Speaker 1: Welcome to the Psychology Podcast, where we give you insights
Speaker 1: into the mind, brained behavior and creativity. I'm doctor Scott
Speaker 1: Barry Kaufman, and in each episode I have a conversation
Speaker 1: with a guest who will stimulate your mind and give
Speaker 1: you a greater understanding of yourself, others, and the world
Speaker 1: to live in. Hopefully we'll also provide a glimpse into
Speaker 1: human possibility. Thanks for listening and enjoy the podcast. So
Speaker 1: today we have Michael Pippach on the podcast. Pippach is
Speaker 1: a licensed marriage and family therapist and has treated a
Speaker 1: wide range of mental disorders and relationship problems in adults
Speaker 1: and adolescents for our thirty years. Michael is also a
Speaker 1: national speaker on bipoor disorder and has been featured on
Speaker 1: radio and print media on a variety of topics. His
Speaker 1: latest book is called Owning by Poor How patients and
Speaker 1: families can take control of bi poor Disorder. Michael, really
Speaker 1: great chat with you today. Thank you very much for
Speaker 1: having me, Scott. It's a pleasure to be here. Glad
Speaker 1: to hear that this is a topic that we have
Speaker 1: not covered yet on the Psychology Podcast, so I think
Speaker 1: it's it'll be a great service to our listeners. So five,
Speaker 1: is this statistic true that five percent of the population
Speaker 1: suffers from bipolar disorder or about three hundred and fifty
Speaker 1: million people worldwide. Well, depending on what research you take
Speaker 1: a look at, I've reviewed research that suggests anything from
Speaker 1: one to two percent, although we up to five percent,
Speaker 1: and I think the more recent data suggests that as
Speaker 1: we get better at identifying bipolar disorder, that number will
Speaker 1: probably hold out. And so if you take five percent
Speaker 1: of the population worldwide, yeah, that's that comes out to
Speaker 1: three hundred and fifty million people thereabouts. And you know
Speaker 1: one and twenty people that you that you meet over
Speaker 1: of course a day, or pass on the sidewalk likely
Speaker 1: has some form of bipolar disorder. I mean that's a
Speaker 1: big deal, geez. So I want to really talk about
Speaker 1: this though. When you say has bipoor disorder, I mean,
Speaker 1: all these things are just labels at the end of
Speaker 1: the day. I mean there's a constellation of characteristics that
Speaker 1: you know go underneath those labels. But you know, there
Speaker 1: was no like ten commandments from God saying like this
Speaker 1: person has bipolar this person doesn't, you know, So I'd
Speaker 1: love to hear your thoughts on how you define bipolar
Speaker 1: and what you see is some of the main characteristics
Speaker 1: of it. Absolutely, I think it's important to talk about it,
Speaker 1: particularly because the more that we as a larger community
Speaker 1: discussed by polar disorder. I think even though that's very important,
Speaker 1: and that's a big reason of course that I wrote
Speaker 1: the book, and you and I have had this conversation today,
Speaker 1: but we know that, particularly when it comes to psychological
Speaker 1: terms and particularly certain mental disorders, it becomes risky to
Speaker 1: kind of use it in casual conversation. Somebody said, you know,
Speaker 1: I think she's really bipolar. Not meant to be a
Speaker 1: diagnostic suggestion, but kind of just to talk about characteristics
Speaker 1: in a way that again is kind of casual, but
Speaker 1: may turn out to be demeaning and in itself identify.
Speaker 1: I think, Scott, when we talk about what is bipolar
Speaker 1: disorder and how to distinguish it, I think it's important
Speaker 1: to talk about at least a little bit of the
Speaker 1: history of what had historically been called manic depression. And
Speaker 1: we have evidence dating back to the ancient Greek physicians
Speaker 1: that chronicled patients that had these extreme mood swings as
Speaker 1: mania and depression, or maybe described as melancholy and so
Speaker 1: forth through the ages, but only recently did we describe
Speaker 1: it as bipolar disorder, and exactly what that term suggests.
