In this short video, Declan Devereux shares his enthusiastic support of the Bipolar Advantage Program and how doing the work helped him turn his marriage around. Are you ready to create the same success in your own life?
According to Dr. Insel, “it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”
One obvious problem is that the reliance on “objective laboratory measure” is also full of problems. In an attempt to turn real Psychiatric issues into “medical diseases,” there has been a widespread effort to claim depression and bipolar disorder a “chemical imbalance.” In “Psychiatry’s New Brain-Mind and the Legend of the ‘Chemical Imbalance,'” Dr. Ronald Pies said, “In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it. On the other hand, the “chemical imbalance” trope has been tossed around a great deal by opponents of psychiatry, who mendaciously attribute the phrase to psychiatrists themselves. And, yes—the “chemical imbalance” image has been vigorously promoted by some pharmaceutical companies, often to the detriment of our patients’ understanding. In truth, the “chemical imbalance” notion was always a kind of urban legend- – never a theory seriously propounded by well-informed psychiatrists.”
I have long argued that the definitions in the DSM regarding depression and bipolar disorder are not accurate. Basing assessments on a short list of symptoms is a huge part of the problem without also considering intensity, awareness, understanding, functionality, comfort, value, and length time it can be kept under control. But, abandoning any criteria because they have yet to find “biomarkers” for depression or bipolar disorder can leave real problems unaddressed. Depression and bipolar are dangerous conditions that destroy the lives of far too many people.
The bigger issue for me is the assumption that the “disease” includes the “symptoms” that are not in disorder. Any biomarker found in the future needs to recognize this fact before they throw the baby out with the bath water. Let’s assume that some day they are able to link bipolar to specific chemical reactions in the brain at specific regions. They will be able to tie the “symptom” of racing thoughts, for example, to a real difference in the brain compared to “normal” people. If they somehow eradicate the “disease” of racing thoughts by altering the brain, they destroy something that has moved mankind forward for millennia. They need to be extremely careful to separate the “disorder” of not understanding the racing thoughts from the in-ordered ability to function highly with them.
My proposal all along is to separate disordered bipolar from in-ordered bipolar. Bipolar Disorder means the condition is causing suffering and incapacitation, whereas Bipolar IN Order does not. Unless Bipolar IN Order is taken into account, using biomarkers to “prove” the condition an illness to be removed is a step backward. As I described in my article challenging the paradigm of remission; “With so many people thinking that remission is the same as ‘cured,’ the problem is all too real. They assume when I say Bipolar IN Order that they have achieved the same thing because they are not currently ill, but during the next cycle they are back in disorder while I am exploring yet another fascinating state with its own unique rewards. What they do not understand is that I, and the many others I have taught, are not ‘symptom’ free in the way commonly thought; we experience ‘traits’ every bit as intense as anyone in disorder, but we neither suffer nor are incapacitated by them. We are no longer in danger of relapse because we are already functioning highly at intensities that those without our understanding mistake for the illness.”
It is great news that the NIMH has decided to challenge the DSM. I hope that in rethinking “mental illness” they do not make the same mistakes in confusing what the “disorder” is.
When bipolar people get angry, the Bipolar IN Order concepts apply just as they do for most other states.
Bipolar in disorder combined with anger is a very dangerous mix. The disordered person tends to become very volatile and can explode into a rage with little provocation. It is best for the person to avoid anything that might trigger anger until the disorder is in remission, but even then an angering stimulus can trigger another manic or depressive episode with anger as one of the troubling elements.
Bipolar people who have their condition in order have learned important lessons that can be applied to most of our experiences. For example, since we understand bipolar so well that we can function highly during depression and mania, we can also handle more intense states of anger without losing control.
As with every experience, most people can usually function fine when anger is at a very low intensity, but when the intensity of anger increases beyond their comfort zone they begin to lose the ability to choose their response to it. They act in ways that are less than optimal. They may even become a danger to themselves and others if the anger becomes too intense.
Knowing each level of intensity is the first step to mastering anger. We need to learn about the three most important intensities before we can move forward: the intensities that are within our high-functioning zone, the intensities just outside of the high-functioning zone, and the intensities that are too far outside to be safe to work with. How angry can you be before the anger starts choosing your behavior for you?
Knowing about anger at the three intensities requires two important things: awareness of how intense your anger is, and understanding how to function during it. Once we gain understanding we can begin to work on functionality, comfort, and recognizing the value of being angry.
