anger becomes too intense.
Individuals and organizations throughout the world are dedicated to the important work of removing the stigma that affects people with depression and bipolar disorder. Unfortunately, too many of them are replacing one type of stigma with another type that is making the situation worse....
The part of our minds that most people identify with is the part that silently talks to us with a running commentary. We listen to it all day long. Let’s call it “The Talker.” “The Talker” prefers pleasure over pain, happiness over sadness, winning over losing, health over sickness, and any of the other judgments that help us navigate our lives. Although it plays a critical role that we cannot live without, “The Talker” is stuck in the duality that makes us judge one thing better than another. It does not allow us to experience the world without judgment. The central principle of mindfulness is to look at experiences without judgment. Adherents of mindfulness often speak of the part that practices mindfulness as “The Watcher.” It lives outside of the duality and sees everything as equally valuable. Mindfulness is a wonderful practice that increases awareness of what is really happening because “The Watcher” does not ignore or accentuate details based on preferences. Unfortunately, many claim that mindfulness leads to happiness. As happiness and sadness are judgments based on preferences, this breaks with the whole concept of looking at our experiences without judgment. Mindfulness practiced properly does not lead to happiness; it leads to a greater awareness of whatever you are experiencing whether you like it or not.
We get a lot of calls from parents who are looking for help with their bipolar children. We make great progress within the first few visits, but too often run into an underlying issue that needs to be addressed. While the bipolar issues are certainly part of the problem, the family dynamics are a bigger issue. Since the child has usually been diagnosed before contacting us, the parents assume all conflicts will be resolved as soon as the child is no longer in disorder. All issues are seen as being caused by bipolar disorder and the rest of the family is completely innocent; it is as if the diagnosis suddenly made everyone else perfect. This does not happen when the parents have been diagnosed with any psychological issues. The parents recognize their own issues that need to be addressed and how those issues play a role in the conflicts. Even if the diagnosis is completely different from bipolar disorder, there is a recognition that nobody is perfect and we all have room for improvement.
Some call it 'state specific memory,' but after ten years and thousands of interviews I prefer to call it 'bi-cycling delusion.' It is the delusion that comes with the bipolar cycles and a primary reason people remain in disorder even with the best intentions. Bipolar is a cyclical condition. We cycle through depressions and manias, sometimes reaching intensities that cause a crisis for us. We also periodically cycle into remission. It might be easier if the cycles were predictable, but for many of us they are completely random. For far too many of us, each cycle has a state-specific delusion that keeps us from moving toward Bipolar IN Order. We all know about delusions that come with intense states of depression and mania, but it is the delusion that comes with remission that holds many back the most. It fools them into thinking they have bipolar under control when in reality they are just in one of the cycles.
I attended a great presentation at the APA annual conference in San Francisco about Achievement, Innovation, and Leadership in the Affective Spectrum. Four distinguished panelists gave presentations about their research into why people with bipolar disorder tend to exhibit advantages in some parts of their lives. They said it was the first time ever that the APA had such a discussion and it was a great honor to be a part of it. First up was Sheri Johnson, PhD, who teaches at UC Berkeley and does basic research on mania. Her talk was about how people with bipolar disorder are more reactive to rewards and goals in their lives. They tend to work harder toward such goals and refuse to give up long after "normal" people do. Dr. Johnson is currently conducting studies to understand the greater reactivity to success in this population, using paradigms drawn from neuroimaging, emotion, information-processing, and impulsivity literatures. She is also considering other psychological traits that might relate to outcomes in bipolar disorder, including stress reactivity, emotion regulation, and social dominance. She believes that figuring out why mania is linked to success will lead to better ways to predict manic episodes.
Please check out our newest video - Eight Essential Steps To Freedom From Bipolar Disorder - This is from the keynote presentation at the annual conference for the California Association of Marriage and Family Therapists - Please comment and share with anyone you think...
