To effectively manage our moods and find treatments that work, it is vital that we clear away the confusion surrounding common misbeliefs about bipolar disorder.
I understand why people get confused about bipolar disorder. It’s a complicated illness with many symptoms. It helps to know what isn’t true about bipolar so that we can make sound choices and seek appropriate treatment.
Clearing up misconceptions grounds us in reality and allows us to move forward with what does work, so that we can achieve our goals and dreams. Let’s explore my top three misconceptions:
“People with bipolar don’t know they’re unwell.”
Psychiatrists and psychologists use the terms “poor insight” or “lack of insight” when individuals with a diagnosed disorder don’t recognize when their behaviors or thought patterns are different than usual, don’t relate those behaviors to being ill, or don’t understand that treatment can be helpful. Severe lack of insight, or anosognosia—from the Greek, meaning “to not know a disease”—is when changes in the brain cause people to consistently fail to recognize that they are sick.
When people with bipolar experience lack of insight—and only a percentage of us do—it’s typically attached to a specific mood swing that has a beginning and an end. It’s often associated with elevated mood and manic/psychotic episodes. When the episode is over, we are often quite aware that something “off” has happened in our lives.
If most of us genuinely lacked insight, we wouldn’t seek treatment. Yet plenty of us turn to therapists, doctors, herbalists, healers, exercise regimes, diet changes, and more to find balance. If we refuse to admit that our mood shifts and symptoms belong to a bipolar disorder, that’s likely linked to denying or not accepting the diagnosis rather than failing to understand that something’s going on.
We don’t want to be sick, and we often don’t want to change. But that’s because change is hard—not because we consistently lack insight into our situation.
“Euphoric mania is worse than depression.” (Or vice versa.)
Euphoric mania gets a lot of attention, likely because it’s common to make reckless decisions about sexual activity, finances, employment, and more when in its grip. That over-the-top grandiosity—described as wonderful, beautiful, and expansive—can end up ruining our relationships, careers, and future plans.
The flip side of bipolar, depression, can weigh us down for days, if not months. It creates a life without pleasure or hope. It makes us withdrawn, angry, and irritable. Just as with hypo/mania, relationships and job performance suffer or become impossible to maintain.
Both conditions are undeniably serious and have painful consequences. Bipolar depression feels so terrible that everyone longs for a depressive episode to end. We need to approach mania the same way. (Not to mention hypomania, which feels so good but puts us on the path to more destructive moods.)
There’s a third mood state that needs more attention. In my personal experience and through coaching others, I’ve found it’s the “mixed” episodes—depression laced with symptoms of hypomania or mania, or the other way around—that put us in the most danger.
In contrast with euphoric mania—the kind that comes with that top-of-the-world exuberance—dysphoric mania gives us the pessimistic, unhappy, and irritated feelings of depression along with the restlessness and energy of elevated mood. These are my most out-of-control mood episodes.
Often described as a civil war of body and mind, episodes with mixed features are difficult to manage once they’ve started. Since treatment is more challenging, mixed mood episodes need to be recognized, planned for, and ultimately prevented.
“Medication alone is enough to treat bipolar.”
Anyone who deals with a chronic illness like arthritis or diabetes knows that medications are a key part of a management plan, but not the whole answer. Why take a medication designed to control mood shifts, but continue the behaviors that keep us sick?
Learning better lifestyle management can help us to avoid triggering mood swings or allow us to moderate them before they take over. Is this easy? Of course not! Making lifestyle changes is hard. Really hard. But we can make different choices and lessen the hold bipolar has on our lives. Then we can use medications to take up the slack for what we can’t control on our own, ideally reducing the number or dosage of meds we need. I find this a positive, possible, and uplifting proposition.
Printed as “Fast Talk: Three big bipolar misconceptions,” Winter 2020
Julie A. Fast is the author of Loving Someone with Bipolar Disorder, Take Charge of Bipolar Disorder, Get It Done When You’re Depressed, and The Health Cards Treatment System for Bipolar Disorder. She is a columnist and blogger for bp Magazine, and she won the Mental Health America journalism award for the best mental health column in the US. Julie was also the recipient of the Eli Lilly Reintegration Achievement Award for her work in bipolar disorder advocacy. Julie is a bipolar disorder expert for ShareCare, a site created by Dr. Oz and Oprah. Julie is CEU certified and regularly trains health care professionals, including psychiatric residents, social workers, therapists, and general practitioners, on bipolar disorder management skills. She was the original consultant for Claire Danes for the show Homeland and is on the mental health expert registry for People magazine. She works as a coach for parents and partners of people with bipolar disorder. Julie is currently writing a book for children called "Hortensia and the Magical Brain: Poems for Kids with Bipolar, Anxiety, Psychosis, and Depression." You can find more about her work at JulieFast.com and BipolarHappens.com.
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