A relative of mine, sadly no longer with us, was the kind of person who always knew best. His cardiac consultant once told him that his heart muscle was as thin as a paper bag. It may seem like an insensitive thing for a medical professional to say, but I think it was an attempt to impress upon my relative the seriousness of this condition. His response was to continue smoking, drinking, and eating whatever he wanted. When questioned he appeared to understand that his heart condition was severe, but his behavior never changed; it was as if this diagnosis didn’t really affect him.
I mention this because I think my relative’s reaction demonstrates a fairly common form of denial termed “under-identification,” something that doesn’t just affect people with physical conditions.
One example is bipolar disorder. Quite naturally this isn’t a diagnosis to relish, although for some patients it may at least provide an answer for the way they have been feeling and behaving. One of the big problems for the newly diagnosed is getting past all the misconceptions about bipolar disorder and mental illness in general, many of which these patients may hold themselves. It’s very common for the newly diagnosed to feel the doctor has got it wrong, and so they externalize their symptoms by pointing to, for example, work stress or poor sleep—in fact, anything but themselves.
To a greater or lesser extent we are all familiar with denial. It is a mental process that shields us from some of the most painful and upsetting emotions that come our way. We may see it when people are informed of an unexpected bereavement, or are told the love of their life is a cheat and a fraud. The denial may be outright: “You’ve made a mistake.” Or, as previously mentioned, it’s under-identified, as in, “Yes, I know he stays over at her house, but nothing is happening.” The point is that emotions like anger, grief, shame, guilt, and sadness are hard to cope with and so faced with one or more of these emotions, the defenses go up.
Stigma around issues of mental illness is commonplace. It’s hardly surprising that so many people fall back on denial as a way of coping. But denying something like bipolar is no better than pretending the roof isn’t leaking. There may be days when things don’t seem so bad but if ignored things will just go from bad to worse.
Denial simply prevents treatment as symptoms worsen. Even reluctant acceptance is better than none at all because without this there can be no relief from symptoms. Having more than one episode does tend to reinforce the fact that things aren’t right and that somehow the symptoms need to be managed.
It’s only human to feel royally fed up when told you’ve got what amounts to a chronic mental illness. Fear and anger are close companions but fear diminishes in the face of knowledge and so, therefore, does much of the associated anger.
Acceptance is important because it lends itself to treatment. Once you’re prepared to make use of treatment you’ll find anger subsides. This isn’t due to medication; it’s due to the fact that you’re beginning to feel better and more confident about the future.
People react to their diagnosis in different ways. Your personal standards, for example, may conflict directly with the experiences you have gone through.
Separating yourself from the illness is an important step towards adjusting to it. You are not bipolar, you are a person in your own right and bipolar disorder is something you have. So yes, your self-image may take quite a hit when you’re first diagnosed, but there are ways to raise self-esteem and over time you should find that it’s possible to fine-tune your strengths and capabilities in order to accommodate the new situation.
It’s important not to go overboard, however. The opposite of denial is over-identification and this is something to be avoided. Over-identifying with your illness basically means everything that happens to you is explained by the illness. For example, you might interpret your anger and irritation at perfectly understandable situations as bipolar symptoms. Equally, you can’t use the disorder as an excuse to say and do as you please.
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Jerry Kennard, Ph.D., is a chartered psychologist and associate fellow of the British Psychological Society. Jerry’s clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.