When I look at how they account for time in the DSM-V, I wonder if they know anything about depression or bipolar. They know time plays an important role, but they don't seem to understand the role that time plays whatsoever. By the way they define it, you can have a very low intensity depression for 14 days and it's called depression, yet an intense depression for 13 days doesn't count. This makes no sense at all, yet is the only accounting for time they provide. Properly accounting for time takes an understanding of the relationship between time and intensity. You cannot learn that relationship by asking people a brief checklist of common symptoms as is done in the currently popular assessments. You need to know the right questions to ask. I learned the right questions by doing more accurate assessments that include asking about the relationship at different intensities between awareness, understanding, functionality, comfort, and value mentioned in the previous articles in this series. This led to a deeper understanding of how to ask about time. The most important question to ask about time is how long before each level of intensity causes one to lose functionality. When we base the answer on a thorough functionality assessment, we understand the relationship between time and intensity in ways the authors of the DSM completely miss. Although intensity is a major factor in predicting how long one can remain highly functional, there are many others equally important. If one is not aware of the lowest intensities of depression or mania until functionality has already been lost, for example, there is very little time to do something about it and avoid another crisis.
Assuming you are not deeply depressed right now, try to remember the time when you were in the deepest depression of your life. Can you see any way it might have changed your life for the better? Did it make you more sensitive to the feelings of others? Are you better at helping others during their difficult times because you have had the experience yourself? Are there things you learned from being deeply depressed? Are you a better person because of the experience? What is the value in having been through it? On a scale from one to one hundred, how would you rank the value in having been deeply depressed? These seem like unusual questions to some people. Wouldn't we be better off trying to forget our depressions and get on with our lives? Can't we just hope that depression remains in the past and we never have to face it again? Ignoring past episodes may sound like a better approach, but refusing to take a hard look at depression or mania leaves us ill prepared for the next time it comes. Unfortunately, if depression or mania happened before, it is likely to happen again. Looking at how we value depression and mania is an important part of any assessment; a part that is sorely missing in most protocols. The laundry list of symptoms in most assessments belie an incorrect assumption that the items are all seen as negative. We have been asking the above questions (and many more) for several years now and have learned a great deal about the role value plays in depression and mania. Although our data is not yet extensive enough to make final declarations, there are many surprising trends that are too important to delay sharing.
Understanding the role of comfort is critical for getting Bipolar IN Order. To do so, we must measure comfort at each level of intensity for both mania and depression. When we compare comfort levels to awareness, understanding, functionality, value, and the time before escalation, we find the optimal intensities where bipolar is an advantage in our lives. In any aspect of life, those who only seek comfort are consigned to mediocrity and boredom. Those who judiciously step outside their comfort zone and challenge themselves are the ones who learn and grow. This is equally true with mania and depression. The best growth, though, happens just slightly outside the comfort zone. Too far outside and the lack of comfort can cause you to shrink instead. Too many times, bipolar people step too far outside their comfort zones and find themselves at an intensity of depression or mania that is far beyond their control. Many of them become so frightened by it they hide inside their comfort zone hoping to remain there the rest of their lives. They accept a diminished story of their lives because they believe they have no other choice. They fear one wrong step will rapidly escalate back to an uncomfortable and out-of-control state. When we carefully assess comfort (along with the other criteria) at various levels of intensity, we find close relationships between understanding, functionality, and comfort. One's level of understanding, if accurately assessed, predicts the levels of functionality and comfort, for example. One's level of comfort also influences the ability grow in understanding and function more effectively; all three are intimately tied together. Such assessments lead to a far more accurate identification of the demarcation lines of an individual's comfort zone. These assessments also help the individual to recognize the next level of intensity where depression or mania has just begun to go too far. The ability to find the zone between the lines is the key to success. We need to cross the line and go outside of our comfort zone to grow, but not so far that lack of comfort harms us.
