Sunday, June 30, 2013

The Psychology of Bipolar Disorder

Like my book (Dancing in the Dark - Why? coming - hopefully within a year - to a digital bookstore near you), in this blog I switch between the "micro" (me) and the "macro" (a greater understanding of mental health disorders in general and in particular bipolar disorder). My last two posts were of the macro variety, today is of the micro variety.

I have, as I've mentioned, experienced "bipolar-like symptoms" for about thirty years. I'd go back earlier (to my teens) but I am not a believer in bipolar in youth (a topic for another day). By "biplar-like symptoms" I mean swinging from states of extreme elation, optimism, energy, drive, focus, motivation, elevated thought and clarity and elevated self-esteem to states of incredible sadness and negativity, zero motivation and drive, low and very negative self-esteem, almost zero energy and mud like thinking ability. "States", by the way, is an important distinction and a preferable and more accurate word than "moods". Classifying bipolar as a "mood disorder", I strongly believe, is one of the things that confuses the general public's understanding of what bipolar is. This is because almost anyone can identify with "mood swings". Hey, who doesn't feel happy one day and sad the next? They then think that bipolar is some bullshit disorder cooked up by doctors for a normal human mood variation. Believe me, I've had people tell me this to my face. (that some doctors do sometimes cook up a diagnosis of bipolar for perfectly normal mood variations will be a topic for another day). But this is a complete misunderstanding of what bipolar states are. They are not just "moods", they are entire different states of mind. So different that they feel like entirely different personalities within you. There were many times (years ago, long before I had any idea what was going on or had even heard of the term bipolar) that I swore that I must have had some sort of split personality disorder. And they are not just fleeting "moods"; they generally settle in for days, weeks, or months at a time (though the ratio between being manic and being depressed definitely is far greater towards depression, generally speaking). For the sake of brevity in today's post (and to keep it within the average person's reading tolerance), I'll describe better in future posts what these two states may be like. Today we just need to understand that they are polar opposite to each other and work in cycles (cycles beyond the sufferer's control ... yet another topic for another day).

There is a third state known as a "mixed episode" that I will tackle separately. I have a lot of issues with this state, how it's understood and defined and how it leads to the diagnosis of bipolar disorder. That will require a good number of dedicated posts on its own, however. For now I'd prefer to focus on the classic "high" and "low" states of bipolar.

Beyond how either state - mania or depression - feels and manifests itself at any one time, there are, I'm going to argue, psychological factors as well. To be clear, I am not arguing that mania or manic depression (a form of depression different than uni-polar depression, just to remind) is merely "psychological". That is to say that it is an organic condition which is further to say that it is no doubt neurochemicals running amok in the sufferer's noggin. (that this neurochemical process is not currently understood and that the old "chemical imbalance" theory of bipolar is outmoded and not applicable is yet another topic for another day and future post). So what I'm saying is that neurochemical chaos aside, there are psychological components to living with the disorder that either get overlooked, are poorly understood or are ignored and missed entirely. This will take several posts to explore and establish so today is just a primer. Today I'm just going to touch on the psychological impact I suffered (and am currently working to overcome).

The psychological factors are (among others but I'll just start on these three today):

  • confusion
  • frustration
  • and what we'll call the nocebo effect
Confusion: I talked in the previous two posts how confusing it is to find accurate and up to date information on exactly what bipolar is and this is certainly part of the mix. But what I mean here is identity confusion or in other words, "just who in the fuck am I?". Am I the outgoing, gregarious, brilliant, energetic, highly motivated, positive, optimistic, wonderful, sexy Brad or am I the mopey, dull, brain dead, sad, introverted, zero motivation and energy Brad? This alone would drive me utterly and literally mad sometimes (mostly in the insane sense of the word but the anger sense as well). These states invade your brain at will and there's nothing (seemingly, yet another topic for another day) you can do about it. This, for me personally at least, was a huge factor. I suspect it is for most bipolar people as well. 

Frustration: If you go through true bipolar state swings and do a lot of the things associated with mania, I can guarantee you that there will be disruptions in your life. I'm talking lost jobs, destroyed relationships, multiple and serial sex partners, financial losses, possible violent outbursts and so on. Manic depression - when taking a shower can seem to require Superman like heroic effort - can also lead to lost jobs, relationships and financial losses. There will be days when you have no fucking clue who you are, what you are or how you got there. If life is frustrating at the best of times, try it with all this fun thrown in for good measure. I personally have struggled with frustration all my life. It's just one of my personal weaknesses (and one of my main focuses of self-improvement these days ... this alone has made a big difference for me) but dealing with the whirlwind chaos caused by constantly shifting inner landscapes amped up my frustration levels off the charts. 

The Nocebo Effect: this is the opposite of the well known other side of this psychological coin, the placebo effect. Briefly, the placebo effect makes you feel better, the nocebo effect makes you feel worse. There is controversy over these in the scientific community. No such controversy exists in my mind. Both are absolutely real and both can be clearly demonstrated. Well known Canadian neuroscientist Mario Beauregard explains the placebo and nocebo effects in great detail in his book Brain Wars. How I believe the nocebo effect works with bipolar disorder - and schizophrenia - is that the more one believes the negative long term outcomes of bipolar, the more one will live that. Put in another term, it becomes at least partially a self-fulfilling destiny. This was, until I temporarily rejected the mental health system diagnosis of bipolar, a huge factor in the decline of my mental health, functioning and mental faculties. 

I also need to establish and tie in the psychological factors to the high suicide risk that exists for bipolar peeps. But again, in the future. 

I'll devote separate posts to each of these soon. For now though, I've probably taken up enough of your mental band width for one day. 

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