In bipolar treatment, using the brakes on mania and depression is only the first step to functionality.
In 1964 I was 8 years old. Back then you could take a car out of park without needing a key. I did that by mistake once and it taught me one of the most important lessons of my life. A lesson that can be easily translated to the way we treat bipolar disorder.
Our family car was parked in the driveway which sloped downhill to the road. I was playing in the car by myself when I inadvertently shifted into neutral and the car started to roll downhill towards the street. I knew enough from watching my parents drive that one of the pedals would stop the car. So I pushed the brake pedal with all my might and the car stopped rolling towards what I was sure was a terrible accident.
But at 8 years old I was too small to be able to both hold down the brake pedal and see over the dashboard out the window. That also meant that nobody could see me. As I got tired and I let off the break, the car started rolling downhill again. I was in a total panic and could not figure out what to do. To my luck, my mother came out looking for me and found me in the car. She reached in and put the car back where it belonged and saved the day.Continue reading
My most recent article about fighting stigma challenged the ending stigma campaigns that are so in vogue in the bipolar community. It generated much interest and several thoughtful comments. One particular comment, appropriately titled “Perpetuation of stigma” was a perfect example of what I talked about in the article. As I crafted my response I came to realize it is deserving of its own article. Here is the comment in italics along with my response:
Perpetuation of stigma
Hate to call you out on this Tom… You are right on with the argument for ignorance.. I do feel if people where truly educated there would be no “stigma.” The one thing I do have a problem with is being called a “bipolar”… When teaching public speaking I always try to emphasize that you are not your illness… While I also suffer from fibromyalgia, I am not one… Doesn’t make sense.. Please don’t take this as confrontational as it’s not meant to be. It’s just an observation of perpetuation.
Thanks for all you do,
I have heard the “I am not bipolar, I have bipolar” argument for years and completely disagree with it. When I hear someone say he “has bipolar” it sounds to me like he sees it as an illness to be ashamed of. I am not my illness because I am not ill. I had disordered reactions before I fully understood who I am, but I now have my life “in order.” Calling bipolar an illness is one of the reasons for writing the article about stigma in the first place.Continue reading
Individuals and organizations throughout the world are dedicated to the important work of fighting stigma that affects people with depression and bipolar disorder. Unfortunately, too many of them are replacing one type of stigma with another type that is making the situation worse. While advocating for others to stop judging those who suffer from the conditions, they are causing a self-stigma that increases and prolongs the suffering.
My friend Andy Behrman says, “If we want to eradicate stigma, we must first understand what stigma is: ignorance, fear & discrimination.” Of the hundreds of statements about stigma, this one captures it the best for me. Everything else is an offshoot of these three core problems.
There is certainly an incredible amount of ignorance surrounding depression and bipolar disorder. Even if we were able to clear up the many misperceptions about either condition, there is so much more we need to know to fully understand them. Depression and bipolar disorder affect every part of our lives (physical, mental, emotional, spiritual, social, and career/financial) and most people are aware of only a fraction of any of the parts.Continue reading
A common refrain in the bipolar disorder community is “I’m doing the best I can.” Every time I hear this or a similar phrase my heart weeps. I know all too well the feeling of despair and hopelessness that comes with it. There were so many times, while in tears, I used the exact same phrase. Whenever I hear it now, I want to reach out and empathize with the person so she does not feel alone. I know it feels like the best results we can possibly get and how frustrating that feeling is.
But at the same time I find myself conflicted. I know from my own experience, and from helping so many others, that the results we based the statement on was not the best we could do. Not by a long shot. That part of me wants to say, “you are stigmatizing yourself into accepting a life that is far less fulfilling than what you’re capable of.”Continue reading
I know depression. It destroyed my life in my thirties and almost killed me in my early fifties. Back then, had anyone dared to tell me what I am about to say to you, I would have gotten very upset. I could not imagine that there was anything good about depression. Can you? What you are about to learn could change your mind. By using a new approach to working with depression, I had prepared myself for probably the most extreme crisis our family has ever faced.
