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Bipolar Disorder: Blame the Illness, Not the Person

The National Alliance on Mental Illness (NAMI) has a Stages of Emotional Responses chart that traces the emotional path people generally travel in coming to terms with their loved one’s mental illness. I’m pretty much at the final stage, Stage III: Moving into Advocacy, but I’m still sort of stuck at Stage II: Learning to Cope, which is characterized by Anger/Guilt/Resentment, Recognition and Grief.

Yes, we’ve been living with bipolar disorder for about 12 years now, and I’m still angry and resentful. Now, though, I’m not angry at my wife who has bipolar disorder. I blame bipolar disorder. It accosted my wife, tried to ruin our marriage, emotionally traumatized our children, ruined my wife’s career, and stole tens of thousands of dollars.

45 Comments to
Bipolar Disorder: Blame the Illness, Not the Person

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  1. Joe: I admire how open and honest you are about what you are going through – this illness brings a lot of collateral damage with it. However, I can’t agree here. Manic Depression is chronic – it will not go away or be cured – it is in my DNA, my mind, my soul. To blame the illness is to blame part of me, and that leads to shame. Acceptance is the answer, 100% acceptance. The illness is not the enemy, ignorance is the enemy. The ignorance did not single you out, or her. Over time this illness gave me more than it ever took. Remember; keeps your friends close and your enemies closer. Good luck to you both – Alistair

  2. should have read — the “illness” is not the enemy. sorry!

  3. Alistair–

    I disagree. The illness gave us nothing. God’s ability or the human ability to turn something bad into something good is what spun all the crap bipolar dealt us into the few nuggets of gold we’ve reaped from bipolar. I suppose this is true in your case, too. Your soul and ability to not only overcome adversity but make something good of it is not a gift from bipolar disorder any more than any tragedy of life can be considered a gift.

    I do agree that bipolar (manic depression) is chronic, but it is also treatable. I don’t think blaming the illness is to blame part of the person any more than blaming heart disease is the same as blaming someone for having a heart attack. Sure, I accept the fact that my loved one has bipolar disorder… not that we really have much of a choice in that, but I still blame the illness for the bad stuff we’ve had to deal with as a result of it.

    If bipolar disorder weren’t the enemy, we’d have no reason to try to make it go away, no reason to pursue symptom relief. I’d like to see a cure. In the short term, we try to treat the symptoms. I like having my wife back… and she certainly likes to feel more like herself.

  4. I embrace mine… and I do not blame it. Bipolar does not decision for me, I do decisions for me. I am sometime overemotional and not myself… but I don’t fall into this moder devil possesion. I know my trigggers, I know when I am in an episode. I know I need to sometimes to slow down. I know I have to sometimes use all willpower i have to do so. Sometimes, it does not work. Never ever would I use the bipolar card. I did it, I face the consequences.

    and medical intervention is not a mean to end it all. It maybe helpfull, but it is a small part of “recovery”. It seems to give false hope to people. Pill to make us the person you always wanted to be… forget, will power, your illness is to blame… Seems horribly enabling to me.

  5. Venus–

    Playing the bipolar card? Would anyone say that about heart disease, diabetes, or cancer? Perhaps in some mild cases of bipolar, thought-therapies or “will power” can keep mood episodes at bay, but to think you can just will away bipolar disorder is as inconceivable to me as willing away any serious physical illness.

    Yes, medication is “enabling.” It enables one to function when the illness makes it impossible to do so. Medication isn’t always effective and it can have negative side effects. And you’re right, it may not be the entire solution. Other therapies can help, including mindfulness, CBT, and IPSRT (Interpersonal and Social Rhythm Therapy). I think the best approach is to use everything at our disposal that works. You can’t do CBT and mindfulness when you’re in the grips of full-blown mania or depression.

  6. Joe, diabetes does not mean you snap at people unreasonably, make decisions that effect other’s lifes in a bad way. Hence, no diabetus card. I never made anybody claim that their medical condition made them do anything.

    I was not talking of medication as enabling, I was talking about the medical approach (aka blaming everything bad on chemical imbalance). It may help, but i have yet to meet a person who took pill and life was wonderful. It does not work that way, so let’s not delude ourselves.

    and as for willing away… You cannot will away the condition, but you chose what to think. You can level your moods to a degree. To claim that one cannot do so, just because of their conditions… is disrespectful and does nothing to reduce the stigma. One can learn to manage, to observe, to expand their comfort zone. I did it… and many others did as well.

  7. Venus–Sometimes diabetes does make one snap at people unreasonably, as when the blood sugar is out of whack. Unfortunately one of the symptoms of bipolar disorder can be extreme irritability. Just because the disease has behavioral symptoms doesn’t mean it is any less a disease than others.

    I have met people with bipolar who are much improved on the proper medications — changing from completely irrational and aggressive to rational and caring. It does work that way… not always, but in many cases. I am not deluded.

    It’s not disrespectful to say that a brain illness can eliminate a person’s ability to control what they say or do. That’s the nature of the illness. It has nothing to do with stigmatizing someone any more than saying a person who had a heart attack did so because they had clogged arteries.

    What’s stigmatizing is to imply that someone has control over their thoughts, behaviors, and what they say when they really don’t and are merely too weak of character to control what they say and do as a result.

    I am always happy to hear about you and others who are able to maintain mood stability without medications. I’m not saying it can’t be done. What I am saying is that everyone is different and there are different degrees of the illness. During acute phases, medication can be a lifesaver and get a person back to a point at which they can start reaping the benefits of other therapies.

  8. Thanks Joe! I very much agree with you. I have recurrent depression, and recognizing that the depression is a beast that invades my mind and body helps me conquer some of the shame and fight through those times when I have a bit of breakthrough.

    I think what people who have not suffered from depression don’t always appreciate is that it really is a full-body illness. The fatigue, sleep disturbances, and cognitive problems all take a toll as well as the psychic agony.

    Effective medicine has been the biggest part of bringing me into remission. The difference it has made is enormous. Therapy helps a lot too, although it is not effective if I am not on medication. I’m grateful to have had very competent care. It makes it possible to have a life with much more normal human ups and downs. I have to watch my stress levels and be alert for when I start to slip. The illness isn’t gone, but I can go about the business of living and pursuing my goals. On the whole, good treatment has done well by me.

  9. I find it insulting when people imply I do not suffer, just because I can cope and because I believe in myself and in capability of humans to overcome things.

    I just don’t see how believing that humans are strong is stigmatizing. I think that telling person in vulnerable place “you need to take meds for this and if they don’t work, too bad, because your brain is broken and your capability to think was ELIMINATED (seriously, why not go back to demon possesion? This is much much worse!),” is a very cruel thing to say. I would rather be told that I CAN work it out, that I CAN push and have people who tell me to push and struggle on. I don’t discard role of medication, although it’s not what I chose.

    I think this is about attitude. I believe humans are responsible for themselves and their actions. If I screw up, i try to attone for it. I don’t blame chemical imbalance ex machina for my decisions… because it does not help people who were involved.

    what does sound better “I am bipolar, blame the disorder” or “I am really sorry, is there anything I can do for you now?”.

    • Hi, Venus–

      You’re right. Believing that humans are strong is not stigmatizing. What is stigmatizing is the belief that some people are weaker because they need medications or some people are stronger because they don’t. I’m not saying that you said or implied this, but I know that this is what many people think, and I want to make it very clear how wrong I think this is.

      I know many people with strong characters who need medication to help maintain mood stability. It takes an incredible amount of strength for some of these folks to remain on their meds and do whatever else is necessary to keep major mood episodes at bay. This is their way of being “responsible for themselves and their actions.”

      When I say “blame it on the illness,” I’m suggesting focusing one’s efforts on treating the illness instead of blaming the person. I can tell the difference between when my wife is talking and when mania is talking, and I can’t hold her accountable for what mania makes her say or do. Blaming her does absolutely no good. Encouraging her to will her mania into submission would be futile. Seeing that bipolar is at work enables us to take action to treat the illness and put my wife back in control.

      Some people feel it necessary to apologize for hurting others during a major mood episode, and that’s fine, if it makes them feel better about it. Personally, I see no need to apologize for what results from having an illness.