Speaker 1: There are two extreme poles of emotional experience. Just as
Speaker 1: we kind of think of the globe as having a
Speaker 1: north pole and a south pole, and that represents the
Speaker 1: furthest points on the globe, and bipolar disorder, we're talking
Speaker 1: about the furthest points of a mood state where a
Speaker 1: person experiences very extreme periods what we could describe as
Speaker 1: mania very precisely and also somewhat generically, because there's other
Speaker 1: forms of it, such as hypomaniu and so forth. But
Speaker 1: those symptoms include a very expansive euphoric type of mood
Speaker 1: state that's consistent over a period of time, not something
Speaker 1: that somebody necessarily experiences very quickly in relation to something
Speaker 1: that wonderful that's happened in their life, but because of
Speaker 1: a certain biochemical neurological change, they experience a persistent type
Speaker 1: of either euphoric expansive mood suggesting of feelings of grandiosity
Speaker 1: and just wonderfulness to the possibility of very irritable, dysphoric
Speaker 1: type of mania, and alongside those symptoms either way, whether
Speaker 1: you have euphoria or dysphoria or some combination of that.
Speaker 1: During that period of time, there is often a decreased
Speaker 1: need for sleep, where the individual doesn't really necessarily try
Speaker 1: to sleep or want to sleep. But in the case
Speaker 1: of somebody who's experiencing mania, they don't want to sleep,
Speaker 1: They want to stay up, and they want to do
Speaker 1: all kinds of different things, and under the umption that
Speaker 1: they're hyper productive or hyper creative. Alongside those symptoms, it
Speaker 1: is pressured speech, flight of ideas. It says, if they
Speaker 1: become experts and all kinds of different issues and then
Speaker 1: feel like they have so much to give in that
Speaker 1: moment and try to through various activities, experience a sense
Speaker 1: of productivity and output that they can't in any other
Speaker 1: time without that mood state. Also, and I think most notably,
Speaker 1: they can experience very high levels of impulsive drive, which
Speaker 1: may turn out to be very harmful kinds of activities
Speaker 1: like shopping sprees or hyper sexuality and other kinds of discretions.
Speaker 1: Is that what happens to me every time? That's what
Speaker 1: happens to me every time I go to the Apple store. Yeah,
Speaker 1: But if you have a drive to go to the
Speaker 1: Apple Store for several days in a row and exhaust
Speaker 1: all of your financial means on all kinds of gadgets
Speaker 1: and stuff that that, of course you would need necessarily.
Speaker 1: That's probably indicative more of something that would be we
Speaker 1: would describe as asthmatic. On the other side of that
Speaker 1: pole is a profound sense of depression again that lasts
Speaker 1: consistently over a period of time. Diagnostically, it has to
Speaker 1: be at least two weeks for it to qualify as
Speaker 1: an episode of major depression. So again, bipolar disorder is
Speaker 1: something that is experienced in these extreme mood states where
Speaker 1: an individual can again experience and have to live with
Speaker 1: very severe consequences of their behavior, which often can be
Speaker 1: uncharacteristic of who they are and what they typically do
Speaker 1: when they're not in those mood states. Okay, so that's
Speaker 1: a really good caveat there at the end. Thank you
Speaker 1: for outlining that. Now there are different gradations. I'm not
Speaker 1: fully up on everything, but there's like bipolar one, bipolar two.
Speaker 1: Isn't there like a mild or form of bipore where
Speaker 1: you have more of the mania than the pres and
Speaker 1: that's classified as something Is this right? Well, there's three
Speaker 1: basic types, and within those there are certain qualifiers that
Speaker 1: we see in the DSM that kind of helps us
Speaker 1: to sort of specify varieties along a continuum. But those
Speaker 1: three basic types are bipolar one disorder, bipolar two disorder,
Speaker 1: and then cyclothymia. I guess you can almost describe that
Speaker 1: as bipolar three, though people don't technically use that term,
Speaker 1: but we really look at mostly bipolar one and bipolar two,
Speaker 1: and bipolar one basically is diagnosed when an individual has
Speaker 1: a history, not necessarily in the present moment, but some
Speaker 1: history at least one episode of mania in their life
Speaker 1: where they have those symptoms that I just spoke of,
Speaker 1: but they have it for at least seven days in
Speaker 1: a row. Sometimes it goes on much longer than that.
