In his wisdom about managing rage he grasps the secret to managing depression and mania too. In one brief statement he captured the greatest flaw in the current paradigm about treating bipolar.

Unfortunately, most people missed it because they thought it was just one of the many great jokes in the movie.

The early scenes in The Avengers included much concern that Dr. Banner would lose control and turn into The Hulk. Tony Stark even tried messing with him to see if he could trigger it. Like me, Tony Stark was fascinated with the potential of harnessing the power because he knew it was possible in spite of the protestations of those who feared it. It helped that Tony in his Ironman suit had the tools to protect himself from the danger just as I have developed tools to protect myself and others from the dangers of depression and mania.

If depression or mania get too intense I have tools to lower the intensity without needing to be hospitalized. (You can explore the metaphors of harnessing the cube that had unlimited power and the struggles every character had with control in the comments if you like.)

Later in the movie there was a scene where Dr. Banner was entering into the battle as himself and the others were worried that he needed to turn into The Hulk first. The insinuation was that he needed to get angry first to make the transformation. Dr. Banner smiled back at them and said that the secret to his control is that he is always angry. It was a pretty funny line, but the implications for treating bipolar are profound. It also illustrates what I have been saying for many years.

What Dr. Banner knew was that trying to suppress his anger would never give him the control he needed when anger was provoked. He learned to be angry without allowing it to control him. He was still afraid to let it go too far, but as he grew to understand it he even learned how to harness The Hulk and use the power under control.

Those who do not understand depression and mania think that the only way to control it is to make it go away. It works for a while, but, just like with anger for The Hulk, when mania or depression returns they find themselves back in crisis with no awareness or skills to do something about it. When mania, depression, rage, hallucination, delusion, or any other manifestation return, chaos ensues just as anger triggered The Hulk in previous movies.

You must make sure you are working with a level that you can control. That is what Dr. Banner learned and what I have been teaching people to do for many years. It is not necessary for Dr. Banner to be angry all of the time, but to have enough experience with it to understand both the limits of his control and the tools available to maintain it. We do not learn to control things by avoiding them or denying their existence. We learn by finding the limits of our range and keeping ourselves within it.

The focus of Bipolar IN Order training is recognizing the edge and learning tools to get back within it when we cross it. We teach people how to expand their range instead of contracting it. The focus of the old paradigm is to try to make mania and depression go away. That may not seem like a big change, but it is “the difference that makes the difference” as Gregory Bateson (a famous real person) so eloquently stated. Our approach needs to be different (from the old paradigm of making it go away), but not too different (as it would be by letting depression and mania go completely unchecked).

Dr. Banner learned to BE angry without letting his anger go too far and causing him to start ACTING out-of-control angry as The Hulk. We need to learn to BE bipolar without letting it get to far and losing control. Hiding from it and hoping it will somehow never return does not work. Dr. Banner knew the difference. Do you?

I’ll finish with a quote from my book Bipolar In Order as it illustrates the same point: “Since it is believed impossible to thrive in depression, mania, hallucination, and delusion, we are not taught how to thrive and are instead taught only how to avoid the symptoms and live in fear that they might some day return.”

It is usually presented in the opposite way – I Am Not Bipolar, I Have Bipolar – which includes the argument that calling someone bipolar is like calling someone cancer.

A recent comment from our http://www.bipolaradvantage.com website prompted a great reply from one of our volunteers. I think he really put it in the Bipolar Advantage perspective.

“Thank you for contacting us. You are certainly not your disorder, but you need not have bipolar in disorder at all. The argument you present has been floating around for a long time. The way we look at it is that I am six feet tall, weigh 185 pounds, am male, gay, and bipolar. I am bipolar because I have a wide range of highs and lows, which makes bipolar a description of me just like my height and sexual preference.

I do not have the flu, a cold, or bipolar disorder, which are all illnesses, so I would not want to be identified as any of the illnesses just because I temporarily had them.  I have Bipolar IN Order, which is not an illness at all. I am proud to be identified with being bipolar just as I am proud to be identified with being gay. They used to try to say being gay was a mental illness too. 

Man in the mirror photo available from Shutterstock.

I have spent the last 10 years exploring what we are capable of during the extremes of mania and depression. In the process, I’ve met hundreds of people who’s insights have validated my own experiences.

