Sensitivity and Acceptance of a Bipolar Diagnosis

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.

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

1. Depressed mood
2. Social isolation
3. Extreme shyness
4. Excessive tearfulness
5. Acting out; sudden flare-ups of temper
6. Mood swings in excess of what would be deemed normal
7. Hiding feelings from a parent
8. A “flat line mood,” one which remains instant (does not differ over time)
9. Non-communication with a parent for a sustained period
10. Expressed thoughts of alienation or meaninglessness
11. Hyper behavior or insomnia
12. Poor grooming
13. Erratic behavior
14. Changes in appetite
15. 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.

THE IMAGE OF MENTAL ILLNESS AND WAYS TO EDUCATE

I have been able to give some perspective into the mentally ill mind, to educate, and to be able to see the potential importance of doing so. There is a lot of ignorance and misunderstanding about mental illness, misconceptions abound. Where outward behaviors are the only measures people have, the public view is rooted in the stereotypes of the past. The homeless, a bizarre tragedy making headlines in the news, or the latest controversial court case all typify the image that is applied to mental illness in the public mind.

The interior story, why individuals do the things they do, sparks curiosity, yet, all too often explanation is missing. My job is to shed some light as someone who has been deranged, depressed, and grandiose in delusion. I have both the emotional connection and the firsthand knowledge to relate personally to a client, while also illuminating to others the darkness that often accompanies mental illness.

People want to know more. I am in a unique position to educate. This has been the forerunner of what is now my ease of self-disclosure to teach others about chronic mental illness. To teach is to reaffirm my own health. This is not only my process, but something to be learned by others. Clients and family alike benefit by giving attention and time to a topic that impacts family cohesion and the ability to act in the face of crisis. Being paralyzed by incomprehension and fear should not be an option.

Ten Ways to Educate About Mental Health

1. Read books on your illness.
2. Attend lectures on mental health
3. Join a support group.
4. Speak to psychiatrists and mental health professionals.
5. Seek therapy both for the individual and the family.
6. Subscribe to magazines that feature mental illness and recovery topics.
7. Join advocacy groups --- NAMI & D&BSA
8. Seek to identify your stressors.
9. Maintain a conscious attitude about mental and its treatment.
10. Recognize your limits.