Speaker 1: The only caveat there is that if they are hospitalized
Speaker 1: and treated intervened at some level, that could interrupt that
Speaker 1: seven day period, but that would be considered diagnostic by
Speaker 1: board one. Bipolar two sometimes people and I think we
Speaker 1: used to think this way, but this idea is changing
Speaker 1: that bipolar two is sort of a lesser form of
Speaker 1: bipolar one, sort like bipolar light, if you will. But
Speaker 1: we don't really think of that quite in those terms,
Speaker 1: Bipolar two is diagnosed if there is at least one
Speaker 1: hypo manic episode, which are all the symptoms that I
Speaker 1: just spoke of, but a shorter duration. They could be
Speaker 1: at least four days in length, or either as a
Speaker 1: consequence of a shorter duration compared bi polar one, or
Speaker 1: just because the consequences may not be as fully actualized
Speaker 1: as you might see bipolar one. Hypomania by itself as
Speaker 1: a single episode is typically looked at as less consequential
Speaker 1: than what you would see in what sometimes people call
Speaker 1: full long mania on that bipolar one side. But people
Speaker 1: with bipolar two not only have to have that one
Speaker 1: episode of hypomania, but they also have to have one
Speaker 1: episode of major depression, which is not a part of
Speaker 1: bipolar one diagnostically. So because people with bipolar two are
Speaker 1: only considered having that diagnosis, they have a period of
Speaker 1: depression along with diypomania, we no longer think of it
Speaker 1: as a lesser form of the disorder, because the depression
Speaker 1: itself may be very, very devastating. People with bipolar two
Speaker 1: can suffer many many consequences of their disorder, and including
Speaker 1: a very high rate of suicide. Potential jicks. What are
Speaker 1: the rates of suicide in people who have been diagnosed
Speaker 1: with bipolar Yeah, so we know that that bipolar in general,
Speaker 1: bipolar one and two and its variance collectively, individual that
Speaker 1: has some form of bipolar disorder is at least twenty
Speaker 1: times more at risk for suicide than any population, at
Speaker 1: least twenty percent. There's some research and in the DSM
Speaker 1: five itself, it does mention that one fourth of all
Speaker 1: deaths by suicide may be attributable to bipolar disorder itself,
Speaker 1: and in this country alone, that's over ten thousand lives lost. Everyone. Well,
Speaker 1: let me ask you a question. What's the breakdown of
Speaker 1: people who have commit suicide in a manic state versus
Speaker 1: a depressive state. I often get asked that question, and
Speaker 1: it always compels me to kind of look more deeply
Speaker 1: into the research to see if in fact there are
Speaker 1: differences there. So, the best that I can understand, and
Speaker 1: in working with people with bipolar disorder who have expressed
Speaker 1: suicidal ideation, my best answer to your question is that
Speaker 1: it really can occur in any mood zone across that
Speaker 1: single spectrum, from the very worst form of media and
Speaker 1: by the way, in bipolar one, you can have psychotic
Speaker 1: features associated with your manic episode, hallucinations and delusions and
Speaker 1: so forth. So from the very worst form, which is
Speaker 1: a psycho type of mania, across the board to the
Speaker 1: very worst form of depression, which we would probably expect
Speaker 1: to be the most pernicious time for anybody, particularly with
Speaker 1: respect to self harm and suicide. Still, I think that
Speaker 1: suicide potential and an individual bipolar can occur at any
Speaker 1: point across that spectrum, even when they're not in a
Speaker 1: severe mood state and more of a baseline position. And
Speaker 1: I think the reason for that god is that very
Speaker 1: often would people sort of their moods sort of retreat
Speaker 1: to that middle round or that baseline zone, especially when
Speaker 1: they're not in treatment, they can become aware of the
Speaker 1: damage that they might have enacted as a result of
Speaker 1: these extreme mood events and become more aware of it.
Speaker 1: So it's not as if few I'm baselines, so I'm
Speaker 1: feeling great now, I'm not suicidal. They may be that
Speaker 1: might be their moment of reflection when they've seen the
Speaker 1: damage that has been created as they as they've kind
Speaker 1: of gone through either of those mood events. So I
Speaker 1: think that again that suicidal potential exists across those mood
Speaker 1: states and somebody that has bipolar disorder. Wow, well, this
Speaker 1: is really really important stuff. I'd really like to hear
Speaker 1: about your three phase approach to treating patients with bipolar
Speaker 1: because you argue that it goes beyond the usual treatment
Speaker 1: that's centered on getting patients on meds and keeping them there.