With the help of experts in various complementary fields, including medicine, psychiatry, sociology, spirituality (what theorists like to call Bio-Psycho-Social-Spiritual), accelerated learning, and bipolar-specific meditation techniques, I have developed the most advanced system of training available to date for mastering functionality in all intensities of both mania and depression.

There are many who have established themselves as experts at understanding bipolar in its disordered state. While their focus has been on trying to make bipolar go away, my focus has been on deeper understanding and better functionality at higher intensities. This puts me in a very unique position to discuss what is possible while manic or depressed.

There is one particular area about which I have found an incredible level of confusion: when does controlled hypomania escalate into an out-of-control manic state? Based on discussions with thousands of people, it is generally believed that there is a level of intensity  that is impossible for anyone to control – the line that cannot be crossed. This notion is not only patently false, but irrelevant in the greater scheme of things.

Although the exploration of the furthest reaches is interesting and informative, it is not something most bipolar people are looking for. They simply want to find a way to remove their suffering and get life to work for them. They are not interested in devoting every waking moment of their lives towards mastering the skills necessary to manage higher intensities. For them, there is a far more important line that they need to be careful about crossing.

As a first step, we teach how to minimize manias and depressions to an intensity where people are highly functional. A critical criteria is that the people around them are very comfortable too. This is the most important line of all; the line that should not be crossed without a high level of supervision.

Only when a student proves that he/she can become highly functional and make everyone around completely comfortable with their 20% mania or depression, do we help them to learn how to handle it at 30%. We teach students to be acutely aware at all times of what level of intensity they are at. If they cross the line into an even slightly higher intensity, they immediately use strong enough tools to bring the state back inside of their “functionality and comfort zone.”

Those who diligently apply the advanced tools find that they rapidly gain control of both their manias and depressions. It takes a year or so before they expand their range to become comfortable in their “sweet spot,” typically at a 30 – 40% intensity of mania. At that level they are highly aware and vigilant of never crossing above the intensity line where they begin to lose even minor amounts of control.

Advanced students with incredible discipline and a strong desire sometimes wish to expand their range in exploration of the possibilities. If they show the capacity and are willing to take precautions that minimize the risks, we help them to achieve functionality at higher states. This is where it gets especially interesting for me.

Although we can handle 80 – 90% intensities of mania for as long as a month before it begins to be too much for our bodies to handle, we find that it is not worth the effort it takes to stay in control and detracts from the positives of the state. We choose to explore it to see if it is possible, but then choose not to go there again. We end up preferring the same 30 – 40% intensities as the “sweet spot,” not because we fear higher states, but because we understand the trade-offs of being in them (none of which include danger of losing control any more).

The depressive side is a completely different case, but that is for another article.

What level of intensity can you be highly functional at? What do you do to make sure the people around you are comfortable and agree with your assessment?

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.

We also need to determine the critical role time plays in the escalation from hypomania to out-of-control. We often find that the person is not aware of the level of intensity until it is too late. By the time he/she recognizes the hypomania, there is too little time to get it under control before it begins to escalate. People often find, for example, that once they get to an intense mania they only have a few hours before they end up hospitalized, but at the hypomanic level they often have a week or more before it starts to spiral out-of-control.

It is critical to find the level of intensity that will allow a big enough window of time. That window needs to be a month or more, which for most beginners is at a 10% – 20% intensity.

Advanced Tools

There is a plethora of tools that have proven effective in helping to reduce the intensity of mania. Many of them can be modified to work in maintaining a certain level of intensity, but are also critical in lowering the intensity if it begins to increase. Such tools are an important part of any toolkit. One important thing to keep in mind is that mania affects all aspects of our lives: physical, mental, emotional, spiritual, social, and career/financial. We need to make sure that our toolkit will address all of them.

To master the ability to maintain certain levels of intensity, though, we must use more advanced tools. Several of them have already been developed and have proven effective for a variety of people. Many more will undoubtedly be developed as more and more people discover tools that work for them.

There are many advanced tools specifically designed for controlling mania. Here are just a few of them:

Recognizing Your State

Failure to recognize what state you are in is one of the central causes of bipolar being in disorder. It is critical that one is aware of what the level of intensity is at all times. Sadly, far too many people are completely unaware not only of their current state, but what each level of intensity is. We must learn to recognize the difference between a 10%, 20%, 30%, etc. before we can start trying to control them.

