Imagine you’re at University and you have your first manic episode. You think you are just partying too hard but things get out of control - you can’t sleep and your thoughts are racing. You are admitted to hospital and told you have Bipolar Disorder.
The message you get is that Bipolar Disorder (BD) is a mental illness with unpredictable periods of extreme high and low mood. You’ll never fully recover but daily medication can reduce the frequency of episodes. Unfortunately the medication has nasty side effects and you’re likely to have more episodes over time. Only half of people with BD work consistently, it’s associated with the highest rates of divorce and suicide of all psychiatric diagnoses, and to manage it you need to avoid stress, late nights, drugs and alcohol.
How do you feel? Many people are frightened, defeated and hopeless. They change their lives as advised and take the tablets, maybe dropping out of University to avoid stress. This means giving up life aspirations triggering feelings of failure and low mood – a self-fulfilling prophecy.
What if this message is wrong? Is there a message that acknowledges the difficulties while highlighting positive aspects? It could emphasise positive lifestyle changes and relapse prevention while still pursuing dreams. It might reveal a wider range of outcomes - not just inevitable decline. If you got this message instead would it change things? Might you stay at University?
“I have often asked myself whether given the choice, I would choose to have manic depressive illness…..strangely enough I think I would”¹
Many people with BD value their experiences. A survey of 3330 adults with BD revealed only 54% would definitely eradicate their illness if they could.²
Why retain a mental health problem? There is little empirical research in the area so to find out more myself and colleagues at Lancaster interviewed 10 people with BD about their positive experiences (Read our full paper here).
We found that some common experiences included experiencing perceptions and moods at a far greater intensity than others, and a sense of heightened abilities. These included performance at work and hobbies, but also referred to an increased ability to empathise and feel connected to other people. Enhanced abilities were not confined to high mood. For example, a vicar told us how his own experiences of depression gave him the ability to empathise with people going through difficult experiences, citing the example of comforting parents of children who had recently died. As a result of these positives, participants described feeling lucky to have BD because they felt they got to experience life at a deeper level than most people ever do. To find out how widespread these positives are, we need people with Bipolar experiences to complete this survey.
People can learn effective strategies to manage mood. Managing early warning signs of mood episodes can reduce relapses. CBT, group and family interventions have a growing evidence base. However, these have only been evaluated as additions to current treatment, primarily medication. How well they work as an alternative remains to be tested. More details on BD and treatments is available in this British Psychological Society report.
Research into long-term outcomes is biased as it follows people who identify with the BD label or who access mental health services. This excludes people who have a manic episode without further problems, or who manage effectively without services. Following a broader range of people, managing mood fluctuation may reveal more varied outcomes, allowing us to learn what strategies are successful.
So in conclusion, although BD can have a devastating impact on lives, for some people this isn’t the whole picture. Some report highly valued positive aspects of their BD and manage their mood changes effectively, avoiding a path of inevitable decline. I think we need to learn more from these people so that we are able to give people a more balanced perspective at diagnosis. This change in message could be very powerful, offering hope and self-efficacy rather than defeat and hopelessness.
What do you think? Share your comments with us below.
¹ Jamison, K.R., 1996. An Unquiet Mind. Crown Publishing Group/Random House, New York, NY US. Pp. 217–218.
² Equilibrium: The Bipolar Foundation, 2008. International Bipolar Disorder Survey.
The opinions expressed by our bloggers and those providing comments are personal, and may not necessarily reflect the opinions of Lancaster University. Responsibility for the accuracy of any of the information contained within blog posts belongs to the blogger.