Speaker 1: Could you maybe talk a lot about that approach? Yeah, absolutely,
Speaker 1: I'd be happy to. So can I explain this in
Speaker 1: Owning Bipolar for patients and families to better understand those
Speaker 1: particular treatment needs. But I think again it's you know,
Speaker 1: these are kinds of things that I think it's important
Speaker 1: to understand community wide, and hopefully treatment professionals can also
Speaker 1: adopt some of these this framework and the objectives contained
Speaker 1: within it. So the three phase approach is centered around
Speaker 1: the medical stabilization by polar mood swings, with the centerpiece
Speaker 1: of the treatment being medications and how those medications are
Speaker 1: first prescribed and then monitored towards kind of setting an
Speaker 1: ideal place for any individual with bipolar disorder, knowing that
Speaker 1: everybody has different kinds of medical needs and different body
Speaker 1: chemistry and so forth, requiring you know, whatever medications are
Speaker 1: most appropriate for them, but like you said, it's not
Speaker 1: limited to that. Now. I found if I can just
Speaker 1: say this quickly and then I can talk about the
Speaker 1: spaces kind of is a little bit of the background.
Speaker 1: I found that before I delved into this research and
Speaker 1: began constructing these three phases, that the predominant treatment approach
Speaker 1: for many years, particularly since lithium kind of hit the
Speaker 1: scene in North America during the nineteen seventies and early eighties,
Speaker 1: was that because the medication lithium and then later other
Speaker 1: mood stabilizers were so effective, it seemed to for a
Speaker 1: lot of people to just replace the need for talk therapy,
Speaker 1: which was largely ineffective before those medications were made available.
Speaker 1: And I think a couple of generations of therapists since
Speaker 1: then really have not gotten the training necessary to look
Speaker 1: at it more comprehensively in terms of what's necessary for
Speaker 1: the treatment overall bipolar disorder. So, having said that, the
Speaker 1: three phases begin with the pre stabilization phase. That's the
Speaker 1: first phase that's marked by some sort of crisis related
Speaker 1: to bipolar disorder that's being presented to treatment, and sometimes
Speaker 1: that's not really so noticeable as bipolar symptoms themselves, but
Speaker 1: some sort of crisis. It might be a crisis in
Speaker 1: the relationship of financial, work related problems, or health related problems.
Speaker 1: It's not unusual for me to get referral from the
Speaker 1: court system from an attorney that believes that the client
Speaker 1: has gotten in trouble, probably and maybe repeatedly, and may
Speaker 1: have some sort of mental illness that's striving that very
Speaker 1: often that could be bipolar mania. In that pre stabilization phase,
Speaker 1: there may be other presenting issues, of substance abuse being
Speaker 1: a big one as well, by the way, but that's
Speaker 1: the time when if any evidence of mood swings, either
Speaker 1: by that individual's personal history or through their family history.
Speaker 1: Since bipolar is genetically weighted pretty heavily, we find the
Speaker 1: possibility of bipolar then other treatment needs are essentially set
Speaker 1: aside in favor of really assessing for bipolar disword. And
Speaker 1: during that prestabilization phase, not only is there a crisis
Speaker 1: going on that needs that attention an assessment towards the
Speaker 1: possibility of a bipolar diagnosis, but we also expect during
Speaker 1: that period of time prestabilization that there to one extent
Speaker 1: another is the defense or coping mechanism femial of denial,
Speaker 1: not dissimilar from what you see with substance abuse disorders
Speaker 1: and sobriety and addiction recovery. People who have bipolar disorder
Speaker 1: very often don't want to give up the perceived beneficial
Speaker 1: aspects of such as creativity and productivity and energy and
Speaker 1: feeling really alive. But also so at a deeper level,
Speaker 1: they may fear giving up what they have always experienced
Speaker 1: as an offset to depression and lethargy and lack of
Speaker 1: productivity and low self esteem. So very often, to one
Speaker 1: extent or now, they are a person who's going to
Speaker 1: want to guard that and guard against any possibility by
Speaker 1: poor diagnosis and the suggestion of treatment and so forth.
Speaker 1: So there's a lot of fears that go hand in
Speaker 1: hand with that particular phase of there or any of
Speaker 1: those fears founded, like do you find that when you
Speaker 1: treat people does their aliveness go away? Well, you know,
Speaker 1: that is a very important piece of treatment that is
Speaker 1: addressed as we go through those other phases. Okay, so
Speaker 1: I'll just stop talking and listen to your phases now.
