With the telephone pressed firmly to my ear, I was talking to a potential new client, a lady in her sixties with a five- year diagnosis of bipolar disorder that came after a lifetime of dealing with clinical depression. As she was relaying her story to me, I was using the self-disclosure of my own bipolar history to form a sense of rapport. At one point, I expressed my belief that my wife of 22 years had been a major help to me in recovering from a mental illness to the degree that I had. I wondered whether I had shared too much when the woman on the phone broke into tears. As I heard her begin to sob, I was moved by her struggle, angry with myself at being so clueless. This woman had spent her whole life single. Her entire meaning or purpose in life, her reason to exist, was to take care of her two dogs.
I reflected on the issue of those we have in our lives that make a difference in our quality of life and who ultimately lead to the amount of pleasure we draw from our existence. While I count the support I have had as the central fixture in my struggle to move forward, others have different things that supply the emotional nutrients we need in order to flourish as human beings. For my potential client, her dogs provided her emotional nurture.
Initially, I was struck dumb by this woman’s emotional outpouring at my sharing. In the moment, I castigated myself for not having more sensitivity to her aloneness. But, I was corrected in this by the speaker, as she recovered from her tears and went on to talk about all the things that helped her get through life. They were numerous: a job, friends, and the nursing staff at the hospital she had been to.
She assured me that her struggle had been shared by many, despite her not having been married. It was then I remembered a central truth. We all have our burdens and our high points in the course of living a life. It is what we draw on, the attitude we bring to our issues that counts in the long run. This client had lived a lifetime with depression, but did not live an empty one devoid of meaning. My disclosure was not what moved her to crying. It was her memory of struggles fought, and those who had accompanied her. We broke through the silence and touched in that moment on such things as relationships forged and medicine for the spirit.
Sensitivity and Acceptance of a Bipolar Diagnosis
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Precursors to Mental Illness
Often, when patients are newly diagnosed, they reflect on when it became clear they had a mental illness. Behaviors, which recently became the “stuff” of mental illness, were identified as pathological and were the rightful subject of clarification and treatment. Sometimes though, behaviors and moods can be seen earlier in life, long before a diagnosis and long before it seems to be necessary for an intervention. I am not talking here of childhood bipolar as much as I am precursors to an adult (young adult) onset of bipolar disorder. My own case is a good illustration of what I mean:
Diagnosed as the surfacing of bipolar disorder when in my mid- twenties, I can recall having mood swings in high school. I remember thinking when I had an up mood, to enjoy it while I could because I would be down by the next day at that time. Even then, it was clear to me my moods alternated and more often than not stayed in the dysphoric or melancholy range much of the time. Being a teenager, I just figured this was part of who I was. A thoughtful, sensitive young boy as well as teenager, I tended to be a loner. I spent long periods entertaining myself. Looking back on it, I displayed isolating behavior, another depression forerunner. I was shy and had difficulty mixing with other children. As well, I was super-sensitive to a slight. Children were sometimes unintentional tormentors. Because of this sensitivity to others, the societal imperative placed on correct social behaviors was difficult for me. At the time I simply saw myself as odd, my solitude counter to the accepted social norms. The issue that stems from this is: what is an extreme, and what are normal childhood issues?
Looking back, what may have been precursors to bipolar disorder in childhood and adolescence were often displaced as being normal. Not acknowledging differences in childhood behaviors may be due to wanting to see a child as normal; with social behaviors and parental expectations lived up to. This can lead a child to hide their moods, not reporting them to a parent because of a perceived expectation to the contrary, that they act normal. Not wanting to appear odd or different can motivate a child or teenager to fulfill an expectation of health or normalcy despite what is actually going on.
We know that mood changes are normal for teenagers and this makes it difficult to identify what is ill and what is normal adolescent angst. Certainly abnormal behavior can’t be laid at the door of parents simply because they failed to pick up on what may be illness. Should you as a parent see behaviors and mood swings in your child, it is important to educate yourself in order to pick up on what could be an opportunity that could aid earlier recognition, and if appropriate, treatment. Listening to and not just talking to your children is the first step.
Behaviors That Can Be Red Flags
- Depressed mood
- Social isolation
- Extreme shyness
- Excessive tearfulness
- Acting out; sudden flare-ups of temper
- Mood swings in excess of what would be deemed normal
- Hiding feelings from a parent
- A “flat line mood,” one which remains instant (does not differ over time)
- Non-communication with a parent for a sustained period
- Expressed thoughts of alienation or meaninglessness
- Hyper behavior or insomnia
- Poor grooming
- Erratic behavior
- Changes in appetite
- Sudden weight loss or gain
Should any combination of these red flags arise, it would be good to discuss them with your family doctor or a mental health professional.