Many bipolar people say they are "high-functioning," but most of them mean they function OK when in remission and cannot function when things get too intense. How well one functions DURING depression or mania defines the difference between Bipolar Disorder and Bipolar IN Order. At every intensity, functionality influences the comfort of everyone involved and whether they see value in the experience. Functionality should be the central focus of any approach to bipolar instead of simply trying to make it go away. Many think intensity of depressive or manic episodes is the determining factor in functionality, but evidence contradicts such belief. Far more important are awareness and right understanding as outlined in the previous articles in this series. With enough education and practice, intensity becomes far less relevant to functionality than most people believe. Functionality does not mean driving as fast as your car will go or talking so much you take over the conversation. It must include the ability to do the things necessary to function in society. Measurements for physical, mental, emotional, spiritual, social, and career/financial productivity need to be part of the analysis. Real functionality includes the ability to get along with others and for them to be comfortable with your behavior. The functionality scale, like the other items in the graph, runs from zero to one hundred percent in increments of ten. Fifty is a normal person during normal times. Less than fifty means that depression or mania is causing one to function less well than normal, whereas above fifty means functionality is enhanced.
When I first started putting together the protocol for assessing depression and bipolar disorder, I was working with a professor of Psychiatry to make sure the ideas were sound. His advice was to combine both awareness and understanding in the graph to keep it simpler. I am glad that I did not take the advice. Awareness and understanding are different in ways that matter. Expertise might help someone understand why things happen, but does not necessarily lead to increased awareness. An expert on sex, for example, may be totally unaware that his wife is having an affair. It takes awareness (covered in the first article of the series) to know what is going on whether you understand the phenomenon or not. It turns out that understanding is more related to functionality (covered in the next article) than awareness. You may be completely aware that you are sitting in a car, but unless you understand how to operate it you cannot drive. Understanding is not just about knowing the physical, mental, emotional, spiritual, social, and career/financial aspects and their implications, it also includes knowing about the tools. You need to know how the tools work, have proficiency in using them, and understand which ones to use at each stage of bipolar - the disordered stages of Crisis, Managed, and Recovery, and the IN Order stages of Freedom, Stability, and Self-Mastery. I call this functionality-based understanding. Too many people are holding out those who cannot function as the ones we should be listening to. Those who only know bipolar disorder and have not created Bipolar IN Order in themselves or others have no understanding of what it takes to make it happen. They can learn, but many times their beliefs limit their willingness to do so. They keep insisting it is not possible to be highly functional with bipolar and refuse to consider the evidence that contradicts such beliefs.
You can live in the same neighborhood for thirty years and still have little idea of what is going on there. You can shop in the stores, eat in the restaurants, talk with the neighbors, and feel that you know the community very well. But there are still more things going on than you know about. You simply never knew to look for them or were never taught how. The police that work in the area know about crimes that go on right in front of you. The pest control people see things in the restaurants that might shock you if you knew they were there. Everyone from the woman in the plumbing shop to the guy selling pot (maybe even out of your own house) see things going on that you do not. The preacher knows about the spiritual goings on and the neighborhood doctor sees all of the injuries and illnesses. When a thief sees a saint all he notices is his pockets. We all only see the things we have been trained to look for. As Paul Simon famously sang, "We all see what we want to see and disregard the rest." The same thing is happening in the depression and bipolar worlds. Many doctors and therapists only see it as a disease, family members see behaviors, and people with depression only see pain and suffering. There is so much more going on that none of them have been taught how to see. I have been teaching all three groups for ten years and am amazed how little awareness there is about very important details until I show them were to look.