  10. “I find it insulting when people imply I do not suffer, just because I can cope and because I believe in myself and in capability of humans to overcome things.”

    Umm…Venus…if that was directed at me, I wasn’t talking about you.

  11. Joe –
    I would like to comment to this, as a person with both psychiatric (Schizoaffective Disorder, Bipolar Type – among others), neurological (tic disorder, and later medication-induced movement disorder), respiratory (asthma), cardiac (medication induced arrhythmia) and blood glucose (hypoglycemia) illness and disorder. Though the list may seem a bit long, only two have been coded as severe, and they are the two most relevant to this conversation: my mental illness and my hypoglycemia (aka, low blood sugar).

    You are correct in saying that blood sugar imbalances can cause irritability, mood swings, depression, anxiety, alcohol abuse and other psychological symptoms. For a person who is unaware they have such an imbalance, they feel horrid and are often helpless to fix the situation. The emotions are strong, and can often seem a bit overwhelming. Yet, in most cases, a person will eventually be diagnosed as having either too high or too low of blood glucose levels. It is then their responsibility to make amends to any damaged relationships or burned bridges, and learn to manage their blood sugar and prevent relapse. In my case, with low blood sugar, I can choose not to monitor it, eat healthy, carry/eat snacks when needed, alert others when I need help, and so forth. If I do not manage and take care of the illness, and my blood sugar goes and stays out of whack, then yes – I can be blamed for that.

    The same goes for my psychiatric illness. Now that I am diagnosed and have been in treatment for quite some time, it is my responsibility to manage my illness – keep track of triggers, be aware of an episode, use all possible tools to manage it, and, if all else fails, to reach out and say “I need help”. I can have the most intense impulses and urges, and it is still my choice to act or not – and my responsibility not to. For someone who is not treated, does not have a good support system and does not have the necessarily tools, this can be near impossible; however, I have been at this for most of my life. If I feel I can no longer control myself, it is my responsibility to take steps to gain that back – from simple psychological tools to an intensive hospital environment, depending on the situation. More so, abusive behavior is *never* acceptable. If a person loses control and harms someone, it is their responsibility to make amends, and that goes for any illness.

    There are a few exceptions to this rule – psychosis or mania with lack of insight; younger children and adolescents who are still learning to manage, and may not have the maturity to do so; and those that have not been diagnosed/treated, those new to treatment and those whose treatment is not working/needs to be adjusted. In the midst of an episode, we should be kinder and/or gentler with a person, and we should prioritize; but mental illness, or diabetes, or cancer, does not excuse a person in the majority of cases.

    And this does come from a consumer and patient, not an ignorant lay person. To be honest, I have heard stories from many who claim that professionals who excused all their behavior or habits only prevented them from leading a fuller life, and prevented them from learning to best manage and take control of their illness. To say that, ‘because you are ill, you will not be able to learn to manage or control your behaviors’ can be damaging in many cases.

    Just my two cents.


  12. I think what Joe is saying (correct me if I’m wrong) is that we don’t expect a person with severe heart disease to run marathons. We don’t ask people with Cerebral Palsy to “get with it” and use their arms to dig ditches. People with physical disabilities are much more accepted than those with brain/mental disorders. Bipolar disorder definitely causes certain behaviors: wild mood swings, over-spending, over-sexualization, rages, delusions, hallucinations…the list goes on. Yes, it’s good to take responsibility for our “fits” & apologize. But to imply that we can help others(“what can I do for you?”) while in a psychotic state is absurd. This is a very very serious mental disability. It’s not the average person’s depression.Which is what I think you have, Venus. “Normal” people get down in the dumps & snap at others but are able to get out of that state after a few days. Bipolar causes people to be absolutely unable to move or to be in such a frenzy of mania, they simply cannot think straight & leap from one wild action to another. Psychosis is common, especially after long-term insomnia caused by manias. I cannot imagine, Venus, how you think we can control this.
    Venus, I tried all sorts of methods to fight manic-depression. Cognitive therapy, positive thinking, primal scream therapy, long walks (which I still do), Yoga, prayer, being prayed for, etc. until a severe breakdown (one of many) in my mid-40s. That’s when a psychiatrist, an MD & a neurologist all worked With me & found a combo of meds that really help. The change is amazing! People like me, who have tried every other avenue, to no avail & so use “pill” for mental stability, should not be put down for needing medications. Just as people who have lost legs should not be put down for using prosthetics rather than re-growing their limbs. Venus, you say you got your manic-depression under control by force of will. How? You don’t go into any detail, just smugly state that you have done it, as many others have. I’d be interested in your description of your methodologies.

  13. First, i am glad somebody else feels the same way. Erika is right, people do have responsibility… or at least should have. Even when one does hurt others by accident, they should apologize and try to help with the consequences if possible. It is human decency. As much as it is unpleasant to know we done something wrong… others cannot be expected to apologize our behaviors forever. They too have stressful lifes and their issues. I expect to be treated well… and try to treat others the same.

    Dixie, I did not know it was an requirement to share here your whole life story. I am not being smug. I am just appalled by some implications here. That bipolar overrides your entire personality (it doesn’t), that bipolar person can max out family account and should not stand up the consequences, as their illness is to blame, not them.

    Thanks to my mother I practiced yoga and meditation since very young. I had not people in my life to enable me, which I believed helped in the end. Yes, I have a support, but not enablers. I know natural remedies (herbs mostly), try to eat well (sounds simple, but i know too many people who complain about moodswings yet they won’t give up their ramen noodles and other toxins that can send your mood out of the whack), meditate each day, stay connected with the source… and I don’t do this in a shallow fashion. My spirituality is not a pop spirituality. I have people in my life who help me to keep my feet on the ground…

    and again, I said I don’t have anything against people who try medical approach… as long as they do other things as well and don’t blame their actions on “well, my meds stopped working, it’s not my fault”.

    And yes, you can still help others. After all, we aren’t in episodes all the time. In meantime, we can do good in the world. That is another thing that helps me. Having purpose… yes, it is a responsibility. But it feels wonderful and it contributes to one’s well being.

  14. Dixie –
    I know your comment was to VenusH; however, I hope you do not mind me commenting on what you have said, as I think you are misinterpreting some of what is being said, and I know that your post did not target some of my points (I assume this is because you submitted your comment before mine was approved).

    First off, what you are saying about how Venus likely only has the ‘average person’s’ depression because she has been able to manage it well without use of the medical model, is a common response from many people that I have seen. If a person defies what most consider fact, or what does something that is outside mainstream psychiatry, people commonly respond with a) your case must not have been that bad, b) you were misdiagnosed or don’t truly have Major Depressive Disorder/Bipolar Disorder/Schizophrenia/etc c) you will eventually fail and need X or c) you are lying. I want to point out that those of us walk a different path – one that is not quite medical model, or without medication, or with alternative therapies, etc – well, I want to point out that we are not an enemy here. Most of us truly want people to recover and, if someone recovers best within a medical model/philosophy, then most of us would encourage us. Once again, the grand majority of us are not seething, anti-psychiatry zealots. We just want our pain to be respected and validated, and freedom to be able to pursue recovery and/or survival in a way that is best for us.

    Secondly, though I refuse to claim to speak for anyone else, I do not think anybody here is claiming that talk or behavioral therapy, and other psychological coping tools, can somehow completely ‘cure’ psychological afflictions. I certainly would make no such claim. All I, and I am pretty sure VenusH, is saying is that you can – and, in fact, it is your responsibility – to learn to effectively cope with your symptoms. Once you know there is a problem, it is your responsibility to take ownership of your mistakes, help mend bridges, and ensure that you do not harm someone – especially those you love – again. All that I am saying is that, yes, these emotions and experiences are painful are overwhelming; but, even if you can’t make them go away, you need to learn to respond to them in healthy ways. More so, I am saying that this is possible. One negative impact I have seen come from the medical model is that, not only does it relieve people from responsibility of harm they may done during an episode; but it tells them that they can’t control it, and limits them from being all that they could be in this world. Telling people this – and you do, indirectly, many times with the medical model – is actually very stigmatizing and offensive to a person’s true ability and/or potential. I have seen this happen and I have experienced it on a personal level. People need to know that, except in a very few cases, they can take control of their mental health, learn to manage their emotions and experiences, respond in healthy ways, raise their functioning and take greater responsibility for their life. Even if they have a relapse, and feel out of control of their emotions, they need to reach out and seek help, or make arrangements so that they can receive help if they cannot themselves seek it out. That is their responsibility, to themselves and to others. And, if they do hurt someone, it is their responsibility to make amends.

