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Bipolar Disorder, Receiving the Diagnosis

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

The mental health community has done a very good job in defining, describing, and informing the public about Bipolar Disorder. All this considered, what is it like for a person to receive this diagnosis? While understanding this disorder is enormously important, it is equally important for the patient, family and friends to understand what it means to learn, for the first time, that they have this psychiatric disorder. What is it like to receive a diagnosis of Bipolar Disorder? To begin, here are the major symptoms of Bipolar Disorder:

Symptoms*:

Bipolar disorder causes mood swings that range from the lows of depression to the highs of mania. When  depressed, there are feelings of sadness and hopelessness. The mood will shift in the other direction to feeling euphoric and energetic.

Depressive phase:

1. Sadness
2. Hopelessness
3. Suicidal thoughts or behavior
4. Anxiety
5. Guilt
6. Sleep problems
7. Low appetite or increased appetite
8. Fatigue
9. Loss of interest in daily activities
10. Problems concentrating
11. Irritability
12. Chronic pain without a known cause
13. Frequent absences from work or school
14. Poor performance at work or school

Manic phase:

1. Euphoria
2. Extreme optimism  
3. Rapid speech
4. Racing thoughts
5. Aggressive behavior
6. Agitation or irritation
7. Increased physical activity
8. Risky behavior
9. Spending sprees 
10. Increased drive to perform or achieve goals
11. Increased sex drive
12. Decreased need for sleep
13. Inability to concentrate
14. Careless or dangerous use of drugs or alcohol
15. Frequent absences from work or school 
16. Poor performance at work or school

*Mayo Clinic

Always, lurking in the background when discussing psychiatry, is the issue of stigma. We may try to convince ourselves that it no longer exists, but that would be unrealistic. The plain and simple fact is that psychiatric diagnoses continue to carry a stigma that makes patients feel shame. There is a kind of self reproach that makes it difficult to accept the diagnosis. That self reproach is in the form of, “What, now I’m crazy?” The paradox for these patients is that, suffering these symptoms for many years, the defense mechanism of denial takes over, rendering the diagnosis unacceptable.

Defense mechanisms are ways of thinking that go into action when one is confronted by situations that arouse extreme anxiety. Denial, for example, is aimed at erasing something that is so painful to admit that it is pushed out of existence. Long standing denial helps one to think of depression as nothing more than a reaction to stressful events that are now presenting themselves. While this can be true, Bipolar is much more chronic than this.

Receiving a psychiatric diagnosis is a major blow to one’s ego, sense of dignity and self pride. Often, the reaction can be, “Me, bipolar? It can’t be.” In other words, it is easier to think that, “Yes, I get angry and I get depressed but, so does everyone else and everyone feels out of control sometimes, don’t they?” The fact is that everyone wants to feel a sense of wholeness, competence, and self confidence. Frequently patients feel as though that is being taken away from them. Nevertheless it feels like a condemnation.

There is a danger connected with the denial of the diagnosis and it is that until one is ready to admit they have the illness, treatment, including medication and psychotherapy, cannot begin. It too often happens that, in the process of denial, a patient will start taking their medication and stop soon afterward. I remember one patient who, finding the diagnosis so awful, refused to consider any medication remotely connected with bipolar disorder. It was as though he was allowing medication to define the illness rather than the other way around.

It is important to state that, after all the turmoil about the diagnosis has passed, many patients feel a sense of relief. It is helpful for most people to understand the reasons why they have experienced such turmoil throughout their lives. It is also a relief to learn that something can be done to relieve the life long symptoms that have plagued their lives.

For all of these reasons, it is important for family and friends to be patient and supportive when a loved one receives such a diagnosis. Fundamental to being supportive is being non-judgmental. It can even be pointed out that, “You are the same person now as you were before you saw the doctor, it’s just that you now know what you are dealing with and we love you.”

What are your experiences with someone who has learned they have a mental illness? Your comments and questions are encouraged.

Allan N. Schwartz, PhD.

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