Being aware of anger means we can clearly recognize the physical, mental, emotional, spiritual, social, and career/financial elements of the experience at each level of intensity. When we are fully aware we can clearly detail the differences between each level of intensity as described above. For example, at just outside our high-functioning zone, we notice how our breathing and posture change; our focus increases; our emotions escalate; we consider how much the issue matters to us; we become acutely aware of social dynamics; and we calculate the costs and benefits of different courses of action. We also need to become very vigilant for the signs that the intensity has escalated into unsafe territory.
Having the right kind of understanding is critical. You can be expert in the inner workings of an automobile, know all of the logistics of manufacturing, and successfully finance and operate a car company, but if you do not understand the dynamics of driving, you will crash the next time you take the car out of the garage. The most important understanding is to be able to use something for what it was made for.
The same concept applies to understanding anger. You can learn all of the triggers and how best to avoid them, but next time you are angry you might crash and lose your loved ones. You need to know how to use anger to your advantage as well as how to lower the intensity when it begins to be too much to handle. Understanding when to walk away is often as important as when to argue. When you choose to argue, it is important to understand how anger informs you to make stronger arguments. You also need to be aware when anger makes you do or say things that hurt your case.
A functionality-based understanding of anger helps you to use it to your advantage. An important part of that understanding is to have a clear outcome in mind. Anger gives some of us the uncanny ability to come up with the meanest thing possible to say. We are in disorder when we do that, but the same ability can be used to come up with the best thing to say that helps us achieve our goal. Other things that anger brings that could be turned into an advantage include enhanced awareness, focus, energy, motivation, and many more. Do you understand how to use these traits to help you achieve your goals? When you do, you will become highly functional while angry.
When we become highly functional, we also become more comfortable with the level of intensity of anger we have. Once the anger gets too intense, though, we become both less functional and uncomfortable with the anger. We can learn to be more functional when anger rises to just outside of our comfort zone. When anger becomes too intense we lose control and let it escalate into rage.
An important gauge is how comfortable we can make others with our level of anger. If we get our way because we make others so uncomfortable that they back down, we are not really understanding the power of anger. Those who we are in conflict with remain calm when our anger is properly expressed.
It gets really interesting when we look at the relationship between how much people value the experiences and how well they understand and function during them. Those who value the experiences and search for meaning in them function far better than those who only seek to make the experiences go away.
Helping people to recognize their awareness, understanding, functionality, comfort, and value at different levels of intensity changes their entire relationship to anger. Instead of seeing it as something to remove from their lives, they find that they can master their responses to anger and turn it to their advantage as long as they keep it at intensities within their ability to use it.
Substitute anger with any other state and you can use the same concepts to change your relationship to it. What other states do you think the concepts might apply?
The “dis-abled”argument is central to bipolar disorder.
Stigma, medication, treatment options, recovery, patient rights, and physiological basis are some of the most discussed topics regarding bipolar. There are, of course, many other interesting aspects to debate, but it is hard to find any discussions about bipolar that do not include one or more of these central topics. While it has been very healthy to debate all of them, there is an underlying assumption that must be addressed too.
The paradigm that all of the above topics are based on is that we are incapable of remaining in control when mania and depression reach a certain intensity. We are therefore not responsible for our behaviors when manic or depressed. Because it is not possible in those states to choose better ones. This creates the goal of removing bipolar from our lives (at least at higher intensities) and the debate is about how it is best done. Much of the debate about medication, for example, is about alternative methods to achieve the same goal of reducing intensities of mania and depression.
But, what if we could be highly functional while manic or depressed?
This idea has so many repercussions that people are afraid to even think about it. Consider what is at stake: If we cannot choose how to respond to the different states because it is impossible for anyone to, in-ability becomes central to the arguments in each of the above topics. If anyone can choose, the impossibility argument is removed and the discussion becomes either how to function in mania and depression or why some cannot.
Accepting that it may be possible would affect the lives of those debating bipolar in a profound way. The “dis-abled” argument is so central to bipolar disorder that many people are unwilling to even consider the possibility that it may be wrong. What might be different if we could all learn to choose our behaviors during intense states of mania and depression as some of us have?
