It matters for a number of reasons:

1. Internal mental states affect quality of life. Internal mental states also affect our ability to *understand* how internal mental states are affecting our quality of life.

Someone in a coma might be “happy”, but I don’t think we would say that they are in a healthy mental state. But they can’t understand that they aren’t – unless someone diagnoses and intervenes with the internal mental state.

2. Internal mental states affect our ability to control our behavior, and also our ability to understand whether or not we *are* adequately controlling our behavior.

We may *think* that we are keeping our behavior under control, and we are likely to argue vigorously that we are doing so. But unless our mood or thought disorders are under control, then we probably aren’t.

None of which is to denigrate behavioral approaches … we can try to keep our moods under control *and* learn behavioral approaches to help.

I disagree with the use of behavior disorder to describe what is commonly called mood disorder. Behavior is an outward manifestation while mood is an internal process. Being sent, or going to, a “behavior unit” of a hospital is saying that your behavior is inappropriate. What I have is a psychiatric problem, not a behavior problem. My mood problems are a difficulty for me, emotionally, not behaviorally.

Hi Tom,

I must confess that I’m a bit confused as to why you assume (without my saying anything to that effect) that I can’t or don’t choose how to react when my moods take a downturn. I actually think I react quite well and very practically and have in fact been complimented on the maturity with which I manage my mood disorder.

I do not *believe* that the moods are the primary symptom of my disorder; I *know* they are. (Let’s not forget that moods are only part of the equation – there are energy and cognitive components.) But anyway, my problem is not behavioral – I do not behave badly, nor do I totally cave and cease to function when I have a downturn. And just because I acknowledge that I have a recurrent illness does not mean that it defines me.

My remission is not as temporary as you seem to imply. It’s more the norm. My occasional downturns in fact have been often triggered by medication problems (e.g., a change in generics).

I guess I am not sure why you are putting such a negative spin on what I consider to be tremendous success with my mood disorder. You say that what I’m doing isn’t working. But my current approach is working pretty darned well. In general, I think I’ve been doing great! And I owe a debt of gratitude to the doctors and therapists that have helped me through it.

Martina

Hi Tom,

I simply disagree. The mood disorders of mania and depression are a disorder. However, in our armoury of dealing with them, we only have our behaviour. So, the condition is a mood disorder and the treatment is behavioural. And over the years, I have become quite adept at controlling my behaviour whilst in the depths of very severe depression and anxiety. I can function when I’m really quite ill. Whilst no one knows unless I tell them, it is very taxing. Perhaps I’m missing the point somewhere and I would welcome you clarifying it for me. However, I see no problem in using the term ‘mood disorder’ and the treatment approach ‘behavioural’. One treatment approach ‘Behaviour Activation Therapy’ has been very useful for me. And certainly, no one would ever choose to be bipolar 1 and we all struggle to gain mastery over it, so therefore, it’s a disorder.

Colette

Hi Tom,

Thank you for your kind words, I value them greatly.

Now…to business. I believe you have something unique and important to contribute to the effective treatment of bipolar disorder. However, judging from some of the dismissive &/or affronted responses you have received in this and other posts, your message is easily lost as it is so at odds with conventional thinking on mental illness. There lies its strength and its weakness. How can you best get your message across without alientating the very people who would most benefit from hearing it?

Whilst trying to imagine experiencing bipolar as “beautiful” (I can’t, by the way), I keep reminding myself that I’m just not there yet. But that’s the thing, achieving Bipolar in Order is a journey. I know you’ve made that point in your book (the part about not being able to see the whole picture until you have achieved Bipolar in Order). Maybe that’s something you could stress a little more? And that journey is not for the faint hearted. It’s a journey that requires belief that it’s achievable, laser focussed determination and sheer tenacity despite the inevitable set backs.

My story is not much different from others that I’ve read. I remember bipolar in disorder all too well: suicide attempts, hospitalizations, unemployment, damaged relationships, multiple medication trials, debilitating medication side effects, multiple psychiatrists, multiple psychologists, going off all medications, then trying still more medications. And everything I read on bipolar only frightened & discouraged me more. Somewhere in the midst of all this, I started reading about Bipolar in Order and my outlook changed. What I was experiencing were paths along the way. That put things in perspective.

So, anyway, if, as you say, I am at the point of ‘closer than you think’ to Bipolar in Order (is that a sub-category?), let me describe what that is for me. I’ll use the analogy of how I deal with pain. I’m good at pain. I learned a lot about pain from a very difficult childbirth experience. This is just as well, since I have tiny veins and usually have blood taken from the backs of my hands to test my medication levels. From what I learned from the childbirth pain, I can now just sit there and chat to the nurse as she takes the blood. It’s not “beautiful”. I wouldn’t ask the nurse to take another vial just to be sure, or anything. But pain is “in order”. And that’s pretty much how I deal with depression and anxiety now. I understand what it is and how to deal with it. So, it’s not so bad.

But I aspire to one day see things from your view.

Best Wishes,

Colette

I think moods and behavior are interdependent to a big degree. It’s our behavior that influences our life. And the way our life is going largely influences our mood. It’s hard, if not impossible to be happy when everything is going wrong in our life… especially if it’s going wrong due to our doings and errors.

So I think it’s important not to give in to our moods, at least not too much. Know when we can allow ourselves to act on our impulses and know when it’s absolutelly unacceptable… and try to act by it.
I think I said this in my previous posts, but behavior is learned, so is self-control. And nobody does what they really want all the time… if we all acted according to what we “want”… well, the human civilization would not exist. The human race even, might be extinct.

I learned to work on what I call “autopilot mode”. Might not be ideal for me… but for me at the moment is the next best thing.

Often the moment we first give in to our moods, it’s the first step of the downfall. One day we wake up, we don’t want to communicate with our boyfriend and don’t want to go to work… when we give in, it usually does not get better over night. Sometimes it leads to losing what we have (yes, working can be stressful… but not working is even more damaging. I’ve seen normal and intelligent people to become depressed when they were unemployed for some time…). That way we find ourselves in sucky situation, which means we are down. We are down, therefore we don’t go out and seek other opportunities… We are isolated, therefore we are down. We are down, so we withdraw from the world… and so it goes in circles… I read one study which said that often the first step to curing depression is finding some goal, some meaning in your life… to be able to do that, you need to get yourself under control. No pill, or coping method is going to make you happy in a long term, unless you have something to live for. It doesn’t have to be anything big… but it’s much easier to get out of the bed in the morning, if you have reason to.

Lot of people say I am entertaiming and funny and all this… and apparently, I can be so even if I am depressed… and my close friends know well to stop me from going too crazy when I am manic. (And maybe it’s the way I was raised, to be rational and don’t do things just because I want. So instead of actually buying a ticket to let’s say Tel Aviv for right now, I just spend a while planning, how nice it will be one day to go to Tel Aviv…).

Maning your feelings and moods is absolute must… and it’s often the first step to “recovery” (for whatever it means…).

1. The diminished ability to function (behavior) happens to me when my body’s mood is out of sorts…
But I also can feel sick without any change in outward behavior with my bipolar disorder.

2. Treatments include medication, diet and breathing exercise directly effect the body not the behavior, directly.

3.psychotherapy assist in training a consumer in managing thought patterns… loosely you could these patterns as behavior.
You could argue that almost all “mental illness” health problems are behavior problems, since behaviors aggravate internal symptoms, etc…. all thoughts and responses could be considered behavior.
But what would be the point? How will this help the consumer?

Bipolar is a mood disorder because its treatments and management directly effect the body and behavior, not just behavior.