Hi, u won't like me. Just the fact you are asking this suggests the following as a possible low budget research project:

There seems to be an inexplicable stage in the recovery process where patients get "stuck." These patients are more or less stable, but not well. They can't get their lives back on track. Typically, they are on disability and not in relationships (or they are alienating their partners) and they've just about given up.

Trust me, I see these people in support groups

Various surveys, including from The Stanley Bipolar Network Foundation and STEP-BD show distressingly low rates of employment and successful relationships in bipolar populations, but they don't tell us why. We are left to assume the illness is to blame.

Sarah Russell, a Melbourne researcher about 5 years ago, surveyed 100 "well" bipolar patients to find out what they were doing right. The results were eye-opening. You can check out the Australian and New Zealand Journal of Psychiatry from 4 or 5 years back for the article.

We could use more surveys in what patients are doing right, but we also need surveys on what patients are doing wrong. This is a huge problem, and I don't think we have any research on this. Doctors like to blame patients for meds non-compliance, but the issue is a lot more complex. I suspect patients are making a lot of bad choices, are rationalizing bad behaviors, are stuck in bad habits, are blaming others, and have personality issues that they are not facing.

If we could get some good data on this, then we could develop thereapies that address these problems.

Hope this helps -

u won't like me when i'm angry

9/ 4/09 8:38pm

Hi John, thanks for your quick reply. I think you have highlighted a significant problem for many people trying to claw their way forward with significant bipolar illness. I can see from reading about other people's experiences of bipolar that there is an intense focus on alternative diagnoses, medication changes, quick fixes and an expectation that others will accommodate the behaviour and that it is up to others to be more understanding, etc. I have seen this in my own personal life where I have often wished to have an alternative explanation for my diagnosis (? self-stigmatisation) and have been fortunate enough to have along term partner that (figuratively-speaking) - beat me about the head until I realised that I had to deal with my bipolar issues and that it wasn't an excuse to behave however I liked - it took a while. Yes- so I have some inside understanding of these issues. I think medication compliance is likely to be a big issue, however it may be that trying too much medication, or changing too readily from one to another also fall within that category. I also wonder whether a big factor could be failure to seek ongoing professional follow-up. Perhaps something like a comparison between "well bipolar" and "not so well bipolar" populations comparing such factors plus others (stable relationships) may be in order?

John McManamy

9/ 9/09 4:36pm

Spot on! Comparing a well group to a chronic not-well group would be eye-opening. My guess is that the well group would be leading more disciplined lives and take more responsibility. It would be very interesting to see each group responded to the same set of questions. My guess is the stigma would not loom large with the well group, while the unwell group would view stigma as a huge problem. It would also be good to look at underlying temperaments and anything else that might affect attitudes and responses to treatment (such as trauma and abuse).

 

We badly need this kind of research, and perhaps this would inspire 10 others to research this field, as well. And the benefits are immediate - we would be able to apply the results to our lives right now - not wait two decades for someone to invent a new medication.