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Bipolar Disorder

Who Am I? The Effects of Bipolar Disorder on Identity

Bipolar disorder can shape the way our personal identity develops.

Recently a reader wrote about how about how hard it is to have a sense of identity—to feel like she knows who she is. Essentially she was saying that it hurts when people say “I don’t get you! You change all the time. Who are you?” Her concerns make sense. If you have a bipolar spectrum disorder, it can be hard to have a consistent identity. In the next few posts, we will explore the effects of bipolar spectrum disorder on identity.

What is identity?

Some scientists think our identity reflects our underlying schemas. Schemas are mental structures that are comprised of thoughts, feelings, sensations, attitudes and memories that are linked together around a common theme.

Some of the schemas we have are related to our sense of self—our personal identity. These schemas are shaped by our life experiences, and they reflect our interpretation of these experiences. We can think of these schemas as our internal representations of our most important values and our deepest fears.

Schemas about our personal identity can be organized around themes of competence, acceptability, lovability, and strength, among other themes. The thoughts, feelings, and memories we associate with each theme develop over time. They represent our observations of ourselves in action in the world and in relationships with others.

If we are able to achieve our goals in school, we can develop a schema about our own competence. If we learn to get along with other people, then we can develop a schema about our own acceptability. If we are treated with affection, we can develop a schema about our own lovability.

When schemas are activated by events, they are accompanied by a cascade of other effects. For example, when we do well at school, we activate a schema about competence. We feel well-being or pride. We remember other times we did well. We have sensations of lightness and ease. We think positive things about our abilities and anticipate being able to succeed in the future.

But developing bipolar illness can have a significant effect on the schemas we hold about ourselves. Bipolar disorder is a biological illness, but these biological disruptions affect our behavior and our mental processes. In turn, these changes can have a significant effect on our ability to function in the world and to relate to others. As we observe these changes and have new experiences as a result of bipolar disorder, we can develop a new set of schemas. For example:

- If the symptoms of bipolar disorder interfered with our ability to concentrate and plan and disrupted our ability to work or study, we may develop schemas about incompetence.

- If bipolar disorder drove us to behave in an unpredictable or unusual way (i.e., we were aggressive, impulsive, or hypersexual), we may develop schemas about our unacceptability.

- If we were rejected by others and lost relationships, we may develop schemas about being unlovable.

Schemas are powerful, because we don’t experience the themes simply as ideas or thoughts. The central theme is attached to sensations, images, memories, and feelings. And the combination of the underlying thoughts with the physical reality of the feelings and sensations can make these schemas “feel true”. No matter how irrational we know it is, if events activate a schema about being unlovable, we will feel unlovable.

The schemas that develop as a result of bipolar disorder can still remain active, even when the bipolar symptoms subside and the symptomatic behavior is under control.

Let’s look at an example. In high school and college, Julianne was a successful student. She wanted to pursue a career in advertising, and she got an excellent job right after graduation. She was forming a positive identity, reflecting schemas about competence and strength. She was developing her identity as a creative professional.

Then in her mid 20s, Julianne developed severe bipolar I disorder. Like many other people with bipolar disorder, she had several episodes of prolonged depression or mixed state—episodes that lasted many months. The acute symptoms of bipolar disorder disabled her ability to concentrate or plan effectively. She could not work, and she did not even have enough energy to try.

The experience of being sick and disabled fostered the development of schemas about incompetence, failure, and weakness. In these schemas, the beliefs about incompetence and failure were linked to memories of feeling disappointed or frustrated; to bad sensations of fatigue and pressure; and to negative thoughts about herself and her future. She was afraid to try to work again.

But as Julianne got better and her mood stabilized, she was able to return to work. She was able to focus her attention on her responsibilities. When she did well, she began to feel a little pride, even if the feeling didn’t last too long. After a year, she started to develop a positive identity as a professional—to develop schemas of competence and strength.

Recently had some problems on a very difficult project, and her boss complained about her work. Not a big complaint—more like a little nudge. Now Julianne wants to leave her job. She feels as if she doesn’t want to work in her profession any longer. She thinks this work is not important and not what she wants to do anymore, anyway!

Why does this happen? Why can’t Julianne maintain a positive identity as a professional, even when there are ups and downs at work?

Problems at work can activate negative schemas of failure for anyone. But for Julianne, these schemas are very intense. The events that triggered the development of her schemas about being incompetent and weak were traumatic. She was in severe emotional pain, and her dreams of progressing in her career were shattered. Schemas which develop under these traumatic conditions are easily triggered or activated. (Unless we learn to recognize and address them).

Even a tiny hint of criticism from her boss activated Julianne’s negative schemas—schemas about failure, incompetence and weakness. And when these schemas and all the linked feelings and sensations were activated, Julianne felt she could not tolerate working any longer. She didn’t want any part of her profession. She no longer trusted her own abilities and her stamina.

Julianne’s friends and family (and her boss) were confused by her strong reaction to this problem at work. They remember the month before when Julianne told them she loved her work. Now she wants to walk away. Julianne has been doing so well; her families’ vivid memories of her illness have faded. And they don’t yet understand how schemas—and new identities—can develop after developing bipolar spectrum disorder. It is hard for them to understand what to say or do.

It’s also hard for Julianne. Like most of us, Julianne was not aware she had these schemas. Schemas can operate outside of your awareness. They may affect your behavior without your conscious knowledge. (In fact, one of the jobs of psychotherapy is to help label and recognize these schemas.)

Once we had a chance to talk, Julianne could recognize the schemas she developed when she was very ill. She could see the ways they are still hovering in the background and were triggered by these events at work. And then she was better able to put things in perspective.

Julianne is developing a new identity—an identity that reflects her ability to accept and face the challenges of bipolar disorder—as well as the challenges of her personal and professional life. She is developing an identity that is different from the one she had before she developed bipolar disorder, but an identity that is still real and affirming. As she grows and takes on new responsibilities and lives through the ups and downs of bipolar disorder, she will develop a new and integrated sense of self.

In the next post: schemas can also be activated by circumstances that increase or decrease your energy, increase your negative mood, trigger painful memories, etc. We will talk about how seasonal or stress related changes in mood can activate different schemas and create shifts in identity.