Feelings vs Reactions

Learning to separate what the experience of mania feels like from how we behave as a reaction to it is another critical tool for getting mania under control. Since even the DSM confuses the two it is understandable that this is a difficult task. If you do not realize your behavior is a reaction to and not part of being manic, you will not realize that you actually have a choice to behave differently.

Separating feelings from reactions is not a reference to simply emotional feelings that we may have. It means separating what it feels like to be at a particular level of intensity from our usual reaction to it. This is the central point of cognitive therapies, but taken to another level from how they are normally practiced. This is a prime example of how existing tools can be adapted for different outcomes.

Behavior Inventory

Let’s face it, behavior is why bipolars get in trouble when they are in an out-of-control mania. A thorough inventory of the behaviors that adversely affect others is helpful in becoming more aware of them. Of course, this awareness alone will not prevent bad behaviors, but will present the opportunity to choose better ones.

The above tools are just the beginning and a complete toolkit should be built before beginning. No one would attempt to fly a plane after merely reading about a few of its features. Classroom lessons, studying and learning from a trained professional are not only required but simple common sense. It would be foolish and dangerous to do otherwise. Please treat hypomania with the same wisdom with step by step study and practice.

Realistic Plans

Unfortunately, crisis and bipolar seem synonymous for far too many people. It would be wise to plan for the next crisis with concrete actions to be taken to recover from it. But, It is important to remember that the focus of a crisis plan is on making symptoms go away, not learning how to be hypomanic and in control.

A success plan needs to include who is going to help, how to recognize it immediately when it starts, the estimated time before losing control, what steps are necessary at each time frame, and more. There also needs to be failsafes built in to recognize and mitigate any escalation in intensity.

Please understand that the process will take time, perhaps as much as a year or more. A success plan should not start out with trying a 40% intensity. It is important to master a 10% intensity and progress in 10% increments.

Do The Work

All the plans in the world will do no good if if the work is not done to make them a reality. This is the most important step of all.

Conclusion

Besides the fact that bipolar people want it, there are major benefits to getting hypomania under control for all involved. Greatest among them are increased stability and lowered risk of crisis, but removing the behavioral issues is most appreciated by those who have had to tolerate them for too long.

Please remember that this article is just an introduction and should not be used as a guide to follow. For more complete lessons, please visit the Bipolar Advantage Website.

Part Three of this hypomanic series explores how to find the line between hypomania and out of control.

Please share your thoughts in the discussion below. This is an important topic that needs to be talked about instead of kept in the closet.

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.

Far too often people talk about the possibility of living well while hypomanic but refuse to do the hard work necessary to make it a reality. They periodically find themselves back in crisis, which further reinforces the argument that hypomania is to be avoided. If a hypomanic thinks he/she is under control and everyone else thinks not, it is a pretty clear sign that the hypomanic is delusional about it. Whatever the level of intensity, it is too high to be playing with.

Nonetheless, some of us have already achieved the ability to understand and control our level of hypomania and keep it from getting out-of-control. To ignore our success and not study how we got there Is a grave mistake. As long as we continue to only advocate the complete elimination of mania, those who desire to have the hypomanic state will continue to stop following the program and periodically escalate into a crisis situation. It would be much better to teach them how… instead of trying to convince them that it is not possible.

Is it dangerous to try? Even with the standard elimination-based treatments in use today “at least 25% to 50% of patients with bipolar disorder also attempt suicide at least once.” With that high of a percentage rate of failure it is extremely dangerous to keep doing the same thing expecting different results, which is the very definition of insanity.

For a much more in-depth analysis, please visit the Bipolar Advantage website.

Part Two will show you The Four Secrets To Being Hypomanic Successfully. Part Three will help you find the line between hypomania and out-of-control mania.

Please share your thoughts in the discussion below. This is an important topic that needs to be talked about instead of kept in the closet.

Image courtesy ot Martin Pettitt

The answer to the question depends completely on where one is on the six stage of growth from bipolar disorder to bipolar in order. The inability to see value in the experience is a major contributor to the suffering that those in disorder experience. Finding value in the experience is one of the keys to removing the suffering and starting on the path to self-mastery.

For someone in the Crisis Stage the only positive may be that the person knows that he/she has survived before. This can literally mean the difference between life and death. It would be counterproductive to ask if there are any positives while one is in crisis.

Someone in Managed Stage may have the understanding and tool skills to keep the episode from escalating out of control. The previous episodes will be seen as learning experiences that brought at least some insight into the equation. Most people in managed stage only mention positives in past episodes and not during a heightened level of intensity. They generally do not see value during the experience, only in what they have gained by having been through it.