    You mentioned psychosis specifically and, as someone with Schizoaffective Disorder, I would like to comment on that. The psychotic episodes that I experienced were some of the most painful and terrifying experiences of my life. I look back on it now and, truly, the only thing I can feel is sadness for my younger self – at certain points, much younger self – and the horror that she felt and experienced at the grips of her own mind. That is not pity – just genuine sadness. Yet, even in the midst of those breaks, and especially the ones after diagnosis, I still had a choice: I could hurt others, and/or myself, or I could resist what was at times a constant auditory assault of violent commands. It was the hardest thing I ever did; but I resisted, for months, years, I resisted. And when I could no longer resist or control myself, I reached out for help, told someone and went inpatient.

    And that is the point that I, and I think Venus, was trying to make. You cannot magically make the symptoms go away, no; however, you can – and, in fact, it is your responsibility – to learn to manage them and minimize the impact on your life. Either this be with or without medication; with or without the medical model; or anything else, that responsibility is still yours. And, in fact, when that responsibility is owned, life improves. You become someone who survives, copes and manages, instead of a helpless victim. As, we don’t ask someone with heart disease to run the marathon; but we do ask, and expect them, to take every precaution and step to maximize their health and minimize the risk of serious injury. That is their responsibility. Those with psychiatric disorders have the same one.


  15. Venus, thanks for sharing more info’ from your life & how you deal with the bipolar. It’s not a requirement to share “your whole life’s story” but it’s helpful to others, especially if you are making claims of finding a cure.
    I have a very deep spirituality but that doesn’t heal a brain disorder. It helps me feel better but can’t cure it. Yoga didn’t help me. I do have an extremely severe case of manic-depression. If you read the literature, you know that each deep depressive & manic episode causes brain damage, so being diagnosed late in life (as I was) results in less & less ability to control one’s emotions.–ssb050603.php
    I agree, apologies are good when one has behaved badly. But it is also necessary for people in your life to understand this very complicated illness.”Normals” who throw fits are much more in control of themselves & should be expected to behave better than someone with a brain disorder. People in a psychotic episode are truly not in control & should not be expected to be in control.
    I have worked with adults, teens & children who had all sorts of disorders, from Autism to schizophrenia. None of us who worked with those people expected them to behave like “normals.” We worked to help them function better in society but it’s absurd to put the same requirements on everyone.
    I was raised by an RN who was very strict about our diets, no candy allowed, fresh food only. We picked our own veggies & fruits. But that didn’t lessen the symptoms in me, which I’ve had from birth.
    I’ve never had an enabler in my life. I wish I’d had more support. My husband is wonderful but my parents basically ditched me when I was 20 & in a severe psychosis. The attitude, “pull yourself up by your bootstraps” is what causes many suicides by people who are suffering terribly & without any support systems.
    It’s good that your symptoms are under control by diet, Yoga & so forth. But it’s wrong to expect all sufferers to be at the same place you are. Many people have tried the same methods you have & gotten no results. Medications have helped me & people in my therapy group. I would never expect them to go off meds which are helping them fight a very real & painful disorder.There is a tinge of pride in your postings, as if you have the key to good mental health & we peons need enlightenment. That isn’t helpful, it’s adding to the stigma.
    Of course, we can do good in the world. As I said, I was a carer for adults/teens & children who suffered brain disorders. I was a teacher. I worked very hard in the 1960s as an anti-war activist. I was jailed for my actions. Later in life, I produced brochures & pamphlets for various societal causes. I am a well published poet/short story writer. But I accept that I have a damaged brain & need the medical help that I get. If you sense anger from me, it’s because I wasted a good 40 years of my life listening to people like you, my parents, other family members, therapists, doctors, spiritual leaders, all telling me to “get a grip” & to “behave better” when I was helpless to do so until I got on the proper medications. The difference in how I slept & felt was a complete 180 after finding the proper meds. My family notices it & so does my husband. As do I. If someone with the right knowledge had stepped in before I was 10, I’d have had a much, much better life. I pray that people reading these posts will go for help & get the right meds. Diet helps, exercise helps, meditation & prayer help but many people absolutely need medication.

  16. I see this theme repeatedly over the years….that people with mental illness need to take responsibility for themselves and their lives. What puzzles me is why anyone would think people with mental illness would do otherwise.

    Besides myself, I have several friends with depression or bipolar disorder or anxiety disorders and ALL of them try very very hard to work with their conditions and live fulfilling lives.

    Now maybe I know an exceptionally diligent group of people (lots of studious nerds), but from my experience, the folks with mental illness are more responsible in monitoring and treating their conditions than many people I know with other illnesses.

    It makes me wonder if people with mental illness are not held to a different standard. Are people with other chronic conditions expected to apologize for the stress their friends and family experience when their health worsens because they didn’t follow medical advice? I don’t know the answer to that.

    If I’m cranky when I’m depressed, I apologize. But I also know the people around me understand when I’m in pain and don’t take it too personally. They know I am always doing the best I can and I usually do pretty well.

  17. Erika:
    “We just want our pain to be respected and validated, and freedom to be able to pursue recovery and/or survival in a way that is best for us.”

    This. No wonder some of us “alternatives” tend to be bit too defensive. Our sufferings are lessened… and often just because we don’t cause havoc. I don’t need to be patted on the back for being such a strong person… in fact I wish I was more strong and more serene… I am not gonna give up on becoming the person I wanna be just because of some “brain disorder” (for which there are currently no tests).

    what I am saying here is that giving in to your symptoms makes it much worse to deal with the aftermath. If there isn’t much damage caused, it is easier to recover than if you maxed out your bank account and cheated on your husband or lost your job in midst of episode. It is one’s responsibility to created roadblock to stop themselves, whatever it is, whatever works for you.

    Throwing hands up and saying “I can’t” is not gonna help you achieve the life you want to live. Hoping that magical med combo by itself will help you get there, while doing nothing else in meanwhile… this approach is dangerous. You can do it.


    You are not getting my point. It is preciselly illustrated by blaming “people like me” for your misery. What is it with our society that we no longer accept freedom with all the responsibility it carries? Why do we always need to find someone else to blame?

    I don’t expect much from people than live and let live and not intentionally hurt me. If they hurt me unintentionally, I expect we can sit down and talk it out. And no… blaming your brain is not enough. I think I am relativelly forgiving, but I have my limits. I am quite vulnerable and I need to protect myself first. At the same time, I don’t expect any special treatment in the society. I know my limits… and I try to respect them. If I screw up, I own up to it.

    (not so long ago I had a debate where somebody claimd Gaddafi is bipolar and unmedicated, hence we need to keep that in mind. Now, if we are to accept the “blame the illness and not the person” premise and this rumor is true… the implications are scary).

    “There is a tinge of pride in your postings, as if you have the key to good mental health & we peons need enlightenment. That isn’t helpful, it’s adding to the stigma.”

    and I think “NO YOU CAN’T” is adding to stigma.

    As i said, I am quite hardcore in my spirituality. I mean it. Not saying everybody needs to become like me, but I think for many the whole spiritual approach does not work, because they approach it in selfish manner. “I will become spiritual to get better… and get better now”, instead of embracing it truly. If you are not at peace with yourself, nothing is gonna help. And I think that is where “blaming the illness” gets in the way… you cannot be at peace with yourself if you believe you absolutelly have no control over your doings.

  18. Hi, Venus–

    “I am not gonna give up on becoming the person I wanna be just because of some ‘brain disorder’ (for which there are currently no tests)” sure sounds to me like it’s coming from someone who’s in denial that bipolar disorder is an illness. Arguing with someone who doesn’t accept that fact really is futile, so this is the last comment I’m going to post here.

    Furthermore, nobody here, absolutely nobody has said “NO YOU CAN’T.” Yes, people with bipolar and other serious brain illnesses can and almost always do succeed in managing their illness – with medication or therapy or both.