Moving From Bipolar Disorder To Bipolar IN Order Everyone has up and down times. It is a natural part of life. If we observe our lives over time we might say there are two poles that we have; some days we feel on top of the world and other days perhaps on the bottom. That is the basis for the word bipolar and the reason I say that everyone is bipolar. Some may argue that there are people who are unipolar and only experience the up or down side, but even they have a range of experience with a "pole" on each end. Unfortunately, the word bipolar is generally used to describe a subset of people who have adverse reactions when they go to far toward the high and low poles. Although related to how far from center one is, there is no distance from center that guarantees one would necessarily react to it in an adverse way. It really depends on how far we are from our comfort zone. One person might be perfectly comfortable and highly functional at a certain point from center while another could be so uncomfortable that he/she is literally in danger of suicide. I see the comfortable person as keeping life in-order, while the person in danger of suicide has lost control and is in dis-order. Using bipolar as a term to describe the dis-ordered person is an over-simplification that goes too far. We should at least distinguish the difference between having Bipolar Dis-Order or Bipolar In-Order. But life is not even that simple. If I just won a marathon, for example, I might be very high emotionally yet completely drained and low physically. To really see where we are on the spectrum from high to low we need to consider all of the aspects of our lives: physical, mental, emotional, spiritual, social, and career/financial. It is probably more accurate at any given time to say that we are really in a "mixed state" instead of somewhere on a straight line between the two poles, so we must see even the expansion of bipolar to Bipolar Disorder and Bipolar IN Order as just a convenient simplification of a much more complex topic.
The Experts Are Asking The Wrong Questions About Depression And Bipolar Disorder. Over the last ten years I have spoken with thousands of people diagnosed with bipolar disorder. When I ask them to relate their story of how they were diagnosed, a troubling pattern is pretty evident; the diagnosis was very brief and largely irrelevant in regards to bringing any hope to the situation. Most people I have talked with see the assessment as a life sentence with no path for making life work the way they had hoped for. I wonder where they got that idea? For the last five years I have been speaking to groups of therapists and doctors. When I tell them assessments are not thorough enough they are often in agreement about others, but believe their own assessments are very thorough and use the best evidence-based tools available. What tools? The Beck Depression Inventory (BDI) takes about 10 to 15 minutes to complete the 21 questions in a self-report format including the items intended to measure symptoms of severe depression that would require hospitalization. The BDI has been used for 35 years and is reported as being highly reliable regardless of the population. The Hamilton Depression Scale asks only 17 questions. There are others, of course, but none provide the insight needed to achieve Depression IN Order or Bipolar IN Order.
I have been meditating for over 50 years. I started when, at five years old, I became fascinated with watching my breath go in and out. I intuitively knew that this and other meditative practices would bring me to a state of ecstasy. It didn't take long before pursuing that state became the most important thing in my life. Although I got incredibly close through my efforts in meditation, it wasn't until I looked for ecstasy in depression that I truly found it. Once I found ecstasy in depression I found it everywhere. My hope is that sharing my experience might help others to find the same insights that I have. As I watched my breath go in and out I found some dramatic changes in my state of consciousness. I would detach from my body and find myself floating above and looking down at myself sitting there. It was a very pleasurable state, but also very profound in how I viewed the world. I believed that part of me was untouched by the physical world; the part that I now call my soul. It wasn't long before my soul separations started encroaching on my waking states. I would often find myself turning the corner and suddenly being in a long tunnel with a light at the end of it. During those experiences time would stand still or at least slow down dramatically. I interpreted these experiences as seeing God.
Stigma, medication, treatment options, recovery, patient rights and physiological basis are some of the most discussed topics regarding bipolar. There are, of course, many other interesting aspects to debate, but it is hard to find any discussions about bipolar that do not include one or more of these central topics. While it has been very healthy to debate all of them, there is an underlying assumption that must be addressed too. The paradigm that all of the above topics are based on is that we are incapable of remaining in control when mania and depression reach a certain intensity. We are therefor not responsible for our behaviors when manic or depressed because it is not possible in those states to choose better ones. This creates the goal of removing bipolar from our lives (at least at higher intensities) and the debate is about how it is best done. Much of the debate about medication, for example, is about alternative methods to achieve the same goal of reducing intensities of mania and depression. But, what if we could be highly functional while manic or depressed? This idea has so many repercussions that people are afraid to even think about it. Consider what is at stake: If we cannot choose how to respond to the different states because it is impossible for anyone to, in-ability becomes central to the arguments in each of the above topics. If anyone can choose, the impossibility argument is removed and the discussion becomes either how to function in mania and depression or why some cannot.
