I always thought of recovery from bipolar disorder as a return to the BB (before bipolar) era, but as Class 10 of NAMI’s Family-to-Family course points out, recovery doesn’t necessarily mean going back to the “good old days.” It’s often healthier to look at recovery as moving forward – a process of transformation, of becoming a new you, accepting your new reality, embracing fresh dreams, and drawing up new plans. This seems to be true both for the person with bipolar disorder and his or her loved ones.

Recently, a patient’s mom asked me why I was prescribing an antidepressant, fluoxetine (the generic form of Prozac), for her son’s anxiety disorder. Jeremy had started on this medication in the past few weeks. When I first prescribed it, I carefully outlined the target symptom of anxiety and explained how the medicine would help treat the anxiety through the serotonin system.

Since starting the medicine, Jeremy’s anxiety levels were declining – he was getting better. But mom became concerned when her own mother and some friends of hers asked her why the doctor prescribed an antidepressant for anxiety. They thought he should also be on something “for his anxiety” – an anxiolytic.

Mental illness carries a stigma, no doubt about it. Recently, however, I began to wonder just how deep this stigma really is and how much of it is self-imposed. In other words, do we feel stigmatized mostly because people stigmatize us or because we fear that they would if they knew we were living with mental illness? (And when I say “we” I mean members of the bipolar community, including people who have loved ones with mental illness.)

Two events triggered my thoughts on this.

I just read an article on the FOX News website entitled, “Judge Rules Prison Doctors Can Forcibly Medicate Loughner.” The article says that the key question is whether prison officials or a judge should decide whether Loughner should be forcibly medicated.

Loughner’s attorneys also are fighting the forced medication at the 9th Circuit. The key question is whether prison officials or a judge should decide whether a mentally ill person who poses a danger in prison should be forcibly medicated. Prosecutors say the decision is for prison officials to make, while Loughner’s lawyers say it’s up to a judge.

My immediate thought was “Shouldn’t the doctors be deciding that?” and “Why would Loughner’s attorneys be fighting against the forced medication?”

We distinguish between mental and physical illness. Why? Many illnesses we consider physical have a mental component, including ulcers, asthma, hypertension, irritable bowel syndrome, heart disease, urticaria (hives), and sexual dysfunction. And the illnesses we consider mental all have a physical aspect to them, namely the brain. Yes, the brain is physical. It’s not just some nebulous collection of emotions, thoughts, and brain waves concentrated in a person’s head. In addition, some so-called mental illnesses – anorexia, for instance – have readily observable physical symptoms.

Whenever we use the phrase “mental illness,” regardless of whether we intend to do so, we reinforce the false dichotomy of mental vs. physical, mind vs. body. This leads many people to question whether brain dysfunctions such as depression and bipolar disorder are truly illnesses, even when they have no trouble recognizing that that certain so-called mental illnesses, such as autism, epilepsy, and Alzheimer’s are physical.

Several weeks ago, the British Psychological Society published a report online entitled “Understanding Bipolar Disorder.” (You can download the 88-page report for free; although you must go through the purchase process to “buy” it, you’re charged nothing for it. According to BPSShop.org.uk, the report will be available for free “for a limited period.”)

Although the report doesn’t make any groundbreaking revelations, it does contain some important reminders, including the following:

People often have a different idea of what “recovery” means in relation to bipolar disorder.

Some think of it as no longer needing to take medication or see a doctor or therapist. Others may think of it as regaining control of their lives with medication, therapy, lifestyle changes, and/or other approaches. Some people don’t view bipolar as an illness (they may even view it as a gift) and seek lifestyle changes as a way of accommodating their extreme highs and lows.

What does “recovery” mean to you?

According the NPR health blog “Shots,” three psychiatrists at Harvard University who were leaders in research on bipolar disorder in children were punished over not disclosing payments from drug companies for research and other activities totaling more than $4.2 million dollars. (See “Harvard Punishes 3 Psychiatrists Over Undisclosed Industry Pay,” by Richard Knox.) The psychiatrists cannot accept any payments from industry for one year and must seek approval for any such payments after that period. Additionally they will suffer a “delay of consideration” for promotions and advancements in their institutions.

The doctors’ public response to this suggests that they felt that they operated in good faith and that they now realize they should have paid more attention to the details regarding disclosure.

As a psychiatrist, every day I encounter families struggling with mental illness, especially in their children whose lives range from disrupted to shattered as a consequence of these challenges. In these daily battles I’m most frustrated and saddened by the jaw-dropping lack of compassion surrounding me and my patients regarding their family struggles and their child’s distress.

Unfortunately, many people still view mental illness as a moral rather than a medical or developmental issue. As a result, they readily dispense judgment when someone is struggling with emotional and behavioral symptoms – shutting down open discussion and squashing attempts to problem solve rather than blame.

Even worse, stigma and misunderstanding paralyze many people who might consider seeking help but don’t because they’re afraid of being judged or feel somehow to blame. Families are told they’re being manipulated by their loved one who’s suffering or that their parenting is impaired. Just “try harder” says the teacher, the coach, the neighbor, and the in-laws.

At times, I become resentful that bipolar disorder occupies any part of my life, but because it does and because writing about is one of the things I do, I sort of accept that it’s going to occupy a corner in my mind.

Some time ago, when Candida and I were having trouble cooking up ideas for blog posts, I asked my wife Cecie to help us drum up some topic ideas. Soon, we were talking about bipolar disorder every day. We read books, articles, and research studies about bipolar. We even watched a couple movies and videos. I began to notice that when friends or family members asked what we had been up to lately, the topic turned to bipolar disorder.