    We need to remind ourselves that people are individuals and that no single approach is effective for everyone.

  19. Joe –
    “We need to remind ourselves that people are individuals and that no single approach is effective for everyone.”

    Yes, and you see, that is what we have been trying to say. We don’t mind if someone uses the medical model, or takes medication for Bipolar Disorder. We are asking our stories and experiences to be validated, to be respected.

    ““I am not gonna give up on becoming the person I wanna be just because of some ‘brain disorder’ (for which there are currently no tests)” sure sounds to me like it’s coming from someone who’s in denial that bipolar disorder is an illness. Arguing with someone who doesn’t accept that fact really is futile, so this is the last comment I’m going to post here.”

    That sounds like awful debating technique!

    If she is in denial, then it is far from a harmful one. She may not believe it to be a disease (and, just to note, I have a recent medical dictionary that uses a mental illness – PTSD – as an example of something that makes someone ill/is an illness; but is not a disease); but she takes steps to manage it, and is successful at it. If she were “in denial” – and I don’t see it that way – and she were failing or struggling, then I might see that as supporting evidence to the disease model. But she isn’t. She’s coping and functioning – without the medical model.

    Once again, nobody here is anti-medication, anti-psychiatry, or any other such thing. We want people to recover, and to have a full life. We want people to be allowed to pursue this any way they feel is best for them. Recovery – functioning, life, happiness – it does happen without medication, though Your response – “you’re just in denial” – is one I have commonly seen from people when this fact is presented to them. When you say that medication helped you or a loved one, and that the medical model was a right fit for you, we don’t say “you’re in denial about it not being an illness” (More so, there is a difference between an illness and disease).

    “Furthermore, nobody here, absolutely nobody has said “NO YOU CAN’T.” Yes, people with bipolar and other serious brain illnesses can and almost always do succeed in managing their illness – with medication or therapy or both.”

    I realize that nobody said this; however, I was pointing out that using a strict medical model can create such attitudes, even if they are not conscious. If you tell people that you have a disease, and should not have to take responsibility for harmful or negative behavior, you are telling them they cannot learn to control such behavior. You are telling them they will always struggle to function, and when overwhelming emotions do strike, the only thing they can do is up a dosage or switch medications. Telling people that no, they can’t necessarily always stop or prevent these episodes from happening; but they can learn to respond in healthy ways, learn to control their behaviors and take control of themselves, is – in my opinion and experience – much more empowering, hopeful and helpful.

    Yet, as I said, if the medical model helps someone more than any other philosophy would, then they should use that. They should also, however, be able to explore all methods of recovery without being criticized, judged or told they are “in denial”.

    I want to highlight, once more, that I am not blaming anyone for their mental illness, or saying that people can necessarily control their emotions. I don’t think people should “pull themselves up by their bootstraps”. People need support, and treatment. But, and I’m going to quote what I said before:

    “People need to know that, except in a very few cases, they can take control of their mental health, learn to manage their emotions and experiences, respond in healthy ways, raise their functioning and take greater responsibility for their life. Even if they have a relapse, and feel out of control of their emotions, they need to reach out and seek help, or make arrangements so that they can receive help if they cannot themselves seek it out. That is their responsibility, to themselves and to others. And, if they do hurt someone, it is their responsibility to make amends.”

    Personally, in most cases, I do lean towards biopsychosocialism. Yet, as a person diagnosed with Schizoaffective Disorder, Bipolar Type, Severe, Recurring, I am off medication. I have had severe episodes; but I have managed to cope, and respond – without hurting anyone, myself or others. And, if I do feel like I am about to lose control, it is my responsibility to reach out for help. This has, just to note, all been with the support of my psychiatrist.

    I’m not in denial, either. People just need to be shown all their options, and supported in whatever they take.


  20. VenusH and Erika, I really identify with what you have written. I can tell you that finally finding a mental health professional who actually believed I could be well had a profoundly positive impact on me.

    For so long I heard “chronic illness,” “severe mental illness,” severe, severe, severe. Multiple hospitalizations. They had given up on me, and I had too. Where was I supposed to find any hope in all of these dire predictions about my future? When I heard the word “chronic,” I gave up. Chronic meant I was always going to live in hell, and I wasn’t remotely interested in that. I needed some hope that I could be well.

    I don’t care whether people take meds or not. It’s not my business. I chose to come off of them, and that was the right choice for me. I do think that the mental health professionals who kept insisting I accept their dire predictions about my future, fueled my hopelessness. Glad I found someone who thought differently.

  21. anon –
    Exactly. Every word of it.

    The fact that my psychiatrist believes I can actually become well – not “managed”; but, truly *WELL* – has made all the difference for me. He was the one that proposed we taper off medication, actually. I hadn’t even realized it was an option, and nobody had ever suggested that I could actually be *ME* again. That my symptoms were not things that could only be controlled or managed by upping the dosage or changing the prescription – that I could actually take control, and learn to manage and cope. The process has been a struggle at times; however, I have few regrets about doing it.

    “I don’t care whether people take meds or not. It’s not my business. I chose to come off of them, and that was the right choice for me. I do think that the mental health professionals who kept insisting I accept their dire predictions about my future, fueled my hopelessness. Glad I found someone who thought differently.”

    Once again, exactly. Every word.

  22. This discussion is going in circles. One person says “I am doing well on meds.” Then another person says “You can do well without meds.” No you can’t, yes you can.
    No MD, no psychiatrist ever told me that due to having manic-depression, I could not “do anything.” I was never given an “it’s useless, you have a brain disorder” attitude or any other “dire prediction.” Not sure where you live but there are very enlightened people in the medical profession. Perhaps you (Erika, Venus & anon.) live in places where you do not have access to highly informed doctors?
    The people on this message board who keep saying they are not against “the medical model” certainly use negative terms whenever they speak of doctors, psychiatrists, medicines. That’s conflicting, mixed messages. Either it’s OK or it’s not.
    Venus, you say “I am hard core in my spirituality” as if someone is questioning your spirituality. Nobody has done that. I am also deeply devout & believe that God,Jesus, the Holy Spirit, the Virgin Mary helped me through a lot of bad times.
    Thanks to God, I have never been hospitalized, even in the deepest depths of psychosis b/c my husband & family chose to help me at home.And prayer has helped me very much.
    So people who use meds can also have “hardcore spirituality.”
    Doctors tried to help me first with therapy (cognitive, biofeedback training). But since those didn’t work (after 5 years), we went the meds route.
    My therapist told me 3 years ago “you are graduated!” In other words, I am AOK without her help.
    Yes, I take meds & get blood tests to be sure they aren’t messing me up. They aren’t. I go to group therapy 2-3x/month. It helps to check in with people who are also working on how to deal with the ups & downs of this disorder. They are good friends.
    Erika, this definitely is a physical brain disorder, unlike PTSD. PET & CAT scans show differences in the brains of people in manias & depressions, in the limbic system & amygdala. That’s a scientific fact.
    I have read numerous books & articles about these physical changes of the brain in people with bipolar, schizophrenia & etc. Anyone can find these books/medical journals in the library, if they are interested in self-educating.
    The fact that this is a brain based, physical difference doesn’t make us more or less human or able than anyone else. In fact, there are more poets, painters, musicians with some form of brain “disorder” than those with normal brains.
    A disorder is different than a disease. A disease damages organs. A disorder affects the organs,making them perform differently.
    Since getting on the right meds I have not had one psychotic episode in 15 years.
    What do I do to help myself besides take Rxs? Have a lot of alone/down time after being in noisy places. Hike in Nature, one of my joys.When I lived near an ocean, I swam every day. I read for fun & to be updated/informed on manic-dep. Dance often. Laugh a lot. Go to plays my husband is in & socialize with theater people. Enjoy writing clubs & Poetry groups.Pray. Write a lot & celebrate when my poetry & stories get published. Am happily retired. Watch goofy monster movies with my husband & friends. Avoid negative people.
    I will always speak up for people who have mental differences. It should be OK to get treatment for this, just as it is OK not to get treatment.

  23. Dixie, I’m really glad your doctor didn’t make dire predictions about your future. Mine did, though.

  24. Erika, it sounds like you have a great doctor. I think it shows how open minded he is that he is willing to look at both options.