Many people say you should not discuss politics or religion with your friends because you might not be friends much longer. If your friends are Bipolar or associated with it in any way you might want to add meds to the list. The extremes both for and against meds give new meaning to the word Bipolar. The poles often seem further apart than the most intense debates in politics or religion. I have been speaking with groups about Bipolar for almost ten years now and have tried my best to stay out of the debate. But many in the audience won't let me. At the end of my talks I am frequently accosted by members of one camp or both. It is pretty clear that neither side even heard what I said and the only thing they listened for is whether I took their side in the only thing that matters to them. I didn't validate their extreme point of view and they are furious with me. In his song The Boxer, Paul Simon said, "Still, a man hears what he wants to hear and disregards the rest." In my case they often hear things that were not even said. In their minds I gave a talk siding with the enemy. I have always pretty much ignored the med controversy because it is not central to my message. Until now. I heard something recently that made me want to take a stand.
My daughter Kate is in her fourth year of medical school and is well on her way to becoming a very caring doctor. Her greatest gift is the ability to connect with people, which thankfully is being recognized in the hospital settings as an asset. She creates strong bonds with her patients and their families by communicating how much she cares about them. Among so many other admirable traits it is the one that makes me the most proud of her. It has been her greatest gift for as long as I can remember. The ability to form strong emotional bonds is not without tremendous risks though. It hurts her deeply when a patient that she is involved with dies. It is a testament to her awareness, understanding and strength that she can perform even on days when she sees the worst aspects of the medical profession; in spite of their best efforts, they cannot save everyone. Kate has grappled with that many times and come out the better for it. As her father I like to think that I have something to do with Kate's insights. We discuss the topic often. As someone who deeply understands depression and has learned to function fully while in the most intense states, I know my insights have helped Kate to develop the skills in her own life. I believe such skills are the key to her success and will help her to stand out amongst her peers. A recent study about how doctors are affected by grief was published in the Archives of Internal Medicine and was described in an article in the NY Times. I read both reviews with great interest and was very excited that it confirmed what Kate and I had been discussing. I have worried that the grief that Kate experiences might overwhelm someone without the insights and support that she has. This is exactly what the study was about.
I have long been a fan of The Hulk, but I had not noticed the incredible wisdom of Dr. David Banner until The Avengers movie made it clear. In his wisdom about managing rage he grasps the secret to managing depression and mania too. In one brief statement he captured the greatest flaw in the current paradigm about treating bipolar. Unfortunately, most people missed it because they thought it was just one of the many great jokes in the movie.
Exploring the potential of the human mind has been a central fascination for most of my 55 years. I have spent as much as eight hours a day in meditation and lived in a monastic environment for over eight years. One thing I am very sure of is that we are capable of far more than most of us even imagine. This is especially true regarding those of us who are bipolar. I have spent the last 10 years exploring what we are capable of during the extremes of mania and depression. In the process, I've met hundreds of people who's insights have validated my own experiences. With the help of experts in various complementary fields, including medicine, psychiatry, sociology, spirituality (what theorists like to call Bio-Psycho-Social-Spiritual), accelerated learning, and bipolar-specific meditation techniques, I have developed the most advanced system of training available to date for mastering functionality in all intensities of both mania and depression.
My previous article covered the controversy about why people think it is not possible to be hypomanic without losing control. It's a good backdrop for this article. There are four steps that lead to hypomanic success: Determine the starting point. Assemble the tools necessary for the task and become proficient at using them. Create a realistic plan. Do the work. Assessments Most assessment tools for bipolar disorder are only for making a diagnosis. Rarely does one assess where someone is in terms of their ability to actually handle elevated states. If we are going to succeed at being hypomanic without losing control, we need to assess a number of factors, including intensity, awareness, understanding, functionality, comfort, and what value the person sees in the experience. These criteria need to be gauged at different levels of intensity until you find the one where they are all optimized.