Bipolar people might be held accountable for their behaviors at all times. Many might lose their primary excuse for alienating friends and family or losing their jobs. Many might lose their housing and other forms of government support. Many might see it as having everything to lose and nothing to gain but the burden of trying to control themselves in states that have so far proven impossible. It is hard to see any upside from that point of view, so it is easy to see why they would be very resistant to considering the possibility and even angry that one would bring it up.
Providers of services for bipolar people might be faced with a completely different kind of accountability. People might choose providers based on ability to help them become functional in both mania and depression instead of removing bipolar from their lives. Those that cling to the illness model might fall out of favor and could even lose their livelihoods. Anyone with income related to bipolar could be affected, whether they were psychiatrists, therapists, non-profit employees, government workers, peer supporters, and others.
The stigma issue might be upended. The illness model that says we are incapable of choosing behaviors provides a clear argument against stigma, yet adds to the stigma in suggesting that bipolar people are incapable of being accountable for their actions. Stigma could be rolled into a much broader discussion about each person’s responsibility to behave as a member of society.
Pharmaceutical companies might take a huge hit financially. Psych meds are promoted as the critical tools for reducing mania and depression, but we would not need to remove or moderate manias or depressions if we were highly functional while experiencing them. Usage of medicine may not go away completely, but the number of people taking multiple drugs on a daily basis for the rest of their lives would certainly go down.
Treatment options might open up. Some existing ones might be found effective for only some stages of bipolar disorder, while new ones that prove more effective at helping people to achieve Bipolar IN Order might flourish.
Recovery might no longer be the end goal of treatment.
It might be seen instead as a starting point toward better results as detailed in the concepts of Bipolar IN Order.
Patients rights would be commensurate with patients behaviors. When people take responsibility for their behavior they will no longer be seen as patients.
The search for a physiological basis for bipolar might take a new direction. Bipolar disorder might be seen as a behavioral issue while physiological factors are seen as influencing the way we think and act, but not the overriding cause that cannot be overcome. Those who use the physiological elements as proof of disorder would lose a critical part of their argument. Who knows, they might even figure out why other people cannot experience the states we do.
These are just a few of the major ramifications to such a huge shift in the bipolar paradigm. With so much at stake it is no wonder there is tremendous resistance to even considering the possibility that people with bipolar could choose better responses to both intense manias and deep depressions. Too many people are frightened about what that could mean in their own lives. Being held responsible for our thoughts and actions is too much to bear when the dis-ability paradigm has excused our behaviors for so long.
What would change in your life if bipolar people were expected to learn how to behave while manic and depressed? Do the risks influence your willingness to consider that it might be possible? Are you attached to the idea that it is not?
Please share your thoughts in the discussion below. This is an important topic that needs to be talked about.
Doctors’ inability to handle or acknowledge grief is negatively affecting care.
My daughter Kate is in her fourth year of medical school and is well on her way to becoming a very caring doctor. Her greatest gift is the ability to connect with people, which thankfully is being recognized in the hospital settings as an asset. She creates strong bonds with her patients and their families by communicating how much she cares about them. Among so many other admirable traits it is the one that makes me the most proud of her. It has been her greatest gift for as long as I can remember.
The ability to form strong emotional bonds is not without tremendous risks though. It hurts her deeply when a patient that she is involved with dies. It is a testament to her awareness, understanding, and strength that she can perform even on days when she sees the worst aspects of the medical profession; in spite of their best efforts, they cannot save everyone. Kate has grappled with that many times and come out the better for it.
As her father I like to think that I have something to do with Kate’s insights. We discuss the topic often. As someone who deeply understands depression and has learned to function fully while in the most intense states, I know my insights have helped Kate to develop the skills in her own life. I believe such skills are the key to her success and will help her to stand out amongst her peers.
A recent study about how doctors are affected by grief was published in the Archives of Internal Medicine and was described in an article in the NY Times. I read both reviews with great interest and was very excited that it confirmed what Kate and I had been discussing. I have worried that the grief that Kate experiences might overwhelm someone without the insights and support that she has. This is exactly what the study was about.
A few highlights really stand out for me in the NY Times article: “Not only do doctors experience grief, but the professional taboo on the emotion also has negative consequences for the doctors themselves, as well as for the quality of care they provide… The impact of all this unacknowledged grief was exactly what we don’t want our doctors to experience: inattentiveness, impatience, irritability, emotional exhaustion and burnout… Even more distressing, half our participants reported that their discomfort with their grief over patient loss could affect their treatment decisions with subsequent patients — leading them, for instance, to provide more aggressive chemotherapy, to put a patient in a clinical trial, or to recommend further surgery when palliative care might be a better option.”
