Living with bipolar - common misconceptions

The 30th of March is bipolar day. People who live with bipolar may struggle with severe episodes of mood swings, often with extreme lows (depression) and extreme highs (mania). Behaviour and thinking at the extremes can be disrupted and erratic, such as leaving jobs or relationships. This often creates further stress which can then lead to another episode. People can also experience significant shame and guilt for their behaviour during episodes. Clients often attend therapy with a number of misconceptions about their presentation, such as:

• Mania is exclusively positive

Mania describes the extreme of high mood in bipolar disorder. Clients often report increased energy, lots of ideas, and positive self-esteem during this phase. It is generally described as a positive experience, and relapse into a manic episode can sometimes happen because people do not want to end this state, as it can feel refreshing particularly after a period of depression. The experience of mania is often linked to increased creativity, leading some to use the metaphor of a “dangerous gift” (Stott et al., 2010). However, at both ends of the spectrum people can experience psychotic symptoms, such as delusions or voice hearing. During mania people can also experience high anxiety and paranoia, feeling that others around them cannot keep up with their ideas and therefore may turn against them. Clients can also report suicidal ideation during both mania and depression and can require hospitalisation in both.

Similarly, while depression is generally characterised by low motivation, low energy and negative views of oneself such as feeling worthless, some people are still able to continue to go to work or complete their classes despite this. Clients might be masking symptoms of either depression or mania.

• I won’t get better

Clients sometimes worry that they will not get better and will continue to experience relapses. Some do attend therapy having had multiple episodes and hospital stays. However, clients also often experience long periods of wellness in between episodes during which they are able to return to work or education. In recent years, celebrities (e.g., Stephen Fry in his 2006 documentary The Secret Life of the Manic Depressive) have shared their experience of bipolar, showing that a “normal” life is possible with this diagnosis. While research often indicates that relapse rates are high, each relapse may differ. After therapy, clients may still experience episodes of mania or depression (and thereby relapse), however, they might be milder, shorter in duration and can be managed without hospitalisation. During therapy, I often use the analogy of learning to live with bipolar as being much like someone learning to live with diabetes - through monitoring signs and acting as and when necessary.

• Therapy cannot help me

The National Institute for Health and Care Excellence (NICE) guidelines recommend therapy for the management of bipolar (NICE, 2014). Therapy is tailored to a bespoke treatment plan for each individual client, but in general will cover:

• Learning how to monitor mood and identify early warning signs of mania and depression
• Skills to manage these early warning signs and return to wellness
• How to communicate effectively with loved ones about bipolar, as social networks can be hard to navigate during and after episodes

If you are concerned about yourself or someone you know, you can access Bipolar UK (https://www.bipolaruk.org/) for information and resources such as peer support. You can also discuss your concerns with your GP or psychiatrist, who can facilitate an onwards referral for therapy. While symptoms will differ from person to person, some common symptoms include:

For mania:

• A reduced need for sleep & feeling high in energy despite little sleep
• Having lots of ideas and feeling pressure to speak about them, so that others often struggle to keep up or follow conversations
• Acting in a way that is out of character, for example using substances

For depression:

• Not enjoying the things you used to enjoy
• Severe low mood that lasts for days, despite engaging in hobbies or socialising
• Views about the self suddenly become really negative such as feeling worthless or like a failure, and experiencing urges to self-harm

If you are interested in therapy for bipolar contact HelloSelf today to be matched with one of our experts.

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References

BBC Four. (2006). Stephen Fry: The Secret Life of the Manic Depressive.

National Institute for Health and Care Excellence (NICE). (2014). Bipolar Disorder: Assessment and Management. https://www.nice.org.uk/guidance/cg185

Stott, R., Mansell, W., Salkovskis, P., Lavender, A., & Cartwright-Hatton, S. (2010). Oxford Guide to Metaphors in CBT: Building Cognitive Bridges. Oxford University Press.

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