Duh Diagnosis

Posted by fxckfeelings on April 18, 2013

Whether it’s mental illness, high blood pressure, or Bieber Fever, finding out that you or a loved one has a chronic, incurable condition stirs up feelings that you must learn to manage if they aren’t to manage you. Instead of attempting to change what you can’t or fleeing into comforting activities with bad hangovers, gather your courage and learn about actual risks and the limits of treatment. If you do that and avoid panic, self-medication, and/or dubious musical choices, you’ll become effective at helping yourself while staying focused on your life rather than your disease.
–Dr. Lastname

I met the greatest girl six months ago—she’s smart, hard-working, and we share the same values, so it’s not just an infatuation based on her looks or laugh or whatever. As I was getting to know her, I was thinking she’s the sort of person I would want to have a family with. Then, a couple of weeks ago, I got the feeling that she was getting a little…weird? She wasn’t sleeping, and was working obsessively on random stuff like color-coding the bookshelves, couldn’t stay focused, even while driving, which was pretty scary. Then last week, she started to talk fast/non-stop and text our friends about how great our sex was. The next thing I knew she was in the hospital, where I now understand she’s been once before, and her parents tell me she’s bipolar. I’m really not discouraged about her having a mental illness freak-out, I just want to find a way to help and also not let this get in the way of our relationship.

We tag every post on this side with “acceptance,” and that’s because it’s central, not just to dealing with life’s problems and getting to use the iTunes store, but in terms of long-term relationships. Acceptance isn’t easy for most, but it’s clear you have full faith in your girlfriend, in sickness and in health.

The downside to such natural, positive acceptance, however, is the lack of screening process for the life you wish to share with her; if you’re looking for a partner, you also have to ask whether her illness will allow her to do the job. Your relationship is rooted in something real, but so is her illness.

There are some chronic, burdensome illnesses that don’t take away your personality and ability to function except for brief periods, but there are others that do. You owe it to yourself, her, and the family you might want to raise together to think practically about her ability to continue to be who she is and stay as strong as she needs to be.

As someone who loves her, you may well want to nurse her back to health and place prime responsibility on her support system, including yourself, for how well she does. Unfortunately, the power of loving family and friends is limited, as it is with any illness. Instead of immersing yourself in her recovery, spend some time assessing the traits that make recovery possible, like whether she’s been steady with her medication and avoiding illegal substances.

The fact that she has been hospitalized for a bipolar illness after becoming manic and crazy doesn’t mean she can’t be healthy; she didn’t have symptoms for most of the time you’ve known her, and, with luck, she can manage her illness so that episodes are few and brief, if they occur at all. Your job is to determine her chances of doing so and, to do that, you need to know a little about bipolar illness and what makes it manageable for both of you.

Basically, predicting how well she’ll do is a matter of common sense. She’ll do better if she’s had only a few episodes, responded well to medication, taken it regularly, and stayed away from alcohol and non-prescribed drugs. In other words, the better she’s done, and the more rationally she’s managed her illness, the better she can be expected to do. The less her emotional swings have affected her character and habits, the better she’ll handle her illness going forward. If you find out she’s had trouble with medication—both finding a good one and sticking with it—and struggled to keep her illness from sabotaging her jobs, relationships, and dreams, then the outlook is less positive.

Review the quality of her decision-making when she isn’t sick, like whether she can control impulsivity and wishful thinking in order to do what’s necessary. Find out whether she’s stayed connected to important relationships, regardless of illness and the ups and downs of her mood. Above all, don’t let your loving, protective urges prevent your from gathering facts and assessing her ability to manage her illness and the periodic disability it may cause.

Hopefully, you’ll discover that she’s a good manager who can use your extra love and support to help her rebuild her life. Whether she is or not, however, being realistic will help you make the partnership decision that will work out best for both of you, given the fact that illness sometimes makes certain dreams impossible, and acceptance, while crucial, should not be given as lightly as a tag on a website.

STATEMENT:
“I love my girlfriend and I’m determined to help her recover from mental illness, but I don’t yet know how impaired she really is. As painful as it may be, I will gather the information I need to make a good decision about our possible partnership and will not decide on the basis of love alone.”

I was always depressed growing up, although we never called it that because my family doesn’t know anything about depression and doesn’t want to know. When counseling was offered for free in college, I started to get treatment and even feel better. Then, after a couple antidepressants stopped helping me, the doctor tried lithium and it really made a difference. Since then, he’s been telling me I have a “bipolar illness”, which freaks me out, so now I’m depressed about my diagnosis. I wonder whether I’ll always have it and whether it will ruin my life or force me to take medication forever. My goal is to understand why he would give a diagnosis like that and what it means for my life.

Perhaps because mental illness is not well understood and has such a potentially devastating effect on the way we feel, think, and form our personalities, psychiatric diagnoses are scary, despite the fact that they have very little predictive value. You were given the bipolar diagnosis, however, not because you acted like a nutty speed freak who couldn’t stop talking, spending, or cleaning (all classic manic symptoms), but because the medications that help those symptoms in others happened to help your depression. That’s all it means—it’s not a prediction of doom, just an attempt to categorize what’s already going on.

While it’s true that a few people who carry the bipolar diagnosis spend a lot of time feeling too high or low (usually too low) to stay functional, working, and out of trouble, there are many more people who have painful mood swings from time to time but have as much control over their lives as anyone else (which is to say, not nearly enough). They may have episodes of pain and dysfunction when their medication doesn’t work, much like people with arthritis or colitis, but they do well if they can accept the unfairness of their condition, develop active ways of managing it, and stay focused on what they want to do with their lives in spite of it.

So don’t let a bipolar diagnosis scare you. As noted above, your prognosis depends much more on how well you take your medication, stay away from drugs, develop healthy habits, and keep feelings from making decisions for you than it does on your diagnosis.

It’s true that mood-disordered feelings are often powerful and try to make you believe you’re better or worse than you really are, but that’s what feelings do to most of us, which is why it’s important not to over-respect them. You may need to work harder than most people to build a philosophy and protect your beliefs from distortion by depression, pessimism, fear and self-criticism, but you won’t be alone and your efforts will not be that different from what most of us have to do.

Don’t worry, you won’t take medication all your life unless you find it’s necessary, and this is a condition where you must be the judge as well as main scientific observer who figures out what’s necessary or not. If your symptoms don’t fade away by themselves, or if, as often happens, they come back from time to time, you’re the one who must decide whether a medication, or any other treatment, is useful and whether it needs to be continued to prevent another attack. People who continue medication are those who have found something that works and have decided that their symptoms are too painful, disruptive, and persistent to ignore.

Of course, fearing a diagnosis can easily cause bad things to happen, confirm your fears, and drive you to drink or avoid treatment when you need it. So treating your fear is often more important than treating your diagnosis. Don’t think for a moment, then, that the shrink thinks you’re going to go crazy or that you’re doomed to be ill.

The good news is that the shrink believes there is a class of medication that can help you, and that you now have more ability to control symptoms and prevent relapse than before. We all have problems we can’t control—yours just have a scary name, but because of that name, they’ve also just become a lot more manageable.

STATEMENT:
“Hearing a psychiatric diagnosis felt like a sentence of doom, but everything I learn about mental illness assures me that my worst fears are unlikely to come true and that the better I become at managing fears of mental illness and respecting what I do with them, the better I become at living life.”