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.”

One obvious problem is that the reliance on “objective laboratory measure” is also full of problems. In an attempt to turn real Psychiatric issues into “medical diseases,” there has been a widespread effort to claim depression and bipolar disorder a “chemical imbalance.” In “Psychiatry’s New Brain-Mind and the Legend of the ‘Chemical Imbalance,’”  Dr. Ronald Pies said, “In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it. On the other hand, the “chemical imbalance” trope has been tossed around a great deal by opponents of psychiatry, who mendaciously attribute the phrase to psychiatrists themselves. And, yes—the “chemical imbalance” image has been vigorously promoted by some pharmaceutical companies, often to the detriment of our patients’ understanding. In truth, the “chemical imbalance” notion was always a kind of urban legend- – never a theory seriously propounded by well-informed psychiatrists.”

I have long argued that the definitions in the DSM regarding depression and bipolar disorder are not accurate. Basing assessments on a short list of symptoms is a huge part of the problem without also considering intensity, awareness, understanding, functionality, comfort, value, and length time it can be kept under control. But, abandoning any criteria because they have yet to find “biomarkers” for depression or bipolar disorder can leave real problems unaddressed. Depression and bipolar are dangerous conditions that destroy the lives of far too many people.

The bigger issue for me is the assumption that the “disease” includes the “symptoms” that are not in disorder. Any biomarker found in the future needs to recognize this fact before they throw the baby out with the bath water. Let’s assume that some day they are able to link bipolar to specific chemical reactions in the brain at specific regions. They will be able to tie the “symptom” of racing thoughts, for example, to a real difference in the brain compared to “normal” people. If they somehow eradicate the “disease” of racing thoughts by altering the brain, they destroy something that has moved mankind forward for millennia. They need to be extremely careful to separate the “disorder” of not understanding the racing thoughts from the in-ordered ability to function highly with them.

My proposal all along is to separate disordered bipolar from in-ordered bipolar. Bipolar Disorder means the condition is causing suffering and incapacitation, whereas Bipolar IN Order does not. Unless Bipolar IN Order is taken into account, using biomarkers to “prove” the condition an illness to be removed is a step backward. As I described in my article challenging the paradigm of remission ; “With so many people thinking that remission is the same as ‘cured,’ the problem is all too real. They assume when I say Bipolar IN Order that they have achieved the same thing because they are not currently ill, but during the next cycle they are back in disorder while I am exploring yet another fascinating state with its own unique rewards. What they do not understand is that I, and the many others I have taught, are not ‘symptom’ free in the way commonly thought; we experience ‘traits’ every bit as intense as anyone in disorder, but we neither suffer nor are incapacitated by them. We are no longer in danger of relapse because we are already functioning highly at intensities that those without our understanding mistake for the illness.”

It is great news that the NIMH has decided to challenge the DSM. I hope that in rethinking “mental illness” they do not make the same mistakes in confusing what the “disorder” is.

Book burning photo available from Shutterstock

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.

Most people new to the concepts of Bipolar IN Order do not recognize mania until it is too late. As illustrated in the above graph, they typically have as little as a week before 40% (hypo-mania) escalates into 80-90% (mania) where they often completely lose control within an hour or so.

At that point, who cares if the DSM wants to call it something else? The person is in extreme danger and so are the people he/she comes in contact with.

Depression, on the other hand, often has a much longer window of time at both ends of the intensity spectrum. Even beginners can hold on to a 40% depression for a month or more and can endure an 80-90% depression for a day or so. In both cases, this buys critical time to use interventions to lower the state.

The equations change dramatically when we factor in a properly designed psychoeducation program. The assessments mentioned above play an important part of such education, but are only the beginning. Advanced tools based on improving functionality include, among other things, the skills needed to recognize depression and mania at lower intensities where functionality is enhanced. Stage-specific plans round out the program by providing detailed steps to take according to one’s stage of growth.

As one learns to recognize depression and mania earlier, there is a much longer window of time before the intensity escalates. Combined with intensity reduction tools, students find that a 20% mania can remain stable for up to a month before escalating. Depression often can last even longer. Early recognition and reduction tools are the hallmark of a good managed stage plan.

