How Do We Measure Success In Treating Bipolar Disorder?

Measuring Bipolar Success

What does it mean to have success in treating bipolar disorder? What should we measure to define success? What gets measured gets done.

Tom Peters, the author of management books “In Search of Excellence” and “A Passion for Excellence” talks a lot about measurements and how they affect success. In an article about business success he said, “I think the soundest management advice I’ve heard is the old saw; ‘What gets measured gets done.'” The concept applies especially well when we look at the outcomes from the treatment approaches to bipolar disorder.

The current standard of care for bipolar disorder is to measure how long one can stay in remission. Many tools exist to help achieve such a result, and most people talk about remission as the ultimate goal of treatment. Most academic studies measure outcomes based on the same standard. That is why they are unable to create anything better.

It has been my experience that measuring awareness, understanding, functionality, comfort, value and time at each level of intensity gives us a better picture of what a person with bipolar or depression is truly capable of. How aware are we of the physical, mental, emotional, spiritual, social, and career/financial aspects of the state? How well do we understand how to separate our experience of the state from our ability to function during it? How well do we actually function during the state? How comfortable are we and how comfortable are we able to make the people around us with our being in the state? What value do we see in being in the state? How long can we be in that state before it becomes more difficult to maintain wise behavior? I call the combination of such measurements “functionality assessments” and improving such measurements to the best possible “scores” is what I call Bipolar IN Order.

Functionality assessments are substantially harder to do than simply counting the days in remission. But we really should see which is creating the better outcomes. Like in any endeavor, what we measure tends to dictate what outcomes we produce.

So what is the best outcome that the standard of care measurements have produced? The National Institute of Mental Health did the largest study of its kind measuring outcomes in bipolar disorder treatment. The conclusion of their STEP – BD study is that “According to the researchers, these results indicate that in spite of modern, evidence-based treatment [designed to create remission as a final outcome], bipolar disorder remains a highly recurrent, predominantly depressive illness.”

While we do hear of the rare person who stays in remission for long periods, most eventually return to the disordered states that ruin their lives in many ways. Most of the peers who aim for remission describe a lifetime battle where only constant vigilance and effort keep them from another catastrophic episode.

I freely admit that if you only measure remission, the outcomes from functionality assessments don’t produce any better results. It was never the goal in the first place. But what if we consider the possibility of far greater outcomes? The results produced from a program designed to increase the functionality assessments scores go far beyond what most people consider possible. Many pretend such results don’t exist while they hold up their own temporary remission as examples of why we should follow their advice.

So lets explore the outcomes when we aim for higher scores in the functionality assessments:

To clearly grasp the difference you will need to see the results based on aiming for higher functionality assessment scores as a whole. Each measurement works in synergy (the interaction or cooperation of two or more organizations, substances, or other agents to produce a combined effect greater than the sum of their separate effects. – Apple Dictionary) with all of the others.

As we learn to raise the awareness, understanding, functionality, comfort, value and time scores, we are able to function at an ever higher level of intensity. States that once overwhelmed us are now easy for us to function fully in and are no longer a danger to ourselves or others.

As we learn to raise all of the scores at increasing levels of intensity, our awareness of the states changes in dramatic ways. What was once dominated by fear and suffering, we can now see as a complex tapestry that is often described as elegant and for some even beautiful. The very experience of the state changes from a living hell (in deep depressive states, for example) to bliss. My article about How I Found Ecstasy in Depression is an example of that. An article by Margaret Miller, a graduate of the Bipolar IN Order online education program, covers some of the same concepts.

As we learn to function in all states, our experience and feelings of our states affect our behaviors less. We can choose our behaviors based on what we want to accomplish instead of having our actions predicated on our feelings. We no longer alienate those around us and can fulfill our work and relationship responsibilities. Our friends and family become comfortable with our varied states and can see advantages in them too. We, and they, no longer fear negative repercussions of any state and instead see them as incredibly valuable to experience.

As our comfort level increases, we begin to see tremendous value in being in all of our states. Our ability to use that value in our behavior turns the state into a value for everyone around us. We become tremendous assets during crisis, for example, instead of becoming a burden as most people who use remission as the goal of treatment fear will happen. A typical fear among remission advocates is that a crisis situation will trigger another episode and the concurrent out-of-control behaviors that typically go with it. My article about How Depression Prepared Me For A Death In The Family is an example of what could be instead.

When we master time as related to depression and mania, we find that we can stay in states longer before needing to use tools or interventions to lower the intensity of the state. That alone makes us much safer, but that is not the ultimate outcome. Those of us who have increased all of the measurements (intensity, awareness, understanding, functionality, comfort, value and time) end up in mastery of the states themselves. We can choose states like an actor does for a role. We assess the situation and the ultimate role we could play to create desired outcomes inline with our core values, and we choose the state best suited for the role. My article about Choosing Mania or Depression Without Disorder describes that ability.

Using remission as the yardstick for measuring success has never produced results comparable to the ones associated with functionality assessments. Those who advocate remission as the standard of measurement are stigmatizing people into accepting a life far less than what they are capable of. As mentioned previously, permanent remission is a false hope that the NIMH has already determined unlikely to happen.

With the ultimate success based on functionality assessments, we simply no longer need to lower the intensity of the states. Remission becomes irrelevant when we achieve such results, as I and others have already proven to be the case. It is past time to consider better results than remission and start using measurement tools that are more likely to produce them. What gets measured gets done.

The functionality assessments are available for study at the Bipolar Advantage website along with an education program that has been effective in creating the results mentioned above.


Tom Wootton founded Bipolar Advantage with the mission to help people with mental conditions shift their thinking and behavior so that they can lead extraordinary lives. His most recent work focuses on moving beyond recovery in bipolar disorder to what he calls Bipolar In Order.