  25. Anon, your MD obviously isn’t up to date about manic-dep. No MD or pyschiatrist should make dire warnings. They should give good information, let us know where we can go to read more & encourage us to be informed. The more information, the better we can make our decisions about our health

  26. Dixie –
    PTSD (and trauma, in general) sufferers have been shown to have changes to their brain structure, hormone levels and telomeres. There is just as much evidence for PTSD being biologically based as there is for Bipolar Disorder. Never in my posts have I denied that there is a biological basis. I have a subscription to Biological Psychiatry. My career goal is an MD, with combined Neurology-Psychiatry board certification. I devour research studies, and the passion is there. It wouldn’t make sense without biological basis – everything related to life is biology, and everything we feel or do is based in it. Abnormal biology, by most’s standards, would, of course, be a major contributer to what we know as mental illness.

    As you seem to be confused at to my points, or believe that I am “running in circles”, I will summarize:

    . As the cause and labeling of mental illness, there are three main factors: genetics, environmental and social factors.
    . Genetics code our DNA. From the moment we are conceived, they are shaping who we will be – from the color of our eyes to the complex details of personality. Thus, if there is a family history, or if something codes differently despite no family history, we are naturally predisposed to a certain brain wiring.
    . Environment – both pre and post natal – plays a role as stress, trauma, etc. can all change the biology and structure of your brain, and trigger certain responses in those already predisposed. Heck, even the month you were born has been shown to have an impact on the development of Schizophrenia. This is why mental illnesses usually appear in the early 20s, as that is a major transitional age.
    . Social factors define what is considered mentally disordered. In hunter-gatherer times, ADHD was likely not a bad thing – if anything, it provided an advantage. In a time when the common man did not read, dyslexia would not have been an issue. Homosexuality was once a disorder, a mental disorder, in the DSM. Most no longer consider homosexuality to be a mental illness. This is not because of advancing science – the brains of male homosexuals are structurally different, there is more evidence each day that it is based in biology, and your risk for certain things does raise if you identify as bisexual and/or straight (just to note, this is not homophobia – at all. Do not confuse the issue. This is just one of the better examples I could think of) – it is because of a changing society and its viewpoints. To deny society’s influence on what is considered mentally ill is blind.
    . A person can have every symptom of a mental illness; if, however, it does not interfere with their functioning, it is not considered mental illness. Someone could be hearing voices telling them to jump off of a bridge or push someone in front of a subway, or they could be severely depressed; but, if they have good GAF (Global Assessment of Functioning) scores – good social, occupational functioning – they, according to both the DSM-IV and upcoming DSM-5, are not mentally ill.
    . Therefore, if, for example, the majority of the population’s brains were wired or damaged as to present Bipolar Disorder, it would not be a disorder. Society would be built up around such a wiring and, thus, it would not interfere with their functioning. Those who moods did not dramatically shift would be considered disordered. There are, in fact, cultures that do embrace such wired brains. This is, of course, true for many things. It could also be true for physical disability. “The Eye of the Beholder”, an episode of the Twilight Zone, comes to mind. (
    . Unfortunately/fortunately, the majority of brains are wired and structured so that they do not present as Bipolar. Thus, that leaves those of us with differently wired brains – and those who care for us – to try to find a way to cope and survive in this world.
    . Though there is some evidence that CBT, meditation, etc can create lasting changes in our brain chemistry, I think we all agree that these brain chemistries are not things we can “snap out of”. When someone is severely depressed, they cannot suddenly become chipper, energy-filled beings. When someone is manic, they cannot snap their fingers and have their thoughts slowed down. Nobody wakes up in the morning and actually wants to be psychotic. Treating a person as such is hurtful, invalidating, discriminatory and offensive. As things are now, it can be – and usually is – an incredibly painful experience. People need support, not criticism.
    . Thus, though mental illnesses are largely labeled as such based on societal norms, they are biologically and genetically based, and can be painful. In this society, unmanaged and untreated, they keep us from being all we have the potential to be. They interfere with school, work, relationships, etc. The brain is “disordered”. They can even lead to suicide. One cannot, and does not deserve, to live in such a state of constant pain and struggle. It needs to be treated, and managed, just like any other field of science-based medicine. And that does not contradict what I just said, either. Even psychotherapy is evidence and science-based.
    . What one does from here is their choice. If they choose to use medication to manage their brain chemistry, then that is their choice. If they chose not to, then that is also their choice, and it needs to be respected as such.
    . Too often, it is not respected. When one goes off medication, it is almost always seen by mainstream psychiatry as a symptom of the disorder – not a choice to be supported and explored. Not taking medication, and managing well, does not mean that one’s case was/is less severe, or that they are “in denial” about their illness.
    . The pure form of the “medical model” – and I know there is variation, and this is the most strict form of it – says that the only way to manage symptoms, and/or control behavior, is with medications and other chemical means. This says “I can’t” because it tells people their behavior – not emotions, behavior – is out of their control, not their responsibility (if done in the midst of an episode), and the only proper response is to treat it with a dosage adjustment. This is simply false. Even if medication is used, it is not a magic bullet, and therapy, in almost all cases, NEEDS to be a component to learn to control behavior and respond to strong emotions and impulses. CBT, DBT, REBT, Psychoanalysis – a combination, perhaps.
    . Behaviors associated with Bipolar Disorder can be managed without medication. Even in cases labeled as severe, as mine was, it is possible. It is extremely difficult at times and, thus, is a personal choice. It won’t change what got you on drugs in the first place. It will all still be there; but it is possible, and I do not regret it for a moment. Even in the midst of some of the most severe, suicidal depressive episodes, or extremely, irritable manic ones, I’m glad I did it.

    . And, to re-quote what my original point was, and the actual gist of this post – which was not medical model vs other – is responsibility. This is my comment on that:

    “People need to know that, except in a very few cases, they can take control of their mental health, learn to manage their emotions and experiences, respond in healthy ways, raise their functioning and take greater responsibility for their life. Even if they have a relapse, and feel out of control of their emotions, they need to reach out and seek help, or make arrangements so that they can receive help if they cannot themselves seek it out. That is their responsibility, to themselves and to others. And, if they do hurt someone, it is their responsibility to make amends.”

    No matter what model you follow, I believe this to be fact. As, more than any other model, I believe in the recovery model. Are mental illnesses biologically based? Yes, they are. The illness, or whichever word you choose, is the emotions and experiences. Your behavior is a display of how well you are managing it. Having Bipolar Disorder, or such, does not excuse you of responsibility. It is your responsibility, as a consumer and patient, to manage it in whatever way you feel is best, and to prevent harm from coming to yourself or others. This was my first, and primary, point.


  27. To clarify one of my sentences: “The illness, or whichever word you choose, is the emotions and experiences.” This is not a statement of opinion as to if I believe it to be illness or not. Refer to my fourth “bulleted point”.

    anon – Yes, he is. Truly, I have no negative words to speak. He has helped me in more ways than one, and I consider him pushing me to try to wean off medication to be one of the best. I had to search for awhile, though. Everyone deserves the best care possible. Anything less should not be accepted.

  28. I’m sorry for those who have gotten messages from a psychiatrist or other medical professional that their illness would ultimately limit them. That is really too bad. But please keep in mind that that is not universally the case.

    My psychiatrists have made it clear that they believe I need to remain on medication. They definitely worked with me when I wanted to taper off, but I ultimately relapsed, so now I stick with what works for me. But never once, EVER, was I given any indication that I could not succeed. When I was ready to give up on myself and my capacity to thrive, my psychiatrist held that hope and confidence and repeatedly told me “you can do it.”

    Dixie makes a lot of valid points. There’s a lot we don’t know about the brain, but there’s also a lot we do know. Anxiety and depression are bad for the brain. Medical treatment for mental illness is not tantamount to telling someone to give up! It’s about getting them back to where they can go about the business of living. If yoga and other aspects of your life get the job done for you, that is good. But those of us who also need psychiatrists aren’t all being fed hopelessness or sold short. I promise. There are some very fine professionals out there. And if you get one who doesn’t believe in you, move along till you find a better one.

