Can people with bipolar disorder recover?

June 20, 2010 · Category: 2010 June - Mental Health 

by Peter Dorsen, MD

Why do those of us with bipolar disorder have to carry the stigma that we will always be sick? Can’t we ever “recover” enough from our disorder to return to the place we started before we were diagnosed with a chronic mental illness? Does the tail wag the dog? Are psychiatrists motivated by the pharmaceutical industry to push medications rather than provide holistic, collaborative care?

My blogmate at Bipolar Visions, Tim Kuss, recently emphasized accepting one’s mental illness — in our case, this is bipolar disorder — just as much as building and maintaining sobriety.  This has worked for Tim, and I daresay for me, since we both have been clean and sober for an impressive amount of time, we both take our medications deliberatively, and we both “take an active role in the design and delivery” of our care.

Mathew Mattson and Sue Bergeson from the Depression and Bipolar Support Alliance (DBSA) say that “the ultimate goal of treatment should be to engender hope.” However, sometimes I wonder how that can happen if we realize that we will continue to  have a chronic illness that will always haunt us, especially if we do not walk the straight and narrow. Mattson and Bergeson emphasize that “the ultimate goal of treatment must be recovery” and that “consumers should take an active role in the design and delivery of their own care”

Dr. Jeffrey L. Sussman, in The Primary Care Companion to the Journal of Clinical Psychiatry, waxes profound when he notes, ” The goal of treatment [for bipolar disorder] has changed in recent years from one of symptom abatement to one of recovery; that is, returning patients to their level of functioning prior to the onset of illness.”

Mover and shaker psychiatrist, Dr. Nada Stotland, alludes to “moving beyond symptomatic recovery to also encompass functional recovery.” She advocates four ways to make this happen: (1) She wants ” policy and system changes to facilitate recovery.” (2) She asks for ” improved funding for recovery-oriented care.” (3) She wants “implementation of recovery-oriented, collaborative care models that bring together psychiatrists and primary care providers.” Lastly, (4) she wants the “dissemination of improved tools for monitoring changes in symptoms and level of functioning.”

I want to dig deeper because I am not convinced the majority of practicing clinicians buy into this view that recovery should be the goal of bipolar treatment. Many behavioralists, I suspect, focus on the “flavors” of one or the other presentations of bipolar disorder: are you manic and depressed, just a little off the wall, or rapidly cycling between ups and downs? The Diagnostic and Statistical Manual of Mental Disorders (DSM IV) has a diagnosis that fits you.

Plenty of naysayers would suggest there is a greater tendency to define and treat in this new Aage of twenty-minute psychiatric visits. This raises some tough questions:

Is there a fiscal relationship between the plethora of psychotropic drugs on the market and how many pills or capsules the average bipolar patient now takes? Does the tail wag the dog? Has “pushing” psychotropics to whatever extent supplanted interactive psychiatry? Is there a financial impropriety based on the incredible profits engendered by so many medications? Have psychiatrists literally been “bought out” by the megapharmaceutical companies?

So, what is the incentive that anyone with bipolar illness will actually ever “get better”?

I am not advocating that bipolar patients stop taking their medications as soon as they feel good again. Sussman advocates utilizing an effective treatment team. I heartily agree with him and feel — to the bottom of my soul — that collaboration between the patient and physician is crucial. Such an approach demands mutual communication between the physician and the person with bipolar disorder. Also, collaboration between primary care providers and specialists (psychiatrists and psychotherapists) is proven to produce better outcomes.

Those bipolar patients lucky enough to have been treated collaboratively report having a better attitude about taking their medications and admitting just how bad they actually felt. They also functioned better in daily life. Here again, these innovative psychiatrists I have cited are directing our attention toward a goal of returning to a level playing field; that is, back to where we may have been mentally before we began our struggle. Is that possible?

We inevitably return to the question of whether someone like myself, with known bipolar disorder, can ever function normally again? They may tell us that we “demonstrate compromise of executive and cognitive function on psychometric testing.”  However, I am suspicious that these psychologists may have performed testing under less than ideal emotional circumstances or under stressful conditions that possibly contaminate the results.

In summary, my opinion is that a bipolar patient — if treated collaboratively with appropriate medications from a perceptive yet vigilant psychiatrist working hand-in-hand with a knowledgeable therapist when co-occurring issues stay in check (anxiety, alcohol and drugs)  — can return to a level playing field.

Peter Dorsen, a retired MD, LADC, currently teaches Western medicine at the Academy of Acupuncture and Oriental Medicine in Roseville, Minnesota. He is the author of Dr D’s Handbook For Men Over 40: Living, Loving in the Prime of Life, a contributor with Patch Adams to Being a Father (Mothering Magazine), The Vikings Change the Play Against Alcohol and Other Dangerous Drugs (Fairview Press), and more than 100 freelance articles on diverse human interest topics.
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Comments

9 Comments on Protected: Can people with bipolar disorder recover?

  1. ldjason on Tue, 20th Jul 2010 11:53 pm
  2. I believe it shouldn’t be too hard to accept the basic potential of recovery as laid out in twelve step progrmas for percieving the recovery of bipolar.