Freedom stage is where one begins to focus on increasing functionality at intensities still below what is often labeled hypo-mania (40%). Although most people function very well at 20%, their skills are challenged when the intensity hits 30% for longer than a few hours. As they develop greater understanding and skills, the length of time when they can function highly increases to thirty days or more. This gives them plenty of time to moderate the intensity if necessary.

With enough training and practice, most people can learn to function highly during 30% depressions and manias. By then they have taken the first steps toward IN Order instead of leaving their condition in disorder. They recognize higher intensities, including 40%, are beyond their current understanding and abilities, but are afforded a normal life with highs and lows comparable to people without depression or bipolar disorder.

Along with such changes, the time they can be in the more intense states without completely losing control lengthens. Their awareness and understanding is such that they not only recognize it earlier, but take necessary interventions in time to keep it from turning into a crisis.

Some people are motivated to do the work it takes to function highly at 40% intensities or higher. They see benefits in these hypo-manic and hypo-depressed states and are willing to follow a process that enables them to safely expand their range. They find they are enhanced by the states when they understand each so well that they are able to function highly during all states of 40% intensity and below. They, and importantly the people around them, become very comfortable with such states as their behavior proves mastery over both depression and mania within the bounds of 40% intensity.

Those who master 40% intensities find that they can remain in such states for 30 or more days without losing high-functionality and without undue risk of the intensity escalating. Some of us have mastered even higher states that would normally be called fully manic or depressed (80-90%), yet since we are highly functional and in full control for up to a month in mania and for several months in depression, the definitions of depression and mania as defined by the DSM no longer apply.

This renders the DSM guidelines moot and illustrates the lack of understanding I mentioned at the beginning. Basing a diagnosis on an arbitrary number of days or a simple list of symptoms is neither accurate nor very useful. It is a foolish waste of time (pun intended) without accounting for intensity, awareness, understanding, functionality, comfort, value, and a proper understanding of time.

Depression and bipolar are much more complex than most people are aware of. It takes far better assessments, tools, and plans than are currently in vogue to understand enough to function highly during more intense experiences. The first step is to recognize the limitations of the currently popular assessments, tools, and plans. Supplementing, and in some cases replacing, them with better ones will bring us to a much needed revolution in the way we diagnose and treat those who are still experiencing depression and bipolar in disordered ways.

Please share your questions and insights in the comments or contact me through our Facebook page if you prefer.

These seem like unusual questions to some people. Wouldn’t we be better off trying to forget our depressions and get on with our lives? Can’t we just hope that depression remains in the past and we never have to face it again? Ignoring past episodes may sound like a better approach, but refusing to take a hard look at depression or mania leaves us ill prepared for the next time it comes. Unfortunately, if depression or mania happened before, it is likely to happen again.

Looking at how we value depression and mania is an important part of any assessment; a part that is sorely missing in most protocols. The laundry list of symptoms in most assessments belie an incorrect assumption that the items are all seen as negative.

We have been asking the above questions (and many more) for several years now and have learned a great deal about the role value plays in depression and mania. Although our data is not yet extensive enough to make final declarations, there are many surprising trends that are too important to delay sharing.

Perhaps the biggest surprise is that once someone goes through the process of answering questions and rating their awareness, understanding, functionality, and comfort at various intensities of depression and mania, they often rate the value of having been through deep depression pretty high. It seems that just asking the questions is enough to plant the seeds of tremendous growth. Before being taught tools and plans for better outcomes, they have already begun to understand the difference between liking the experience and seeing value in having it.

When designing the functionality assessment, I expected most people to see little or no value in deep depressions, but possibly higher than normal value in shallow ones. My idea at the time was the artists and writers would see value in depressions that were low enough to give them a creative spark, but not deep enough to debilitate them. Was I ever wrong. Most people who have been through only the assessment process see shallow depressions as a minor annoyance with less value while finding great value in the deeper depressions, as already mentioned.