But, one point in the article caught my attention — “… no one wants their doctor to be walking around openly grief-stricken.” I am afraid that they missed a critical point; there is a huge difference between being “openly grief-stricken” and the ability to perform. Those of us who have Depression IN Order know how to experience intense emotions without letting it affect our performance. Only those who have not yet been taught how to function are debilitated by it. I want my doctor to be so concerned with my health that she is “openly grief-stricken.” It shows that she cares. I don’t want her to lose her ability to give the best care possible, though.
The NY Times article ends with a tremendous ray of hope: “To improve the quality of end-of-life care for patients and their families, we also need to improve the quality of life of their physicians, by making space for them to grieve like everyone else.” It opens up the possibility that they might learn from us. We depressives can teach them how to grieve while still performing their critical duties. Of course we will need to teach them how to grieve differently from “everyone else,” but perhaps the doctors can then teach their patients that grieving is an important part of life that does not need to be in disorder.
Depression in self-mastery is often seen as a rich spiritual experience.
A recent question on our Depression and Bipolar Advantage LinkedIN Group brings up a point that needs to be addressed if we are to fully understand depression: What are some of the positives about having experienced bouts of depression? Since most people assume there are none, it is important to put it in perspective.
Source: Bipolar Advantage
The answer to the question depends completely on where one is on the six stage of growth from bipolar disorder to bipolar in order. The inability to see value in the experience is a major contributor to the suffering that those in disorder experience. Finding value in the experience is one of the keys to removing the suffering and starting on the path to self-mastery.
For someone in the Crisis Stage the only positive may be that the person knows that he/she has survived before. This can literally mean the difference between life and death. It would be counterproductive to ask if there are any positives while one is in crisis.
Someone in Managed Stage may have the understanding and tool skills to keep the episode from escalating out of control. The previous episodes will be seen as learning experiences that brought at least some insight into the equation. Most people in managed stage only mention positives in past episodes and not during a heightened level of intensity. They generally do not see value during the experience, only in what they have gained by having been through it.
In Recovery Stage, people often wrongly believe that they are free from ever having to face another episode. Their inability to see value in the experience leads to a fear of it ever coming back. They often say the only thing positive is that they will never be in crisis again. Unfortunately, recovery has been proven by the National Institute of Mental Health to be a temporary condition; those who believe otherwise are often poorly prepared for the next episode.
Freedom Stage begins the process of understanding depression and mania enough to be able to see value in at least minor episodes. As you increase your ability to function and be comfortable during them, you begin to be able to see value in lower intensity depressions. You find that in some ways depression enhances your life and improves your functionality. For example, an artist would find depression to be a muse or one may see that depression gave insights that helped deepen relationships.
Stability Stage is where the value of depression is self-evident. When you no longer suffer from the experience and can function even in the deeper states, you begin to understand something that those in disorder cannot comprehend. You understand that there is a huge difference between the experience of pain and suffering from it. This insight affects the rest of your life and is clearly seen as a positive both during and after each episode.
For most people in Stability Stage, functioning in depression is seen as the key to being able to function in mania. There are a plethora of positives once you reach Stability Stage. It is much more difficult to find negatives in the experience.
Self-Mastery Stage is where one understands that all experiences are equally beautiful and valuable. Even depressions that are much deeper than those once causing crisis are seen as so positive that you cannot imagine life without them. This is so far beyond the comprehension of those in disorder that they become upset about it. They prefer to delude themselves (and others) into thinking that their limited understanding is all that is possible. It is unfortunate because their lives would be immeasurably improved if they listened to those in Self-Mastery instead of those still in disorder. It is not an easy path, but we can show you how to get there.
Depression in Self-Mastery is often seen as a rich spiritual experience. There are countless examples throughout the various faiths in the world. For example, Milarepa used emotional pain as a path to enlightenment, while Saint Teresa of Avila said “The pain is still there. It bothers me so little now that I feel the Lord is served by it.”
What are some of the positives about having experienced bouts of depression? Do you notice the past tense in the question? It takes someone IN Order to see the positives during intense depressive times. What positives have you found related to depression?
Exploring the relationship between value and functionality in bipolar disorder.