In Recovery Stage, people often wrongly believe that they are free from ever having to face another episode. Their inability to see value in the experience leads to a fear of it ever coming back. They often say the only thing positive is that they will never be in crisis again. Unfortunately, recovery has been proven by the National Institute of Mental Health to be a temporary condition; those who believe otherwise are often poorly prepared for the next episode.

Freedom Stage begins the process of understanding depression and mania enough to be able to see value in at least minor episodes. As you increase your ability to function and be comfortable during them, you begin to be able to see value in lower intensity depressions. You find that in some ways depression enhances your life and improves your functionality. For example, an artist would find depression to be a muse or one may see that depression gave insights that helped deepen relationships.

Stability Stage is where the value of depression is self-evident. When you no longer suffer from the experience and can function even in the deeper states, you begin to understand something that those in disorder cannot comprehend. You understand that there is a huge difference between the experience of pain and suffering from it. This insight affects the rest of your life and is clearly seen as a positive both during and after each episode.

For most people in Stability Stage, functioning in depression is seen as the key to being able to function in mania. There are a plethora of positives once you reach Stability Stage. It is much more difficult to find negatives in the experience.

Self-Mastery Stage is where one understands that all experiences are equally beautiful and valuable. Even depressions that are much deeper than those once causing crisis are seen as so positive that you cannot imagine life without them. This is so far beyond the comprehension of those in disorder that they become upset about it. They prefer to delude themselves (and others) into thinking that their limited understanding is all that is possible.

It is unfortunate because their lives would be immeasurably improved if they listened to those in Self-Mastery instead of those still in disorder. It is not an easy path, but we can show you how to get there.

Depression in Self-Mastery is often seen as a rich spiritual experience. There are countless examples throughout the various faiths in the world. For example, Milarepa used emotional pain as a path to enlightenment, while Saint Teresa of Avila said “The pain is still there. It bothers me so little now that I feel the Lord is served by it.”

What are some of the positives about having experienced bouts of depression? Do you notice the past tense in the question? It takes someone IN Order to see the positives during intense depressive times. What positives have you found related to depression?

The first few minutes repeat the study by the National Institute of Mental Health so those who have not seen the previous video can understand the context. The video is part of a much longer video available at http://www.bipolaradvantage.com as a part of the free online concepts course.

Please share your thoughts in the comment section below.

photo credit: John Piekos

© http://jonathanwallacestudio.com/

My ankle was broken during a hockey game when I was sixteen. The pain was so intense that by the time I got to the hospital an hour later I couldn’t bear it any longer.

If the doctor had given me a choice between suffering from the pain or cutting my leg off at the knee I would have chosen the amputation. I would still be paying for the mistake if he told me the best evidence calls for amputation and gave me no other option other than suffering for the rest of my life.

This sounds absurd. But, what if the pain was in my head? According to a recent article in the BBC News Magazine (http://www.bbc.co.uk/news/magazine-15629160), they did something even worse in the 1950s – they amputated part of people’s brains.

They lobotomized people with depression and bipolar (and other issues) because it was the best evidence-based treatment at the time. From the article, “But from the mid-1950s, it rapidly fell out of favour, partly because of poor results and partly because of the introduction of the first wave of effective psychiatric drugs.” Chemical lobotomies became the evidence-based treatment of the day.

Today’s evidence-based treatments are so much more humane. Or are they? The tools are more refined, but the goal of treatment is the same: cut off the part that is broken. We are no longer poking ice picks into people’s eye sockets, but are still trying to accomplish similar outcomes.

We cannot imagine cutting off a leg for a broken ankle, but every day another patient hears the false choice between a lifetime of suffering and a diminished life where our capacity to experience high and low states has been cut off. The reason I say it is a false choice is because too many pretend that there are only two choices: remove the highs and lows or not treat it at all. When I challenge the outcomes as unacceptable I often hear that I am advocating the “no treatment” choice, which is a ridiculous assumption. I advocate using the same tools along with new tools while collecting evidence of their efficacy for better outcomes. I believe we need a new paradigm altogether. I call it IN Order-based instead of disorder-based.