Mania, of course, has been the opposite. People see tremendous value in low manias and no value at all in the intense manias that get them in so much trouble. They enjoy being high, but recognize the negative impact it has on their relationships, careers, and other aspects of their lives.

It gets really interesting when we look at the relationship between how much people value the experiences and how well they understand and function during them. Those who value the experiences and search for meaning in them function far better than those who only seek to make the experiences go away.

Not surprising are the answers we hear when we ask about present states. While people can see value in having been through an intense depression, for example, they do not value having another one today. They do want another mania, though, which is a major contributing factor in the failure of remission as the end goal of treatment for bipolar disorder. Understanding the role of value in all states needs to be part of treatment and goal setting too.

Mindfulness is a popular tool for treating bipolar disorder and value is a major part of it. Central to the concept is to see everything without judgement. Many people believe such an approach reduces everything to a valueless experience, but nothing could be further from the truth. Mindfulness is about seeing every moment as highly valuable.

From the perspective of mindfulness, we suffer when we place different values on our experiences. Our preference for pleasurable moments is what makes us resist those that are painful. Such resistance is the cause of suffering, not the intensity of the pain. When we develop mindful equanimity, every moment is equally beautiful and we find tremendous insight in each part of the experience.

The insight gained from equanimity leads to the ability to function highly and find comfort no matter the outward or inner environment. The Bhagavad-Gita advises us to “Perform your duty without attachment, remaining equal to success or failure. Such equanimity of mind is called Yoga.” In other words, learn to find value in every intensity of depression and mania so you can start on the path to ending the behaviors that are in disorder.

The final article in the series will cover the effect of time on depression and mania. In the mean time, please share your questions and insights in the comments or contact me through our Facebook page at https://www.facebook.com/bipolaradvantage if you prefer. Be sure to check out the other articles in the series about Awareness, Understanding, and Functionality, and Comfort, too.

In any aspect of life, those who only seek comfort are consigned to mediocrity and boredom. Those who judiciously step outside their comfort zone and challenge themselves are the ones who learn and grow. This is equally true with mania and depression.

The best growth, though, happens just slightly outside the comfort zone. Too far outside and the lack of comfort can cause you to shrink instead.

Too many times, bipolar people step too far outside their comfort zones and find themselves at an intensity of depression or mania that is far beyond their control. Many of them become so frightened by it they hide inside their comfort zone hoping to remain there the rest of their lives. They accept a diminished story of their lives because they believe they have no other choice. They fear one wrong step will rapidly escalate back to an uncomfortable and out-of-control state.

When we carefully assess comfort (along with the other criteria) at various levels of intensity, we find close relationships between understanding, functionality, and comfort. One’s level of understanding, if accurately assessed, predicts the levels of functionality and comfort, for example. One’s level of comfort also influences the ability grow in understanding and function more effectively; all three are intimately tied together.

Such assessments lead to a far more accurate identification of the demarcation lines of an individual’s comfort zone. These assessments also help the individual to recognize the next level of intensity where depression or mania has just begun to go too far. The ability to find the zone between the lines is the key to success. We need to cross the line and go outside of our comfort zone to grow, but not so far that lack of comfort harms us.

If we look at any other field, we expand our understanding and functionality by taking on challenges that are slightly outside of our comfort zone. We are taught to take on reasonable challenges and make sure the risks that come with them are reasonable. We do not, for example, climb the Himalayas on our first hiking trip. We start out slowly and carefully until we develop skills. Most of us do not climb the most difficult peaks, but we usually go far beyond the first steps we took as a baby.

But, mostly due to ignorance and fear, many (most) do not treat depression or bipolar the in the same manner. They believe it is not possible to safely expand their comfort zone and refuse to accept that many of us have already done it. They narrow their range and call it “recovery” when a more effective method would be to expand their range and call it “growth”.

Because of such false beliefs, most programs for depression or bipolar disorder are only designed to lower the intensity until one is inside of the comfort zone. They do not teach how to cross safely into the growth zone or to recognize the next critical line where we have gone too far.