Assuming you are not deeply depressed right now, try to remember the time when you were in the deepest depression of your life. Can you see any way it might have changed your life for the better? Did it make you more sensitive to the feelings of others? Are you better at helping others during their difficult times because you have had the experience yourself? Are there things you learned from being deeply depressed? Are you a better person because of the experience? What is the value in having been through it? On a scale from one to one hundred, how would you rank the value in having been deeply depressed?
These seem like unusual questions to some people. Wouldn’t we be better off trying to forget our depressions and get on with our lives? Can’t we just hope that depression remains in the past and we never have to face it again? Ignoring past episodes may sound like a better approach, but refusing to take a hard look at depression or mania leaves us ill prepared for the next time it comes. Unfortunately, if depression or mania happened before, it is likely to happen again.
Looking at how we value depression and mania is an important part of any assessment; a part that is sorely missing in most protocols. The laundry list of symptoms in most assessments belie an incorrect assumption that the items are all seen as negative.
We have been asking the above questions (and many more) for several years now and have learned a great deal about the role value plays in depression and mania. Although our data is not yet extensive enough to make final declarations, there are many surprising trends that are too important to delay sharing.
Perhaps the biggest surprise is that once someone goes through the process of answering questions and rating their awareness, understanding, functionality, and comfort at various intensities of depression and mania, they often rate the value of having been through deep depression pretty high. It seems that just asking the questions is enough to plant the seeds of tremendous growth. Before being taught tools and plans for better outcomes, they have already begun to understand the difference between liking the experience and seeing value in having it.
When designing the functionality assessment, I expected most people to see little or no value in deep depressions, but possibly higher than normal value in shallow ones. My idea at the time was the artists and writers would see value in depressions that were low enough to give them a creative spark, but not deep enough to debilitate them. Was I ever wrong. Most people who have been through only the assessment process see shallow depressions as a minor annoyance with less value while finding great value in the deeper depressions, as already mentioned.
Mania, of course, has been the opposite. People see tremendous value in low manias and no value at all in the intense manias that get them in so much trouble. They enjoy being high, but recognize the negative impact it has on their relationships, careers, and other aspects of their lives.
It gets really interesting when we look at the relationship between how much people value the experiences and how well they understand and function during them. Those who value the experiences and search for meaning in them function far better than those who only seek to make the experiences go away.
Not surprising are the answers we hear when we ask about present states. While people can see value in having been through an intense depression, for example, they do not value having another one today. They do want another mania, though, which is a major contributing factor in the failure of remission as the end goal of treatment for bipolar disorder. Understanding the role of value in all states needs to be part of treatment and goal setting too.
Mindfulness is a popular tool for treating bipolar disorder and value is a major part of it. Central to the concept is to see everything without judgement. Many people believe such an approach reduces everything to a valueless experience, but nothing could be further from the truth. Mindfulness is about seeing every moment as highly valuable.
From the perspective of mindfulness, we suffer when we place different values on our experiences. Our preference for pleasurable moments is what makes us resist those that are painful. Such resistance is the cause of suffering, not the intensity of the pain. When we develop mindful equanimity, every moment is equally beautiful and we find tremendous insight in each part of the experience.
The insight gained from equanimity leads to the ability to function highly and find comfort no matter the outward or inner environment. The Bhagavad-Gita advises us to “Perform your duty without attachment, remaining equal to success or failure. Such equanimity of mind is called Yoga.” In other words, learn to find value in every intensity of depression and mania so you can start on the path to ending the behaviors that are in disorder.
Expanding the depression and bipolar comfort zone.
Understanding the role of comfort is critical for getting Bipolar IN Order. To do so, we must measure comfort at each level of intensity for both mania and depression. When we compare comfort levels to awareness, understanding, functionality, value, and the time before escalation, we find the optimal intensities where bipolar is an advantage in our lives.
In any aspect of life, those who only seek comfort are consigned to mediocrity and boredom. Those who judiciously step outside their comfort zone and challenge themselves are the ones who learn and grow. This is equally as true with mania and depression.
The best growth, though, happens just slightly outside the comfort zone. Too far outside and the lack of comfort can cause you to shrink instead.
Too many times, bipolar people step too far outside their comfort zones and find themselves at an intensity of depression or mania that is far beyond their control. Many of them become so frightened by it they hide inside their comfort zone hoping to remain there the rest of their lives. They accept a diminished story of their lives because they believe they have no other choice. They fear one wrong step will rapidly escalate back to an uncomfortable and out-of-control state.
