In his excellent book ‘Strictly Bipolar’ the psychoanalyst Darian Leader describes the dramatic rise in diagnosis of bipolar disorder in current times. Almost 25% of Americans are now diagnosed with some form of bipolarity, an increase of some 4000% since the mid-90’s. Leader writes, ‘The question today is not ‘Are you bipolar? But ‘How bipolar are you?’
The burgeoning of bipolar categories into Biploar 1, 2 and 3 and the proliferation of websites and articles online with a kind of checklist of ‘symptoms‘ has encouraged people to self-diagnose. For a person suffering mental ill health there is an understandable longing to find out what is causing their distress. Clients can come into therapy with questions around diagnosis, ‘Am I bipolar?’ Whilst anyone can become low in spirits at times and then elated at others, the extreme experience of true manic- depression is underpinned by a particular mental structure. A good psychotherapist can help clients explore the experience of their illness, better understand themselves and find ways to manage what can feel at times truly terrifying. If the therapist believes their client is truly bipolar they may refer on to a psychiatrist, for only a psychiatrist can give a definitive diagnosis and prescribe the drugs that may help control distressing thoughts and behaviour.
In a manic state the individual often describes feeling truly ‘alive’, intimately connected with other people and the world. Stephen Fry writes, ‘We are kings of the world, nothing is beyond us, society is too slow for our racing minds, everything is connected in a web of glorious colour, creativity and meaning.’
This elated state is intoxicating, yet on the downward spiral these states bring dreadful lows and nightmarish agitation that make sleep and rest elusive. The paradox of bi-polarity is that despite the suffering it may bring, the giving up of the manic states of creative elation may feel too much of a devastating loss. Compliance with medication is frequently poor for these reasons.
The experience of the manic highs and desperate lows of bipolar disorder are truly terrifying for the sufferer. It is a serious thing and with it comes a devastating sense of loss of the ‘self’. Often recovery requires the combination of medication and psychotherapy to help the person integrate the bipolarity so that is part of the ‘self’ without defining or overruling it in ways that are harmful. Whilst a person may fully recover from a depressive episode, bipolar disorder is a lifelong condition. With any devastating diagnosis comes loss, and loss requires mourning so that the individual can move on and have the best and most fulfilling life possible.
Whilst the most obvious aspects of bipolar disorder might be the contrast and disconnection between high and low moods, a psychotherapist will explore with a client the quality of these states of being and the thought processes that underpin them. We are all after all individuals, our stories unique.