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Ten Questions to Ask When Determining A Bipolar Diagnosis
Searching for a diagnosis takes persistence and determination. It is not always easy and implies the need for a professional’s help in pulling together a picture of an illness. Pieces of information from the client are fit with one another like pieces of a jigsaw puzzle, each impression a unique piece of the puzzle taken together and creating a unified whole that presents one image, the diagnosis. These images are symptoms.
You can help your doctor by providing information about what you experience. While your doctor knows what questions to ask, you can help the process by being aware beforehand what he will want to know during your appointment. You have already come to the conclusion there is something wrong or you would not have made an appointment to begin with. By thinking about your concerns ahead of time, you can begin to identify what seems odd or unusual about your behavior. If you have a notion what kind of symptoms to look for, you can help narrow down the data that will make a diagnosis.
Here are ten questions your doctor needs answered in order to make a diagnosis:
- Are you motivated or anxious more than usual?
- Do you have a lot of excess energy?
- How are your sleeping patterns – increased or decreased?
- Are you irritated or agitated?
- Are you blue or in a funk; do you feel depressed?
- Do you gain pleasure from your activities?
- Are you experiencing behavioral changes?
- Have you had any recent conflicts that are out of the ordinary?
- Has your appetite changed?
- Are you drinking alcohol more than usual?
The doctor may ask questions designed more to access your reaction in the here and now than the actual data requested. The important piece to remember is that you are seeking help to gain closure, to get treatment following a correct diagnosis. The mental health professional can be an ally in that quest. Give her the benefit of the doubt and trust her expertise to help guide you. You and your doctor are a team. Asking the right questions and giving accurate responses will help forge a bond.
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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.
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Recognizing the Need for Treatment of Bipolar Disorder
Bipolar disorder is one of the most elusive illnesses we know of. Recognizing our thoughts are askew and our judgment is impaired is a risky business for those struggling with a mental illness. It all seems so sensible in our delusional state. We need to come to the conclusion there is an impairment in our functioning that prevents us from living life normally. Sometimes life is the best teacher.
As the morning overcast burned off, I pondered my pending appointment with a psychiatrist. Up until his point I had been able to work and take care of myself. I stood on the sidewalk in front of a shabby hotel. I had been offered a job painting a room in exchange for rent. Prepared to paint the room, my thoughts raced as I worked. I became less and less able to function. Lost in thought, I could not seem to retrieve my focusing ability. My mind wandered. At the end of the day, I had less than one wall painted. I had cause for alarm as I realized I could not concentrate enough to work.
I never did finish painting that room. I knew that something major had happened to me, but I didn’t understand the ramifications. Part of me felt disbelief at the thought I had a major illness, a major mental illness. It would be a long time and further episodes before my denial would give way to a desire to understand the illness.
Fifteen Ways to Recognize It’s Time For Treatment
- Lack of focus.
- A decrease in ability to do activities of daily living.
- Difficulty expressing oneself.
- Distrust of those around you.
- Ignoring stressors.
- Perseveration----Constant going over thoughts.
- Avoidance of contact with others.
- Questioning the motives of others.
- Irritability.
- Extended periods of sleeplessness.
- Decrease in self-care.
- Inability to do work.
- Isolating yourself.
- Excessive energy.
- Inability to relax.
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Trusting Your Diagnosis of Bipolar
“To comply or not to comply, that is the question.” How d you know when your meds are working? When is it ok to stop, or so you think? How do you know when taking them that normalcy has returned and you question whether it’s the meds or a turn for the better in your mental outlook? More to the point, is your diagnosis correct?
We have many fears and biases when it comes to illness. There are those who will go to the doctor at the first sign of a sniffle or a cold. At the other end of the spectrum, there are those who attribute their good health to the lack of medical intervention. Somewhere in the middle of that is a nagging persistence of symptoms, which causes us to question whether a trip to the doctor is prudent.
With bipolar disorder we are sometimes the last to see the efficacy of seeing a doctor, going for treatment, or getting a prescription. In my own case it took 12 years before I firmly accepted that the adherence to taking medication on a daily basis and for the rest of my life was a necessity; no more questioning, but rather acceptance.
How do you know when your meds are working? You know when the drama exits your life, or when your friends and family comment on your newly-acquired stability; when you wake up in the morning feeling refreshed by sleep, anticipating a daily structure to your life. Recognizing others’ feedback has some value to it. It has less to do with accepting a label and more to do with the orderliness of your life.
Sometimes we only see ourselves through the gaze of others. Before you decide to quit your meds, think about the long view, of having a life you find worth living. How else can you measure compliance and stop screwing up you life with one more question, one more doubt of a bipolar diagnosis?
