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Home: Articles: Miscellaneous: A Consumer Speaks Out

A Consumer Speaks Out

Talk therapy and people with bipolar disorder

by Kristen Quigley and Ken Braiterman

Not every problem in the life of a person with bipolar disorder comes from the bipolar chemical imbalance. People with bipolar disorder and their therapists must understand this, first and always. We cannot always control our feelings or "chemical mood,"but we are more than just chemical reactions.

Talking therapy can change behavior and thought patterns, which people with bipolar disorder have spent a lifetime developing. It does not matter that these were formed partly by a chemical imbalance. The behavior patterns still need to he confronted and changed. Thatís not easy.

Thinking that every problem has a physical cause can make behavior even harder to change, responsibility harder to assume. It can lead to unrealistic expectations of the antidepressant medicine.

Bipolar disorder is often inherited. Itís been treated as a physical illness less than 40 years, and, therefore, many of us were raised among undiagnosed adults with this illness who were abusive, negligent, or substance abusers. Therapists must deal with us clients as they would any adult with similar childhood problems.

Bipolar disorder is living with a mind you canít trust. What clinicians call "mood swings" are, to us, changes in who we are. They occur without reason or notice and are completely outside our control.

Manic episodes, whether violent, irritable, or euphoric, often feel as if the "real you" is watching some disconnected mad person lose all control and inhibition. It can feel good: social, talkative, energetic, everything bright, clear, and beautiful. It can be hell: suicidal, every noise grating, every light too bright, every person painfully annoying. Thoughts can circle incessantly or clang from one track to another uncontrollably.

Depression leaves you feeling worthless and helpless, no place you want to be, nothing you want to do, no one you want to be with. Dishes, laundry, bill-paying, even bathing can become overwhelming. Suicidal feelings come in long sieges, not manic impulses or flashes.

Accepting these changes as a physical fact of our lives is against common sense and human instinct. Itís one of the things we can learn in therapy. We can also learn, in therapy, that these feelings are unavoidable, but acting them out is unacceptable.

Two therapeutic strategies helped us learn to manage our illness and still help us day-to-day.

A diary: We began to write down concrete actions, words, or events that triggered anger or hurt. This helped us change our patterned reactions and behavior. Itís like a river that follows the same path for years and has cut a deep channel through the earth. Changing paths is daunting, but possible. How to do it will vary for each person.

A written log also helps identify cycles. Many peopleís episodes come every few days, weeks, or months, or with anniversaries, season changes, or holidays. A diary helps you look back and say, "Iíve been here before. This too shall pass." Some people can even learn to anticipate their cycles and soften them with medicine or emotional preparation. A diary is also an outlet for extreme feelings. It can help lance and drain a mood infection.

Scheduling isolated, controlled, sympathetic "mood management time" lets you release tension in a safe way.

Isolation is important because you canít really let go if other people are around. Controlled means a conscious decision about how you will acceptably act on eccentric feelings that you canít avoid. There are hundreds of ways, like exercise or meditation. Ken sings or talks out loud (alone). Kristen puts on headphones each day, selects music, and just rides with it.

Sympathy does not mean people feeling sorry for you because you have an illness. It means regular contact with other people with bipolar disorder, the only people who can truthfully say, "I know how it feels." Support groups can be extremely helpful, but a regular, reliable, telephone friendship with one or two people with the same illness can be just as good. You can find live support group chat rooms on the Internet by searching under the keywords "bipolar disorder." Intimacy and happiness are two extremely hard issues for most people with bipolar disorder, who often fail in relationships and feel unlovable because spouses, significant others, and family members canít live with someone so unpredictable and moody.

Flipping between omnipotence and helplessness makes it difficult for a person with this disorder to set limits in a relationship or maintain a stable feeling of where one person stops and the other begins. One minute he wants to solve all his partnerís problems now; the next minute he canít do anything for himself. He might isolate in ways intimate partners canít understand, control, live with, or overcome.

Therapy can help couples and families isolate which patterns flow from the bipolar disorder. We with this disorder also have all the same problems "normal" people have in relationships. The couple, family, and therapist need to know which is which and have strategies for both.

Finally, people with bipolar disorder must learn the difference between manic euphoria and real happiness. Mania can feel fun, carefree, powerful, exhilarating, but when the mood dissolves, there is nothing left except despair, regret, shame, humiliation, and often debts to repay. Many of us resist treatment because weíre afraid medicine will take all the fun out of life. We think life without mania would be boring and the inevitable crash from the heights is worth it.

The key to jumping this hurdle is the concept of joy. There is no joy in mania.

Joy comes from achievement, love, loved ones, nature, family, work, or friendship. Warmth, security, and peace are still there when the mood shifts. Real happiness makes the people closest to you happy. Manic euphoria makes those same people instinctively nervous, angry, and irritable.

Talking psychotherapy can help people with bipolar disorder learn the difference between the happiness that disappears like air when you pop a balloon and the kind that builds on itself and creates joy in being alive.

Bipolar disorder is living with a mind you canít trust. What clinicians call "mood swings" are, to us, changes in who we are. They occur without reason or notice and are completely outside our control.

Depression leaves you feeling worthless and helpless: no place you want to be, nothing you want to do, no one you want to be with. Dishes, laundry, bill-paying, even bathing can become overwhelming. Suicidal feelings come in long sieges, not manic impulses or flashes.

©1997 National Alliance for the Mentally Ill (NAMI)
200 North Glebe Road, Suite 1015
Arlington, VA 22203, (703) 524-7000
www.nami.org

About the Authors

Kristen Quigley, 28, and Ken Braiterman, 48, are both freelance writers who have been diagnosed with bipolar disorder. They wrote this piece "as a community service for our bipolar brothers and sisters and the people who treat them." They describe themselves as "bipolar survivors" and "bipolar people," which NAMI changed to "people with bipolar disorder" because this piece may be reprinted and we want to honor their commitment to "putting people first."

Modified December 25, 2002

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The information at this web site is for consumers, family members and mental health workers to make informed decisions about the care and treatment of bipolar disorder, AKA manic depression. These pages are not a substitute for consultation with your counselor, therapist, doctor, or psychiatrist.

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