The result of such treatment leaves us with people who live in fear that the next episode will escalate out of their control. Unfortunately, since they do not develop understanding or skills that lead to functionality and comfort across a wider range of intensities, their fears are validated during the next episode (which is virtually guaranteed to happen unless they are willing to be a zombie for the rest of their lives).

For all of the talk about stigma, this is the worst one. The judgement of others may keep us from some opportunities, but our self-judgement keeps us from even trying. Accepting a narrow comfort zone regarding depression or bipolar influences the expansion of every other part of our lives.

When I was first diagnosed, I was told many times that I should not take on stressful challenges or certain jobs because they would trigger my “illness.” Such statements were coming from the same people screaming the most about stigma. There is nothing more stigmatizing than being told you cannot expand your comfort zone and take on reasonable challenges, especially coming from those who have restricted their own. If you want to stop the stigma, you need to stop saying “can’t” and expand your own comfort zone.

Some say that I do not understand depression or mania because there is a line that cannot be crossed and these concepts only apply to very minor cases. They think “real” depression or mania is overwhelming and uncomfortable for everyone. They say it is not possible to function during them because we are all incapable of understanding what is going on while it is happening. They are wrong.

Many of us are highly functional and comfortable at extreme intensities of both mania and depression. The people around us are also comfortable with us when we are in such states. We have taught others to do the same; many of them thought it was impossible at first too.

What the naysayers are really saying is that such intensities are too far outside of their own comfort zone which is restricted by lack of understanding, functionality, and comfort. Accurate measurements bear that out when we determine the previously mentioned lines at the edges of their comfort zones and where intensity is too much for them.

Like with climbing the Himalayas, very few have the desire or resources to reach such lofty heights. Most expand their comfort and functionality zones to intensities that they value (covered in the next article of the series). However, they recognize that those of us with more expansive ranges are the experts to listen to. If you want to expand your range to one where you live more fully, you should take advice from someone who knows how to get there and ignore those who say it is not possible.

What are your comfort zone intensities for depression and mania? What would need to change for you to be comfortable at the next ten percent intensity? Who do you know that understands how? Do the people advising you know how?The next articles in the series will cover how we value bipolar experiences and the effect of time on them. In the mean time, please share your questions and insights in the comments or contact me through our Facebook page at https://www.facebook.com/bipolaradvantage if you prefer. Be sure to check out the other articles in the series about  Awareness, Understanding, Functionality, and Value too.

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.

With bipolar having the reputation for lowering functionality it is no surprise when someone’s functionality score is below fifty. We nonetheless need to bring clarity to the score by detailing exactly what has changed. It is often a combination of enhancements in some aspects and diminishment in others, such as social enhancement and physical diminishment during low level depression with the combination of all aspects resulting in perhaps a forty average.

Claims of enhanced functionality should be met with serious challenges. Hypo-manics tend to score themselves much higher than circumstances justify, so we need to get concrete examples of the physical, mental, emotional, spiritual, social, and career/financial aspects and how they add up to a more accurate score. If one is making others uncomfortable, the zero social functionality score will bring down any perceived enhancements in the other areas.

As one would expect, functionality for those without training approaches zero during the most intense states of both depression and mania. Zero means dead, so if you are still alive you are at least functioning above that. It is very rare that someone would score above ten percent functionality during intense episodes without advanced training and skills in Bipolar IN Order based tools.

At the lowest intensities that most are aware of (The yellow L scores in the graph), there are many who legitimately justify how their functionality is enhanced by hypomania. You might be amazed, though, of how many depressives find enhanced functionality too. This is especially prevalent among creative types: writers, poets, musicians, artists, and the like.

Notice, though, that functionality is only slightly enhanced during the lowest levels. The reason appears to be due to the inability to recognize low intensities (as mentioned in the awareness article). When we teach how to recognize depression or hypo-mania earlier, students become aware of the optimal level where functionality is at eighty percent or higher. This “Comfort Zone” is illustrated by the blue C scores in the graph.

Part of the optimized functionality is a result of raising both awareness and understanding along with recognizing lower intensity. As understanding increases, awareness goes up. With increased awareness, students begin to recognize lower levels of intensity. The combination of the three factors (yellow arrows in the above graph) increases functionality, which brings comfort and value scores along with it.

