“So, you have bipolar,” said the well-meaning psychiatrist, “So what’s the big deal?”
I had been talking about the stigma associated with presuming that all mental health challenges were disorders. He interrupted me.
But wait! This was the first time anyone ever suggested that I had bipolar!
Was I supposed to give up my perspective and feel I had achieved something? Somehow was this a more socially acceptable diagnosis? Was getting the right diagnosis supposed to fix everything that happened to me?
As a statistic, I was being moved from the 3.2 million individuals in the United States diagnosed with schizophrenia to the 5.7 million who experience bipolar. Of those with bipolar 70% experience psychosis during mania and 50% during depression.
I had been stable ten years. For the past four years I had been running innovative professional group psychotherapy that focuses on exploring psychosis across diagnostic categories.
I’d had the privilege or cracking open hundreds of stories and contrasting them against the diagnosis of differing staff psychiatrists. I felt I learned a lot about the mentality of each distinctive psychiatrist by doing this.
You see, if your bipolar is like mine and includes experiences associated with psychosis a lot can happen to you in the mental health system. If you stick with me through this article you may learn some innovative ways to cope with psychosis across diagnostic divides.
Common Reasons that People with Psychosis Get Diagnosed Bipolar:
From my vantage point, there are many subjective reasons for bipolar to be selected over schizophrenia or schizoaffective. These subjective factors do not always involve a perfect equation of DSM-V criteria. I’ll go ahead and admit that I do not believe DSM criteria really helps the professional understand the reality of psychosis. Nor is being diagnosed with a psychotic disorder likely to result in more humane and appropriate treatment.
Perhaps, you get diagnosed bipolar because you have suffered a mood component and have a history of being expressive about it in the past. Maybe, your psychosis experiences are intermittent and discontinue with proper support. Perhaps you express experiences that are positive and spiritual that can make your mood and energy soar. Or maybe your body is responsive to small doses of antipsychotics.
Many get diagnosed bipolar because they have enough judgement to convincingly conceal or minimize their psychosis experiences. Sometimes you get the stamp because the psychiatrist respects and has hope for you. If you are a person of color or don’t come from a class the professionals relate to, you are less likely to get the bipolar stamp. I don’t feel I personally need research to believe this to be true. I believe my observations over time are acute enough. However, I do understand that this research does exist.
In my experience some professionals are open to learning and seeing people through the bipolar lenses, and some are more chronic in their ways.
Why Upgrade Your Diagnosis?
When in madness, there was no need to upgrade my diagnosis. I was living in an alternate reality, and I only wanted to feel safe. Being bipolar only meant that I was in danger of being killed and having it called a suicide. All I wanted was to get out of the reality as quick as possible.
In my experience of wellness, there is more of a sense of social acceptability associated with a bipolar diagnosis. Perhaps this is largely because of the misconception that schizophrenia is degenerative or only gets worse over time. Although this is not true, it’s arguable that social stigma does not lead the majority of people to believe otherwise. For example, in 2006 schizophrenia.com suggests a host of negative statistics about schizophrenia including that only 35% of sufferers experience repeated episodes without returning to functioning.
Still, negative statistics (like the one above) enhance the damage that gets done when supporters act without understanding that it is likely that people will heal from psychosis. Good people become institutionalized by bad statistics. Families may not finance a sufferer the opportunity to recover if they keep in mind statistic like that.
Looking closer at that 35% statistic, they come from E. Fuller Torrey’s 2006 statistics which suggest that after ten years, 15% of schizophrenics will be permanently hospitalized and 10% will have killed themselves verses those studied over thirty years during which 10% end up permanently hospitalized and 15% will have killed themselves. This starts to sound like a 35% throw away rate.
Consider that many health plans do not even offer treatment to people with schizophrenia. Likewise, I know locally it is easier to find a professional bipolar group or specialist than it is to find a professional schizophrenia group or specialist.
Less stigma, less negative statistics means less social persecution. That is why many people who are looking to make social rehabilitation gains try to suppress their psychosis and fight against a schizophrenia diagnosis. Many suffers learn to do this so people don’t reject you.
What it Takes to Suppress Psychosis Regardless of Diagnosis?
How does one suppress psychosis? I think it has a lot to do with having a project that is very meaningful to you and vying to be successful with it. Then, the sufferer just cannot let anything get in their way. Sound stupidly easy? The best way I can convey that it isn’t is to share pieces of my experience.
In State hospital, most staff who thought I was schizophrenic would just dominate and humiliate me. I believed that if people knew I was schizophrenic that that type of treatment would resume. My complex appeals to staff to convey that I okay with the FBI resulted in a beat-down by the cowboy security squad. Begging for aspirin with a highly uncomfortable fever, caused one nurse to write a note that I was sexually inappropriate with her. These are not the types of things you want to see happen to you on the outside,
Meanwhile many of my peers tried to recruit me into their white supremacy gang, or the Mexican mafia, or the FBI, or in one case, the Navy Seals. Sound safe in there?
These kinds of experiences cannot be spoken of when you suppress your experience. Nothing happened! They become buried secrets.
But the treatment that had the most lasting impact was the experiences I had to suppress in the community.
There was the woman who flashed me a secret service badge. She initially said I would be safe if I took the over-priced apartment. She showed up again the day I came home to find my apartment had been ransacked and accused my uncle of doing it.
There was also the mail that came from my county work applications that was repeatedly torn open in spite of my complaints at the postal service.
There was the occasion when I was followed on my way to work by a resident I knew from Seattle (I was working in California.) He had handcuffs and a jean jacket with a hand made sign that read CIA on it.