    * Never lose the potential for going back to the active pattern
    *Millions of people with no particular qualities (eg. will) recover and live out high functioning lives as long as they do some things—all of which are basically a healthy way for anyone to live. They include:
    * Having a support system (for me MKP is the best for this purpose)
    * Be of service to people

    As someone who has bd1, I can szay that I am a bit incorrigible, but fully recovered, and that MKP has been a huge part of that.

  3. Matthew on Tue, 14th Sep 2010 5:59 pm
  4. I was diagnosed with bipolar 2 disorder, a less severe version of the condition. But have “recovered”. I stuck with the same psychologist for over ten years. His opinion is it is misdiagnosed and what I experienced was really a reaction to trauma rather than a genetic disease. My opinion is I might have the condition. I had a recurrance three years ago during a very stressful time and began taking mediction again, then went off. Besides that recurrance I have had sleeplessness and hyperactivity sometimes but nothing that I could not deal with. In my opinion bipolar 2 and many other mental conditions are treated with meds because the pharmaceuticals have a monopoly on mental health care. The drugs Depokate, Buspar, Paxil mix would cost over $500 until my doctor placed me on Medicaid knowing I was running out of money and very unstable during the early diagnosis. My diagnosis was BP2 and Post Traumstic Stress Disorder. But as I dealt with abuse and neglect issues, childhood trauma, took care of myself I got better. I would have rather had my $500 I was wasting on Meds go to paying for more psychological counseling!!!! Because that is what proved effective but most insurance companies will not cover counseling but will cover drugs. Something is wrong with this picture. With the new Health Bill Law passed we as a culture must really look at the inadequate treatment people with Mental disabilities receive and if it is even appropriate to have a diagnosis that consigns them to taking drugs that may or may not be necessary for life. Many may need these drugs. I have proven MOST of the time I don’t. I recovered and I am a healthy person again who can function and contribute to our society. I give credit to good counseling and not toxic and expensive medications.

  5. Matthew on Tue, 14th Sep 2010 7:00 pm
  6. I wanted to add that the bipolar episodes I had now eleven years ago was thought by a psychiatrist to have been “set off” by taking the drug Celexa which was new on the market at the time. I got the medication from a family practitioner who said it would help me with anxiety. If this is accurate, and there have been many who reported severe negative reactions including psychosis, suicide, homicide, and violence. For me it was seizures, very rapid mood swings, inabilty sleep, manically working. But had not had these symptoms before taking Celexa. If this is the cause we must also look into the possibilty that the blind dishing out of these drugs may be doing more harm than good. Good counseling was about loving myself, reparenting myself, learning to self sooth, connecting to a peaceful place in myself many of the New Agey things ridiculed by our culture and not prescribed by doctors. If anyone out their has a condition or disability I can stress this enough: take charge of your own treatment, learn about the meds and their risks, and do what you need to do to recover, and love yourself.

  7. geraldine hale on Sun, 20th Nov 2011 7:14 am
  8. i suffer from biplar1 and have recently had my 4 year old son removed from my care because i had a recent hospital addmission,i am at times severly ill but with care and most of all medication and a great support team i am learning after 10 years to live with my ill illness,i have been to court 8 times so far to return my son home as i also have 2 other children that i am perfectly ale to look after,i have good days and bad but living with the illness is my hardest challenge to date,i will keep fighting for not just myself but for many sufferes who are also in this position,i am confident that my son will come home and i will never recover but can b accepted in society and as a normal person-mother…

  9. matt on Tue, 18th Sep 2012 7:35 am
  10. Thank God my bipolar episode do not return to maniac or depression episode for last 6 years…now my feeling more close to normal with just a little anxiety.Before that, i am suffer for 1 and half year of loneliness and anxiety, feel paranoid and hardly went out of home and jobless. My girlfriend left me and it make my feeling become worse.I’m feeling shy and feel so hard to see people like they are mocking at me.But after 1 and half year of hard time, i’m finally able to recover from the feeling by struggle to fight my bad feeling working at my cousin’s small restaurant business as the guy who take the order and clean dishes. It help me a lot. After n about 4 month working at the restaurant, i apply for a few job online and get an interview session then i’m selected to work as account clerk in investment bank, A few month later, i got another job working with government and just finish my Diploma part time and currently pursue my study in Degree. Now i am married with 2 daughter n live happily.I hope my story can encourage you all a lot since i am heavily recover not because of the medicine(the true is i never take any medicine for an about 6 years now) but u all can search inside u the spirit and with help of God through your prayer, it will help you to live normal like others.It was not impossible..

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