  29. Martina –
    I am glad that you have found a treatment plan that works.

    I do want to make something clear, however. In no way do I claim, nor think, that yoga or such will cure my symptoms. They are still there, and essentially, just as severe. The depressions, the mixed states, the psychosis has come back a few times. In fact, I am just not coming out of one of the worst suicidal depressive episodes I have ever experienced. Which is why I do suggest caution to anyone who wants to work on tapering off. It is hard, expect your symptoms to return and have a support group in place. I still see my psychiatrist, every week – just not for medication, for therapy.

    I also do not reject or deny the research into the brain and how the one diagnosed with mental illness. Once again, I have a subscription to Biological Psychiatry (medical journal) and keep up with the latest research. Once again, refer to points four through six on my previous comment.

    My pain point in posting here was originally to discuss responsibility. I stand by my statements, especially in relation to that. I also don’t think that the medical model, just to note, is incompatible with saying that people are responsible for their actions and behavior – episode or note. Once again, I would feel the same way for a person with blood glucose disorders.


  30. I would agree that the diagnosis does not absolve people of responsibility for their actions. The only caveat to that, I would make, would be if someone was legally incompetent to make decisions. With freedom comes responsibility. People can’t have one without the other.

    In fact, I would argue that psychiatrists expect patients to take responsibililty for their actions. No matter how ill, they still expect patients to pay their bills, show up on time, and call 24 hrs in advance to cancel an appointment. Even in the psych ward they expect patients to take responsbility for their actions – try and lie in bed when it’s time for group. They tend to get really angry about that. It’s not a mean thing to hold people responsible for their behavior. Enabling people can cripple them.

  31. Typo Corrections

    *just now coming out of one of the worst
    *and how the one diagnosed with mental illness works
    *My main point in posting here
    *or their actions and behavior – episode or not.

    Joe –
    Though we may disagree on a few key points, I do think this conversation was and is important – all of it, from responsibility to things like the medical model (vs other models, such as the recovery model) – to have. The mental health community is extraordinarily varied in its views and approaches, all have some evidence or the other supporting it and all are valid to a certain extent. I think that, in consideration to how this conversation has gone in other situations, this was a success. There was none, or very little, venom, zealotism, and attacking. I think, if we can agree on something, is that we all handled ourselves fairly diplomatically in the face of a subject that is highly emotionally charged.

    Once again, if anyone wants clarification to my view points and opinions, I direct you to the comment I posted at “3:44 pm on May 6th, 2011”. I feel as if I have repeated myself a few times, and/or been misinterpreted. I think things were clearly stated in that comment and, looking back on them just now, there is nothing I wish to recant.

    If anyone would like to ever debate this in further detail, on a more personal level, I am posting my e-mail: doveerikams@gmail.

    Before responding, however, please read at least that one comment. It highlights my view points, and leaves little room for misinterpretation.


  32. anon –
    “I would agree that the diagnosis does not absolve people of responsibility for their actions. The only caveat to that, I would make, would be if someone was legally incompetent to make decisions. With freedom comes responsibility. People can’t have one without the other.”

    Agreed. This is the situation where I make the exception.

    I agree with your second paragraph, as well.

  33. Martina, thank you for your comments & I’m so glad you have good medical personnel who listen to you. That’s a huge plus in facing this brain disorder.
    Erika, First of all, congratulations on working toward medical school! What a difficult but rewarding route! I applaud your high goals.
    Much of what you quote in your last post links to things I’ve read.
    “The Eye of the Beholder” is a great comparison. I love the Twilight Zone & yes, what we see as beautiful/acceptable is a product of our societal norms.
    My father was of Irish & Scottish descent on his mother’s side & African-American/Cherokee/Scots on his Dad’s side. He was “into” alternate visions. So when I went psychotic at 18, he insisted that it was a spiritual experience. He’d always called me a “contrary” as I’d frequently gone the opposite direction compared with societal norms.
    But I was suffering terribly and as you say, we deserve to have our suffering alleviated in whatever way works for us.

    You have obviously experienced people putting you down for not going along with “the medical model” (a term I had never heard until reading this thread). But I’ve experienced the opposite: people putting me (& friends with brain disorders) down for using medications.

    Either way is unfair. There should be agreement that we are all trying to get to a place where we are able to function in whatever role we choose, to reach our goals, to be independent (as possible) & to find happiness.

    So I am highly sensitized when people preach that medications are not the way to go. I’ve heard that over & over from Scientologists, from people who are convinced that Yoga or a low gluten diet can heal this condition (whether we call it a brain disorder, disease or condition is irrelevant–it’s a difference.)
    I apologize for being so strong-spoken towards medications. I tried for decades (age 18-46) to not take medications, to find other treatments, but to no avail. I have friends who had that same experience.

    You are right, there is no “magic bullet” for anything. I’ve known people who committed suicide who never used medications. And others who had been on meds who attempted suicide.

    Like I said b4, this is a complicated condition & we are all individuals who must be treated individually. If a medical professional is not listening to you, move on!

    It takes time & effort (& is frustrating) to find an MD or psych’ who is willing to work With you, not dictate methods to you. I am very fortunate to have found this type of medical personnel. None of them wanted to have me coming to them forever, they all had the goal that I find freedom & relief through whatever methods worked for me.

    Your statement (if I’m reading it right) that we are responsible for our behavior even during a manic or depressive episode seems far-fetched. I’ve been in such bad “fits” that I didn’t know the difference between a car & a dog. I know many people who have had the same experience in psychotic episodes, thinking a TV show was telling them to jump off a bridge.

    That’s dangerous & it worries me that anyone thinks we can rely on our judgement in times like that. There has to be a plan, with family/spouse involved, for such events.

    However, if you meant that we are responsible in that we must apologize after the fact, that makes more sense. However, I think that if our family members, spouses & friends know about this very real & serious brain disorder, they will come to understand those “fits” (for lack of a better word) & we don’t need to apologize over & over & over again. That’s sort of like expecting a person in a wheelchair to apologize over & over for needing an elevator rather than trying to go up stairs.

    When I said manic-depression is a physical disease of the brain, I was responding to this in one of your posts: “She (Venus)may not believe it to be a disease (and, just to note, I have a recent medical dictionary that uses a mental illness – PTSD – as an example of something that makes someone ill/is an illness; but is not a disease)”

    And you seem to be taking personally something I meant about everyone on this message board (that we are talking in circles). That wasn’t directed at you. But I know how sensitive we all are, we who have “different” brains. So it’s understandable that you might have taken that to heart.

    re: societal views as to what is mental illness–I have, all along here, been speaking up against that stigma.
    Everything you say (biological, societal, environmental effects on the brain) is true & right out of medical journals. Glad you can elucidate it so clearly. Many people with this disorder fail to read/study. It is difficult when in the midst of a depression or mania b/c the words literally turn indecipherable at those bad times. So it’s very important to get as much information as we can when we are in lucid periods.

    Yikes, why do you assume that I or anyone else here would confuse the issue—think you were being homophobic? Not a chance. I am part of a community of poets, musicians, theater people. There are more gay people per square inch in those communities than most others. So nobody is taking you wrong, I hope.

    But if you are just trying to make a comparison of how society sees one group of people as “wrong” then that does make sense.

    Maybe I am mis-reading here but are you saying that a person who hears voices telling them to jump off a bridge is not mentally ill as long as they have a good GAF score (according to the DSMV?) I would totally disagree in that case. If anyone is hearing voices or is tempted to jump off a bridge or commit suicide in any way, that is a serious bout of mental illness & needs prompt attention & intervention.

    In that case, the DSMV is completely wrong. I apologize if I’m reading you incorrectly, I was up late at my husband’s play/after party.

    You are right, ADHD was probably useful in neolithic cultures, for hunting, for being super alert in case predators were coming. People with manic edges are often far more sensitive & artistic. So that part of it can be good.

    But we can all agree that the really horrible times, when we are so depressive that we cannot function or when we are in such manic states that we don’t sleep for weeks (see Charlie Sheen) & babble utter nonsense, to harm ourselves—there has to be some form of intervention & treatment.

    Whatever form that takes, whatever works for the individual, I am for it.

