Answer to Request for Bipolar Information

I recently received an email request from an individual outside of the United States, asking for help regarding treatment for bipolar disorder beyond medication. I am publishing my reply and hope that it will be of assistance to others who are similarly interested:

Dear Ruben:

I received your email and am hoping I can be of some assistance to you.

As you may know, the medication taken for bipolar disorder is critical to recovery. While there are co-existing treatments that stabilize biochemistry, I believe medication is essential.

As well, "talk" therapy is helpful in sorting out the issues which arise from having a mood disorder. Breakdown in communication with friends and loved ones can occur in the midst of an episode, and we must learn to confront and take responsibility for the consequences of our behavior at those times.

My not knowing the culture in your country is a drawback because I am not able to assess the amount of stigma there may be in seeking psychological therapy and whether that is an option for you. Regardless, going for counseling is also an important therapy.

Support groups may be helpful in maintaining self-esteem. Being with others who share your diagnosis can be helpful and relaxing to the tension which can surround a diagnosis. Often, the feedback of others can reduce stigma and help you feel connected and less isolated.

One organization you can contact in the U.S. is the National Alliance for the Mentally Ill, or Nami as it is called. They may be able to put you in touch with treatment options closer to you. Their website address is: www.nami.org.

Also, the Depression and Bipolar Support Alliance (DBSA) is a helpful organization for those with bipolar disorder. You can contact them at: DBSAlliance.org. for information about the illness, its treatment, and referral to professionals who can help. They may have more information about treatment.

Cognitive-Behavioral Therapy has been found to be helpful as a psychotherapy for bipolar disorder. Doing a search of the internet will give you more information on this. It is the type of therapy that stresses our mind's ability to control our behavior.

As well, educating yourself about your illness is the most important thing you can do to help treat it. Learning what you are up against, and dispelling untruths about mental illness can be one of the key things you can do to empower yourself to persist in recovery.

Websites like PsyhcCentral, FinkShrink, and StableMoods are but a few of many sites that can increase and expand your knowledge and sense of well-being.

Lastly, don't be discouraged. With persistence, you can have a life and maybe someday help others to learn more, maybe even start your own support group in your own country.

Good Luck,

Donald Kern, MFT
email: info@kerntherapy.com
Author: Mind Gone Awry
website: kerntherapy.com
blog: bipolarbychance.blogspot.com

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.

Medicating for Bipolar Disorder

When a patient is first admitted to a psychiatric unit, the treating psychiatrist must make a determination as to the administering of medication. There are two basic models the doctor can choose from. He can start from a zero medication format where he begins with a low, minimum dosage level and adds small incremental amounts of medication until a level is reached whereby the patient approximates a normal behavioral level; or he can flood the patient with a large dose of meds to quickly bring the patient to a non-symptom level and then reduce the meds until a normal behavioral level is achieved. Either method is an acceptable treatment, although many people who are uneducated about treatment believe over-medicating is a bad thing no matter the results.

We are not well-served by a knee-jerk reaction in judging a particular regimen. In the case of “flooding” someone with medication, a person in the throes of a flagrant manic attack would best be served by bringing them down from the manic heights as quickly as possible. There will be time enough to adjust the dosage once they have returned to a semblance of normalcy. In the event of a depressive slide into despondency, we may have the luxury of slowly increasing meds over time, although suicidality ramps up the need to respond with speed of action.

Dogmatic adherence clouds perception whatever the situation and enhances the prospects of not making the best decision. Many times education is the avenue to wise treatment. I went for years not understanding the principle of over-medicating, assuming keeping someone in a stupor was at all times bad for them. It was only several years ago that a cousin who is a physician explained to me the intricacies of dosage decisions in treatment. It is this I am trying to pass on to others.

The general public is not aware of some treatment factors such as those of medicating. It seems it is rarely explained to family or patients. The psychiatric community would be serving a public good if they were to be more explicit about the logic of their decisions. An educated public is the best treatment outcome.

My remarks are not out of a narrow finger-pointing toward clinicians who work long hours under pressure to make the right decision, but to bring an understanding to what goes into a medical decision. This is often not addressed due to lack of time. Treatment would be improved if families and patients were more enlightened.

Learning to Find Creativity After Medication for Bipolar

There are some creative individuals who are burdened by a mental disorder. For many, the issue of creativity is tied to mania. They deal with their finest displays of artistic fervor and accomplishment in their manic phase of a bipolar diagnosis. The flame of original thinking combined with an expansive self-confidence propels them into a productive frenzy. At these times, artistic, bipolar types revel in the quantity and endurance one needs to take on a project.