Speaker 1: But I mean, it's an excellent question, and it is
Speaker 1: something that you know presents itself. I think in one
Speaker 1: way or another in that prestabilization phase, you know, if okay,
Speaker 1: so if I do have this problem, and if I
Speaker 1: do get treatment, what's going to happen to me? So
Speaker 1: it is something that we kind of begin to take
Speaker 1: a look at in that pre stabilization phase, but really
Speaker 1: focus on as they go through stabilization, which is the
Speaker 1: second phase. So as we address that with the individual
Speaker 1: in that particular phase, we also, if possible, try to
Speaker 1: bring in one or two at the minimum, family members
Speaker 1: loved ones that the patient is identified as being somebody
Speaker 1: close to them in their life. Obviously, if it's a child,
Speaker 1: it would be a parent, or two depending on their circumstances.
Speaker 1: Certainly for individual who's married or in an intimate relationship,
Speaker 1: it would be their partner, spouse. For an older individual,
Speaker 1: maybe a caregiver, perhaps an adult child or sibling, but
Speaker 1: hopefully some family member that can be an entrusted and
Speaker 1: somewhat observational type of position relative to that individual and
Speaker 1: begin to help them with education too, because very often
Speaker 1: those individuals can be in some level of denial too,
Speaker 1: not so much in terms of their experience and the
Speaker 1: consequences of my Polard, but of the diagnostic label itself
Speaker 1: and what needs to be done for it. That's particularly
Speaker 1: true I think with parents when the conversation begins about
Speaker 1: what's going on with their child, and I would expect
Speaker 1: that so working through denial requires education, addressing their particular fears,
Speaker 1: and also breaking down symptoms so that we don't get
Speaker 1: just caught into this idea of bipolar disorder is a
Speaker 1: bad thing when individuals very very often want to protect
Speaker 1: certain aspects of it. So we kind of break down
Speaker 1: those symptoms between the perceived good and the obvious bad,
Speaker 1: if you will, and whatever makes the greatest amount of
Speaker 1: sense to that individual and that family to begin to say, hey,
Speaker 1: you know what, there is a treatment for these particular
Speaker 1: pieces of what you suffer with, so that you don't
Speaker 1: have to suffer that any So as we move from
Speaker 1: previous stabilization, we move together collaboratively into the second phase,
Speaker 1: which is stabilization, and where medications are a big part
Speaker 1: of the conversation. But it's not just about medically stabilizing
Speaker 1: the mood in the individual of bipolar disorder. This is
Speaker 1: also about helping the family stabilize. Maybe that stabilization requires
Speaker 1: therapy and support, and maybe there's been so much trauma
Speaker 1: suffered by a family member or family members as a
Speaker 1: result of bipolar disorder that they may need their own
Speaker 1: therapy as well. But there's sort of a comprehensive stabilization
Speaker 1: that requires medication on a medical level but also on
Speaker 1: the social and familial levels to really begin to repair
Speaker 1: the damage that may have been done by bipolar disorder.
Speaker 1: And that stabilization phase is it can be a very
Speaker 1: rough time for people. Sometimes you get somebody on medication,
Speaker 1: perhaps lithium or an anti compulsion or whatever, and they
Speaker 1: do very well and there's no parent side effects and
Speaker 1: it makes it easy for everyone. But as you probably know,
Speaker 1: that doesn't always happen. Sometimes there's some trial and experimentation
Speaker 1: that has to go on during that period of time,
Speaker 1: and it can be very frustrating, and people can feel
Speaker 1: like giving up sometimes, particularly if they're experiencing some side effects,
Speaker 1: even if they're common side effects that can be easily
Speaker 1: resolved with and attention. But these are all very pertinent
Speaker 1: issues and important for people to work through collaboratively and
Speaker 1: in a therapeutic context. It's not just about sending a
Speaker 1: patient to a doctor and the doctor is going to
Speaker 1: prescribe and all of me, well, there are so many
Speaker 1: issues contained with that and owning bipolari. I do spend
Speaker 1: time talking to the family members as well as the
Speaker 1: patients to make sure that everybody feels like they're a
Speaker 1: part of the process and whatever pain they're suffering, whatever
Speaker 1: they've gone through, is relevant and can be addressed. And