When we carefully assess comfort (along with the other criteria) at various levels of intensity, we find close relationships between understanding, functionality, and comfort. One’s level of understanding, if accurately assessed, predicts the levels of functionality and comfort, for example. One’s level of comfort also influences the ability grow in understanding and function more effectively; all three are intimately tied together.
Such assessments lead to a far more accurate identification of the demarcation lines of an individual’s comfort zone. These assessments also help the individual to recognize the next level of intensity where depression or mania has just begun to go too far. The ability to find the zone between the lines is the key to success. We need to cross the line and go outside of our comfort zone to grow, but not so far that lack of comfort harms us.
If we look at any other field, whether physical, medical, or academic, we expand our understanding and functionality by taking on challenges that are slightly outside of our comfort zone. We are taught to take on reasonable challenges and make sure the risks that come with them are reasonable. We do not, for example, climb the Himalayas on our first hiking trip. We start out slowly and carefully until we develop skills. Most of us do not climb the most difficult peaks, but we usually go far beyond the first steps we took as a baby.
But, mostly due to ignorance and fear, many (most) do not treat depression or bipolar the in the same manner. They believe it is not possible to safely expand their comfort zone and refuse to accept that many of us have already done it. They narrow their range and call it “recovery” when a more effective method would be to expand their range and call it “growth”.
Because of such false beliefs, most programs for depression or bipolar disorder are only designed to lower the intensity until one is inside of the comfort zone. They do not teach how to cross safely into the growth zone or to recognize the next critical line where we have gone too far.
The result of such treatment leaves us with people who live in fear that the next episode will escalate out of their control. Unfortunately, since they do not develop understanding or skills that lead to functionality and comfort across a wider range of intensities, their fears are validated during the next episode (which is virtually guaranteed to happen unless they are willing to be a zombie for the rest of their lives).
For all of the talk about stigma, this is the worst one. The judgement of others may keep us from some opportunities, but our self-judgement keeps us from even trying. Accepting a narrow comfort zone regarding depression or bipolar influences the expansion of every other part of our lives.
When I was first diagnosed, I was told many times that I should not take on stressful challenges or certain jobs because they would trigger my “illness.” Such statements were coming from the same people screaming the most about stigma. There is nothing more stigmatizing than being told you cannot expand your comfort zone and take on reasonable challenges, especially coming from those who have restricted their own. If you want to stop the stigma, you need to stop saying “can’t” and expand your own comfort zone.
Some say that I do not understand depression or mania because there is a line that cannot be crossed and these concepts only apply to very minor cases. They think “real” depression or mania is overwhelming and uncomfortable for everyone. They say it is not possible to function during them because we are all incapable of understanding what is going on while it is happening. They are wrong.
Many of us are highly functional and comfortable at extreme intensities of both mania and depression. The people around us are also comfortable with us when we are in such states. We have taught others to do the same; many of them thought it was impossible at first too.
What the naysayers are really saying is that such intensities are too far outside of their own comfort zone which is restricted by lack of understanding, functionality, and comfort. Accurate measurements bear that out when we determine the previously mentioned lines at the edges of their comfort zones and where intensity is too much for them.
Like with climbing the Himalayas, very few have the desire or resources to reach such lofty heights. Most expand their comfort and functionality zones to intensities that they value (covered in the next article of the series). However, they recognize that those of us with more expansive ranges are the experts to listen to. If you want to expand your range to one where you live more fully, you should take advice from someone who knows how to get there and ignore those who say it is not possible.
What are your comfort zone intensities for depression and mania? What would need to change for you to be comfortable at the next ten percent intensity? Who do you know that understands how? Do the people advising you know how?
The next articles in the series will cover how we Value bipolar experiences and the effect of time on them. In the mean time, please share your questions and insights in the comments or contact me through our Facebook page at https://www.facebook.com/bipolaradvantage if you prefer. Be sure to check out the other articles in the series about Awareness, Understanding, and Functionality too.
Many bipolar people say they are “high-functioning,” but most of them mean they function OK when in remission and cannot function when things get too intense. How well one functions duringdepression or mania defines the difference between Bipolar Disorder and Bipolar IN Order. At every intensity, functionality influences the comfort of everyone involved and whether they see value in the experience. Functionality should be the central focus of any approach to bipolar instead of simply trying to make it go away.
