When you have a close connection with someone diagnosed with the disorder, it’s so easy to rapidly want to move towards solutions and positive adaptations.  If people are struggling with depression or recurrent mood instability, you want to see them do better.   You want to convince them that they will gradually get better.  You want to offer hope and positive attitudinal change.  And, if you’re the in the early stages of living with bipolarity, then you may find yourself on the receiving end of a lot of support and positive encouragement and support.

Modification of negative thinking, development of positive attitude, and optimism about future are frequently encouraged in those who live with bipolar disorder.  After all, it’s not good to persistently mope or feel bad for one’s situation.  Those negative thoughts can absolutely lower the bottom end of a bipolar depressive episode.  It’s like adding weight to someone who is already having a hard time with gravity. Attention to positive thinking is also very much reinforced by many contemporary treatment approaches rooted in cognitive-behavioral therapy.  After all, CBT is the most commonly used treatment approach for depressive disorders.  

But there’s something that accompanies the bipolar diagnosis that can often be missed in the efforts to help someone manage the early phases of their bipolarity.  I’m referring to attunement to the painful losses that come with the illness.  It’s the experience of saying to the person with bipolar disorder – “I know you’re hurting … I can see your pain … I understand it’s not something you can't easily rise above … and while you’re in it, I can still accept you and be present to what your feeling.” 

Too often this kind of attunement… the experience of being present to another’s pain, is missed.  We’re too quick to try to circumvent the painful stuff and progress towards that which feels more positive.

I recently saw a 34- year-old female I’ll refer to as Emma.  Emma was diagnosed three months ago with bipolar disorder during a five-day hospitalization for very high-level hypomania.  She was agitated and only sleeping a few hours nightly.  Cognition was racing, planning was unrealistic and impulsive desires to act on her grand plans were quite strong.  While she was still able to marginally get through her days (she wasn’t fully out-of-control), both her psychiatrist and her husband thought it would be best if she spent some time in the hospital in order to receive appropriate medication and essentially come down from her elevated mood intensity.  Emma complied, but not without a sense of defeat.  She also found that once her hypomania broke, she quickly dropped into depressed mood.

A challenging aspect of Emma’s experience involved the reality that she grew up with a mother diagnosed with bipolar disorder.  Throughout Emma’s development she strived to achieve and accomplish all that she could as a bold statement to self and others - “I am not my mother …I have the strength and determination to hold on to my high functioning stability.” 

This worked for Emma up through her early career years in computer science.  She accrued a lot of evidence to support her counter-identification (not being her mother); and until her mid-30s, she thought she gotten there.  She thought she had escaped bipolarity.  When her maternal genetics finally arrived on the scene, her own bipolarity expressed its presence through a host of symptoms that were reminiscent of her mother’s experience during Emma’s childhood.    

Emma’s hypomanic derailment hit her quite hard.  It wasn’t just that she was sidelined and depressed, but more that she was in the grip of something that was likely stick around well into her adulthood.  She didn’t have the option of rising above it and leaving it behind.  The more Emma let this in, the more her grief and emotional pain came to the foreground.  Essentially, she had to begin to say goodbye to the image of the life she was reaching for in order to allow herself to accept the bipolar reality she was faced with.

Early on in her therapy, Emma conveyed that our discussions in therapy were inconsistent with the approach being taken by others in her support system.  Her husband, her friends, even her psychiatric provider, were all oriented towards encouragement and positive change.  If Emma was deeply saddened, she was encouraged not to dwell in it.  The individuals in her support system were all saying – “With enough strength and motivation; you can get back to that high functioning place you’ve occupied.”

In some respects this message was accurate.  Emma was a very capable young woman.  However, what was being overlooked was the fact that her high achieving self was overdetermined.  More than simply being an expression of her strengths, her strong functioning was a much-needed escape from something she feared.  Once that defensive structure broke, she found herself flooded by memories and feelings that took her back into painful identifications that she thought had been left in the past.    

Feeling the pain of one’s losses isn’t an attractive option.  It’s like the dental appointment we dread but know we should attend.  The surprise for those who do attend to their grief is that the progression into painful emotion can actually be relieving, at least more so than remaining invested in resistance to the pain.   

Emma found that once she was able to feel the emotional impact of the bipolar diagnosis, the gradually ensuing acceptance allowed for a different kind of forward progression.  She was able to say to self and others - “OK, I've been knocked over by something I couldn't vanquish.  My strengths and my capabilities do have limitations.  Now it's time to figure out how I integrate this newly emerging part of myself into my forward progression.”

The point of Emma's vignette is to convey the simple truth that once we can deeply accept what is, we can progress forward with positive adaptation.  The painful response to the diagnosis is present for all who find that their life trajectory has become altered by a chronic illness.  Limitation is limitation.  It’s unwanted and difficult to come to terms with, regardless of how it manifests.

Issues of mourning and loss are but one aspect of adaptation to chronic illness.  I don’t mean to convey that we only do well through embracing our weakness.  That tactic doesn’t work.  For most, the connection to strength and resilience is essential to living well.  But such isn’t effective if the approach reflects a one-sided attachment to potency without also allowing for the very real human quality of vulnerability and weakness.  Only by allowing both to coexist can one find a sustainable approach the task of living with chronic illness, be it bipolarity or anything else that has long-term enduring impact on our well-being.

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Russ Federman, Ph.D., ABPP is in private practice in Charlottesville, VA (www.RussFederman.com). He is co-author of Facing Bipolar: The Young Adult’s Guide to Dealing with Bipolar Disorder (New Harbinger Publications). 

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