Archives for Treatment
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.
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.
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.
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.