Mania is tied to the creative impulse. While prolific as one can be in mania, a mood shift dispels original thinking. When an episode has run its course, the artist finds himself in an odd position, yearning for creative release, but too depressed to reclaim it. The artist gives way to the patient. Medication comes with normalcy and life takes on a drab, passionless existence. The artistic, bipolar patient decries his situation, but inspiration is nowhere to be found.

A common complaint of bipolar clients is their level of creative expression. It comes as no surprise that many such persons choose their creative manias over medicated normalcy, while others give up, take their pills, and make the best out of a stale existence. When mania is suppressed, boredom steps in; or so goes the given wisdom. This is true in the short term, but not necessarily the long.

In the immediate, medication locks down the fountain of creative urge. The switch is flipped off abruptly as a fantasy life is replaced by the more immediate needs of everyday. Often there is the sense that life has been drained of its essence, and this state is all there is, a spiritual wasteland governed by the pills one must take for stability.

My experience of 35 years says otherwise. There is a creative life after medication. It just takes time and persistence to resurface. Inspiration reasserts itself a bit at a time and needs to be nurtured. Once a stable platform is rebuilt, thoughts turn from the mundane. While initially stability struggles with staleness, appreciation of the commonplace spawns shoots of possibility. This takes time, and patience is of primary value. One reacquaints oneself with a creative vision a piece at a time. Eventually, hope for the ridiculous and the sublime re-emerge. Medication cannot hold back the urge to a larger view of life.

Thirty five years of living with manic depression has taught me that even when I give up in despair, I keep on growing, although I am unaware of this at the time. Life grows at its own pace. Becoming aware and being thankful are accomplished in small steps.

Twenty five years ago when I was newly recovering, there was no urge to write, sing, make music, or shape metal. At the time, I simply wanted to get back my life. I wasn’t interested in anything else. It was difficult enough to discipline myself to get up and go to work everyday. Eventually, that learned, I progressed to venturing out to meet others, to engage in uncomfortable but pursuant conversation. It was five years before I picked up a pen to write. I had nothing to say before that. Eventually my ear for music returned, and learning to share myself with others began. All of this led to a vitality in my everyday life.

During this time, I was, as I still am, on medication. It’s about a regrowth of spirit that helps us reclaim our lives. Life is a verb. It’s about doing. Medication cannot teach us this, only a life lived can do that. It’s like being in a dark closet. You keep bumping into walls whichever way you turn as you feel the bruises form. Eventually, the pain goes away and some light creeps in. You find that the walls you bumped into were actually mirrors. The longer you look, the more light seeps in. You see yourself again and again, always in a new and different way. And so, creative endeavor emerges over time. Medication can’t take that away. In fact, it can help.

The Necessity of Medication for Bipolar Disorder

Medication is my lifeline to stability for bipolar disorder. Having found a medication that works for me, I have become accustomed to the idea of long-term use.

While in the past I equated medication with illness, I began to reinvent myself by equating it with health. As long as I stay on meds, I have no episodes, no life disruptions. I have become an advocate of long-term medication to such a degree that in the past, when my psychiatrist brought up reducing the dosage or weaning me off, I implored him to keep me on.

In the mid 1980’s, this was counter to the standard of psychiatry. Long-term medication with psychiatric drugs was frowned upon due to the chance of side effects that consisted of irreversible muscle and lip movement. I decided I could live with this possibility if it would fend off the near-certainty of another episode of delusional mania, which would make a shambles of my life.

The doctors were reticent but obliged me in my steadfast opposition to discontinue. This has turned out to be a good decision, an integral part of my playing “catch up.” Saying goodbye to psychotic mania in favor of recovery is my prescription for having a life.

It is easy to understand the initial negativity a patient has toward medication. Quite often it doesn’t feel good. In fact, sometimes it feels awful. The argument that the cure is worse than the illness is not a just response. Timing and temperance play a role in recovery as do the multiple medications we have to choose from today. Though one medication may bring side effects, to live in a crazed world where there are no boundaries between fact and fiction is by far worse, and one which has no alternative. The symptoms of the illness are worse than the side effects of the meds.

We, today, don’t know it, but we are blessed. A short 40 or 50 years ago, there were no antipsychotic drugs as we know them today. Recovery as a concept didn’t exist. Again, we are blessed to live in the era we do.