By Pulkit Sharma October 2013 Bipolar Disorder is a psychological condition where the person shuttles back and forth between two extreme poles of ‘mania’ and ‘depression’. Pulkit Sharma demystifies the condition, and shows us how to handle it While happiness and sadness add spice to life, for some people these feelings turn into prisons from which they cannot escape despite brave attempts. Bipolar Disorder is a psychological condition where the person shuttles back and forth between two extreme poles of ‘mania’ and ‘depression’. It leads to confusing symptoms. In the manic state, the person is extremely cheerful without any reason, confident, irritable at times and feels on top of the world. They feel that they can accomplish big, are entitled to special treatment by everyone, talk a lot and are highly distractible. The need for sleep decreases and there is an excessive investment in pleasurable activities. Individuals in the manic phase make big plans and take quick decisions but all of it is poorly thought out, due to the disorder. As a result, they encounter huge setbacks and failures. In the depressed state, they are quite the opposite. The person feels extremely sad without any reason most of the time. Even when there are occasions that should otherwise bring joy, the individual does not react and continues to experience despair. Depressed people tend to view themselves negatively, focussing on and exaggerating their shortcomings. They think that they are no good and that nothing good can ever happen. Everything including the self, the world and the future is seen negatively. The individual withdraws from the outside world and does not take interest in anything. He or she feels tired and drained out. The re may be a feeling that life is not worth living and as a result, the person may also contemplate suicide. The high and the low An individual suffering from bipolar disorder alternates between manic and depressive episodes. These episodes vary in duration but are often cyclical. As a result, they disrupt the person’s normal course of life and relationships. The individual suffering from bipolar disorder starts behaving in an unpredictable manner and is unable to commit. It leads to chronic symptoms and serious trouble in studies, work, relationships and other spheres of life. While many rush to conclude that the condition is hopeless and untreatable, there are rays of hope waiting to be found. Writing a diary, charting their mood swings are ways of building insight into their world Under all circumstances, we must never forget a simple truth that any disorder whether psychiatric, cultural, physical or biological in its origin does respond to human will and efforts. The same is true for bipolar disorder. The conventional treatment of bipolar disorder includes psychiatric medication and psychotherapy. However, one can see huge advances in treatment of bipolar disorder by the combined efforts of the patient, the treating team and the family. Becoming aware of oneself Observing and becoming aware of oneself can be an important step in developing some self-control in the otherwise chaotic bipolar disorder. Self-awareness and self-control are two strong pillars that promote healing. Pranav, a 34-year-old male, came for counselling with a history of two manic and three depressive episodes spanning over four years. He had benefitted from mood stabilisers, the conventional psychiatric treatment of bipolar disorder in controlling his emotional states, but he struggled to lead a functional life. Together we found out that Pranav had a very low tolerance for pain and often rushed to deny negative thoughts, feelings and occurrences. In his efforts to run away from pain, he often became extremely hyperactive, indulged in pleasurable activities, gave up treatment and made big plans, which played a role in precipitating a manic episode. After going through a manic episode, he felt ashamed and guilty, and these feelings played a role in precipitating depressive episodes. After a long inward journey, Pranav realised that negative feelings are a part of life. In order to liberate oneself, negative feelings need to be confronted and dealt with rather than denied. Once his tolerance for pain increased, he accepted the symptoms of bipolar disorder and came up with constructive efforts to deal with it. It improved his treatment compliance, enhanced overall quality of life and reduced the occurrence of both manic and depressive episodes. Individuals having bipolar disorder often take up extreme measures to run away from pain including self-harm and use of drugs. Writing a daily diary, charting their mood on a scale of 1 to 10 are the starting points of building insight into their inner world. People suffering from the disorder have an extremely grand image of themselves during manic or hypomanic episodes. However, deep down they have a very low self-esteem and struggle to come to terms with it. They feel that they are ill, weak, undesirable, bad and crazy and that no one genuinely loves them. It is extremely important to help them build a healthy self-esteem by identifying and appreciating their strengths. People living close to a bipolar person develop bitterness due to their symptoms and as a result are unable to appreciate the positives that the person has. Although we may find someone is functioning grossly subnormally as per our standards, they are often making huge efforts internally. Ignoring someone’s efforts makes them feel either sad (there is no point in trying, nobody values me, it is better to give up) or enraged (let everyone go to hell, I will be as bad as possible). We must hold on to the fact about human nature that everyone tries to do the best they can. Anjali, a 27-year-old female having bipolar disorder, had attempted suicide twice because she felt that she was a complete failure at work and her career would never pick up. The view was shared by her family as well. Even when there are occasions that should otherwise bring joy, the individual does not react and continues to experience despair. However, a change in the family’s perspective brought a huge change in her. Once her family acknowledged her continued will to deal with the bipolar symptoms despite multiple failures, Anjali started valuing herself. It made her rebuild a successful career, albeit on a smaller scale. Connecting to oneself People with bipolar disorder often see the condition as an overpowering disability. They wish for the condition to vanish completely from their lives. This wish brings intense pain and hopelessness, because rather than concentrating on their lives, they end up concentrating on the illness and giving it unnecessary importance. They keep on waiting for that ideal mental state to arrive. Nickolas, a middle-aged man suffering from bipolar disorder, harboured the desire for nearly 22 years. I told him that bipolar disorder was a symbol of negativity in his life and what he has asking for was a perfect state. He was giving too much importance to the condition, telling himself that nothing would go right unless he was completely cured. I told him that sometimes being with imperfection is the way to perfection. One day he let go of the wish. He came back and told me that life had a new meaning or him. He shared, “Throughout my life I felt that there was something toxic inside my head and I desperately wanted to throw it out. As I struggled to do it, I felt even more toxic. Now, I tell myself I am not bipolar disorder, I have bipolar disorder. I realised there is a lot more to me than having bipolar disorder. I am also a sensitive person with creative abilities and I choose the latter as my identity.” The moment of developing genuine self-love is an important milestone in recovery from bipolar disorder. It is crucial that they do not reduce their identity to just being a patient of bipolar disorder. They need to and should be motivated to connect to healthy and growth-oriented parts of their self. Communicate positively Understanding the role of communication skills in close relationships is an area all of us choose to ignore. Most of us treat close relationships as cathartic bins where we wish to dump all our feelings and impulses without understanding its impact on others. People living close to individuals having bipolar disorder have their own emotional turmoil to cope with, but they should try to develop empathy for bipolar patients. Negative feedback needs to be communicated skilfully without destroying the already fragile self-image of the bipolar patient. Do not make global statements like ‘you are a failure.’ Instead, target specific negative behaviours along with boosting their morale such as – “Although you are making huge efforts to go back to work, I often find that you get up very late. It can spoil your plan and I wish to help you out in preventing it.” People suffering from bipolar disorder have a short attention span; therefore, one must use short and clear sentences to communicate with them rather than giving long discourses. Do not discuss their behaviour in front of a group of people, because it makes them feel humiliated and enraged. Talk to them when there is ample time and private space. We have been taught to strike when the iron is hot, but people suffering from bipolar disorder cannot take in any feedback or guidance when they are emotionally hyper. Allow them to settle down first and when their emotional arousal decreases, you may put forth your points. In a nutshell, a sensitive, caring, and loving approach has the potential of working wonders in the seemingly hopeless condition. We always look out for advanced techniques and ignore the basics. It is time that we get down to the basi
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