Manic-depression, or bipolar disorder, is one of the most misdiagnosed conditions in psychiatry. Part of the problem, as noted in yesterday's post, is that the term bipolar has been watered down to an adjective for moody. Anyone who has worked in mental health can tell you that if someone's symptoms are erratic and involve mood changes, an (inappropriate) bipolar diagnosis may be on the way. As the title of John McManamy's book, Not Just Up and Down, tells us, it's, well, not simply up and down moods. Using the term manic-depression is much more descriptive and could help practitioners stop and think about what they're looking at before any knee-jerk diagnosis is applied.
Aside from the rampant, erroneous notions about what constitutes the illness come other faulty conceptualizations driven by popular culture. Unfortunately, students and new practitioners, and even some long-term practitioners, fall prey to misunderstanding the illness and tend to conceive it as Hollywood portrays it.
In today's post, I've teamed up with mental health advocate Gabe Howard, who experiences the condition himself, to talk about some things he wishes people, especially providers, knew about bipolar disorder.
1. Besides that it is inaccurately perceived, what's the biggest misunderstanding about bipolar disorder that you've encountered?
That mania is good, it's better than being depressed. Well, in deep depression you're usually just there. There's little energy to do things, you don't talk much. Most people can identify with being depressed, which feels awful, so might assume that mania, since it is the opposite, is better.
Not the case. Mania is destructive! It might feel good at the time, but feelings aren't facts. You're not doing great things. You're usually doing stupid things that feel good. Also, people hurt others more often when they're manic. In manic phases, you have no filter, you say hurtful things you have to deal with later and you don't even remember saying them.
2. What could treatment providers do better for bipolar patients?
First, providers do a poor job explaining that the illness is like a spectrum and that the symptoms aren't always there. People will tell me, "Hey, I've seen you be ok," and that's true. Even untreated, I could go months without a manic or depressive episode. So then I get to thinking, when I do start getting symptoms, "Why am I acting this way now? It has to be a choice." It messes with your head.
Second, they can do a less-than-stellar job explaining the nature of the illness. There's a lot of bad information out there on bipolar disorder that newly-diagnosed people may have heard and thus worry about now that they have the diagnosis. If they're left to learn about it on their own they'll find a lot of bad information that won't help. From what I knew about bipolar disorder, I was scared. I was simply told the diagnosis like I'd understand it as easily as a broken bone. I thought my life was going to consist of an institution and that suicide was inevitable. I remember thinking, "Thank God they caught this now before I murdered my family," because we're told mentally ill people are dangerous. People are scared, and they need comfort and reassurance in the face of a diagnosis like this.
Third, providers are good at helping people stabilize, at getting out of that depressive or hypomanic/manic episode. Then what? What about keeping stable? It shouldn't be, "You're stable now. Out you go." Getting stable is easy; keeping stability is the challenge and where the therapy really is. Patients often aren't coached on developing a smoke alarm for sensing symptoms coming on. Or we don't want to because we've been stable, and thinking about being unstable is scary. It's denial. Providers have to work with bipolar patients on accepting taking responsibility and that it is a lifestyle now to manage the illness.
3. If you could drive home the most meddling thing about the bipolar experience you think providers need to understand, what is it?
That your thoughts are not your own. I really wish people got that. There's this idea they are the patient's voluntary thoughts. No, they're diseased thoughts emanating from their brain; that's the extent they own them. You can't be in complete control of your faculties and happen to be manic or severely depressed. Getting frustrated with people who want help but don't have the wherewithal to fully engage it at the moment is an insult to injury.
Providers need to meet patients where they're at. If that's simply being supportive and monitoring them for risk while a new medication kicks in, so be it. Then, the real work of keeping them stable can start, using the experience they're coming out of as fresh motivation to work on lifestyle changes that can help keep episodes at bay, or developing a smoke alarm system to detect the tiniest signs an episode may be starting and seek out providers as soon as possible.
G. Howard, personal communication, November 18, 2020.