A few days ago, I received the following email:
Hi Phil,
I would like to hear from you how we can survive the bipolar disorder, as I understand bipolar is a very serious disease.
Regards,
[Name]
The question seems important enough to warrant a more public response, though I have omitted the writer’s name to safeguard confidentiality.
So here’s my reply.
Firstly, the condition known as “bipolar disorder” is emphatically NOT a disease. Rather, it is a loose cluster of behaviors which psychiatrists – in concert with the pharmaceutical companies – have called an illness with the purpose of selling drugs.
The DSM criteria for this so-called diagnosis are set out in my earlier post on this subject.
In practice, the behaviors likely to attract a “diagnosis” of bipolar are:
- Hyperactivity of any kind for an extended period
- Marked irritability; grouchiness; snapping at family, co-workers, etc.
- Marked boastfulness; expressions of grandiosity
- Pronounced sleeplessness
- Excessive talk; rapid shifting from topic to topic
- Temper tantrums
- Behavior that would normally be called “irresponsible,” e.g. sexually reckless activity; buying sprees; gambling; risky ventures; etc.
Traditional psychiatry says that if you’re functioning in this fashion, you have an illness called “bipolar disorder.” The formal criteria call for a certain number of behaviors within certain time frames. Also, a measure of oscillation is required – i.e. the “symptoms” abate periodically, then resurge. And so on. In practice, any of the behaviors listed above will attract this “diagnosis.” And the “treatment,” of course, is: drugs. Usually lithium carbonate – but in the past decade or so other drugs are being used to impact these behaviors. Especially worrying in this regard is the prescription of these drugs to very young children to treat tempter tantrums. (I am aware that temper tantrums as such are not included in the DSM criteria list, but over the past decade or two, proneness to temper tantrums has been conceptualized as “mood swings,” and has become a kind of backdoor feature of this so-called mental illness.)
But, back to the question in the email. What should one do?
Well the answer, of course, depends on what kind of problem behavior we are talking about.
Let’s say that the problem behavior is irritability and temper tantrums.
The first requirement is to describe the problem clearly and completely. “Temper tantrum” can mean different things – everything from stomping one’s foot and saying “drat,” to throwing the furniture out the window. So if a person feels that he/she has problems with anger control, the first thing is to write down exactly what kind of behaviors are occurring and with what frequency (Daily? Weekly? Monthly? etc..)
Duration is important. Has it been going on for years or just in the past few days?
Context is also critical. Where does the problem behavior occur? At home? Work? When visiting in-laws? etc.. Or perhaps everywhere?
And triggers. What kind of situations seem to “trigger” the anger response? Other people’s driving? People talking on cell phones? Outbursts of anger usually occur when we feel frustrated or attacked. Frustration arises when we are trying to do something but can’t manage to do it. And attacks may be real or imaginary.
And substance abuse. Is there a problem with alcohol or other drugs?
And so on. The point being that a simple phrase like “temper tantrums’ or “bipolar disorder” tells us nothing. What’s needed is a detailed written statement of the problem.
I do not know the enquirer personally, so it would not be proper for me to give him/her specific advice. And I don’t know if temper tantrums is the issue or what – but the point is this: specify the problem as honestly as possible and with as much detail as possible.
Often at this point the solutions start to suggest themselves. For instance, if a person is routinely throwing temper tantrums when the car breaks down, then maybe it’s time to get some repairs done or get a new car – or even just decide to get stoical about it – try to let it wash over one.
The point here is that finding solutions to behavioral problems is not quantum physics – usually if one has done a thorough and honest job identifying the problem, then the solutions are forthcoming.
In this regard it is often helpful to break problems down into components and tackle them one at a time. Or to set intermediate goals. A person who identified over-talkativeness as a problem might initially aim to sit silent for one minute, then two, and so on.
I have mentioned elsewhere in this blog the importance – indeed I would say the necessity – of having at least one good friend – someone with whom one can be completely honest. Often the kinds of problems we are talking about here benefit from a second perspective. Other people often see us more accurately than we see ourselves. A best friend can be a spouse, a brother, sister, or just the guy who lives next door. The point is that if I have a significant behavioral problem and if I genuinely want to change this, then asking for help is clearly a positive step.
Some other pointers:
- Try to find and pursue an activity that is incompatible with the target activity. For instance if you feel a temper tantrum coming on, start singing or whistling. It’s difficult to have a temper tantrum while singing a happy tune.
- Acknowledge successes. If you had been having daily temper tantrums and you’ve got it down to one per week – that’s great – acknowledge the gain, but keep working.
- Avoid triggers as much as possible. If a person finds that he has temper tantrums whenever the dog starts barking, then maybe it’s time to get rid of the dog – or get one of those bark suppression collars.
I’ve picked the example of temper tantrums and used it in this reply. But I’m conscious of the fact that this might not be the issue of the enquirer. That’s one of the problems with the term “bipolar disorder.” It simply is not specific enough. But the essential point here is that whatever the behavior is that attracted the diagnosis of bipolar disorder, this behavior can be identified, specified clearly, and remediated. And in this regard you have to do what we all have to do with life’s problems – exploit your strengths to counter your weaknesses. In other words – use your ingenuity. Find solutions to the problem. Don’t give in. Don’t go on doing things the same. Break patterns, etc..
If your problem behavior, in fact, lies in some other direction and you would like further thoughts, don’t hesitate to come back and let me know the specific behaviors that are causing concern.
Now, of course, having said all this, I should add that you can take the conventional step: go see a psychiatrist and take the “happy pills.” I’m not recommending this course of action, but I’m sure you realize that it is an option. Drugs can be effective in suppressing certain kinds of behavior. However, they always have negative side effects, and although they may suppress the worst aspects of the problem behavior, the result is a far cry from normal human existence.