Archives for Depression
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.