Many bipolar people say they are “high-functioning,” but most of them mean they function OK when in remission and cannot function when things get too intense. How well one functions DURING depression or mania defines the difference between Bipolar Disorder and Bipolar IN Order. At every intensity, functionality influences the comfort of everyone involved and whether they see value in the experience. Functionality should be the central focus of any approach to bipolar instead of simply trying to make it go away.
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.
When I first started putting together the protocol for assessing depression and bipolar disorder, I was working with a professor of Psychiatry to make sure the ideas were sound. His advice was to combine both awareness and understanding in the graph to keep it simpler. I am glad that I did not take the advice.
Awareness and understanding are different in ways that matter. Expertise might help someone understand why things happen, but does not necessarily lead to increased awareness. An expert on sex, for example, may be totally unaware that his wife is having an affair. It takes awareness (covered in the first article of the series) to know what is going on whether you understand the phenomenon or not.
It turns out that understanding is more related to functionality (covered in the next article) than awareness. You may be completely aware that you are sitting in a car, but unless you understand how to operate it you cannot drive.
Understanding is not just about knowing the physical, mental, emotional, spiritual, social, and career/financial aspects and their implications, it also includes knowing about the tools. You need to know how the tools work, have proficiency in using them, and understand which ones to use at each stage of bipolar – the disordered stages of Crisis, Managed, and Recovery, and the IN Order stages of Freedom, Stability, and Self-Mastery. I call this functionality-based understanding.
Too many people are holding out those who cannot function as the ones we should be listening to. Those who only know bipolar disorder and have not created Bipolar IN Order in themselves or others have no understanding of what it takes to make it happen. They can learn, but many times their beliefs limit their willingness to do so. They keep insisting it is not possible to be highly functional with bipolar and refuse to consider the evidence that contradicts such beliefs.
You can live in the same neighborhood for thirty years and still have little idea of what is going on there. You can shop in the stores, eat in the restaurants, talk with the neighbors, and feel that you know the community very well. But there are still more things going on than you know about. You simply never knew to look for them or were never taught how.
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.
This video is from a public television program called “Moving From Bipolar Disorder To Bipolar IN Order.” It explains what bipolar is and the difference between disorder and IN Order by detailing the six stages that one goes through as understanding and functionality improves. It outlines more complete assessments geared toward success, advanced tools that supplement existing tools, and stage specific plans that accommodate the needs of each of the six stages. It builds on the previous article called The Six Stages Of Bipolar And Depression.
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.
Moving From Bipolar Disorder To Bipolar IN Order
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.
The Experts Are Asking The Wrong Questions About Depression And Bipolar Disorder.
Over the last ten years I have spoken with thousands of people diagnosed with bipolar disorder. When I ask them to relate their story of how they were diagnosed, a troubling pattern is pretty evident; the diagnosis was very brief and largely irrelevant in regards to bringing any hope to the situation.
Most people I have talked with see the assessment as a life sentence with no path for making life work the way they had hoped for. I wonder where they got that idea?
For the last five years I have been speaking to groups of therapists and doctors. When I tell them assessments are not thorough enough they are often in agreement about others, but believe their own assessments are very thorough and use the best evidence-based tools available.
What tools? The Beck Depression Inventory (BDI) takes about 10 to 15 minutes to complete the 21 questions in a self-report format including the items intended to measure symptoms of severe depression that would require hospitalization. The BDI has been used for 35 years and is reported as being highly reliable regardless of the population. The Hamilton Depression Scale asks only 17 questions. There are others, of course, but none provide the insight needed to achieve Depression IN Order or Bipolar IN Order.
I have been meditating for over 50 years. I started when, at five years old, I became fascinated with watching my breath go in and out. I intuitively knew that this and other meditative practices would bring me to a state of ecstasy. It didn’t take long before pursuing that state became the most important thing in my life.
Although I got incredibly close through my efforts in meditation, it wasn’t until I looked for ecstasy in depression that I truly found it. Once I found ecstasy in depression I found it everywhere. My hope is that sharing my experience might help others to find the same insights that I have.
As I watched my breath go in and out I found some dramatic changes in my state of consciousness. I would detach from my body and find myself floating above and looking down at myself sitting there. It was a very pleasurable state, but also very profound in how I viewed the world. I believed that part of me was untouched by the physical world; the part that I now call my soul.
It wasn’t long before my soul separations started encroaching on my waking states. I would often find myself turning the corner and suddenly being in a long tunnel with a light at the end of it. During those experiences time would stand still or at least slow down dramatically. I interpreted these experiences as seeing God.
Stigma, medication, treatment options, recovery, patient rights and physiological basis are some of the most discussed topics regarding bipolar. There are, of course, many other interesting aspects to debate, but it is hard to find any discussions about bipolar that do not include one or more of these central topics.
While it has been very healthy to debate all of them, there is an underlying assumption that must be addressed too.
The paradigm that all of the above topics are based on is that we are incapable of remaining in control when mania and depression reach a certain intensity.
We are therefor not responsible for our behaviors when manic or depressed because it is not possible in those states to choose better ones. This creates the goal of removing bipolar from our lives (at least at higher intensities) and the debate is about how it is best done. Much of the debate about medication, for example, is about alternative methods to achieve the same goal of reducing intensities of mania and depression.
But, what if we could be highly functional while manic or depressed? This idea has so many repercussions that people are afraid to even think about it. Consider what is at stake: If we cannot choose how to respond to the different states because it is impossible for anyone to, in-ability becomes central to the arguments in each of the above topics.
If anyone can choose, the impossibility argument is removed and the discussion becomes either how to function in mania and depression or why some cannot.
My recent article called “Why I Am Against Bipolar Meds” turned out to be less controversial than I expected. Some people refused to read past the title and that is unfortunate because the vast majority of those who commented said that it was a very fair assessment of both sides of the debate. There were several misconceptions, though, that need to be cleared up.
I mentioned the three stages of Bipolar Dis-Order and the three stages of Bipolar IN Order assuming most of the readers are familiar with the terms and my work. Unfortunately, that was not the case for many readers. In trying to keep the article to under 1000 words, I did not go into detail regarding the stages and what I mean by Bipolar IN Order.
This caused confusion for several Psychiatrists who assumed that Self-Mastery means remission. At the other end of the scale were several people with Bipolar Dis-Order who declared that they were in Self-Mastery when their statements seemed to contradict their self-assessment. It seems greater detail of the Bipolar IN Order concept is warranted.
The primary objective for someone with Bipolar Dis-Order is to lower the intensity of mania and depression and move away from Crisis toward Recovery. Bipolar IN Order is about becoming more functional in an expanding range of intensity and moving from Recovery toward Self-Mastery.
Many people say you should not discuss politics or religion with your friends because you might not be friends much longer. If your friends are Bipolar or associated with it in any way you might want to add meds to the list. The extremes both for and against meds give new meaning to the word Bipolar. The poles often seem further apart than the most intense debates in politics or religion.
I have been speaking with groups about Bipolar for almost ten years now and have tried my best to stay out of the debate. But many in the audience won’t let me. At the end of my talks I am frequently accosted by members of one camp or both. It is pretty clear that neither side even heard what I said and the only thing they listened for is whether I took their side in the only thing that matters to them. I didn’t validate their extreme point of view and they are furious with me.
In his song The Boxer, Paul Simon said, “Still, a man hears what he wants to hear and disregards the rest.” In my case they often hear things that were not even said. In their minds I gave a talk siding with the enemy.
I have always pretty much ignored the med controversy because it is not central to my message. Until now. I heard something recently that made me want to take a stand.