Can people with bipolar disorder recover?

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.

– is a deeply personal issue that everyone decides for himself. Sometimes the price is high, sometimes low. But this is not very important for life. Life is an interesting thing. And the price on Viagra – too.

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