I have discussed bipolar with thousands of people over the last 10 years and would guesstimate that being hypomanic without losing control is the Holy Grail for 75% or 80% of them. Most say their goal is "permanent hypomania and to never be depressed again." If you ask their parents, though, they will say "I don't mind him being a little depressed, but could you make the mania and deep depression go away forever?" There is good reason for the discrepancy between parents and bipolars. Bipolar people may like being manic, but their behaviors are so often out-of-control that they become a problem for those around them. Bipolars and non-bipolars alike are justifiably afraid of mania because of past history with manic episodes. It is commonly believed that it is impossible to even be hypomanic without rapidly escalating to an out-of-control state. The belief is so prevalent that the standard of care for mania according to the National Institute of Mental Health is to make it go away entirely. On the other hand, there are many people who advocate that bipolar is a dangerous gift. Some take it too far and say we should allow all states no matter the consequences. While I fully agree with the dangerous gift idea, we must learn to take responsibility for our states and keep them from getting to places that we cannot control.
A recent question on our Depression and Bipolar Advantage LinkedIN Group brings up a point that needs to be addressed if we are to fully understand depression: What are some of the positives about having experienced bouts of depression? Since most people assume there are none it is important to put it in perspective. The answer to the question depends completely on where one is on the six stage of growth from bipolar disorder to bipolar in order. The inability to see value in the experience is a major contributor to the suffering that those in disorder experience. Finding value in the experience is one of the keys to removing the suffering and starting on the path to self-mastery. For someone in the Crisis Stage the only positive may be that the person knows that he/she has survived before. This can literally mean the difference between life and death. It would be counterproductive to ask if there are any positives while one is in crisis.
You cannot fully understand bipolar until you see the whole picture. This video shows the pieces that are missing in most descriptions. For those of you who have seen the video along with the article "The Shocking Truth About Recovery From Bipolar Disorder" you can skip forward in this video to about 3:15. The first few minutes repeat the study by the National Institute of Mental Health so those who have not seen the previous video can understand the context. The video is part of a much longer video available at http://www.bipolaradvantage.com as a part of the free online concepts course.
My ankle was broken during a hockey game when I was sixteen. The pain was so intense that by the time I got to the hospital an hour later I couldn't bear it any longer. If the doctor had given me a choice between suffering from the pain or cutting my leg off at the knee I would have chosen the amputation. I would still be paying for the mistake if he told me the best evidence calls for amputation and gave me no other option other than suffering for the rest of my life. This sounds absurd. But, what if the pain was in my head? According to a recent article in the BBC News Magazine (http://www.bbc.co.uk/news/magazine-15629160), they did something even worse in the 1950s - they amputated part of people's brains. They lobotomized people with depression and bipolar (and other issues) because it was the best evidence-based treatment at the time. From the article, "But from the mid-1950s, it rapidly fell out of favour, partly because of poor results and partly because of the introduction of the first wave of effective psychiatric drugs." Chemical lobotomies became the evidence-based treatment of the day. Today's evidence-based treatments are so much more humane. Or are they? The tools are more refined, but the goal of treatment is the same: cut off the part that is broken. We are no longer poking ice picks into people's eye sockets, but are still trying to accomplish similar outcomes.
This video It explains the three stages of bipolar disorder: Crisis, Managed, and Recovery. It reveals the results of an important recent study by the National Institute of Mental Health that you will find shocking. There are many who wish the study would remain buried, but as they say, "The cat is out of the bag now!" Be sure to check it out and share your comments.
