Archives for Psychiatry
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.
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?
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.
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.
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.
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.