I have to say respectfully that I disagree about people with Bipolar "always knowing when they are off balance "and being able to take responsibility. IF this were the case, they would not have this illness ! we would not have half the difficulties we have as partners of those with Bipolar or as Bipolar sufferes if tis were the case. His is an ideal situation but not apply to many people. Loss of control and impulsive behaviour, inappropriate thinking and behaviour are all symptoms of a condition which is undertreated or unsuccessfully stabilized, and is particularly difficult to even achieve with some forms of Rapid Cycling, or even with people who have infrequent episodes interspersed with long periods of wellness who are the most responsible and disciplined self managers and have made many sacrifices and life style changes, however, they can still be caught out by episodes coming on suddenly completely out of their control. This may be some poeple's experience of how they feel when unwell or how thier loved on acts and feels withgood levels of self awareness and knowledge of the illness or waht steps to take igf they are lucky enough to spot and accept early warning signs, but is an assumption that people with this illness can all do this, which is not confirmed by research, experience and is more of an expectation hat people will behave in gthis way. It is a steep expectation we can hope for but have no right to demand. Thats like syainmg someon e should have control over their relapses and remissions of Multiple sclerosis, or epilepsy, or a brain tumour, all of which can and do in some case alter mood and behaviour and perception with neuronal brain changes. 50% of people with Bipolar apprently do not recognise hypomania or mania coming on or realise when they are acting out of character or have any mental abilioty to se it this way or control it. It is down to brain malfunction at a neurobiological biochemical level. This is not a behavooural or personaility disorder which can treated usong these models of care . They can only "enhance" self management and assist someon to deveolp knowledge and accepotance and coping skills, but effective treatment still hinges on restoring the brain functionality, biochemically as this is fundamentally a Medica condition which only presents with psychological / psychistric symptoms becuse it affects the physical, bodilt organ responsible for those processes. It Bipolar were affecting the stomach . the symptoms would be gastric or dietary difficulties. The brain is responsible for the functional areas of thinking, learning ( cognitive processes),behaviours, emotions, feelings, speech and activity. This has nothing to even do with awareness or knowledge of the illness though this can help some . Loss of mental insight comes on for some people very early on as hypomania is emerging and sometimes nothing anyone can say or dohowever well trained or experineced can shift the thinking or perception or someone in this mood emergent state. The brain is in control, not the person's normal well character. And if the brain is not firing on all cylinders or messages are being misdirected this will be reflected in thinking, behviour and perception, and decisions and judgement.If individuals do retain insight they have an opportunity to seek help and take responsibility moreso that those who loss their insight and rational thinking processes. This is often not within their control in many cases and is not a choice ! THis is the illness in action. THis is the nature of this mental / medical illness and the loss of awareness and inability to reason or perceive things as the onlooker sees the behaviour is due to the biologocal changes taking place in someones brain chemisry at this point. If someone truly believes themselves to be well , against all evidence to the contrary , however convincing the argument, or exoert the person presenting it, this is a perceptual deficit, and they can not be expected to take responsibilty for an illness they simply are unable to see. Would you treat for b;leeing if you could not see any blood, and felt absolutely fine, and thought you were well and beleived you were behaving appropriately and that everyone else was the problem and the enemy ? It is not about "not wanting" to see it or being in denial as in addic tive illness, it is about the brain not allowing you to see things as they realy are. For example , my partner can see this only too cleary when he comes out of the manic / hypomanic episode, and starts to take full responsibility again, however, he is also dependant on his psychiatrist establishing the correct combination of effective medication, which he seems unable to achieve. My partner has made numerous lifestyle changes to self manage during the depressive or euthymic phases when his insight and awareness returns and he can think rationally. He does not choose to lose his insight or do anything to cause it to go again ! However ,at the point when hypomania or mania start to creep back in again he is totaly unable to see this, and can not be persuaded otherwise. Ifcat to attept to do say will make him go higher and aggravate matters. It is impossible to get it right or raise his awareness. All awareness, knowledge, previous insight gained disappear and he reverts to manic thinking an reverts to past manic thremes than only emerge