  34. i have this diagnosis.
    my sister has this diagnosis.
    i take medication.
    my sister does not.
    guess who’s experienced more manic-to-depressive cycles?
    my poor sister.
    so it irks me to hear people with this illness or without this illness knock medication.
    it’s letting me get back to being myself.
    unfortunately, this includes a frontrow seat to seeing my family suffer as we watch my sister suffer the reprecussions of “I’m choosing not to be manic anymore.”
    it’s round 6, in just as many years
    Yup, soooo fun.

  35. Eliza, am very glad you have found a good route for treatment. And I hope & pray that your sister will allow herself the benefits of medication, since nothing else has worked for her. There is nothing at all wrong with seeking professional care. I wish more people could realize that. Best wishes to you!

  36. Dixie –
    Thank you. It truly will be a great victory for me. It allow me to turn all of these experiences – good, bad, neutral and horrible – into something that will hopefully help people. I remember that, while I was in the hospital, one of the biggest complaints I heard from other patients is that they didn’t feel listened to, or that their doctors invalidated them in some way (either that be the symptoms themselves, complaints about side effects, etc). Hopefully, I can change that for at least a few people.

    The Twilight Zone is one of my favorite shows of all time. My psychiatrist was actually the one to introduce it to me. The political, social and philosophical ideas it brings up are timeless.

    My father had similar ideas. He told me I was psychic, and more “in tune” with the spiritual world. It was a terrifying thought to me. It seemed so real – and, for awhile, I thought it was – and was scary enough already. The idea that it may actually was reality (by the time I told anyone, I intellectually realized it was irrational – not emotionally, though) was the worst thought in the world.

    I think we have had similar experiences, in respect to other people – just from different ends of the spectrum. I agree, we’re all just trying to survive. Everyone is, not just those with Bipolar Disorder; but we do have more struggles to face. Our defensiveness comes from a genuine place of trauma, pain and at times awful past experiences. I have had people verbally attack me for going off medication. On one site, I posted these opinions and that I was tapering off. A few weeks later, one member sent me a message, in a very bitter and unsympathetic tone, and said “Are you still lucid? I doubt it.”

    Going off of medication was one of the most difficult things I have done. As I stated previously, I am just now coming out of one of the most severely suicidal depressive episodes I have ever experienced (it was a huge step for me to be able to go through that, and not have it significantly impact functioning – barely at all). I am glad that I went off medication; but I am also glad that I was on them initially, as it gave me time to heal from a complete breakdown, and learn the tools I have now. I am lucky to have the support of my psychiatrist and family. If they all shared the same views as that one poster, I would have given up.

    I also believe that, and I think this is something everyone can agree on, is that, when someone does opt to use medication, it should be the lowest possible dosage to maintain stability. I have met psychiatrist who go by the “highest possible dosage without killing the patient.”

    Finding my current psychiatrist took years, and a lot of trial and error with other professionals that just did not work out. Truly, I have no ill words to say of him. He has carried me through some of my darkest periods. I know he wishes there was more he could do to help some of his patients; but, his impact has been huge on my life. Having the right ‘fit’ for a treatment provider can make all the difference.

    In terms of responsibility, I did mention in a few previous posts that I do exclude untreated and undiagnosed severe psychosis where the person lacks insight (and/or when they have been ruled mentally incompetent). Once a person has been diagnosed and treated, however, I quote this point:

    “People need to know that, except in a very few cases, they can take control of their mental health, learn to manage their emotions and experiences, respond in healthy ways, raise their functioning and take greater responsibility for their life. Even if they have a relapse, and feel out of control of their emotions, they need to reach out and seek help, or make arrangements so that they can receive help if they cannot themselves seek it out. That is their responsibility, to themselves and to others. And, if they do hurt someone, it is their responsibility to make amends.”

    In other words, once someone is aware and has a period of wellness, it is their responsibility to ensure they seek treatment if it occurs again, or make arrangements so treatment can be given if they can no longer seek it out (Psychiatric Advanced Directives are recommended in that situation, for example). It is that person’s responsibility, as a patient and consumer, to ensure that their symptoms cause as little harm to those around them as possible. If they know, ahead of time, that they will lose insight in the midst of psychosis, it is their responsibility to plan for that. (From what I am reading, I think we are in agreement with that?)

    In cases where insight and/or competence is not lost, I do believe it is the person’s responsibility to learn coping tools to manage the strong emotional states and impulses that accompany the disorder. For example, I am mildly hypo-manic at the moment, which often leads to increased irritability. It is my responsibility to, if I feel I am about to snap at someone, to use a coping tool to calm myself, walk away or reach out for help. If I do snap, it is then my responsibility to apologize, make amends and try to think of ways to prevent it from happening again. Though hypo-mania is mild, I use this same standard for mania, mixed states and depression.

    I mentioned the definition from the medical dictionary (Taber’s, just in case anyone was wondering) just to show that she is certainly not alone in that thinking and that, medicine as a whole, still does not completely accept mental illnesses as physical. This could be debated as a good or bad thing, right or wrong; but it is what it is.

    I knew that you were not speaking directly to me, and I apologize if it came off as snappy. That was in no way my intention. I did see a point in what you were saying, however, and saw it as a good time to clarify my points and opinions. It was actually a good exercise, both so I could clarify it for others and to myself.

    Informed consent is so important. To make it, you need to do the research. I agree.

    I didn’t personally think that anyone would confuse the issue. I just didn’t want anyone to take what I was saying as homophobic, as that is *so* far from the truth (I myself am actually bisexual, and come from a large family of gays, lesbians, etc). I hope nobody is taking me wrong, too; but I have seen it happen. I wanted to make sure nobody took that wrong way, and ended up offended or hurt as a result.

    What I said about the DSM-IV, and DSM-5, is true. To be diagnosed as mentally ill, your functioning has to be impaired. The actual wording is, “B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).” You may disagree with it, and it can be debated that someone experiencing such symptoms needs to be evaluated; but that does not change the fact of the matter. Of course, most people who hear such voices do have disturbance of functioning; however, if there is none, they technically cannot be diagnosed. is the site for the current DSM-5 draft, and it has both the draft and DSM-IV criteria for the disorder.

    Yes, that is something that I hope we can all agree on. If someone is in pain, and struggling, they need to be validated, supported and need to receive treatment. If treatment is yoga and meditation, so be it. If it is medication, so be it. Everyone deserves to be safe and whole.

    eliza –
    None of the people here spoke as those who do not suffer. All of the posters here, from any side, have had personal or close (as, with a family member) experience with it. None of us are speaking blindly. And, yes, those off medical will cycle more. I certainly do, now that I am off it. It wasn’t decreasing symptoms that most mattered to me. It was coping and functioning.

    And I am sorry for your family’s suffering. Truly. I *do* understand.

  37. For those who can ‘cope’ with being bipolar, or who can basically ‘control it through medication’, I am genuinely happy for you. A lot of the comments I’ve read here I cannot even identify with. I use both medical and cognitive therapy, which is helpful during those relatively stable times. But when an episode starts neither medication or any other therapy works for me….for when I am in the throes of an episode I am not thinking clearly and the therapy is useless as it eludes me. The meds keep me from doing harm during these episodes and I take them religiously.
    But in the end, I just let myself go, as it is sometimes best to go with the flow than try to swim against the tide. What I learned that has helped me the most, is the knowledge that I know it will pass. There is a light at the end of the tunnel even if I cannot yet see it. People do not understand this disease – even when they see the disease they are still in dis-ease. Just as I cannot possibly know what it’s like to have cancer, no one can possibly know what it’s like to be bipolar. No blame should be put on anyone, it is more a matter of acceptance of what is.

