To Accept or Not to Accept a Bipolar Diagosis

I recently became aware of a commentary that made reference to an article I had posted on my blog. The author found me in agreement with one thesis, yet differed in another, namely that medication compliance is impacted by the acceptance of diagnosis. While I respect a difference in view (the idea that acceptance doesn’t necessarily bring compliance), it occurred to me that the difference might be more a question of semantics than thrust.

Acquiescence to my diagnosis of bipolar disorder and adherence to an ongoing medication regimen was a long, 12 year process and not a simple or logical shift over a short duration of time.

My clinical opinion as a therapist is that it takes a significant period before those with bipolar disorder are able to accept the illness as a factor that is lifelong and incurable, without ambivalence. Many patients are in process of gaining insight and accept compliance, yet after each episode, hope it is a fluke and won’t happen again. They may verbalize compliance, but subconsciously deny any consequences their behavior and actions may bring. It is only at the end of this ambivalence that true acknowledgment comes. I am not certain the author of the initial commentary and I are of different opinions, as might seem at first blush.

I would not in most cases dispute the point that buying into one’s diagnosis is sufficient to result in medication being taken on a regular ongoing basis. There is another compelling issue and that is duration. Suffering with a mental illness for a decade, for example, is more likely to result in taking medication regularly than a year or two. Exceptions permitting, attitude shifts with time.

Having arrived at the point where expectation of healing has given way to hopelessness that yields frustration, that frustration over lack of regaining one’s prior level of mental health can yield to having a second chance. Resignation gives way to a more realistic evaluation of the desire for a medication alternative to treatment, an attitude which is more likely to accept side effects in favor of the relief meds can bring.

The thrust of the post that today’s social context gives accusations of paternalism and condescension toward clinicians, I heartily agree with. This perspective all too often sabotages treatment. Socially induced resistance trumps insight, even insight gained from the passage of time.

It is gratifying, however, to know that some will sustain a recovery long-term by persistence of a self-realized perception that there is no alternative. It would appear that medication is quite often the only game in town other than living with the roller coaster of emotion and mood that mania and depression bring, and the terrible cost in human suffering resulting.