In recent months, discussions about the boom and bust cycles of our economy going back to the Great Depression have been the focus of many news stories. During boom cycles, too many of us experience periods of inflated feelings of power or delusions of grandeur, characterized by excessive risk taking and out of control spending. During bust cycles, many of us experience periods of indecisiveness, black and white thinking, loss of energy and fatigue, even feelings of worthlessness and suicidal thoughts. These reactions are classic symptoms of bipolar disorder. Companies can and do prosper during times of economic turmoil. What do GE, Disney, HP, Microsoft, and Apple have in common? They were all startups during steep declines in the U.S. economy. GE started during the panic of 1873, Disney started during the recession of 1923-24, HP began during the Great Depression, and Bill Gates and Paul Allen founded Microsoft during the recession of 1975. Even today, while the economy is in the worst down period since the Great Depression, Apple is thriving. All these companies realized that they had an advantage by adopting a different mindset, a different way of seeing the crisis. Instead of succumbing to the situation, they saw it as an opportunity to innovate and grow.
One of the many traits of being bipolar is the ability to see the world in a different way. Many might say it is a curse, but it can also be a gift when looked at from a positive perspective. This change in perspective can literally help you to see with greater clarity. From early childhood, we have been taking tests to assess our understanding of the world. These tests have had a profound impact on us in ways that we are often unaware. They have created a world view that places too much importance on passing the test and not enough on learning more about ourselves. In some ways, the tests themselves have gotten in the way of what the goal was in the first place. I have been wearing glasses for almost thirty years. Every year or so I take a new exam to make sure my prescription is still the same. The test seems simple enough: the clinician shows me letters at different sizes and asks me to identify what letters I see. Anyone who has a driver's license has taken a similar test as has anyone who wears glasses or contact lenses. A few years ago I discovered a major breakthrough that has completely changed my life. It has brought my life into focus in many ways. I share it with you in hope that it will help you to see better too.
"You don't know the half of it" is a once-common phrase that is generally applied to negative things. It usually means that you don't really know how bad it is. It is easy to see how bipolar people can use the phrase to describe how horrible bipolar disorder is to someone who does not experience it. I imagine many people would expect this article to be a rant on how people without bipolar disorder have no idea how bad we have it. I am sorry. It is not. It is for those who already know how bad it can be. They may not know the half of it, either. I often joke that depression is so terrible that we sometimes wish we were dead and we act so badly during mania that everyone else wishes we were. It is good for a laugh, because we all know it has some truth in it. The horrible symptoms of depression and mania that can occur when an individual is in a disordered state are well known. They include physical, mental, emotional, spiritual, social and career/financial dysfunction. Funded massively by the pharmaceutical industry, partly because it is one of their biggest profit centers, there have been countless studies about bipolar disorder and how to move people from crisis through managed stage to recovery. There are many who argue over the choice of tools to address depression and bipolar, but nearly everyone agrees on one thing: depression and bipolar are horrible mental illnesses that need to be removed from our lives. They don't know the half of it.
Depressed individuals have a shorter life expectancy than those without depression, in part because depressed patients are at risk of dying by suicide.1 However, we also have a higher rate of dying from other causes.2 Some researchers conclude that we may be more susceptible to medical conditions such as heart disease.3 I had an experience that might point to another cause that we need to address: we don't treat many health issues because we think they are just symptoms of depression. Last winter, I went through one of the deepest depressions of my life. It was very intense physically, mentally, emotionally, and spiritually. It was a beautiful experience, but that is for another article. The physical aspect is what I want to focus on here. My physical experience this time was far more intense than any other depression. I was in tremendous pain throughout my body, but especially in my digestive track and chest. I was also completely drained of energy. It took a tremendous act of will just to get out of bed. It was so intense that I found myself reviewing my life in search of any other time that I had similar experiences.
I gave a talk the other day for NAMI Santa Rosa about my next book and a woman remarked how different it is from my previous ones. I said that my first three were about me being the black swan. The black swan is Karl Popper's concept from the 1930s that suggested that if you observe only white swans, you are using inductive reasoning to extrapolate that all swans are white. This was falsified when black swans were discovered by the English naturalist John Latham in 1790. Science was forced to change the hypothesis that all swans are white by the new evidence.
