living with bipolar disorder  

By liam Gildea  

In this article I am going to critically analyse Bipolar Disorder. I will delve into the reasons why I believe the illness is much misunderstood and I will look at the role medication plays in managing the condition. I will also examine what is contributing to the stigma that exists around the disorder. Finally, I will conclude with a question: can one live a fulfilling life with the condition? Throughout the piece I will also reflect on my own experience of living with bipolar illness for the past 20 years.  

Bipolar disorder is a brain disorder that causes unusual shifts in mood, energy, activities, and the ability to carry out daily tasks. According to the National Institution of Mental Health, there are 27 million people world-wide excluding children who have bipolarity. It affects both men and women equally. So, what causes the condition? This is still unclear; however, research suggests that it is a mix of genetic and environmental factors. People suffering from the illness can’t directly alter brain chemistry any more than a person with diabetes can regulate insulin level through willpower alone. (Preston, Fast, 2006)  

With any mental illness there is the difficulty for the sufferer, friends, and family of not being able to see the ailment. This is very much the case for bipolar disorder. It’s not like a broken leg where it is clear to everyone there is an issue of impairment. This is a contributing factor towards society struggling to comprehend what bipolar disorder is. As humans we like to apply logic to whatever the issue might be. Herein lies the problem with bipolar disorder: there is no logic. There’s a sense of upheaval that accompanies the disorder, from the elated highs to the pits of depression, and it is a condition that is difficult to comprehend.

I believe as a society we are slowly coming to understand depression. I think a lot of people can relate to someone who is suffering, based on personal experience of a difficult time in their own lives. We are not quite there yet in understanding how clinical depression impairs one’s basic functioning day to day. The periods of mania or hypomania that mark the illness are the more misunderstood manifestation of the illness for the sufferer and society in the main.  

I think it’s important to distinguish between the different types of the disorder. There are two main types of bipolar disorder, designated as Types 1 and 2. With both strains of the illness, a person with the diagnosis will experience periods of clinical depression. The key difference is that in bipolar Type I the mood is more elated or associated with psychosis. My own diagnosis is Type 2, so I experience periods of severe depression and hypomania.  

Hypomania and mania are periods of overactive and excited behaviour that have a significant impact on day-to-day life (Warin, 2016). So, what symptoms do I and others display when at the beginning of a hypomanic period? My own experience is that I feel great; I have boundless energy and have little need for sleep. I am highly confident with grandiose delusions and I spend excessively. Everything about life excites me. I experience rapid speech, which is an incessant need to keep talking (Purse, 2019).  

It took me twenty years to identify that these hypomanic periods were part of a mental illness. I often reflect that if I never had the illness myself would I be able to understand the disorder? I wouldn’t. That is why I would never judge any person who doesn’t fully grasp the condition. For a person who didn’t know me these symptoms could be seen as traits of my personality rather than symptoms of an illness. The longer a hypomanic episode goes untreated the more unpleasant characteristics of the illness come to the fore. I become more argumentative and increasingly hostile. I come across as an arrogant individual with no awareness of their actions. People close to me can identify that I am acting out of character. When the inevitable clinical depression arrives a few months later I am left with a feeling of embarrassment for my elated behaviour. 

I have often sat in front of a medical professional and unknowingly masked my elated mood. As hypomania is an enjoyable feeling, the individual is less likely to seek medical advice. If a person only represents themselves to a doctor when they are depressed and not in the elated phase of the disorder, they will be treated for depression. This leads to difficulties in detecting the illness. A large retrospective study of patients with bipolar disorder reported that there was an average of 5-10 years’ delay from a person’s first recollected mood episode to receiving a diagnosis of bipolar disorder (O’Carroll, 2013).  

Herein lies the crux of the illness: many of those with the disorder never get a proper diagnosis. In other cases, as my psychiatrist said, people never fully come to grips with the disorder. All of this contributes to an illness that is very misunderstood. I believe that medication is one of the key cornerstones for keeping the illness at bay. Whilst they are not magic bullets, they are an essential part of a care plan for any person with the condition. Adherence to medication is one major piece of a maintenance treatment jigsaw. Undoubtedly talk therapy plays just as an important role. Based on my own recovery and opinions of my medical team, it was clear that for me to partake of therapy I needed to take my medication. Without it my mood was too low to participate fully in talk therapy.  

For years I would have been of the opposing view that medication had no place in an ongoing recovery from any mental health disorder. Only through traumatic personal experience would I learn how ignorant I was. When I first received my diagnosis in 2013 I wasn’t aware that this was a lifelong condition. I would need ongoing maintenance treatment primarily in the form of mood stabilising medication and talk therapy, indefinitely.  

So why had I such a negative attitude towards medication? I believe this was borne out of the pressure I felt from having a stigmatised illness. I allowed society’s views to close off an open mind when it came to taking medication. This suspicion of bipolarity medication is a worldwide phenomenon. Research in the UK found that over 60% of people with the diagnosis stop taking their medication at some point (Smith, 2015). I have done this on three occasions to my own detriment.  

As we grow in knowledge of how to combat mental illness the recovery model is fast becoming the more dominant form of treatment as opposed to the medical model of the past. When we look at a personal recovery we talk about the triad of hope, control, and opportunity (Collins, 2016). The patient becomes an active self-manager of their own condition.  

Many people who work in the recovery area have a negative attitude towards medication. I have experienced it first hand in my own recovery, as several counsellors were anti-medication. They believed the medication only dampened my emotions and had no tangible benefits. I am of the view that the medical model and recovery model can co-exist in a treatment plan for a person with a bipolar diagnosis.  