The understanding and awareness gained during lower intensity high-functioning episodes applies also to the more intense depressions and manias. While not necessarily raising functionality to even “normal” levels of fifty percent, small increases can buy critical time to take actions that will avert another crisis. What we learn by increasing functionality at lower intensities can be the difference between life and death during the next intense episode.

Contrary to popular belief, the level of intensity one can become highly functional in has no limit. We have helped people become highly functional in states that were previously thought impossible, but the amount of work necessary inhibits all but a few who have the resources and desire to challenge the boundaries. The same can be said of climbing the Himalayas, racing cars, or any number of things some of us do to explore our capabilities.

High-functionality becomes substantially more difficult at each level of intensity. Most people find a range of intensity that works for them and they take steps to avoid or mitigate any intensity beyond their comfort zone. Like the casual hiker who is comfortable hiking in the mountains and does not push beyond the safe limits, they recognize the skills and effort it would take to function at the next ten percent level and choose whether it is worth the effort.

The comfort zone range for most people tends to be twenty to forty percent intensity for the manic side and forty to sixty on the depressive side. Beyond that takes takes too much effort. Very few people climb the Himalayas for the same reason, but we do recognize those who do as the top experts in the world.

What are your comfort zone intensities for depression and mania? What would need to change for you to function highly at the next ten percent intensity? Who do you know that understands how? Do the people advising you know how?

The next articles in the series will cover comfort, value, and the effect of time. In the mean time, please share your questions and insights in the comments or contact me through our Facebook page at https://www.facebook.com/bipolaradvantage if you prefer. Be sure to check out the other articles about Awareness and Understanding too.

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.

Functionality-based understanding has a tremendous influence on awareness. Knowing what to focus on tends to make people more aware of the important details mentioned in the previous article. Such awareness leads to greater understanding. The combination tends to create a feedback loop where both awareness and understanding increase together. But, as in any field, it generally does not happen without lessons from someone who has already created success and knows how to point you in the right direction.

This awareness/understanding combination has a major affect on our ability to function at any intensity of depression or mania. It helps us recognize the level of intensity where we begin to lose functionality and provides the tools to lower the intensity when it gets outside of the high-functioning range. It also helps us to expand the range to one guided by wisdom instead of ignorance and fear. In time we become highly functional at intensities that were previously the cause of crisis in our lives. Mastering the combination of awareness and understanding is the difference between disorder and In Order when it comes to functioning during depression and bipolar (and most other things).

I have had the honor of helping many people graph out their levels of awareness, understanding, functionality, comfort, and value at various levels of intensity. It is a great privilege to learn from them in the process. While we do not have enough data to make definitive conclusions, some interesting observations are clear.

When first asked about lower levels of intensity, the majority of people thought they had a much deeper understanding and were more functional during states than was the case. This may be related to the observation in the assessment article where we found that most people are not aware of levels of intensity until they have already lost functionality. They recognize their lack of functionality in the more extreme states, but during lower intensities they mistake the hypo-manic highs they enjoy with actual functionality.

Interestingly, they often equate the feelings they do not like during depression with a misperceived lack of functionality. It is generally believed that it is harder to function during depressive states than manic ones. We have more often found the opposite to be true. Those who understand depression find that it enhances their ability to function and doing so is far easier at any given intensity than the same intensity of mania.

At higher intensities, it is generally believed impossible to function. That may be true for some people, but when intense states do happen, their increased awareness/understanding measurably opens the window of time that they have to take effective steps to lower the intensity to a more functional level (I will cover time later in the series).

Those with Bipolar IN Order find a range of intensity where they benefit from the increased functionality that awareness and understanding affords them. They previously felt something was missing in their lives and they now understand that they can have some of the highs they were missing if they take responsibility for how they function, for example. They have been able to increase functionality in both depression and mania at all levels of intensity. They also know when to bring in someone with specialized knowledge appropriate for the needs at hand.