during thjis phase. Hios rationailty goed completely out of the window again once high and this is not deliberate or withinh his control .He starts to question all his previous acceptance and acknowledgements and his diagnosis. This is however normal to think like this for many people during highs periods , and frankly if they had insight and awareness, and control, and were able to retain it,they would not have this diagnosis of Bipolar Disorder. That's what it is all about, and it is a disorder of brain function and biochemistry, a medical illness in fact in that sense affecting a bodily organ of thought. If they did not have the illness, most would not be behaving in the destructive or upsetting ways they do. It has little to do with noraml personality traits. It does alter personality (character ) drammatically . Medication and self management does in some but not all cases successfully restore normal bfrain function and brain chemistry thereby restoring character and behaviours within the persons normal personailty ranges. It is such a misunderstood illness and difficult to grasp, particulary if non medically orientated. We expect a tremendous amount from people with Bipolar diosorder which we would not expect of those with other chronic illnesses simply because we can not see the physical / medical abnormailty of the organ it affects. Would we expect a Diabetic to have control over thier bodies insulin swings, before diagnosis or even when taking the prescribed treatments. No! The difference is that Diabetics do not lose insight ,therefore , have the ability to choose to follow treatment and oif taken approparitely it is still not without problems. They will still have some high and low blood sugars. How can someone take full responsibilty for an illness which they can not even see, as part of the illness biology os to convince people they feel well whe manic / hypomnic simply because that is the effect on the brian of excessive dopamine, to increase energy levels, feelings of wellbeing. confidence, decreased need for sleep, which will inturn lead to high levels of irritability, yet the person remains driven on furthur by the continued release of dopamine despite lack of sleep, and theexcessively hig amounts lead to loss of judgement ,grandiosity, impulsiveness, hypersexuality, loss of reasoning, euphoria or dysphoria with aggression. They are not responsible for having dopamine malfunction. That is why stabiising medications are mainly Dopamine antagonists. and work on aother brain chemistry such as norepinepherine and serotonin in one form or another. Poeple believe they are better than ever maybe when high, have unrealistic perceptions of their activities and can see no harm in them as judgement and inhibition is lost alongside loss of insight Just as it would be if someone who had taken sufficient mood altering drugs/ alcohol as they can knock out the inhibition centres of the brain and significantly alter behaviour out of the person's control or awareness , with or without an addiction problem ) periodically removes their reason and ability to see things rationally through no fault of their own ? With Bipolar thr biochemical [proceeses taking place in the brain whe manic are just like having Cocain ein the system, except without having taken any. Bipolar Disorder is apparently caused by the brians inability to regulate ( turn on and off ) Dopamine release and function, and how it interacts with Serotonin. It has nothing to do with taking responsibilty. It totally alters the way a person thinks , sees thimgs and feels and is not within their control unless they are on the correct medication ( For which the psychiatrists are responsible, not the client, and is sometimes very hard to achieve for complex reasons ). If someone can not see they have a illness of course there will be compliance or resistance problems but this is part of the ilness itself, and a common pattern of all chronic illnesses, though far more likely where insight is lost. Even when people are taking full responsibilty, taking al the medicatio they are told to take, and appropriately at correct times and disages, and following self help aproaches, and engaging in therapy, this illness can still rear its ugly head at any time, and all their reason and knowledge can be lost at the drop of a hat, and is in no way deliberate or due to anything the person has done wrong or not done, if they have the type of Bipolar which leads to loss of mental insight. Not all people have such a dimished level of loss of insight but more do than than don't according to all research, especially if they have been undiagnosed or undertreated for years and have just been considered a difficult personality and family and friends have accepted or tolertaed it due to the persons resistance or lack of acknowledgement of there being anything wrong, and have been unable to get the person to agree to seek treatment. WE need to stop blaming people with this illness and expecting so much responsibilty for them all the time when it is not always acheivable. It is too simplistic an approach and just mirrors our own frustration about the loved on not being able to get well, stay well, or accept sommetimg is wrong which they can not see. I feel the GPs and psychiatric teams need to take a more responsible and proactive approach and become far more expert in