“Yeah, the bipolar diagnosis makes sense. I’ve been on and off medication for quite some time.”
“I’m just so ashamed and embarrassed to have that as my diagnosis.”
“You are just the same as all the other so-called counselors labeling me with this crap.”
These are just some of the responses I’ve received as I explored with my clients the bipolar diagnosis assigned to them upon intake during my tenure at a community mental health agency.
Their responses, as you can probably tell, differed in their level of acceptance, insight, and place in recovery. I am recounting my interactions without any judgment, and to make a point that we all fall under a spectrum within stages of change and recovery.
My hope for you is you reach for a conclusion in which improvement in your mental health facilitates peace, stability, and wellbeing. Before going into steps in addressing bipolar symptoms, let’s answer the questions, “What is bipolar disorder, and how does it differ from other mental health diagnoses?”
What is Bipolar Disorder?
A clear distinction in a bipolar diagnosis among other mental health illnesses is the occurrence of a manic episode. A manic episode is characterized by a period of noticeable change in which one’s mood becomes abnormally elevated or irritable with increased energy.
Alongside this mood change is the following possible behavioral changes: inflated self-esteem, decreased need for sleep, increased speed with speech or thought process, easily distracted, highly focused in accomplishing goals and/or unable to keep still, and involvement in activities with a high likelihood of negative consequences [i.e. gambling, sexual indiscretions, etc.].
These changes must occur for at least 1 week and cause a great deal of difficulty and challenges with functioning [social, educational, employment, etc.] and/or necessitate hospitalization for a manic episode. Those who experience symptoms congruent with a manic episode would fall under Bipolar I, and may or may not go through a depressive episode.
A Bipolar II diagnosis, however, involves a depressive episode and a hypomanic episode where the aforementioned symptoms are present for at least 4 days; but do not cause the same level of impairment in functioning as it would in a manic episode, nor does it lead to hospitalization.
The information in this column is not exhaustive, but to highlight the presence of a manic/hypomanic episode as a key indicator for the diagnosis – further discussions with your provider and therapist are warranted!
If you have received this diagnosis and are asking questions about how to move forward, you are in a good place – you have noticed something is amiss and are looking to improve your livelihood. In my experience working with the clients, I believe there are two crucial components to recovery: symptom management and readiness for change.
Managing Symptoms Related to a Bipolar Diagnosis
I look at mental health treatment like two sides of a coin: on one side is medication management and on the other is addressing external stressors and alleviating the internal experience in response to those environments. They are both needed in recovery and cannot go without the other.
Let us say for example an individual with a bipolar diagnosis was prescribed the appropriate medication but is also struggling with homelessness or relational difficulties. Although this person is taking psychiatric medication, the external stressors will trigger manic/depressive symptoms. The same goes for internal processes throughout day-to-day events and how an individual can manage emotional distress.
Medication Management for a Bipolar Diagnosis
Mood stabilizers are regarded as the treatment model for this diagnosis, and I cannot stress enough how important it is to begin medication to address symptoms. Just as there are many kinds of antidepressants and varying responses to them, the same goes for mood stabilizers; thus, it is imperative to navigate the side effects, challenges, and successes with their medication provider.
I have professionally found family physicians and primary care providers to be reluctant to prescribe and/or continue the management of mood stabilizers and they will refer to a psychiatric ARNP or psychiatrist, so if you find your PCP to respond accordingly there are providers that will explore medication with you.
Sometimes, depending on the medication, the benefits will not occur as quickly as we want them to, or side effects will present themselves and be difficult to cope with. Being compliant and adherent with medication is not easy, so I implore you to please speak up and be open with your medication provider.
They are there to make any adjustments needed or add/remove medications to help with any side effects. I have worked with clients where they stopped taking medication both for the reasons above and more, and the cost is great. Your providers are there not to gaslight you, but to help you feel well.
Knowledge is Power
As mentioned earlier, mitigating external cues, and knowing how to manage and respond to the environment is critical to recovery. How you think, feel, and behave during manic/depressive episodes will be unique to you, and this is where mental health therapy will be of use.
A therapist can assist with building insight into key challenges and successes in your daily living that hinder or promote recovery; and these challenges and successes might come from external sources[i.e. financial, housing, relationships] or internal [i.e. emotional regulation]. There is little you can do with insight alone, and a therapist can offer practical tools to handle symptoms and problem-solve ways to deal with stressors.
Readiness for Change
Readiness for change is needed for positive movement, but it is easier said than done. You are up against not only your internalized understanding of a bipolar diagnosis but also those perceptions that are influenced by societal/cultural ignorance. Changes in daily functioning due to symptoms or treatment side effects are also challenging and can pose as barriers to recovery.
I use a coin analogy to illustrate the required presence of both medication and therapy for recovery. I argue the same as it relates to readiness for change: acceptance of the diagnosis and taking the necessary steps for change.
Accepting the “New Normal” after a Bipolar Diagnosis
You are not crazy, and it is not your fault — I would wager my right pinky toenail you had thought the opposite of either one of those statements to be true. Media has done society a great disservice regarding how we understand mental illness, and the lack of general education around it further promotes misunderstanding.
What should have been relayed to you is that there is a strong correlation of bipolar disorder to trauma and/or a bipolar diagnosis within the family. Instead, what you probably heard or felt was that something was wrong with you, and yet we do not say that for other physical hereditary diseases.
Imagine going to a cancer patient and blaming them for the disease due to lack of exercise or poor diet – certainly cringe-worthy isn’t it? Bipolar disorder should be treated as it is: a disease that needs to be addressed for the sake of the person struggling through it. We often forget the human being overshadowed by the label.
So, what does it mean to accept the “new normal”? Knowing what bipolar disorder is rather than what it is made out to be does not make the diagnosis any easier. It still shakes the very foundations of your life. However, I believe having a healthier and more proper view of both the diagnosis and of yourself will give you the forward momentum that you need for recovery. Denial will only extend misery.
Make the Step
The bipolar diagnosis is not your doing nor does it reflect your sanity. You had very little control at the onset of the disease, but here we are, and you are trying to figure out how to deal with it. After reading this article you have an idea of what it takes to treat bipolar disorder, so what will you do now?
I have worked with clients where soon after being informed of their diagnosis, they jumped into treatment and witnessed dramatic changes in their lives, including improvement with relationships and meeting educational goals.
I cannot guarantee the immediacy or speed in which recovery occurs, but the alternative means acute symptoms and persistent suffering. My challenge to you with this article is you move into treatment and thus into recovery and wellness.
“Tired”, Courtesy of Adrian Swancar, Unsplash.com, CC0 License; “I’m freaking out, man!”, Courtesy of Photo Boards, Unsplash.com, CC0 License; “Meds”, Courtesy of Pina Messina, Unsplash.com, CC0 License; “Walking on the Beach”, Courtesy of Khadeeja Yasser, Unsplash.com, CC0 License