Paranoia, Helping Your Loved One, A Word to the Young: Three Questions, Three Answers

Patient Expert

Several days ago, I presented a webinar, The Five Faces of Normal, hosted by the International Bipolar Foundation. My talk ran 35 minutes, question time a lot longer. My audience came up with extremely intelligent (and often challenging) questions. Here are the first three, together with my replies …

How do you feel about the word, “paranoia”? Is paranoia a “state” or a “trait”.

This is why I love audience questions. This one took me totally by surprise. But after a lot of um’s and ah’s, I was able to fashion a reasonably credible answer that went something like this:

In my talk, I referred to mood states as opposed to personality traits. The two are separate, but influence the other. Paranoia is associated with psychosis, which in a bipolar context tends to hitch a ride on depression and mania. The implication is that when the state passes, the paranoia goes away.

But if paranoia is bundled in our personality traits, then the world is going to be a frightening place just about all the time. Walking out the door for a coffee and donut in the daytime is going to be as terrifying as stepping into a dark alley in a bad neighborhood at night.

If the world looks scary to you while you’re feeling “normal,” it’s a good idea to explore the issue yourself, and to see a talking therapist to work through your issues on this. It’s confusing. But if it’s confusing, it’s good. It means we’re asking questions.

As a care-giver, how can I help my partner to know himself, to find his normality?

My talk focused on finding our own true “normal,” which may be different from our clinicians’ and loved ones’ views of “normal.” This involves a rigorous process of self-examination, in a quest to “know thyself.”

Of course, our partners can be our greatest allies in this quest, and I made sure to bring this up in my answer, which went something like this:

Your partner has to feel safe around you, and I’m assuming this is already the case. We can be very problematic to get along with, but if you make it a safe environment for your partner to talk about his or her issues with you, this will help enormously. This is the start.

If you can share one message with a young person just diagnosed with bipolar disorder, what would that be?

This is an issue dear to my heart. My answer went something like this:

It’s not the end of the world. There is hope. Embrace the diagnosis.

Bipolar tends to break out in our late teens-early twenties, when we are still finding our identity and working very hard to fit in. In college, fitting in often involves staying up to all kinds of crazy hours instead of going home early and taking care of yourself.

Staying up late, of course, is the road to mania and subsequent depressions. So - ironically - by fitting in - we’re not fitting in. Next thing, our parents are driving us home in mid-semester.

I really am convinced people with bipolar have gifts. We’re the people north of “normal,” but we need to acknowledge that mania and depression are our kryptonite. So if we can handle to kryptonite and get to our north of normal state, we can be super people.

But we have to embrace the diagnosis and manage the illness, and this can be very hard for a young person to do. So keep driving home the message.

That’s all for now …

More questions (and answers) in future posts.

Click the link to view my webinar, which includes question time: The Five Faces of Normal.