The real goal of treatment is not remission, but to remove suffering in bipolar disorder.
Do you suffer from bipolar disorder or know someone who does? If you want to end all suffering you need to understand the difference between why and how. The reason so many people are still suffering is because this difference has not been made clear enough.
Why do people go to a psychiatrist? To end the suffering. Why do they go to a therapist? To end the suffering. Why do they engage in any treatment regimen? To end the suffering. We don’t go there for medicine, for therapy, or for any of the other tools that we are given. We go there in hopes that they can help us remove the suffering.
And we didn’t go there seeking remission for mania or depression. We went there to remove the suffering. We were told, though, that remission and the tools that aim to produce remission is the way to do it.
Does remission work? Perhaps temporarily. But in the end we must admit that the answer is no. And that is the conclusion of the biggest research on bipolar disorder ever conducted by the National Institute Of Mental Health. The research is called STEP-BD and this is what they say: “According to the researchers, these results indicate that in spite of modern, evidence-based treatment, bipolar disorder remains a highly recurrent, predominantly depressive illness.” In other words, even if remission did end suffering temporarily it will not remove it permanently.
But somewhere along the line they confused ‘why’ (remove suffering) with ‘how’ (remission) and made the ‘how’ the central focus of treatment: “This finding may indicate that complete symptomatic remission, i.e, the absence of all symptoms, should be the goal of treatment, as it is in non-bipolar, major depression.” In other words, since remission does not work you need to accept periodic suffering as the best possible outcome.
If you ask a therapist why she helps people to create remission she will say because that’s what they came here looking for; “I am just helping them get what they want” is a very common answer. They are not in the business of defining what people want, but in providing methods to help people achieve their own desires.
The problem is that the patient, along with everyone else, is confusing ‘why’ (end suffering) with ‘how’ (remission). We all know ‘why’ people are seeking treatment. They want to end the suffering. Although it is believed that remission is ‘how’ to end the suffering, remission is in reality just an ineffective tool and we need to stop seeing it as the goal of treatment. The goal of treatment is to permanently end all suffering. Why can’t they see that?
I used to suffer tremendously when I became deeply depressed. And when I became highly manic the people around me suffered right along with me. I was told, like everyone else, that the solution to the suffering was remission and I tried all of the methods I could find to produce it. I got temporarily relief, but the states inevitably came back just like the STEP-BD study predicts and I was once again debilitated and suffering each time. During the next remission, which might have come on its own anyway considering the cyclical nature of bipolar disorder, I found myself living in fear of the next return of mania or depression and wondering how it will again destroy my career, relationships, and life. I was getting temporary relief but still suffering even during remission.
I eventually figured out that remission will never work and it was time to try something different. As the saying goes – insanity is trying the same thing over and over again and expecting different results.
So I tried the opposite approach; thinking that perhaps I could learn to function during my inevitable future episodes and at least keep my life from falling apart each time. Everyone told me it was impossible, but I was not going to try yet another remission-based method that I knew was sure to fail.
It certainly wasn’t easy. But the more I tried and the better I understood, I was eventually able to function fully during my deepest depressions and my most extreme manias. This, of course, created an incredible difference in my ability to maintain my work, my relationships, etc. But more importantly I no longer suffer. I still feel the pain of depression in my body, my mind, my emotions, and my spiritual life, but the suffering has completely gone. I no longer suffer from mania or depression because there is no level of intensity where I suffer from it.
But more than that, my ability to be deeply depressed while functioning fully and not suffering carried over into all aspects of my life. When I feel tremendous pain like the loss of a loved one it has nothing to do with mania or depression, and it does not cause me to lose functionality or suffer. And isn’t that what we were all looking for in the first place?
I know it sounds strange to say that the pain is still there and I do not suffer from it, but that idea has been presented throughout history as the only real solution to suffering. The Buddhists say “pain is inevitable; suffering is optional” and countless saints of all faiths have said a similar thing. Saint Teresa of Avila said “The pain is still there. It bothers me so little now I feel my soul is served by it.” The concept is also central to Saint John of the Cross’s “Dark Night of the Soul” where the pain at the hand of his torturers was the very thing that brought him to the end of all suffering.
I have since taught thousands of people the methods that I have developed and have helped produce a growing group of people who no longer suffer either (or have at least substantially reduced their suffering while functioning far better in all states). But when we mention our success, instead of being asked how to do it we are more often told that it is not possible and the only solution is to continue to confuse the failed ‘how’ (remission) with ‘why’ (end of suffering).
An interesting corollary observation is that many people say they have tried everything and therefore know that nothing works. But they are confusing a bunch of tools whose aim is to create the ‘how’ of remission with the ‘why’ of ending suffering and they don’t realize that I am talking about an approach that they have never tried. Their claim that it is impossible is based on the very real notion that it is impossible to end all suffering through remission. Everything they have tried has of course failed, as the researchers concluded in STEP-BD.
And it’s not just that remission doesn’t hold. Even if it was successful, you would still periodically suffer for the rest of your life. If you never had another mania or another depression, you would still face times of intense pain and suffer during them. If you want to permanently end all suffering you have to understand the difference between ‘how’ and “why.” And when you understand that difference you will understand why the current treatments don’t work and never will.
Or perhaps they are confusing their failed efforts at getting out of bed (or some other activity) with the methods that we use to actually accomplish it. They have tried to get out of bed during their deep depressions, but since they didn’t know how they confuse their attempt of using sheer willpower with the far more sophisticated tools that I have been teaching. In this case they perhaps get the ‘why’ right but don’t know ‘how’ and therefore declare it impossible while discounting the very real proof in those of us who have shown that we can.
If you have accepted that mania and depression are coming back it is time to try this new approach. You don’t have to take my word for it but can prove it in your own life. You can start learning how to function during it instead of waiting in fear of the next episode. You will find next time that it is harder than you thought but with time and effort you too will understand how to function during manic and depressive states and that will change your life forever.