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Bipolar Disorder

Self-Scrutiny and Bipolar Disorder: A Unique Necessity

Importance of replacing neurotypical spontaneity with bipolar self-monitoring.

I lead a support group for professionals diagnosed with bipolar disorder and during a recent group meeting, I observed three group members struggling with an issue that I find to be quintessentially unique to life with bipolarity: self-monitoring versus spontaneity.

Group member one recently had her lithium prescription changed to a lower dose. Within a few days of the change, she noticed that she felt more in touch with her feelings. The affective blunting that can sometimes be a side effect of lithium was greatly diminished.

In its place was her return to a more vital sense of self that had been missing for months while she was on a higher dose of lithium, due to frequent mood switching combined with strong suicidal impulses.

She definitely liked her experience of self on the lower dose. She felt more alive, more present, and with no clear evidence of any hypomanic symptoms, but she was worried. She didn’t know whether her new experience was something she could relax into or whether it might herald a return towards stronger mood intensity that she had found to be problematic.

Group member two had a long history of rapid cycling where she’d experience significant mood shifts every two to three months. The roller-coaster moods were getting worse.

Several months earlier, she had resigned from a high-stress employment position due to the negative impact it was having upon her mood stability. The choice had worked. She was far less stressed. Not so surprisingly, she entered a period of mid-range mood that had lasted almost two months, which was quite unusual for her. Mid-range had been a place rapidly passed through while transiting between depressed and elevated mood states.

However, in the week proceeding the group, she found herself feeling more socially engaged than she had for a while. She was talking with friends on the phone, seeking out old high-school connections on Facebook, and arranging several networking luncheon dates. After all, she knew she wanted to return to her profession and was hoping to find something in the healthcare field that was less stressful than her previous position.

She noted that she wasn’t experiencing increased energy nor any decreased need for sleep. Her demeanor in group was congruent with her mid-range mood. But she nonetheless was noticing her increased desire for social engagement and she was worried. Was this an indication that her two-month experience of mid-range mood was about to shift, or was it a normal and acceptable reaction to her recent experience of sustained stability?

Group member three had a long history of a seasonal mood pattern where he was typically depressed during the fall and winter months and prone towards hypomanic elevations during spring and summer. By late summer of this past year, his psychiatrist had transitioned him from Lamictal to Lithium, due to the increasing amplitude and frequency of his mood changes.

To his surprise, since commencing lithium, his mood had evened out significantly. Furthermore, he had not experienced the downward progression of mood that he typically saw during the months of fall.

But in the week prior to group, he found his experience quite opposite to group member two. He felt less engaged and less desirous of social contact. He also found himself sleeping later in the morning than he had over the previous several months. He hadn’t yet reached the point where he was experiencing aspects of painful mood that he associated with depressive episodes, but he was fearful of where he might be headed.

As I listened to the group process the different issues that each member was sharing, I was struck by the uniqueness of their discussion. I found myself wondering: in what other realms of the general population’s day-to-day experience do we typically find people worried about subtle shifts in mood, energy, or motivation?

I also heard the group acknowledge that in order to live responsibly with bipolar disorder, each had to learn to accept the necessity of ongoing self-observation or self-monitoring. Essentially, they couldn’t just allow for subtle mood shifts without some degree of concern. Contrast this with most neurotypicals (people without psychiatric disorders), who get to live with the ebb and flow of varying mood states representing the normal and expected range of experience that may be occurring at any point in time.

The conundrum here entails this question: How does the individual with bipolarity get to retain their spontaneous engagement with life — while also having to be partly positioned in a self-observing space — in order to make sure that mood doesn’t progress towards strong intensity before being able to intervene with corrective measures?

I truly wish I had an easy answer, one that I could provide some reassurance or solace to those who face the challenges of living with bipolarity. I suspect it comes as no surprise to the reader that I don’t.

What I can say is that each challenge we face in life requires some degree of adaptation. We don’t always just get to vanquish the problems that make living hard. Instead, we’ve got to discover what adaptive choices are needed in order to maintain as much quality of life as is possible. Such perspective is relevant not only to bipolarity, but to anyone facing difficult realities that can’t be undone and must be reckoned with as an ongoing dimension of one’s future life trajectory.

More from Russ Federman Ph.D., A.B.P.P.
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More from Russ Federman Ph.D., A.B.P.P.
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