Bipolar Disorder: Dispelling the Fears
During a recent conversation with colleagues we were struck by the way in which we have begun to think about those clients who are very sensitive to their environments as having a place on the continuum of bipolar disorder. Bipolar Disorder has an underlying chemical and behavioral footprint that helps us make better sense of what we observe clinically and offers more depth and flexibility in terms of treatment.
We realize that in more and more of our practice we notice cyclothymia or cycling moods in our clients. As we check in with colleagues we see that more as a form of bipolar disorder. We know that it has such an unsettling connotation in the perception of the public that we thought it would be useful to write this article about our clinical observations and try to dispel some of the fears that people may hold if they or a family member is given this diagnosis.
It is probably fair to say that there is no adult person who has not experienced at least mild depression from time to time. We think of such mild mood disturbances as being on the same continuum as more severe disorders. This is similar to the way we might think of diabetes or hypoglycemia. Mood disturbances can also be thought of as ‘understandable’ responses to unavoidable experiences that elicit disturbing thoughts and feelings. Business issues, run of the mill frustration when dealing with energetic and curious children, housework, as well as significant traumatic personal, relationship, or economic events are all possible sources for an episode of distress. Most importantly, we believe that humans are always trying to find good ways to cope with their lives and may not know when their way isn’t working. It is when an episode goes beyond certain limits of time and intensity that help may be needed. Polyanna would even go so far as to say that the disturbance may be a useful red flag for something that has gone unresolved and needs to be addressed.
In some cases, work with a new treatment modality called EMDR can ease symptoms, and in some cases medication is needed, and in other cases both of these and other modalities can only maintain some containment of the symptoms. Our understanding of the continuum of Bipolar Disorder is still emerging and at this time we don’t understand why these differences exist. But we want to encourage people to learn how to acknowledge and manage the reality of their own situation in the most helpful way.
The following example is based on a number of cases, but serves as a good illustration of what we see in our practices:
Jodie is a 35 year old married mother of two young children. She and her husband enjoy much of their lives together and with their children but, on a fairly regular basis, Jodie felt, and acted, out of control. After these episodes, her belief and fear was that she was going crazy because her reactivity made no sense in the situation. Her mother observed her unhappiness and occasional difficulties with the children and her husband and strongly urged her to get help.
As we explored her life to this point we discovered that other family members had similar symptoms of dramatic mood changes which helped her feel less alone. The history of her growing up years was very significant, as well, in helping her understand the negative feelings about herself that still impact her in the present.
Jodie’s parents divorced when she was 6 and, in most ways, each was emotionally unavailable to her during those distressing years before and after. Her parents were trying to do what was best for Jodie but they were both so consumed by their own physical and emotional upheaval that they were unable to help Jodie through this traumatic time. As a result, Jodie interpreted these events as not only meaning she was unworthy of attention but that she was also responsible for anticipating and managing the emotional needs of the people close to her. Without parental oversight any child would develop this belief or one very like it. She was overwhelmed with those experiences but was unable to show her distress or process it, and so was left with a hyper-sensitivity to the moods of others and a hyper-reactivity to the fear that things were going to fall apart, like they did when she was 6 years old.
Understanding and empathizing with the legacy of these experiences has helped Jodie be less critical of herself and feel less crazy. She can see that her own 6 year old son or daughter would be devastated by such an event and require an enormous amount of attention and emotional support.
Jodie’s symptoms are somewhere in the mid range on our continuum and are only to illustrate the sense of mystery that some people feel around their symptoms. For instance, situations that are not ordinarily bothersome might, at other times, elicit extreme reactions that don’t ‘make sense.’
After an integrated course of EMDR, Emotional Focused Therapy, and cognitive therapy, Jodie understood the connection between her past experiences and her present reactivity. She began to feel less reactive and ‘crazy’, and was no longer frightened by the episodes with her children. She learned clear communication skills, to self-soothe, and behavioral strategies which helped her to be more in control of her impact on others.
The therapy, therefore, was helpful in many ways but Jodie and the therapist believed that her reactivity to stress was still more uncomfortable than was necessary. It was evident that she was improving but that she might benefit from medication that could help increase her chemical resilience in the face of this stress and further enhance her capacity to manage her reactivity.
Jodie agreed to an evaluation for medication and it was decided that her situation warranted a trial course of a mood stabilizing medication.
Upon reflection, Jodie was surprised to realize how much her experiences of childhood had frightened her and caused her reactivity in her present relationships. She was so relieved now that those memories were both understandable, had so little power, and thus were no longer impacting her daily life in the way that they were.
We hope this vignette illustrates how the therapeutic process can tease out those aspects of a mood discrepancy that can be helped by a number of therapy modalities from those that, in addition, will require medication to address chemical imbalances.
If you or someone you care about struggles with moods, feelings or episodes that just don’t feel right, please seek help.