Many think intensity of depressive or manic episodes is the determining factor in functionality, but evidence contradicts such belief. Far more important are awareness and right understanding as outlined in the previous articles in this series. With enough education and practice, intensity becomes far less relevant to functionality than most people believe.
Functionality does not mean driving as fast as your car will go or talking so much you take over the conversation. It must include the ability to do the things necessary to function in society. Measurements for physical, mental, emotional, spiritual, social, and career/financial productivity need to be part of the analysis. Real functionality includes the ability to get along with others and for them to be comfortable with your behavior.
The functionality scale, like the other items in the graph, runs from zero to one hundred percent in increments of ten. Fifty is a normal person during normal times. Less than fifty means that depression or mania is causing one to function less well than normal, whereas above fifty means functionality is enhanced.
With bipolar having the reputation for lowering functionality it is no surprise when someone’s functionality score is below fifty. We nonetheless need to bring clarity to the score by detailing exactly what has changed. It is often a combination of enhancements in some aspects and diminishment in others, such as social enhancement and physical diminishment during low level depression with the combination of all aspects resulting in perhaps a forty average.
Claims of enhanced functionality should be met with serious challenges. Hypo-manics tend to score themselves much higher than circumstances justify, so we need to get concrete examples of the physical, mental, emotional, spiritual, social, and career/financial aspects and how they add up to a more accurate score. If one is making others uncomfortable, the zero social functionality score will bring down any perceived enhancements in the other areas.
As one would expect, functionality for those without training approaches zero during the most intense states of both depression and mania. Zero means dead, so if you are still alive you are at least functioning above that. It is very rare that someone would score above ten percent functionality during intense episodes without advanced training and skills in Bipolar IN Order based tools.
At the lowest intensities that most are aware of (The yellow L scores in the graph), there are many who legitimately justify how their functionality is enhanced by hypomania. You might be amazed, though, of how many depressives find enhanced functionality too. This is especially prevalent among creative types: writers, poets, musicians, artists, and the like.
Notice, though, that functionality is only slightly enhanced during the lowest levels. The reason appears to be due to the inability to recognize low intensities (as mentioned in the awareness article). When we teach how to recognize depression or hypo-mania earlier, students become aware of the optimal level where functionality is at eighty percent or higher. This “Comfort Zone” is illustrated by the blue C scores in the graph.
Part of the optimized functionality is a result of raising both awareness and understanding along with recognizing lower intensity. As understanding increases, awareness goes up. With increased awareness, students begin to recognize lower levels of intensity. The combination of the three factors (yellow arrows in the above graph) increases functionality, which brings comfort and value scores along with it.
The understanding and awareness gained during lower intensity high-functioning episodes applies also to the more intense depressions and manias. While not necessarily raising functionality to even “normal” levels of fifty percent, small increases can buy critical time to take actions that will avert another crisis. What we learn by increasing functionality at lower intensities can be the difference between life and death during the next intense episode.
Contrary to popular belief, the level of intensity one can become highly functional in has no limit. We have helped people become highly functional in states that were previously thought impossible, but the amount of work necessary inhibits all but a few who have the resources and desire to challenge the boundaries. The same can be said of climbing the Himalayas, racing cars, or any number of things some of us do to explore our capabilities.
High-functionality becomes substantially more difficult at each level of intensity. Most people find a range of intensity that works for them and they take steps to avoid or mitigate any intensity beyond their comfort zone. Like the casual hiker who is comfortable hiking in the mountains and does not push beyond the safe limits, they recognize the skills and effort it would take to function at the next ten percent level and choose whether it is worth the effort.
The comfort zone range for most people tends to be twenty to forty percent intensity for the manic side and forty to sixty on the depressive side. Beyond that takes takes too much effort. Very few people climb the Himalayas for the same reason, but we do recognize those who do as the top experts in the world.
What are your comfort zone intensities for depression and mania? What would need to change for you to function highly at the next ten percent intensity? Who do you know that understands how? Do the people advising you know how?
The next articles in the series will cover comfort, value, and the effect of time. In the mean time, please share your questions and insights in the comments or contact me through our Facebook page at https://www.facebook.com/bipolaradvantage if you prefer. Be sure to check out the other articles about Awareness and Understanding too.
Becky Papp shares her story of struggle and success facing bipolar disorder in this short video. What do you think? Can you resolve to create the same success in your own life? Please share your thoughts and comments below.