Speaker 1: so as medications and the whole stabilization process begins to
Speaker 1: take shape, we eventually move to that post stabilization phase,
Speaker 1: that third phase, and that postabilization phase can be a
Speaker 1: very long period of time of treatment because it really
Speaker 1: does represent a lifelong chronic illness management type of model,
Speaker 1: and recognizing in particular a couple of features that I
Speaker 1: think are very very important to address. And the first
Speaker 1: of all, a person's identity, their sense of self can
Speaker 1: really change as a result of bipolar treatment for the better,
Speaker 1: we would think. But remember that if bipolar is a
Speaker 1: genetic disorder, which we believe it is, it's something that
Speaker 1: that person is carried throughout their life. As a result
Speaker 1: of that, they have seen the world themselves and others
Speaker 1: through that bipolar prism of extreme mood events and so
Speaker 1: reshaping how their brain handles emotional regulation, while again we
Speaker 1: would expect to be a good thing, represents a real
Speaker 1: drastic change and how that person again perceives self in others,
Speaker 1: and like you suggested earlier, how they will see their
Speaker 1: own creative process, their own intellectual process, and what those
Speaker 1: perhaps repercussions are for the long term. So we have
Speaker 1: to talk about that creative process and a person's ability
Speaker 1: to organize themselves in a more consistent fashion rather than
Speaker 1: relying on manic energy to do kind of the work
Speaker 1: for them. And so there's a whole change and identity,
Speaker 1: but there's also changes in family dynamics that have to
Speaker 1: be addressed during that post stabilization phase, which includes how
Speaker 1: the person with the bipolar condition and the loved ones
Speaker 1: around that person interact and talk about ongoing bipolar issues
Speaker 1: without making bipolar the centerpiece of their life. Because people
Speaker 1: with bipolar like to think that as they go through
Speaker 1: treatment that they're starting to experience life more authentically and
Speaker 1: more in terms in relation to the reality of life
Speaker 1: around them. So it's not as if they're going to
Speaker 1: just stay in a baseline mood zone forever. Thanks to treatment,
Speaker 1: they're going to experience joys and sorrows and frustrations and
Speaker 1: anger and a whole range of what I think makes
Speaker 1: life colorful and sometimes enjoyable, but sometimes grief stricken. So
Speaker 1: when a person with bipolar who's on a good management
Speaker 1: schedule and process through post stabilization gets really angry about something,
Speaker 1: particularly something a loved one is doing, they don't want
Speaker 1: to think that the first thing the loved one is
Speaker 1: going to look at them and say, are you off
Speaker 1: your meds? Instead, be able to have a conversation about
Speaker 1: what those feelings are in real time, with an occasional
Speaker 1: review in terms of how bipolar may kind of reassert
Speaker 1: itself in one way or another in their life. So
Speaker 1: these are some that I think of the highlights of
Speaker 1: that three phase approach that again I talk about in
Speaker 1: an ring bipolar, and that I really stress when people
Speaker 1: come through that treatment process that medications alone are not
Speaker 1: the answer, but a combination of medications and that ongoing
Speaker 1: therapeutic process and conversation with loved ones and supportive individuals
Speaker 1: to make a real comprehensive life management a program for
Speaker 1: that individual, for the family for long term success. I
Speaker 1: appreciate that you know there's some research in the creativity
Speaker 1: literature suggesting that relatives of those who have full blown
Speaker 1: bipolar tend to show increased levels of creativity. Kay Redfield
Speaker 1: Jamison has written a little bit about her own personal
Speaker 1: experiences with bipolar and creativity. What do you what do
Speaker 1: you make of the hypothesis that that perhaps these traits
Speaker 1: in a sort of water down version might be in
Speaker 1: a manageable version conducive to creativity. Well, what I have
Speaker 1: really found in my therapy work with people with bipolar
Speaker 1: disorder is that I believe that the creative process is
Speaker 1: it is something that that essentially develops, maybe to some
Speaker 1: extent with regard to these mood extremes, but only on
Speaker 1: a perhaps on an energy or motivational level. So for example,
Speaker 1: any one of us can we can probably think of
Speaker 1: something that we're particularly good at. Okay, hopefully we can.
