Friday Counseling Issues: Psycholabels–Bipolar

Have you ever been in a bad mood?  A good mood?  Elated?  Discouraged?  Better watch out, someone’s going to paste a “Bipolar” label on you! And if you should have the temerity to experience all those moods in one day,  you’re really  in danger of being name-called.

I find the use of “Bipolar” to be particularly offensive, because Bipolar Disorder is not something anyone would want to have.  It’s difficult to experience, difficult for family members.  Difficult to medicate correctly, because everyone’s chemistry is different from everyne else’s, and there is no “one-size-fits-all” medicine for Bipolar Disorder.

Being Bipolar is also terribly stigmatized, especially in some Christian circles, as nothing more than demon possession.  To accuse anyone of demon possession is pretty serious to begin with, and should never be taken lightly. To throw that accusation at someone who happens to be in a very bad mood or a very good mood is just silly.

Some people are, by nature, very calm.  They don’t show much outward expression of their inner emotions, and that’s fine.  I’m happy for them. It’s who they are.  Not all of us are like that, though, and some people are very expressive.  If they are sad, you know it.  If they’re angry, hurt, discouraged, or very happy, you know that too. These are all normal human emotions, and they don’t indicate any psychological disorders.

Before you’re tempted to call someone Bipolar, I hope you’ll do some research to find out exactly what that disorder involves. You can start here, and I really hope you will.  Bipolar is no fun, and no one would ever choose it.

 

Friday Counseling Issues: Bipolar Disorder Treatment

Is it possible to treat Bipolar Disorder without medical intervention?

Well, sure.  It’s also possible to eat popcorn without butter, but what would be the point of that? 

I stated in an earlier post that my hard-and-fast rule is that I will not see a client who has Bipolar Disorder unless that client is compliant and faithful with his meds. The reason for that is simple.  When a person is in a manic swing, he is not reasonable. There is no talk therapy that can bring him down so that you can have a helpful therapuetic conversation.  The medication is vitally important, and sometimes it takes a while to get the proper set of meds, properly balanced, for every client. Everyone’s chemistry is a little bit different from everyone else’s.

When a client is effectively medicated–and I don’t mean she’s in LaLa Land–then she is more able to listen and process conversation that can be helpful in controlling her behavior.

Here is something I will always say to a Bipolar client:  “I’m sorry you have Bipolar Disorder. That’s no fun, and I know it has caused you and those who love you a lot of pain.  One thing you need to know, however, is that having Bipolar Disorder does not give you a pass to behave horribly, or to not follow the rules everyone else has to follow.  It just means that things are going to be harder for you, and you’re going to have to learn some skills that will keep you from getting into trouble and hurting the people who love you.

“Understand that you’re not the only one who has to live with a difficult condition. Some people are deaf. Some are blind. Some have severe food allergies. Some are autistic.  This is part of life, and we all have to deal with what we’re given. You can feel sorry for yourself, or you can get a grip and work hard.  Coming to therapy on a regular basis will help you to stay on track.  Taking your meds faithfully will help, too.  Work with me,  It will help you.”

Here are some talk therapies that can be helpful for Bipolar Disorder:

• Cognitive behavioral therapy
• Interpersonal/social rhythm therapy
• Psychoeducation
• Prodrome detection therapy – particularly useful for preventing mania relapses
• Family-focused therapy

Cognitive Behavorial Therapy is based on the premise that it is what you think about that controls how you feel and what you say and do. Learning to recognize common cognitive errors, and to tell yourself the truth, is, in my opinion, one of the best therapies out there.

For example, one cognitive error would be, “I have Bipolar Disorder, so I can’t help how I act or feel. There’s nothing I can do.”

That’s not true. There are many things you can do.  I will help you learn to recognize wrong thinking, and to replace it with truth.  The truth here is, “You have Bipolar Disorder, so you need to learn to recognize symptoms that you are going into a manic swing, and to put up safeguards. Your family can help you.”