I am no expert on mental health crisis intervention. I have only seven personal experiences to base my opinions on. Nonetheless, it is not a stretch to say that there are some major flaws in the system that should be addressed. I know I am not alone in such an assessment and hope that we can share our ideas for how to make it better. In trying to better understand all of the points of view, I have spent a lot of time discussing it with all sides of the debate. I gained some great insight from those who identify themselves as part of the anti-psychiatry movement. I could be wrong, but it seems that much of the hostility that they have comes from bad experiences when in crisis. I have a unique perspective on such experiences because I was once hired to stay with someone during his lockdown in a psych facility. I saw first hand how bad it can be while I had the clarity to know what was going on.
We often hear people make the distinction between HAVING Bipolar and BEING Bipolar. Rarely, do we hear a distinction comparing Bipolar to Bipolar Disorder. I coined the term Bipolar In Order ten years ago to help make the distinction, but wonder what it means to you? Bipolar used to be called Manic-Depression. Mania means that we are elevated. Depression means lowered. Bipolar means that we have two poles (high and low), so it is meant to replace manic-depression as a more acceptable way of describing the same thing. Or, is it just more marketable?
One of my earliest memories is of learning to ride a bike. I remember the fear, exhilaration, and hyper-awareness, along with the tension in my body and how my breath became both more rapid and shorter. I was outside of my comfort zone and challenging myself to grow. It was also a blast! My father had a wisdom common with most dads. He didn’t push me down a steep hill and hope I survived; he ran along next to me making sure I was not too far outside of my comfort zone as to be incapable of handling it. He taught me one of the most important lessons that day about what it is to be human. We need to challenge ourselves to grow, while at the same time making sure we don’t go too far outside of our comfort zone. The thrill of learning something new and challenging myself to grow has been a constant companion ever since my first bike ride. On too many occasions, I took on challenges far outside of my comfort zone and was either debilitated by the fear and lack of skills, or took risks that caused more harm than the potential reward from succeeding.
The diagnosis of mental illness is the most dangerous time for many of us. Overwhelmed by fear, confusion and the numbing effect of over-medication, we are vulnerable to any messages that can have long-term consequences. It was during my first months after diagnosis that I fell victim to the myths of mental illness. As I was trying to make sense of what was happening to me, I was given a list of the most offensive comments anyone could say to the mentally ill. I'm sure you've heard of at least some of them. Examples include: “snap out of it,” “you can do anything you want to if you just set your mind to it,” “get a grip,” and the worst one of all, “pull yourself up by your bootstraps.” While the Advocates are well intentioned, the result is quite the opposite.
It happened several years ago, but I remember it like it was yesterday. My depression was too much for me and I tried to end it by taking my own life. The physical sensations, mental activity, emotions, and spiritual desolation were the deepest I had ever experienced. I thought it was the deepest anyone could go and the only way out was suicide. I was wrong. I have since been much deeper in every way - physical, mental, emotional, and spiritual. I am currently in the deepest depression of my life. It has been going on for five months now, yet I don't feel overwhelmed at all. The level of depression that once almost killed me now seems like a walk in the park. So does this one. Since it doesn't overwhelm me or control my reactions to it, I wonder: Am I even depressed at all?
Every single day I think about the time I tried to kill myself. It is one of my strongest and most detailed memories. I mention it in passing in my talks as if it is just a point of reference, but it has a profound impact on my every thought. I have not heard the bipolar or depression world debating pro-choice vs. pro-life suicide, but it is an internal debate that I often have myself. I wonder if others have had similar thoughts? My debate is further colored by the suicide of my best friend Santiago. I think about his hanging himself every day, and the effect it had on everyone around him. It is another memory that is so strong it could have just happened. It too has a profound effect on my every thought. The other day I was showing a visitor around San Francisco and he brought up suicide when we drove by the Golden Gate Bridge. He asked how many people have jumped off (over 1,200 so far) and whether they have put up a barrier yet. I found myself sharing my internal debate and chose to take the pro-choice side.