Speaker 1: I would think we all have gifts and whether these
Speaker 1: things are kind of in the more traditional or classic
Speaker 1: idea of creativity, like people who are artistic or musical
Speaker 1: and that sort of thing. But I think creativity in
Speaker 1: general is basically the ability to solve problems from a
Speaker 1: unique perspective. It's basically how we solve a problem outside
Speaker 1: of maybe again a more conventional means. And if we
Speaker 1: kind of take that point of view for a moment,
Speaker 1: I think we all have gifts where we can look
Speaker 1: at things or actually certain things and affect outcomes in
Speaker 1: a creative way, in a special way, and in a
Speaker 1: way that we kind of maybe have our own process
Speaker 1: or our own signature apply to that. And when I
Speaker 1: do that, I think it helps to kind of take
Speaker 1: it out of the realm of what we typically think
Speaker 1: about it better. Very creative, eccentric people and particularly those
Speaker 1: who may have had a bipolar disorder. And we can
Speaker 1: name some very famous people who would believed to have
Speaker 1: bipolar disorder, including and so then go Mozart, Abraham Lincoln,
Speaker 1: Winston Churchill used to describe his bipolar as his black dog.
Speaker 1: So these very well known, obviously great leaders and great
Speaker 1: thinkers and who've produced the creative output in one way
Speaker 1: or another, in ways that it's hard to imagine for
Speaker 1: us in your immortals, if you will, you know, we
Speaker 1: tend to think of those kinds of individuals as having
Speaker 1: some sort of special process, maybe related to their madness,
Speaker 1: you know, that whole fine line between genius and meness.
Speaker 1: But what I have found is that in sort of
Speaker 1: the ordinary, if you will, everyday person who may be
Speaker 1: suffering bipolar disorder, they still rely on that manic energy
Speaker 1: as fuel for that process. And what I help them
Speaker 1: to try to understand very basically is that there's a
Speaker 1: difference between the process itself and the fuel for it.
Speaker 1: And I realized that that's maybe somewhat controversial, and there
Speaker 1: might be some people who disagree with that, and that's fine,
Speaker 1: but that's my approach for the people that I work with.
Speaker 1: And when we separate the pieces of the creative process
Speaker 1: and we're less confused about that energy and motivational piece
Speaker 1: as being the process itself, aside from the necessary skills
Speaker 1: and practice of those skills and refinement of those skills,
Speaker 1: whatever they are, within that creative process, then we can
Speaker 1: see that perhaps we're just relying on bipolar media to
Speaker 1: kind of do the work for us, rather than reinventing
Speaker 1: an organizational plan and a real scheme so that people
Speaker 1: who do have these creative gifts can learn to refine
Speaker 1: them and practice them in a more consistent way rather
Speaker 1: than just in these peaks and values depending on what
Speaker 1: their energy level is relatives for their bipolar experience, well,
Speaker 1: I do appreciate that response, and I'm thinking about, like
Speaker 1: specifically what aspects of It's mostly the menia that is
Speaker 1: linked to the creativity, although I guess depression can be
Speaker 1: linked to certain forms of certain stages, like when you
Speaker 1: need to really focus and narrow your attention, but when
Speaker 1: you really want to generate lots of ideas and things.
Speaker 1: You know, you find sometimes that the personality trait hypomania
Speaker 1: is linked to diversion, thinking, what do you make of
Speaker 1: that personality trait, hypomania. It's not bipolar, it's just like
Speaker 1: a continuum that we're all on. Well, I think that's
Speaker 1: an excellent point, and in fact, if we can just
Speaker 1: for a minute kind of go back to the sort
Speaker 1: of clinical diagnostic concept where hypomania is concerned as a
Speaker 1: part of a bipolar two diagnosis. As you recall, I
Speaker 1: mentioned a moment ago that to have bipolar two as
Speaker 1: a diagnosis you have to have at least one hypomanic
Speaker 1: episode and one major depressive episode. So if you remove
Speaker 1: the depressive aspect, then according to the DSM, you can
Speaker 1: have hypomania through your life and not really have a
Speaker 1: bipolar disorder. Now, you may have some problems associating. But
Speaker 1: I think again from a diagnostic standpoint, there's sort of
Speaker 1: a wink and a nod towards this. From a sort
Speaker 1: of a personality or character logical standpoint, that there are
Speaker 1: people that do have these moments a periods of intense
Speaker 1: energy and as a result of that intense output, And
Speaker 1: again it's kind of a fine line between you know,
Speaker 1: is that genius or madness? Is that something that is
Speaker 1: acceptable or something that can be problematic? And it kind
Speaker 1: of lies on that fine line. But I think, at
Speaker 1: least most recently in the DSM five, there's sort of
Speaker 1: that acknowledgment that, yeah, there are people and I think
Speaker 1: you're kind of suggesting that that have a trait that's
Speaker 1: more embedded in their character that maybe causes them fewer
Speaker 1: problems compared to those who meet that diagnostic criteria. And
Speaker 1: it's in the complete constellation of all those symptoms that
Speaker 1: they can have a functioning life and there may be
Speaker 1: some problems along the way, but again, nothing that kind
Speaker 1: of rises to a level of what we would call
Speaker 1: a mood disorder that requires specific treatment and specific care. Right.
