Tuesday, June 9, 2009

Rerun: Illness or Personality?

First Oprah, then Andy Behrman. Time for a mental health break from this blog. Following is a rerun from January. These are the type of pieces I prefer to do (and ones I'm sure you would rather read), ones that shed insight into what makes us tick:

I answer questions as an "Expert Patient" at BipolarConnect. Two days ago, Dark Angel asked, "Why does bipolar seem like your personality?"

The question goes right to the heart of how we see ourselves, and is central to every issue we discuss here at "Knowledge is Necessity."

"Welcome to a lifelong quest for self-knowledge," I began. Okay, let's see if we can figure this out:

The experts distinguish between "state" and "trait." A state equates to an illness episode whereas a trait is part of your personality. Let's use hypomania as an example:

People tend to pair "exuberant" with "personality." Exuberant is seen as beneficial, and, most important, people see YOU as in control.

In hypomania, for the purposes of this conversation, we are talking about over-exuberance. Not only that, hypomania is often a sign that we are really about to lose control of our brain, or that we have already lost it.

I would contend that for many of us hypomania is a normal part of our personality, only in this case we're mixing bad with good. For some, it may be a rational choice to accept the bad with the good. Others understandably want no part of hypomania.

The DSM sheds some interesting light on the topic. According to the DSM, we are in hypomania when we experience "unequivocal change in functioning that is uncharacteristic ... "

In other words, we are talking about a "state" that is not a true part of our personality.

I would argue that for many of us this is not necessarily the case. Nevertheless, the DSM is making a valid point. Keep cranking up the volume, and, at a certain point, we are definitely not ourselves. We are not in control of our brains.

Think of two individuals who are "up." They are thinking alike, they are acting alike. But one is behaving rationally and in character while the other is not. Same behavior, yet a profound difference. One may be on his game, the other may need meds. On and on it goes.

Hypomania is just one example. We need to apply this ruthless self-examination to all our behaviors, as well. This includes our depressions and anxieties, as well as a range of personality quirks.

For many people, our illness is fully integrated into our personality. Others rightfully view their illness as an interloper. Well-meaning experts, including friends and family, are not hesitant to proffer advice, but, in the end, you are the only expert in knowing where you stand. But this kind of wisdom only results from responsible self-enquiry. Welcome to "Knowledge is Necessity."


Heidi said...

I wish it were easier to tell the difference between my "natural" personality ups and the illness pushing me up. I tend to worry whenever I feel good, which is a drag. Usually only in retrospect can I see what was really going on.

Thanks for the thoughtful remarks. I've been bipolar since 17 (or earlier); diagnosed at 39; currently 48.

Anonymous said...

I actually remember my personality---before Bipolar was in full swing. It was so much different, however now the added stresses of managing an uncertain career, dealing with ever limited finances and raising young children has a lot to do with my changing personality.

diagnosed bipolar (rapid cycling bpII)at age 29. Now 33 years later I feel I am a patient expert as well, which helps in my fight to keep it all together--my greatest fear is when could it or will it happen when all of the accumulated stresses and my illness take over and I will lose total control. My children will suffer the most--that fear keeps me in the fight.