When I was first diagnosed with bipolar disorder, I wholeheartedly bought into the idea that depression is a dark hole from which the only hope is to escape. It was certainly impossible to function well during deep depression. To function while deeply depressed meant to stay alive and minimize the harm it was clearly causing in my life and in the lives of those around me. High-functioning as related to depression meant that I needed to find ways to get out of it and back to a state where functioning in any productive way was possible.
Finding agreement for such beliefs is easy. Finding someone who challenges those beliefs is difficult. Even more difficult is letting go of society’s belief that it is impossible to function while in manic or depressed states. But once you become open to the possibility that you can learn to function during manic or depressive states, your life will change in ways that you cannot imagine. You will come to understand something that few people do. You may well consider it the most important lesson of your life.
I learned that lesson several years ago and continue to learn more as time goes by. I now teach people how to do this. I want to give you a sense of what life could be like once you accept the possibility and do the work to change. I want to share with you a very personal example of how functioning highly while depressed enriches my life and that of my family.Continue reading
Imagine you’ve never seen a car before and the first one you see was involved in a fatal accident. You express how tragic that is and that you would really love to be able to help keep that from happening to others. You watch videos of all kinds of car crashes and learn how they devastate millions of lives.
Since you don’t understand the point of having cars, you may suggest doing away with them altogether, or perhaps creating a 20 mph speed limit on all roads. Neither of these solutions would work, of course, because you wouldn’t get any compliance from car owners.
It would be far more productive to study all of the costs and benefits of having cars and use that study to determine the best desired outcomes. In this case, the premise would change from “cars are inherently bad” to recognizing that cars have value but are also dangerous. The focus of all efforts would be to maximize cars’ benefits while minimizing the accident rate.
Starting from such a premise would lead you to suggest that better education and training would make better drivers. In looking for people to perform that education you would be looking for those who drove the best and not those who crash every time they take the car out.Continue reading
I attended a great presentation at the APA annual conference in San Francisco about Achievement, Innovation, and Leadership in the Affective Spectrum. Four distinguished panelists gave presentations about their research into why people with bipolar disorder tend to exhibit advantages in some parts of their lives. They said it was the first time ever that the APA had such a discussion and it was a great honor to be a part of it.
First up was Sheri Johnson, PhD, who teaches at UC Berkeley and does basic research on mania. Her talk was about how people with bipolar disorder are more reactive to rewards and goals in their lives. They tend to work harder toward such goals and refuse to give up long after “normal” people do. Dr. Johnson is currently conducting studies to understand the greater reactivity to success in this population, using paradigms drawn from neuroimaging, emotion, information-processing, and impulsivity literatures. She is also considering other psychological traits that might relate to outcomes in bipolar disorder, including stress reactivity, emotion regulation, and social dominance. She believes that figuring out why mania is linked to success will lead to better ways to predict manic episodes.Continue reading
Imagine you’ve never seen a car before and the first one you see was involved in a fatal accident. You express how tragic that is and that you would really love to be able to help keep that from happening to others. They show you videos of all kinds of car crashes and tell you how many millions of lives are devastated by them.
Since you don’t understand the utility of having cars, you may suggest doing away with cars altogether. Or perhaps creating a 20 mph speed limit on all roads. Neither of these solutions would work, of course, because you wouldn’t get any compliance from those who have cars.
It would be far more productive to study all of the costs and benefits of having cars and use that study to determine the best desired outcomes. In this case, the premise would change from “cars are inherently bad” to recognizing that cars have value but are also dangerous. The focus of all efforts would be to maximize the usage of cars while minimizing the accident rate.Continue reading
Bipolar disorder is an incredibly complex condition. It can be approached from so many angles that you might specialize in any one of them. Unfortunately, most of the specialized approaches will do you no good when in the throes of an intense mania or depression. The only thing that matters at that point is whether your specialty is knowing how to function during the state.
I find many of the points of view about bipolar disorder to be immensely interesting. The biological aspects are fascinating; the research that has looked at the inner workings of the brain, the electrical and chemical reactions within it, and the influence of external substances is fascinating. Researchers have found some truly amazing things through that approach and it has made a huge difference in many peoples lives. But there are so many other approaches that I find just as interesting and have proven equally fruitful.Continue reading