Defining functionality, of course, is critical to the entire concept. I will be doing that in the next article. Deeper understanding, along with the increase in functionality that comes with it, leads to more comfort and perceived value in both depression and mania (at least hypo-mania). I will be covering these concepts later in the series.

In the mean time, please share your questions and insights in the comments or contact me through our Facebook page at https://www.facebook.com/bipolaradvantage if you prefer.

Discussion photo available from Shutterstock

The police that work in the area know about crimes that go on right in front of you. The pest control people see things in the restaurants that might shock you if you knew they were there. Everyone from the woman in the plumbing shop to the guy selling pot (maybe even out of your own house) see things going on that you do not. The preacher knows about the spiritual goings on and the neighborhood doctor sees all of the injuries and illnesses.

When a thief sees a saint all he notices is his pockets. We all only see the things we have been trained to look for. As Paul Simon famously sang, “We all see what we want to see and disregard the rest.”

The same thing is happening in the depression and bipolar worlds. Many doctors and therapists only see it as a disease, family members see behaviors, and people with depression only see pain and suffering. There is so much more going on that none of them have been taught how to see. I have been teaching all three groups for ten years and am amazed how little awareness there is about very important details until I show them were to look.

Increased awareness results in deeper understanding, better functionality, more comfort for all involved, and recognition of value in what was once seen only as a disorder. It can literally be the difference between a diminished life and a great one.

The first thing we all need to learn is to be able to see the differences between each level of intensity. It is not so hard to do once you are taught what to look for. Our graduates, from seasoned professionals in the field to the recently diagnosed, can see each increment of ten from zero intensity to their most intense depressions and manias. They can differentiate the physical, mental, emotional, spiritual, social, and career/financial elements of each level of intensity. They learn very quickly how to notice each element and how even small changes in intensities affect their understanding, functionality, comfort, and value both in past experiences and if they were to have another episode tomorrow.

But, that is not how it starts for beginners. When first asked, most people have high awareness of their deep depressions and low awareness of their high manias. Even worse, they have no awareness at all of mania or depression until they get to thirty or forty percent intensities. Unfortunately, by the time they are aware it is often too late to do anything about it. They are too close to it spiraling out of control, which contributes to the mistaken belief that lack of awareness is part of the condition.

One of the amazing things is that awareness seems to increase just from asking the right questions. It may be that asking about awareness the way we do tells them that it is possible. They start to pay attention to all of the aspects (physical, mental, emotional, spiritual, social, and career/financial) and begin to catch depression and mania at lower intensities when they still have time to get it under control.

What is most surprising is the similarity in answers we get. So far, most people have described each intensity level with remarkably common statements. With enough data, we might soon have clear definitions for mania and depression that include specific criteria for each intensity. Diagnosis will be much more accurate because we asked questions that yesterday’s experts believed the person could not answer.

Awareness is not enough, of course. The rest of this series will cover understanding, functionality, comfort, value, and the effect of time. In the mean time, please share your questions and insights in the comments or contact me through our Facebook page at https://www.facebook.com/bipolaradvantage if you prefer.

Police officer photo available from Shutterstock

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.

Everyone has up and down times. It is a natural part of life. If we observe our lives over time we might say there are two poles that we have; some days we feel on top of the world and other days perhaps on the bottom. That is the basis for the word bipolar and the reason I say that everyone is bipolar. Some may argue that there are people who are unipolar and only experience the up or down side, but even they have a range of experience with a “pole” on each end.

Unfortunately, the word bipolar is generally used to describe a subset of people who have adverse reactions when they go to far toward the high and low poles. Although related to how far from center one is, there is no distance from center that guarantees one would necessarily react to it in an adverse way. It really depends on how far we are from our comfort zone. One person might be perfectly comfortable and highly functional at a certain point from center while another could be so uncomfortable that he/she is literally in danger of suicide. I see the comfortable person as keeping life in-order, while the person in danger of suicide has lost control and is in dis-order. Using bipolar as a term to describe the dis-ordered person is an over-simplification that goes too far. We should at least distinguish the difference between having Bipolar Dis-Order or Bipolar In-Order.

