Seven Key Misconceptions Clinicians and Researchers Make About Bipolar
We have no shortage of expert opinion written about us, often by people with no lived experience of bipolar. Make no mistake - I am very grateful to those who have devoted their lives to improving mine. But we don't always share the same assumptions, and this can lead to a number of critical misconceptions, namely:
We want to be normal.
Wrong. We want to be ourselves. “Normal” is a mean, an average. In a social sense, normal implies an unquestioning conformity to a “norm.” For many of us, “normal” would involve a complete personality shift. A number of years ago, I told a roomful of clinicians that we don’t want to be like them. The looks on their faces.
We want to be stable.
Wrong. “Stable” is the no-life state of limbo we find ourselves in when we emerge from crisis. This is a far cry from being able to function. A return to wellness may involve various trade-offs between stability and function, but as a general rule functionality should not be sacrificed in the name of stability.
Bottom line: we don’t want to be fat stupid zombie eunuchs. A lot of doctors have trouble getting with the program.
We are addicted to our highs.
Wrong. Our highs are often extremely frightening, the equivalent of driving down a mountain with no brakes. Yes, we enjoy our periods of feeling alive and productive. Who doesn’t? But you don’t find us longing to be out of control of our brains. No way.
A 2003 study by Pope and Scott found that clinicians identified “missing highs” and “feeling well” as the main reasons patients quit their lithium. Patients cited other reasons.
We lack insight into our illness.
Wrong. In fact, it tends to be the other way around. Unless we happen to turn up in an emergency room floridly manic, doctors demonstrate amazing incompetency at diagnosing us. For those with bipolar II, it tends to take doctors about ten years to make the right diagnostic call.
Gritting our teeth through the psychic pain - not yet realizing that our brains have been mugged - is hardly the same as lacking insight. Neither is objecting to our doctors’ unfortunate tendency to over-medicate us.
Treating bipolar is all about treating depression and mania.
Wrong. It may be more important to address the things in our lives that set us up for depression and mania: Stress, trauma, sleep problems, challenging living conditions, personal issues. If only it were just depression and mania we were dealing with. The good news is depression and mania can be a lot easier to manage once we are able to resolve (even partially) some of these issues.
Medications are the cornerstone of bipolar treatment.
Wrong. Over the long term, meds are but one of our many tools in managing bipolar. The short term, during crisis, is a different story. But as we move out of crisis and as we learn more about the things we need to be doing to get well and stay well (such as proper sleep and exercise), meds move off center stage.
Those with bipolar are different.
Right - but for all the wrong reasons. In theory, illness and personality are distinct. But in reality, a bipolar condition is going to affect personality. So, we are going to be different - both for better and worse, even when we return to “normal.”
But “different” is hardly a psychiatric condition. The psychiatric profession and the world in general have a very hard time understanding this. Trust me, being different is okay. In fact, I would call it normal.