Monday, March 7, 2011

Please Tell Me It's Bipolar

 Following is an article I recently posted on mcmanweb ...

"Do all bipolar people lie or is it just my husband?"
"My boyfriend is bipolar and is coping with heroin."
"Is this an episode loving another man not my husband?"
"My husband is bipolar and every time we talk he always tells me I'm attacking him."

This is a sampling of queries that frequently arise on HealthCentral's BipolarConnect, where I contribute as an "expert patient." Are you beginning to spot a pattern?

First, let me say that these people and others are asking in good faith. They are going through hell. They are at the end of their rope. They are desperate for answers.

But I am also reading into their questions the type of answer they wish to hear, namely:

Yes, bipolar is the cause of [your husband's lying, your boyfriend's drug habit, your own infidelity, your husband's inability to discuss issues with you, and on and on]. Bipolar is a highly treatable illness, and with the right treatment these problems will all go away.

If only ...

These days, bipolar is copping a bad rap for no end of inappropriate behaviors. I think a lot of it has to do with the raised awareness of bipolar. Now, when people encounter behavior they don't like, the prime suspect is bipolar. Ironically, raising awareness may have raised stigma.

Inevitably, when responding to these questions, I point out that a mood disorder is very different from a personality issue or a personality disorder. Yes, there may be a connection. Yes, a mood episode obviously influences behavior. But first, it pays to make a separation.

To start, a mood disorder is morally neutral. Fluctuations in mood have nothing to do with one's personal character or values. Hitler may have had bipolar, but he was going to invade Poland, anyway.

On the other hand, there are complications. Hitler imprudently invaded Russia with winter coming on. Were it not for his unbalanced mental state, it is possible to imagine a far different outcome to World War II.

Psychiatry makes a very clear distinction between mood disorders and personality disorders. To vastly oversimplify, a mood episode is seen as "uncharacteristic" of an individual's baseline behavior. With a personality disorder, outrageous behavior is seen as embedded into an individual's make-up. With the former, the perception is that meds will quickly resolve the issue. With the latter, we see a far more problematic future.

Thus, you can see the logic in the desperate pleas of my readers. Please tell me it's bipolar, they seem to be saying. Then with a quick fix my abusive husband will become loving, my selfish wife will become considerate, my egotistical boyfriend will become understanding, my indifferent girlfriend will become caring.

Unfortunately, my correspondents almost always describe behavior far more indicative of a personality disorder than a mood disorder.

The bottom line is a loved one should not have to distinguish a bipolar episode from a personality disorder or just plain inappropriate behavior in the first place. Hurt is hurt, no matter what illness or condition or character defect you assign to it, and no one - for any reason - should have to put up with this type of abuse. But the people I hear from are willing to give their partners a second chance, to work with them, to help them. To give the relationship a chance.

If only, if only ...

Alas, I have to tell them probably not.

More relationship articles on mcmanweb: Family and Relationship Fallout; Validating Family Pain; My Loved One Doesn't Understand - Really?; Emotional Safety - My Relationship Bottom Line; What Goes Up


Anonymous said...

Thank you, John, for saying "no". I am bipolar and have done things when manic that are uncharacteristic for me and that I hope I would never do again. During those times I was sick. Ill. Not well. Needing medical attention. Thank you for pointing out the difference.


Tony Previte said...

You know, for me I don't view the things I do as inherently wrong, or misguided, malicious or even mischievous.

I just do what I do.

I don't label it either. I'm not manic, hypo-manic, depressed, apathetic or otherwise disordered.

It's life, it happens to all of us all the time, whether we want it to or not.

I guess I'm fortunate in that I've never done anything that I'm ashamed of, or have anything to feel guilty about. Others in my life would disagree with me, but that's their perspective.

Have I spent money I didn't have... Yes. Who hasn't? Just look at the economic mess we're in and how we got there!

Have I drank to excess and blacked out, even endangering others on the road while doing so? Yes. I've now been sober for years, my last DUI was over 20 years ago.

Have I put myself in compromising positions? Absolutely! Is it because I'm sick? No, it's because I'm human.

That's just how "I" choose to look at it. It doesn't mean I think it's a right approach for everyone. Everyone has their own understanding of themselves and will act accordingly and that's perfectly fine.

I'm just the kind of guy who likes to dispense with psychobabble and recovery language and talk about core issues; things like fear, guilt, love, hate, anger and anxiety. I Bipolar? Probably... but I view it as part of my being, not something that needs to be fixed. Does that mean I don't use medications? No, it means I manage this condition in ways that are not harmful to me. There are times when I need help from medications, but it's a short term solution that resolves itself within days and I'm back to normal and the need for medication ceases.

I DO think Knowledge Is Necessity, but I also believe that we need to be careful about how we apply that knowledge to our own existence and truly get in touch with what resonates with us as individuals and quietly dispense with stuff that doesn't.