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.
The Mood Disorders Program at Tufts University Medical Center has just completed a pilot study of the Bipolar IN Order peer-directed online education program. They found it to be “the first psychosocial intervention that has improved awareness of mood symptoms (insight) in bipolar illness… If confirmed, these data would indicate that this peer-based psycho-educational intervention could produce quality of life benefits, when combined with appropriate medications, not obtained with psychopharmacological treatment alone.”
Nassir Ghaemi MD and his team at Tufts are directing a full follow-up study in January and are looking for 750 people to join. Participants take the Bipolar IN Order program for free and the research team tracks the progress over one year. All data is collected anonymously.and there are strong protections for each persons privacy built into the study.
The Bipolar IN Order program is a simple yet powerful education program that anyone can do in the privacy of their own home. The program includes:
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.
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.
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 most discussion:
I wrote an article some time ago that I deviously titled “Why I Am Against Bipolar Meds” because I wanted to attract and call out both extremes in the debate. I argued for a moderate stance and we had a good discussion with all points of view respectfully considered.
My friend Dr. Nassir Ghaemi wrote an article recently in response and clarified some important points. Dr Ghaemi is the Director of the Mood Disorders Program at Tufts Medical Center in Boston and is familiar with my work; he quoted some of it in his recent book, “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.” The discussion from his article went further into the med controversy, but also veered into new territory that I would like to address: My opposition to remission as the end goal of treatment.
One particular reply from Dr. Ghaemi gets to the crux of my issue; “In a substantial minority of people with bipolar disorder, about one-third, lithium produces complete remission of all symptoms. They never have another bipolar episode, and sometimes symptom, the rest of their lives. My point is, though, that even with full remission of all symptoms, people often need to make other efforts to get to functional recovery in life, repairing relationships and resuming work or other activities that they had not been able to complete in the past due to the interference of bipolar symptoms.”
As I am familiar with his work, I understand the point of view, but am concerned that some might misinterpret this to mean something different from what I believe he intends. Such a view is certainly not compatible with the premise of “A First Rate Madness,” so I am pretty sure Dr. Ghaemi does not mean what it may sound like to some. I am hoping this article will help clarify it …
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.
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 might be interested.
Thomas R. Insel, M.D., Director of the National Institute of Mental Health, has issued a sharply worded condemnation of the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM has long been considered the “Bible” of Psychiatry and has recently been under attack from many angles, but this announcement might be a game changer. It will be interesting to watch how it all plays out.
According to Dr. Insel, “it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”
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.