The medications prescribed for bipolar illness and depression are different. Whilst a person with depression is treated with anti-depressants, someone with bipolarity is treated with mood stabilising medication. Bipolar disorder is often misdiagnosed as depression. The issue with misdiagnosis is that if an individual with bipolar is treated with anti-depressants it can lead to a medicated high and inevitably a crash soon after.  

Mood stabilizing medication has proven to be successful for many with the illness and there are different choices, with lithium being the most common. Australian psychiatrist John Cade first suggested in 1949 that lithium could be used to treat depressive type episodes, and he also demonstrated that it could calm manic symptoms (Levine, 2012).  

I am being treated with alternative mood stabilizing medication. Once I had overcome my own issues with taking medication this became the easiest and most effective part of ongoing treatment for my illness.  

The fact that I didn’t know one other person with the disorder made me feel stigmatized and less willing to accept that I had the illness. Acceptance was one of the biggest barriers I had to overcome. It took twenty years for me to finally be comfortable with the condition, and to not feel like I was being judged. I now realise the only person that was judging me was my critical self.  

I still feel mental health stigma is very much ingrained in society. Where did this stigma originate? Was it a feeling of guilt and shame for not appreciating the gift of life? Was it the older generation’s associations of asylums and how families tried to cover up a family member with a condition? Even in our legislation, negative terminology such as the Lunacy Regulation Act 1871 is still referenced in our courts today. I feel it is a mixture of all of these things.  

I believe that bipolar disorder, due to the complexities of the illness, is even more stigmatised. Whilst one can claim that people have a lack of knowledge of the illness, there is no denying we live in an era where information is freely available in a matter of seconds.  

Mass media is what we mostly rely on when it comes to knowledge of any mental health condition. We’ve witnessed great leaps of awareness about relatively common mental health issues such as depression and anxiety. Thankfully, there has been an increased dismissal of unhelpful prejudices that surround these conditions. However, severe mental health conditions such as bipolar illness are consistently misrepresented and misunderstood.  

The media tend to focus on the dramatic side of bipolar. In the early stages of my diagnosis, I felt uncomfortable with the misrepresentation of the illness. The levels of behaviour depicted in manic periods was not something I could relate to and I felt it painted an inexact picture of what the sufferer can go through.  

I’ve seen ill-advised journalists writing for national newspapers refer to Bipolar 2 as a made-up illness. I have to say it infuriates me that a journalist would write an article on a sensitive subject and do no research. Is it any wonder people think it’s an illness of choice when such views are in the public domain? All that aside, I believe that we are turning a corner. The charity Aware is doing great work in educating people about the illness.  

Can one live a fulfilling life with bipolar disorder? Yes, but with great self-compassion and an understanding that treatment is needed to become and to remain well. As my psychiatrist said to me recently not everyone has the good fortune that I have had coming to grips with bipolar illness. In my opinion, for a sufferer, it is the most important thing in their life they need to overcome.  

I don’t let the disorder dictate my life, but I always keep it in consideration. Since I’ve been well I’ve been compliant with my medication. I think for a person to remain well they need to be super vigilant on how they live their life. A disciplined routine really helps. Particularly when it comes to sleep, it is vital that a person gets 7 to 8 hours sleep per night. Without regular sleep a person can tip into mania or hypomania.  

To successfully live with the condition one needs to overcome stigma. Whilst it is difficult at first, as you mature over time with the illness this becomes less of an obstacle. I believe anyone with bipolar disorder should consider themselves always in recovery. There are no guarantees that a relapse will not ever happen again. Yes, medication, talk therapy and a good lifestyle can minimise the risk but there is no certainty that if you have a traumatic event in your life this could cause a relapse.  

Bipolar Disorder can be a great teacher. It has taught me empathy for others who are also struggling, and a newfound appreciation of how wonderful life can be. Bipolarity forces one’s hand to live a healthy life and there are positives to be drawn from this challenging mental disorder. I do believe in 50 years’ time we will look back and find it difficult to fathom how mental illness was viewed differently than a physical condition. Until then, the onus is on me and other sufferers to continue flying the flag for people with bipolar disorder. 

Liam Gildea is a facilitator for the HSE Living Well Programme, which offers self-management skills for people with long term chronic disease. He also presents informational talks at schools, universities, and mental health organisations. Liam is 38 years old and has lived with mental illness for over 20 years. He was recently diagnosed with Bipolar II. This article is excerpted from his book High life low life: living with Bipolar Disorder. Liam is from Co. Mayo and is an avid GAA fan.  

References

Collins, P. (Ed.). (2016). Recovery: A Journey for all Disciplines. National Office for Advancing Recovery in Ireland. HSE: Mental Health Division.  

Levine, B. (2012). A Therapist’s journey to overcoming one of the world’s most challenging mental disorders. Hay house UK Ltd.  

O’Carroll, S. (2013). Delays of 10 years in diagnosis of bipolar disorder. https://www.thejournal.ie/ delays-of-up-to-10-years-in-diagnosing-bipolar-disorder-902005-May2013/, accessed 21 March 2022.  

Preston, J. & Fast, J. (2006). Take charge of bipolar disorder. Grand Central Publishing.  

Purse M, (2019). Pressured Speech in Bipolar Disorder. https://www.verywellmind.com/what-ispressured-speech-378822, accessed 25 March 2022.  

Smith I, (2015). Managing bipolar without medication. http://theconversation.com/managing-bipolardisorder-without-medication-48640, accessed 28 March 2022.  

Warin C, (2016) Understanding Hypomania and Mania. Mind 2016. 

IAHIP 2022 - INSIDE OUT 97 - Summer 2022