Is "Bye, Bipolar" possible?
What do the following represent?
Mania or hypomania, delirium, hallucinations, paranoia, irritability, dysphoria.
Are they (a) the most common conditions in mental health care institutions, (b) the state of mind of those who perpetrate gun massacres, or (c) some of the adverse reactions associated with a commonly prescribed drug?
It is the latter. The drug is an antidepressant although it's hard to imagine anything as dispiriting as seeking medical help for depression and instead coming away with mania, paranoia, delirium or hallucinations as a result of taking the medication.
Of course, many take these drugs without an adverse reaction. But for those less fortunate, taking the pills can lead into a downward spiral - often without an exit strategy.
Are there alternatives? After year's of giving antidepressants to patients a British doctor realised they worked mainly as placebos - medicine-free pills effective due to the patient's expectancy of receiving help - but with a risk of serious side effects.
The doctor is Irving Kirsch, Harvard Medical School's Associate Director of the Program in Placebo Studies. He has shared his journey from prescriber to chief skeptic in The Emperor's New Drugs: Exploding the Antidepressant Myth.
Dr Kirsch recommends a more thought-oriented approach - psychotherapy. He points to better results from it as well as cost benefits. Like the pills, the improvement at least partly stems from the patient's expectancy of getting better. In contrast to drugs, however, that isn't a problem. Psychotherapy is designed to bring about a mental shift while drugs "are supposed to work because of their chemistry, not because of the psychological factors".
He writes: "Psychotherapists are trained to provide a warm and caring environment in which therapeutic change can take place. Their intention is to replace the hopelessness of depression with a sense of hope and faith in the future."
Are there other ways to achieve that crucial change of thought? Irving Kirsch cites a couple of self-help books proved to work as well as the pill-outperforming psychotherapy for mild or moderate depression. And the English Department of Health just endorsed a Welsh-pioneered scheme allowing doctors to prescribe such self-help books instead of pharmaceuticals for some mental health cases, according to the Guardian.
"There is a wealth of evidence to show that prescribing such books does work, the latest being research published in the journal Plos One which showed that people who used them over a year had measurably lower levels of depression."
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders points to another possibility. The American Psychiatric Association's "mental health bible" added a diagnostic category of "Religious or Spiritual Problem". That "marked a significant breakthrough", according to David Lukoff, Ph.D., Professor of Psychology at Saybrook Graduate School.
He writes: "For the first time, there is acknowledgment of distressing religious and spiritual experiences as non-pathological problems." His online instruction course highlights ways that clinicians can help patients resolve a spiritual crisis.
Someone who drifted from her spiritual roots found she needed this kind of resolution when a mental breakdown resulted in a bipolar diagnosis. She recalls: "The doctors said the disease was incurable, that it would become more severe as I aged, and that medication would be required for the rest of my life to control the symptoms. The diagnosis was devastating."
That led to a decade-long struggle with the disease and side effects from the drugs.
However, one of her psychologists advised her that regardless of how "convincing" those bipolar symptoms appeared they were never really her - they were just "the disease talking".
That advice echoed ideas that had previously addressed her health needs - as a Christian Scientist - before that "devastating" diagnosis alienated her from that spiritual way of life.
Following what she calls " a day of reckoning" she began revisiting those ideas. As she did so, she became increasingly convinced the symptoms were indeed no part of her identity, drawn from a divine source that loved her "without reservation". That gave her increasing inner strength to refuse to listen when the disease was "talking".
There followed months of spiritual growth and struggle during which moments of sweet release were intertwined with times when the disease seemed insurmountable. Finally she clearly saw the nature of the bipolar diagnosis as an imposition on her and became convinced "it was not part of me or anyone".
At the same time, from a spiritual commentary on the Bible, she gained an insight into Jesus' life that inspired her to see she needn't resign to being a victim of the disease.
"With those realizations, I knew I was safe. I still do not have the vocabulary to fully explain the spiritual charge that went through me that morning. Fear was replaced with the feeling of being well—really, truly well."
So it remains, years later.
Not all spiritual and religious beliefs are helpful to mental health. Research has shown fear of a punishing God having a negative impact, for instance. And a lively discussion following a blog on The Spiritual Side of Bipolar Disorder Management shows a broad range of views on the interaction between spirituality and bipolar disorder.
But if one person found a way out of an endless cycle of diagnoses and drugs dependency it suggests there is hope for others to discover, as she concluded after her healing, that whatever "troubled sea" we struggle through "underneath is a deep-settled calm" (Mary Baker Eddy).
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