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.

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.

This video is from a public television program called “Moving From Bipolar Disorder To Bipolar IN Order.” It explains what bipolar is and the difference between disorder and IN Order by detailing the six stages that one goes through as understanding and functionality improves. It outlines more complete assessments geared toward success, advanced tools that supplement existing tools, and stage specific plans that accommodate the needs of each of the six stages. It builds on the previous article called The Six Stages Of Bipolar And Depression.

The direct link to youtube for the video is http://www.youtube.com/BipolarAdvantage and http://www.bipolaradvantage.com goes into more detail about it. I would love to hear your feedback on it and where on the scale you think you might be at.

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.

http://jonathanwallacestudio.com/

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.

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.

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:

1. Determine the starting point.
2. Assemble the tools necessary for the task and become proficient at using them.
3. Create a realistic plan.
4. 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.