Archives for Treatment

Bipolar

The Most Important Thing To Know During Bipolar Episodes

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.

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Bipolar

Confusing How and Why Is Prolonging The Suffering in Bipolar Disorder

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: "
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Bipolar

We Are Capable Of Far More Than The Limitations Most People Accept

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.
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Bipolar

Bipolar People Get Angry Too

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.

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Bipolar

Mindfulness Does Not Lead To Happiness

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.
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Bipolar

Bipolar Children of Undiagnosed Parents

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.
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Bipolar

Burning The Bible – Let’s not replace one set of dogma with another.

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."
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Bipolar

Accounting For Time In Depression and Mania

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.
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Bipolar

Functionality-Based Understanding For Depression and Bipolar Disorder

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.
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