Please note that I am fully supportive of the evidence-based model of vigorously studying and debating the efficacy of tools. While corporate interests are skewing studies toward pharmaceutical approaches, I am in full agreement that we need to scientifically assess each tool to make sure the evidence supports its use. My issue is the lack of debate about outcomes. For the most part, the outcome is assumed to be removal of symptoms. It is almost universally assumed that the disorder is that we have highs and lows. There is little willingness to consider that we can have them without them being in disorder.

Perhaps the problem is the pain is so great that we are willing to jump at the solution without considering our options. It may be that people in authority are giving us a false choice comparable to cutting off our leg or suffering from a broken ankle for the rest of our lives. It is funny how the people most advocating evidence-based treatment are the ones unwilling to consider evidence that refutes their claim that we have to cut out our highs and lows to remove the disorder. Worse yet are the doctors mixing multiple drugs with no evidence at all of their efficacy while hypocritically deriding other options as not being evidence-based (http://www.psychiatrist.com/brainstorms/br6510.pdf).

There are a growing number of people who are achieving Bipolar IN Order instead of staying in disorder. We have learned to remove the disorder without cutting a part of ourselves away. We are fully bipolar, but we are not in disorder. We still have highs and lows, but they do not affect our ability to choose how to respond to the increased flow of energy and information associated with the bipolar condition.

We use the same tools that were used to achieve lesser results and have added more advanced tools to the toolbox. We have developed a program of assessments, tools, and realistic plans that have worked for many people, while recognizing that each individual will create their own plans from the template. Evidence is growing that we can achieve results that the “illness” model refuses to consider.

“Since it is believed impossible to thrive in depression, mania, hallucination, and delusion, we are not taught how to thrive. We are instead taught only how to avoid the symptoms and live in fear that they might some day return.”
- Bipolar In Order

If you really believe in science, you need to consider the evidence of our outcomes. IN Order-based does not mean treatment-free; It means that we consider evidence that is based on better outcomes instead of dogmatic belief in removal of highs and lows as the only possible solution. Once you see the outcomes that we are already producing, you will find the argument for cutting out our capacity for a wider range of experience as preposterous as the argument for removing a leg because of a broken ankle.

What evidence can you share of living with Bipolar IN Order?

I have heard many people postulate that Steve is bipolar, so I thought the stunt would get his attention. The book cover was easy for people to mistake as him and with his name on it the legal team would be wondering what it was about. The crazy idea was that they would show it to him and he would contact me because of it. He has been a hero to me and at the time I was obsessed like so many with finding examples of famous people who were bipolar.

The recent announcement that Steve Jobs is stepping down reminded me of my old fantasy. Back then I was convinced that his success was a result of being bipolar and it was proof that we have advantage, which is partly why I named the book The Bipolar Advantage. He may be bipolar, but the fantasy really says more about where I was at the time than anything else. Like so many others, I needed to find things that made up for the horrors of the condition. If we could just survive all of the terrible things about mania and depression, perhaps we could gain something from having been through it.

My evidence was pretty flimsy though (as was the premise itself, I have since found reasons that bipolar is an advantage DURING mania and depression, not in spite of it). Steve is said to be mercurial – I was mercurial = bipolar. Steve is creative – I want to be creative = bipolar. Steve works very hard – I do when I am manic = bipolar… Looking back it was delusion combined with grasping at straws. We take hearsay evidence and filter it through our own desires to see what we hope to see. Does anyone have any strong evidence for or against the notion that Steve is bipolar?

Although it would be interesting to learn that Steve Jobs is bipolar, what does it matter? Does it change my day-to-day life with my own bipolar condition? Perhaps yes, if it inspires me to work harder on becoming a better person. If it leads to making excuses for my behavior because Steve Jobs didn’t address his own flaws, I would be better off paying attention to other things.

Although Steve is one of my heroes for what he has accomplished with Apple, from a Bipolar IN Order perspective there are far greater examples to look up to. My greater heroes are those who changed themselves into better people no matter what hardships they faced. I can see some of that in Steve as a result of facing cancer and that is what I admire about him the most, but there are countless examples throughout the world of people making real changes in their behaviors. What we need as heroes are bipolar people who have done the same.

Are you a bipolar hero? What changes have you made in your behavior that made you a better person? Are you using bipolar as an excuse for bad behavior, or are you using it to gain insight that leads to becoming a better person? Who do you know that has made the effort to grow towards Bipolar IN Order?

Photo by Ben Stanfield, available under a Creative Commons attribution license.