Sandra lives with bipolar disorder. I am her psychiatrist or p-doc or shrink (as in Dr. Fink, the shrink). Sandra (not her real name), and I have worked together for many years. At today's appointment, she is moving a little slowly due to some back pain, but she tells me that her mood and energy have remained steady. That is outstanding news, because until a couple of months ago she was experiencing a terrible mood episode that rocked her life—a difficult mixed episode (mania and depression), along with substance use and memory and thinking problems. Her symptoms disrupted relationships with her family and worsened existing financial troubles. But, fortunately, her mood and energy level have not wavered to any clinically significant degree. Today she smiles and tells me about her volunteer work and playing tennis with a friend. Then she stops, and she cries softly and asks me how to help her parents understand what is wrong with her.
While the good news is that many people in Sandra's life are starting to grasp that bipolar disorder is the problem (and that Sandra is not the problem), her own family of origin shuns and shames her, telling her that they have been advised to "stop enabling" her "bad behavior." They will not let her come to stay with them, and she has been excluded from family events. Sandra is heartbroken.