diagnosis, early detection , be prepared to listen to carers / partners, and stop ignoring observations of loved ones who often know exactly when their partner is unwell even if the partner disagrees. The outlook is far better the earlier someone starts to receive treatment and the better chance they have of gaining some insight and developing knowledge and coping skills that might stick before decades of maladaptive coping skills become part of someone makeup and belief system. There is always hope but I feel we must stop making people feel responsible when they become unwell if it is not through their own fault or awareness and for attempting to self medicate unsuccessfully managed or inadequately traeted distresing symptoms of the illness with either drink or alcohol. Of course these will aggravate the symptoms but in some cases people have beleived or found them to temporarily help, ot it my have been that they have inly gravated to using thing sin excess or in an out of character way bcause they are actually already in an episode. This is commih with hypomania and mania. The mania or hypomnia usually precedes the increased use of drugs or due to loss of judgement and an increased desire to take risks or excesses. It is not the other around way around and this has been shown in research. However, in turn these substances will over time make the lows and highs worse ofcourse, but for some at the time they feel it will keep them up there, or calm anxious feelings depending on what they are feeling at the time. Lets face it most average poeple do this everytime they reach for a drink. We are all attempting even if not consciously to change the way we feel even just for an evening. What if once you had done that, you could not turn it off even if you had stopped rinking the next daty, the uephoria or dysphora triggered the night before would not stop, even in the absece of alcohol or a stimulating environment ? We rarely drink just for the taste even if we fool ourselves. Alcohol is just unfortunately a legal poison part of our society with a lot to answer for. The fact that we all know the effects alcohol will have yet it is so easy to forget that once it too causes t he same loss of judgement and inhibition and loss of control over behaviour once taken beyond that 1 glass too many , a line which is so easy to cross,and we can do this without Bipolar. So imagine having an illness that causes that loss of judgement and inhibition and poor choice and decision making even without taking anything ! I think we who are not Bipolar need to question our own levels of taking responsibility for behavior as we have far fewer excuses and it si so much easier for us to do this consciously as our awareness is not impaired or temporarily gone for weeks or months, yet we still make mistakes .We do it with full rationality and reason , so can hardly expect so much from those who do not even have that at their disposal in episodes of illness! Most of the people I know with Bipolar Disorder once diagnosed and adequately treated try extremely hard indeed to stay well yet still suffer periods of illness , huge personal losses and stigmatization and lack of understanding about how this illness works.Without medical knowledge or willingness to research thoroughly, and I don't mean personal bloggs or opinions, but backed up by sound research too, it can be adifficult illness to graps or fully accept how it works and affects the individual and all those close to them. Even with that 27 years of medical knowledge, 20 years experience, of living alongside 3 people with with Bipolar Disorder , lots of past and current research and full understanding so far based on current approaches ( Which I accept could be all disproved tommorrow ) It is still very hard to live with and accept and tolerate this illness or any chronic illness which grossly alters someone we love out of character.We cab still only change ourselves and support and ebcourage someone elses change or browth or acceotance. We can not do it for them or make them do that. They still have to reach that point themselves somehow , and that may sometimes only come after a crisis or two sadly. ( So much for crisis intervention in the community ) I feel sure that comes with correct diagnosis initially, above all correct medication at the effective dosage levels, enhanced by good quality infornation rarely given by GPS or mental health teams, about the illness, and self management information being provided by properly trained therapists, and a willingness on behalf of the individual with Bipolar Disorder to consider there may be a probelm worth treating. Hopefully they will have full support from the family, rather than equal denial or resistance from them too which is quite common and does not help. It just reinforces the person's own lack of acceptance of themselves or denial of the illness. I know as we are all human and can at times just react to whatever we are on the receiving end of, however , with hindsight, I often find myself saying why did I take that personally , or waste energy reacting when it was just the illness.What could I have done better to support my husband at that time or what could I have let go, or even when should I have moved on or was it right to stay. It is antural to ask all these questions. There is always Hope and we are all in this together.