But life is not even that simple. If I just won a marathon, for example, I might be very high emotionally yet completely drained and low physically. To really see where we are on the spectrum from high to low we need to consider all of the aspects of our lives: physical, mental, emotional, spiritual, social, and career/financial. It is probably more accurate at any given time to say that we are really in a “mixed state” instead of somewhere on a straight line between the two poles, so we must see even the expansion of bipolar to Bipolar Disorder and Bipolar IN Order as just a convenient simplification of a much more complex topic.

There are six distinct stages of bipolar: Crisis, Managed, Recovery, Freedom, Stability, and Self-Mastery. The first three are considered Disorder, while the last three are clearly IN Order once you understand the difference.

Bipolar Disorder

We are in Crisis when the intensity of our high or low state overwhelms us. On the down side, commonly called depression, we either cannot function or we can function only enough to attempt suicide. On the up side, commonly called mania, we lose our ability to control our behavior and may put ourselves and others at great risk.

But, even the most disordered of us are not in crisis all the time. The majority of people considered to have Bipolar Disorder spend most of their time in Managed Stage. They use various tools to keep the intensity from reaching a Crisis level, yet still experience times when it is clearly uncomfortable. They struggle to minimize the intensity with the goal of getting to Recovery.

Recovery, as defined by the National Institute of Mental Health (NIMH), means the manias and depressions have been removed. The recovery movement might challenge such a definition, but I have yet to hear anyone define recovery as moving further toward the two poles. At the least, recovery means to decrease the intensity of mania and depression to the point where we are in control of our behaviors.

The NIMH has determined Recovery to be an unstable state in their landmark STEP-BD study: “According to the researchers, these results indicate that in spite of modern, evidence-based treatment, bipolar disorder remains a highly recurrent, predominantly depressive illness.” Therefore, one is still considered to have Bipolar Disorder even when in temporary remission.

The medical model that only sees bipolar as a disorder or an illness is not working. The assessments, tools, and goals are all based on the idea that bipolar is a disease that must be managed toward reduction if not completely eliminated. It is a system that has been proven not to work by their own studies and is unacceptable given that we have already produced much better outcomes.

Bipolar IN Order

Freedom Stage begins when we reject the notion that we cannot handle bipolar and are making the effort to expand our comfort zone instead of trying to hold on to remission. We assess where we are in terms of ability to function at different intensities, use tools designed for increasing functionality at slightly elevated intensities instead of reducing them, and take well planned steps slightly outside of our comfort zone and immediately back in again. With practice, we find that we become highly functional and comfortable with intensities that were once outside of our full control. We learn to thrive WHILE manic and depressed instead of aiming for temporary remission.

Stability Stage is achieved when we are able to expand our comfort zone to the same intensities that once caused a Crisis for us. It takes tremendous insight and effort to achieve such Stability, but the idea that it is impossible has already been proven wrong; many of us have already accomplished it. We are definitely Bipolar, but there is no way to consider our condition in disorder. When we are in Stability we are comfortable instead of suffering and so are the people around us.

Some of us have achieved a stage beyond Stability. We call if Self-Mastery because we have mastered ourselves to the point that we can function highly during levels of intensity beyond what once caused a Crisis for us. This stage is reserved for those willing to dedicate a tremendous amount of effort to it. I like to compare it to the difference between a casual hiker and one who would climb the Himalayas. Mastery is functioning at the top level in any endeavor; Self-Mastery comes with understanding (instead of rejecting) every state of mind, while being able to function so highly that you see the value in every one of them.

Even for those who do not aspire to Self-Mastery, breaking out of the disorder model gives us all an opportunity to achieve measurably better results through better assessments, better tools, and stage specific plans that were developed by those of us who have already succeeded with them. In business and sports, we learn from those at the top of their game because they have achieved the ultimate success. We would never seek instruction from someone who settles for half way. Those who struggle with their bipolar condition should learn from those who have achieved Bipolar IN Order and reject the advice of those who defend Bipolar Disorder as the best they can hope for.

Depressed man photo available from Shutterstock