Bipolar Disorder – Re-Conceptualizing and Re-Contextualizing
Sometimes giving up control and responsibility to a psychiatrist and accepting a diagnosis, or that you have in illness, is much easier than facing the real reasons, real emotions, behaviours, choices and resulting consequences that actually lead to emotional and psychological crises.
In other words; the diagnosis of a mental disorder can be much easier to accept than one’s abuse, trauma, poor coping skills, poor communication skills, confusion, insecurity, anxious or angry thoughts, reactive behaviour and substance abuse issues. If predisposing factors such emotional, psychological, physical, or sexual abuse and trauma happen to be inflicted by someone like a parent or a grandparent; where social, cultural, and familial prohibitions and fears of broader ramifications create secrecy, denial, and minimization; the risk that the victim will accept their lack of control and further subjugate themselves and their rights for health and happiness to yet another controlling or oppressive force such as the medical system/psychiatry might be much greater.
In effect it's a parallel process: where psychiatry and the DSM have endorsed the use of denial, minimization, projection, displacement and intellectualization to appear scientific and credible, and to protect itself from rational thought and perspectives about the real factors which cause emotional and psychological health issues.
Over the last two decades of working in social services, psychiatric hospitals and community mental health, I noticed that a noteworthy proportion of reported cases of "bipolar disorder" appeared to have tangible and rational psycho-social etiologies. With some attention to thorough assessment and collaborative formulation, we elucidated an apparent pattern that may be worthy of further consideration: pre-existing self-management deficits (ie: related to trauma, abuse or inter-generationally transmitted poor coping skills for stress and emotional problems)---> psychosocial stressors and emotional problems/depressive symptoms ---> resulting compensatory unconscious thoughts/psychological defence mechanisms, and ineffective/often detrimental behaviour (avoidance, withdrawal, substance abuse etc) ---> increased stress, cognitive dissonance, elevated anxiety and depressive symptoms ---> further disrupted social rhythms and sleep patterns ---> further emotional/psychological decompensation ---> a predictable psychological crisis.
This hypothesized pattern appears similar to the observed stages of a psychological crisis proposed by Caplan and colleagues in 1961: stage 1) an initial rise in tension occurs in response to stressors or an event; stage 2) increased tension disrupts functioning (thought/feeling/behaviour); stage 3) unresolved stress and tension leads to depressive symptoms; stage 4) lack of resolution to the dilemmas result in psychological crisis (psychological defences are engaged ie: overcompensation, reaction formation etc). One can easily see how repeating psychological crises might be conceptualized as bipolar or manic-depressive cycles. More recently, Jeffrey Young and his associates, through the lens of Schema Therapy have developed a well supported formulation demonstrating how maladaptive coping responses vascilate from surrender and avoidance ("depressive" phase) to overcompensation ("manic" phase). When Caplan’s and Young’s formulations are transposed on this hypothesized pattern, it lends further support to this proposed understanding of the emotional and psychological reactions of predisposed persons that is much more tangible than; "….the etiology of the disorder is yet unknown…", which permeates the pseudo-scientific literature about bipolar disorder.
When individuals’ thresholds for psychological and emotional decompensation become routinized by economic and social realities, by the cumulative effect of daily stressors, the cumulative effect of disrupted sleep, cumulative effect of deficient self care, and a pervasive external locus of control – then it stands to reason that their psychological functioning might also become "cyclical". It is very interesting to observe that some cyclical symptoms coincide with income support checks and the resulting increases in substance abuse. Furthermore, given that human functioning is known to be connected to biological and environmental cycles and rhythms: circadian, solar, lunar, menstrual, seasonal, hormonal, etc; cyclical changes might be considered quite normal, adaptive and expected if one lives on the planet earth.
The problem is not the people affected by these tragedies and cycles, or their socially learned tendencies to accept without question what they are told by professional-centric "experts". The problem is with misdiagnosis and over-diagnosis that results from myopic assessment skills of mental health practitioners of all disciplines who seek easy answers for very complex and individually specific emotional and psychological issues through the medical model and scientific lens. The negative effects of quick and easy DSM categorization are undeniable in creating and sustaining such myopathy. The well documented and researched rates of misdiagnosis and lack of diagnostic reliability amongst practitioners make it entirely rational, valid, and necessary, to be critically thoughtful of rampant "flavour of the month" psychiatric diagnoses and the resulting medical treatments which perpetuate an external locus of control for those seeking help.
When client centred formulations have been presented to bio-medically oriented care providers to support patient’s rights to helpful interventions such as therapy and skill development, I and many of my colleagues have faced heavy criticism, oppression, and direction to be respectful of the status, training and authority of medical doctors and psychiatrists and to comply with "evidence based practice". We know that the published research and "evidence" about mental health issues is dramatically skewed by the political and financial needs of special interest groups.
Acquiescence and subjugation can be breeding grounds for emotional and psychological difficulties. As a social worker, a clinician, and an invested member of our society; I chose emotional and psychological health and will remain person-centred in my practice and critically thoughtful of the biomedical model and mental health practice.
"There is something feeble and a little contemptible about a man who cannot face the perils of life without the help of comfortable myths. Almost inevitably some part of him is aware that they are myths and that he believes them only because they are comforting. But he dare not face this thought! Moreover, since he is aware, however dimly, that his opinions are not real, he becomes furious when they are disputed." -----Bertrand Russell
In support of critical thinkers and ethical care,
Yaddi Singh BA, BSW, MSW
Registered Social Worker