Interpersonal and Social Rhythm Therapy (IPSRT) is designed to help people improve their moods by understanding and working with their biological and social rhythms. Originally developed as a form of psychotherapy for a single clinician and a single patient, the program has since been adapted to work in several different kinds of settings, including inpatient and outpatient groups. IPSRT is a compelling adjunctive therapy for people with mood disorders, and it emphasizes techniques to improve medication adherence, manage stressful life events, and reduce disruptions in social rhythms. IPSRT teaches patients skills that let them protect themselves against the development of future episodes.

A major goal of the IPSRT team is to expand the program’s use and the resources available to clinicians wishing to learn the IPSRT model, as well as to provide additional support to clinicians already trained in IPSRT.

( taken from www.ipsrt.org)

Psychoeducation is invaluable for both the patient and his family.  It is important to understand  exactly what Bipolar Disorder is, and how to cope with it.  There is wonderful information these days, easy to access on the internet, at the library, perhaps at your doctor’s office.

• Prodrome detection therapy – particularly useful for preventing mania relapses. Here is an excellent resource for this information: http://bipolar.answers.com/prevention/avoiding-bipolar-relapse-with-prodromal-detection-therapy

Family-focused therapy is helpful because it doesn’t separate the person who has Bipolar Disorder from the rest of the family members. It can help with conflict resolution as well as support and accountability for the patient.

Please understand that what I have mentioned here is only a bird’s-eye view.

There is more.  Some people swear by light therapy; others by a Bipolar-specific diet, others by supplements.  Keep in mind that there is a snake oil salesman out there for every condition imaginable.  You have to be discerning when you read about this stuff, and don’t go off on a tangent.  If it seems weird, it probably is.  If it seems too good to be true, it probably is.

Always consult a doctor or therapist who has experience in treating Bipolar Disorder.  I learn new things from my clients all the time. The study of the human brain continues to intrigue me. New and helpful information is always out there.

The main thing is not to give up. Never, never, never, never quit!

Friday Counseling Issues: Bipolar Disorder, Diagnosing and Treating

Many famous people have struggled with Bipolar Disorder, finding some degree of peace when they finally, so to speak, come out of the closet. But before they reach that point, they have often gone through two or three marriages, addictions of all sorts, and possibly even done jail time.

Mel Gibson, Abraham Lincoln, Robin William, Britney Spears, Angelina Jolie, Diana, Princess of Wales, and Queen Victoria.   There are hundreds more.  One thing all these people have in common is that they are brilliant in some way.  Even stuffy old Queen Victoria managed to keep her realm intact in a world in which women did not hold power.

So how do you know if someone has Bipolar Disorder?  There is a very specific diagnostic protocol.  Often, if I sense that a client has Bipolar, I will refer that person to a psychiatrist for a more in-depth evaluation and for medication.

There is Bipolar I, Bipolar II, and various degrees of both of those; there is also rapid-cycling Bipolar, in which the patient can cycle in and out of extreme moods within minutes, experiencing several cycles per day.

I thought about going into the details, but it’s really more complicated than I am prepared to deal with here. Instead, I’m going to suggest you go to this website:

http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml?rf

Please, please stay away from those online diagnostic tests. You will only make yourself miserable with worry. If you or someone you love seems to be experiencing Bipolar symptoms, you need to see your doctor.   Mood swings are not unique to Bipolar Disorder.  They can show up in ADD and other conditions as well. You need to see a doctor for the medical treatment of Bipolar.  A therapist such as myself cannot prescribe; neither can a psychologist. You need an M.D. for that.  Medicating Bipolar Disorder can take some time and tweaking, and it needs faithful monitoring and compliance with the meds. Everyone’s chemistry is different from everyone else’s.  There is no “one size fits all” medical treatment for Bipolar Disorder. You can read more about medications here:

http://www1.appstate.edu/~hillrw/BipolarNeuro/BiPolar/pages/treatments.html

But isn’t this so-called Bipolar thing really just a spiritual problem?  Isn’t it a form of demon possession?