There was the time a computer hacker marked-up my resume at the local library. Several encounters later he told me that he worked for the multinational corporations.
This kind of treatment accompanied me for two years and stopped when I got professional employment. It was traumatic and perpetuated my emergency state, but I learned to pretend it didn’t matter.
If you can ignore the fact that you have no rights and just persist at your immediate project you can overcome psychosis.
It’s Just a Political Discussion:
Resuming professional employment, I worked seven days a week. Eventually, I managed to get a psychotherapy license and earn enough for a down payment on a house in the bay area. I met my wife and got married.
So finally, once I got that kind of support behind me and put a well-meaning psychiatrist in a spot that challenged his perception of disorders, I got bumped up from schizophrenia to bipolar, yay!
Now the DSM-V, which wasn’t yet written during my escapades, says that people with bipolar who go through psychosis in a low mood can experience fear and paranoia. This is exactly what I experienced. Perhaps, one day I’ll get out of my depression and become hypomanic! That gives me something to look forward to!
However, when we examine the recent research this point may become moot.
Laboratory Science Supports Treating Psychosis Across Diagnostic Divides!
In the laboratory they are coming out with scientific findings that strongly support the view that diagnostic differentiation is irrelevant.
In fact, in a very recent article published by The Psychiatric Times, schizophrenia is being considered a syndrome that is more of a neurodevelopmental disorder than an illness or disease. Additionally, these findings do not support different kinds of neurodevelopmental evidence for bipolar verses schizophrenia verses schizoaffective, verses depression with psychosis.
If treated poorly, the neurodevelopmental process will become more extreme! Thus, sufferers can be trained to cope like dyslexics can be trained to read. This vantage point can help promote training in social functioning like specialized job placement programs like the IPS model out of Dartmouth. This practice can help participants in early prevention programs, or at any stage of recovery. get back to work.
Of course, there are many other social skills to learn when you have to suppress trauma! Of course, social skills are gained through socialization groups.
Other Considerations Stemming from The Research:
Moreover, I believe that understanding that you have an underlying condition like ADD, Dyslexia, or Autism can save you from living out your depression and mania to their fullest. Instead of feeling like a slave to the moods, neurodevelopmental understanding helps understand the basis for the moods. By learning that there are reasons you haven’t been included, one can use it to make meaning of depression and play back tapes of the consequences of mania.
Additionally, sufferers can learn about ways they have been traumatized for being different. Also paying attention to real underlying trauma that exacerbates the expression of the syndrome becomes important.
All this can help people with bipolar psychosis learn how to live in their strengths and focus on their abilities and the ways they are exceptional. Albert Einstein, Temple Grayden, and Earnest Hemmingway are just a few of many examples of how people with neurodevelopmental issues can contribute to society in very advanced ways.
As a society, some of us are learning that celebrating neuro-diversity, like they do in some more traditional societies, can lead to better outcomes for people who are built differently. In fact, some might argue that if the problem is neurodevelopmental, expecting symptom suppression without accommodations and providing support groups is just not humane.
Treatment for Psychosis Across Diagnostic Categories:
Here is where I can help other bipolar people if they are willing to explore those terrifying experiences with other good people who are stigmatized. This may involve getting to know people who are from different cultures and may still be in challenging circumstances.
Losing privilege and connecting with those less fortunate is so counter-intuitive in this land where the haves hate the have-nots. But oddly going against the grain in this manner can help exponentially!
If your bipolar experience includes psychosis, treatment can exist in group therapy that normalizes and permits you to express your stories without getting punished. If you are encouraged to work with people with differing diagnostic histories you can learn to be a leader and supporter.
No doubt, the mental health incarceration system varies based on the socioeconomics of your locale. Regardless, it will train you to suppress those psychosis experiences and pretend like they are not real. If you fail to suppress, you will be rejected and ridiculed by others and if this upsets you, you will be punished by going back to the hospital.
If you are able to play the game and can return to work, go ahead and become the bipolar diagnosis. To do so you can simply engage in social rehabilitation and work without upsetting the applecart. It becomes a political discussion with a psychiatrist like the one I had above.
Group Therapy for Psychosis:
Okay, I’ll admit, suppression is not always so easy for all of us. But over the years I have seen many individuals hide their psychosis, avoid my groups, and pretend like what they went through was just bipolar stuff. Indeed, I had to play this game for six years. I had to start over again without anyone knowing anything about me.
However, if you are like me and had to overcome some dramatic circumstances, suppressing all those experiences and trauma may turn you into a traumatized droid. A part of you is permanently disassociated and all you can do is work and try to act in ways that keep you out of trouble.
I am here to promote one potential outlet that I was eventually able to use: group therapy in which the content of psychosis is shared and participants learn from each other.
For example, I hear very few voices and never thought of aliens, but when I learn from people who do, it helps me be more flexible in the meaning I make of what happened to me. My desire to collaborate and support helps me be flexible and decreases my distress.
As a psychotherapist, I started leading these groups and sharing my story to prompt others to feel comfortable in doing so. I learned that by sharing my story and demonstrating that I had recovered, I could use my suffering towards a useful purpose.
Whether you do it as a professional, a peer counselor, or a volunteer, getting support for those things you’ve been through and teaching others how to survive with psychosis can be very rewarding. It can help bring you back to life!
Opportunities to do this can be available through the hearing voices network movement. This is an international movement that seeks to set up peer support outside the mental health system. In the United States, you can click: www.hvn-usa.org!
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