Ten Ways To Evaluate You Have the Right Diagnosis
- Your life is orderly and measured.
- When your doubts surface, rely on the feedback of friends and family.
- Monitor your inner sense of composure.
- Ask yourself, are you at peace with yourself.
- If there is a repeat of your inner turmoil, when do you question
its cause? - Be aware of sudden shifts in mood and outlook.
- Question your own motives when questioning others’ feedback.
- Seek the advice of professionals when questioning your mental health.
- Question your own behavior if you are in constant conflict with others.
- Allow yourself to take meds and see if calmness returns.
Depression and Bipolar Disorder - The Difficulty of Diagnosis
A major side of the bipolar equation, the depressive side, is also a part of life for those afflicted with bipolar disorder. Like its unipolar cousin, the depressive side of bipolar illness is so much a part of my life. Biological in origin and unlike mania, it has no sense of the grandiose. Where mania is inflating, depression is deflating.
Typically, I was inclined more toward mania than depression in my bipolar days. While I have suffered several significant depressive periods since becoming floridly bipolar, the manias with their psychotic flair were more problematic for me. Therefore, I didn’t always recognize depression when it was upon me. In the early years of my marriage, a challenge occurred, which is a nice way of referring to a crisis. Depressive stays in bed began to occur. Eventually, my failure to perform normal daily tasks such as going to work or arising early in the day became problematic, more acute. Neither my wife nor I saw the problem as depression, which comes in various sizes and shapes.
I marvel now at how we were able to withstand the strain we felt in those years of darkness and alienation. I was weak and impotent and unsure of myself. Through therapy, I soon realized I was depressed.
Ten Ways to Recognize Bipolar Depression
- Lack of pleasure or Enjoyment.
- Loss of desire or motivation.
- Reclusive behavior, avoidance of social connection, isolating.
- Difficulty getting out of bed in the morning. Excessive napping during the day.
- Difficulty focusing, vegetative behavior.
- Irritability.
- Decline in personal hygiene.
- Anxiousness coupled with thoughts of activity, leading to inaction.
- Ongoing achiness, soreness, or tingling despite treatment for physical ailments.
- Decline in sense of self-worth.
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10 Diagnoses that Mimic or Co-Occur with Bipolar Disorder
It is worthwhile to note there are disorders that mimic or co-occur with Bipolar Disorder. Anxiety, substance abuse (dual diagnosis), Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD), thyroid imbalances, as well as pituitary disorders can all resemble and complicate the diagnosis of Bipolar Disorder.
When I was first diagnosed, I was diagnosed Schizophrenic. Attending a day treatment program, I was treated in group therapy with the wisdom of the day, which stated that Schizophrenia was due to poor parenting. I was harangued daily by the group therapist about my dysfunctional relationship with my father. There was only one problem; I didn’t have a dysfunctional relationship with my father. I couldn’t get with the treatment.
Several years later, when I was diagnosed bipolar, I was told the illness was caused by a chemical imbalance. At last, an explanation that made sense. The idea was freeing to me. No one, including my father, was to blame. It was about biochemistry, not poor parenting. I felt relieved. A diagnosis that shared symptoms with another illness was at the root of the problem. The correct diagnosis made way for effective treatment and a return of mental health.
10 Diagnoses that Mimic or Co-Occur with Bipolar Disorder
Noted here are some of the conditions or illnesses most likely to mimic or co-occur with bipolar disorder.
- A component of many depressive disorders, anxiety, often accompanies depression and can even be present equally. Sometimes described as “agitated depression,” it can surface either independently or mislabeled as mania.
- ADD or ADHD symptoms can be experienced as a lack of focus and agitation, mimicking a manic or hypo manic state. The differential diagnosis information of the DSM must be studied to differentiate between a chemical-behavioral imbalance versus a mood disorder. ADD is an example of brain-wiring, while mood disorder is an example of chemical imbalance.
- Substance abuse also can mask symptoms of Bipolar Disorder and only comes to light when substance abuse is treated. As the abuse is recognized as self-medicating behavior, the true diagnosis of mania is revealed.
- On the biological front, there are several illnesses which can be confused with Bipolar Disorder. One is a thyroid condition. Both depression and symptoms of hypo-mania can be due to synthroid imbalances which can be successfully treated. Pituitary gland disorders can also produce depressive or manic symptoms. One of these disorders, Cushing’s Disease parallels depression due to a lack of Cortisol, a necessary, regulatory chemical of the nervous and endocrine systems, impeded by a tumor on the Pituitary Gland. These physically deficient, biological illnesses can come to light in a physical examination, something which should be done at the beginning of evaluation for all mental disorders.