I don’t believe that every single case of Bipolar Disorder is demon possession. It CAN be, but as some wise soul said, if the only tool you have is a hammer, then everything starts looking like a nail.

I have Bipolar clients who are sincere believers, and still they struggle.  Believe me when I tell you that the best way I know to discourage someone like that is to sternly “rebuke the devil” and demand that the client confess his sin and get right with God.  These people are already often overwhelmed with shame and guilt because they don’t understand how a Christian can have such a terrible condition.

May I remind you that God never promised that we believers would be free of all disease, all trouble, all difficulty? Think of the Apostle Paul, who begged God for deliverance from a thorn in the flesh. He didn’t get that deliverance. Was he “not right with God,” or did God simply allow Paul’s thorn to be something that could be used for His own purposes?

We stand in a dangerous place when we deign to judge someone else’s relationship with God.

Next time, I will share with you some things I offer my clients who have Bipolar Disorder. There is help; there can be improvement.

Friday Counseling Issues: Bipolar Disorder

Bipolar Disorder is miserable for the one who has it; difficult for those who live with and love the person who has it, and a challenge for the doctors who treat it as well as the therapists who try to give useful counsel.

This face speaks to me so eloquently of the battle a lot of people have who struggle with Bipolar Disorder. Robin Williams entertained us for years with his lightning-quick repartee, his energy, his incredible wit and brilliance. Here’s what I want you to do with this picture. He has a half-smile on his face. Put your hand over the bottom half of his face and study his eyes. All I see there is sadness.  Now cover his eyes, and even the smile  is sad.

Since I’ve been working in the counseling field, I’ve suspected that Robin Williams, along with a couple of other popular actors,  had struggled with Bipolar Disorder. He could go from high to low to high in a very short period of time. His speech was often rapid-fire, hard for us to keep up with. Remember him as the genie in Aladdin?

He was a gifted actor, able to do serious roles, comedy, and sometimes both in the same movie. Yet, underlying his gifts, he was a very sad and troubled soul, eventually taking his own life. He was weary of the struggle.

I don’t know if he was being compliant with taking his medication. I don’t know what took place toward the end of his life that caused him to just give up. What I do know, from talking with clients who have Bipolar Disorder, is that no matter how successful they may be, there is a lifelong feeling of not having a place in society; of not feeling they’re just like everyone else. 

We used to call it Manic Depression, because of the highs and lows that characterize the condition. The word manic, however, has been widely misunderstood, and I’m glad the label has been changed to Bipolar.

Manic can cover everything from extreme irritability and violent anger all the way to unrestrained euphoria. Typically, men tend to be more irritable and angry, and women tend to lean to euphoria. That is not true in every single case, of course, but is a general observation.

What is euphoria?  Extreme delight. Unusual energy.  Sleep can be done without. The person who is euphoric can often stay up 3-4 days in a row, never seeming to run out of energy.  It is during these bouts of euphoria that a Bipolar person will max out her credit cards, gamble, shop, indulge in promiscuous sex, talk nonstop, save the whales and the spotted owl, and consider running for President.  When the euphoria passes, she comes down with a nasty thud and often sinks into a deep depression that can last for days or weeks.

The angry side of mania is easier to identify. Anger, belligerence, argumentative, confrontational, sometimes physical acting out.  I had a client who would hurl her grandmother’s crystal glassware when she was manic, destroying much of a lovely collection.  I suggested she go to garage sales and pick up boxes of cheap dishes, put them in a corner in her basement where no one would be hurt, and throw dishes to her heart’s content.  She like the idea.  I don’t know if she ever followed through.

One of the biggest problems in counseling Bipolar Disorder is that the client will just stop coming.  They feel better, they no longer need counseling, and they’re fine on their own.  For a while.

I have a hard and fast rule:  I will not work with a person who has Bipolar Disorder unless they make a solemn promise that they will stay faithful to their medication.  And I always know when they’ve decided to quit taking it.

Next time, we’ll go into the specifics of this difficult condition, and talk about some of the medications that are used to stabilize it.