  38. Erika, best to you in your medical studies! Thank you for all the information from the DSMV.
    from Erika: “To be diagnosed as mentally ill, your functioning has to be impaired.”
    My function has been so significantly impaired that I am no longer able to work. However, I worked for a paycheck from age 15-53. So that’s pretty good for someone who has a serious brain dysfunction. My case is complex in that I suffered brain damage at birth. A tumor on my fontanel was treated with radium-tipped needles. Those caused convulsions & 106 deg. fevers. My fontanel never completely healed, so there’s a dent in my head! I’ve met New Age believers who think that means I have a direct line to the Divine.
    Obviously, my brain was damaged from birth. I have had life-long seizures. 3 TBIs (2 car wrecks–in one I was a passenger, one my wheel came off as I was driving down an icy mountain road; one, at my nephew’s graduation party a kid “moshed” into my head, hitting it so hard my ear slammed into my shoulder. I was blind in my left eye for 6 weeks & couldn’t use my left arm for 6 weeks. I walked like a drunken sailor, so off balance. That’s when the neurologist demanded I quit working. I tried hard to keep working, I was so self-identified w/my job. But am doing much much better retired. Financially, it’s difficult. But mentally, I am much better than I’d been my whole life.
    Like Diane, I take my meds religiously. Every job I ever had, after age 18, I’d start hearing voices saying things like “Dixie is no good. She can’t do her job.” I’d quit that job & get another one the next day (I had excellent skills. Typed 100 wpm etc.) But the voices would follow me. Often, I’d run into former coworkers/supervisors who would say “We miss you so much! You were our favorite (coworker/worker)” And I’d be confused b/c the voices, which I thought were my supervisor/coworkers had been saying what a loser I was. So that stymied my work progress. I did work hard & was often offered promotions (which I turned down, not wanting the extra stress).
    We are all affected by this disorder in different ways. Some people thrive in work environments. Others do not. Some love groups, others prefer to be alone much of the time. So treatments have to be tailored to the individual. I hope that all can find a place of peace

  39. I have had Bi-polar (diagnosed for 10 years) i feel robbed of some of my best years (43 now) however my new medication Seroquel XL makes me feel almost “normal” . I put much of this normality down to reasonable sporting abiltity.However i believe what is most important is the individuals determination and character. Necessity is the mother of invention and to get through the last year has meant some unusual ways of coping with my parlous financial situation. I now have almost completed my recovery as i now know that given my “disability” or wheelchair bound disabilty. Mine pales into insignificance compared to the latter.Finally i know that our innate intelligence/creativity coupled with a proper analysis of some of our “manic” thoughts will one day prove successful. For those who have started the “Bi-polar” journey i pray you live to tell your story.

  40. I have two siblings with bipolar disorder. One assumes responsibility for her actions, tracks her manias and depressions, asks for help and accommodation when needed, and generally manages her disease as an adult, not letting it be an excuse for her actions. Does it take over sometimes and cause situations that affect the rest of the family? Yes. Do I resent those manifestations or blame her then? No.

    My brother, on the other hand, justifies all of his actions, refuses to admit to his bipolar, lashes out, attempts half hearted suicide when he doesn’t get his way, abuses people, manipulates people, and takes zero responsibility for his actions. Are some of these things caused by the disease? Probably. Do I resent him? Absolutely. By refusing to make any attempts at recognizing and managing his condition he takes upon himself much more responsibility than he would otherwise have to, because it’s harder to tell where the disease ends and the spoiled, entitled man-child begins (my mother did–and does–coddle him much more than she did my sister or I). To blame EVERYTHING on the disease is an insult to those who DO attempt to manage it and take responsibility for what they can. Having a mental health issue does not give someone a free pass to blame everything on the disease. There is a line in there, and ignoring it, as has been done with my brother, only enables it and adds fuel to the flame.

  41. This article and the one entitled “insensitive jerk or irresponsible oaf” are wonderful. I wish I would have read them several years ago.

    I’d like to point out the dangers of staying with a bipolar person with the hope that nobody has to go through anything similar to my experiences. We are going through horrible divorce proceedings now. My bipolar wife called the police on me 32 times — yes, that is thirty two times during our 7-year marriage. Each story she tells contradicts her previous stories. It is apparently no longer a crime for women to make false accusations. As long as she does not appear suicidal or intending to hurt another, the police leave and there is nothing you can do to protect yourself from her when they do. One officer explained it this way, “we don’t want any woman to be afraid to make the next emergency call.” That is a quote … I learned to record police visits for my safety.

    I’ve tried to get our 6yo deaf son out of house many times when she escalated, which led to her punching and kicking me, and spitting on me, and then her call to the police claiming abuse by me. The police will not arrest a woman or let you leave with your child if she is able to present herself as “calm” (whatever that means) or casts blame onto the husband. You should be very concerned about what awaits you after the police leave.

    I learned the word “anosognasia” because of her bipolar, which essentially means everything and everyone is considered less than her need to hide her illness. If your bipolar spouse calls the police … just one time … don’t be a hero. Get out! You can’t help someone who doesn’t want help and you can’t help your children if you’re in jail.

    If your wife has bipolar, there is a proclivity to believe the man is the aggressor that you cannot fight. Your entire relationship will shift in bad ways with one call to the police, especially after she learns there is no risk to her for making a false accusation. If she swings at you, you cannot block the aggression. Any bruise from blocking her attack will be attributed to you as the aggressor. The legal system then presents a gauntlet that you must run that only makes lawyers wealthy. The single, number one funding line item in most police departments is domestic violence … which is presumed to be an act by men against women. The police are financially motivated to consider men as collateral damage to maintain that funding. Their documentation will exclude and distort the “he said” from the “he said, she said.” There are no men’s shelters to protect you and you will harshly judged and criticized by even your best of friends no matter what you do. You will either be insensitive or irresponsible. I was “lucky” to have escaped and get custody of our son, but at what price?

    In fairness, I do not wish to claim this is a one-way street. My goal was to tell the side of the story that is being pushed under the rug. So, if your husband is bipolar and becomes aggressive, you are in imminent danger. Get out. Men who beat their wives are scum or in need of serious help.

    Either way, get out and stay away, especially when the diagnosis or the illness is rejected by the bipolar person. They will make you pay for telling others. Your life, your freedom, and your well being are all secondary to hiding their condition. So, unless you have super-hero powers, don’t try to be a hero.

    • Hi, David–

      Thanks for sharing your experiences and insights. I’m sorry that you and your family are having to live through this nightmare. Bipolar disorder leaves many victims in its wake. I do feel responsible, however, to cushion your words by pointing out that everyone’s situation is different and divorce isn’t always the only or even the best option.

      I’ve experienced some of what you describe, perhaps to a lesser degree. My family has been very fortunate. Medications have worked and continue to work, and my wife is very good about taking them and managing the illness. I can honestly describe our marriage as happy.

      I know it’s difficult or maybe impossible to do right now, but please try to understand that your wife is suffering. “Anosognosia” means the person is unaware of or in denial that she has a problem. One of the worst things about bipolar disorder is that one of its possible symptoms is that the person is unable to realize that she’s ill. She rejects the diagnosis and refuses treatment. Moreover, as you point out, the system can be very opposed to helping people who refuse help.

      I know how maddening it is to have your hands tied and feel totally powerless to do anything to improve the situation. I hope you’re getting the help and support you need to deal with it. One of the huge gaps in treatment is in educating family members. NAMI’s Family-to-Family course is a great effort at plugging that gap. I’m wishing you and your family all the best.

  42. I agree with venus. Its nice to hear someone nowadays take responsibility for their condition and actions whatever they may be. My sister has been diagnosed with BP and treats my mom worse than a dog. Of course when she realizes she needs something from her she has enough self control to stop this behavior until she gets it. Everything negative that happens in her life is someone elses fault. She won’t stay on her meds for very long which do seem to help. You have to play the hand you are dealt in life. And whether you like it or no you are responsible for finding a way around whatever obsticles present themselves. Its just like alcoholism which has been another one of her problems for the last ten years. When its obvious to you that you have a drinking problem its up to you to figure out a way to avoid putting it into your body. Its ok to call it a disease or a disorder but it IS a condition that you can do something about. You don’t get to throw your hands up and call it a disease that you have no control over and you don’t get a free pass beacuse of your disease to treat people however you see fit.

  43. I have been with my girlfriend for 8 years. Everything I do is wrong and get blamed for I walk on egg shells .she has stolen from me and my room ate .punched me broke my toes. Achaea me off all kinda stuff and . Been on meds for bipolar for at least 20 years. And can’t see any wrong in herself . All in me I am the only one who works she uses drugs illegal. I can’t help her I have tried . And always blame the aisles attempt on me .yet I always am there to save her life . I have seeker out consoling for myself because I am at my wits in .I love her dearly but really don’t think she cares if I live are die when I was put in hospital I drove myself because she was to tired mine u she does not work. And when in hospital she helped everyone else but me what’s wrong with me


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