Speaker 1: So I've seen that too, and you know, I feel
Speaker 1: like the whole DSM is moving towards a more dimensional
Speaker 1: model of all these disorders, recognizing that we're all in
Speaker 1: a continuum somewhere, as opposed to either you have these
Speaker 1: things or you don't. So I think that's going to
Speaker 1: be probably the way the future of psychiatry. Yeah, and
Speaker 1: I don't know if that makes it easier for us
Speaker 1: clinicians are more difficult. Yeah, that's really good. It's so
Speaker 1: nice to be able to go look up symptoms and
Speaker 1: just check boxes and say, ah, there it is, you know. Yeah,
Speaker 1: but it doesn't and why. That's certainly helpful, and I
Speaker 1: think it's relevant more often than not, it doesn't always.
Speaker 1: I think, as you're implying here, it doesn't always give
Speaker 1: us sort of the full story of that individual's complete
Speaker 1: profile and what their experiences may be. Yeah, that's a
Speaker 1: good point. So you're saying, you know, there's hope here
Speaker 1: that one can live with bipolar and thrive. And I'm
Speaker 1: trying to understand this phrase own bipolar, so as part
Speaker 1: of being able to thrive, part is part of it,
Speaker 1: kind of an acceptance, is that what you're getting at
Speaker 1: with that, you know what, that's a big part of
Speaker 1: it right there. Yeah, and sort of contemplating the overall
Speaker 1: theme of the book and eventually it's title itself. It
Speaker 1: just made sense to me, particularly in our kind of
Speaker 1: current culture and our parlance of everyday life, not to
Speaker 1: not to say you have to own it in any
Speaker 1: kind of jarring sort of way, but as a reminder
Speaker 1: first of all, that bipolar disorder is a genetic disorder,
Speaker 1: which means it's nobody's fault that one. That's your fault. Well,
Speaker 1: it's it's the fault of their DNA. You know, we
Speaker 1: don't choose that any action. Yeah, yeah, that's still their cause,
Speaker 1: right actually, And you know, and I recall presenting these
Speaker 1: and community presentation ones said you know, it's it's not
Speaker 1: the result of bad parenting, and and somebody chimed in,
Speaker 1: like what you just did and said, well, you know,
Speaker 1: can I curse my answert? And I said, well, you're
Speaker 1: welcome to do that, But it wasn't their fault either.
Speaker 1: It's just evolved. Yeah, responsibility is not the same thing
Speaker 1: as blame, exactly. That's exactly correct. So we know that
Speaker 1: it's not an excuse, it's an explanation bipolar disorder that
Speaker 1: it can make a good person do bad things. Very simply,
Speaker 1: and can I make a bad person do good things?
Speaker 1: I think that it could take somebody that has maybe
Speaker 1: certain narcissistic or antisocial traits, if you will, and make
Speaker 1: that even worse. But I think it's important to understand
Speaker 1: that while you know, some people with characological disorders like narcissism, unknown,
Speaker 1: antisocial or sociopathy, can also bipolar disorder. I just think
Speaker 1: it's really important for us to understand as a large
Speaker 1: community that the vast majority of people with bipolar disorder
Speaker 1: do not have those consistent kinds of personality deficits or flaws.
Speaker 1: That they're everyday people, just as people without bipolar disorder
Speaker 1: can be good people or maybe not so good people,
Speaker 1: or whatever the case might be. But I think it's
Speaker 1: important to those individuals to understand that as a matter
Speaker 1: among other things destigmatizing the disorder, but also for family
Speaker 1: members likewise to look at their loved one and say, Okay,
Speaker 1: I can understand that this is a disorder that has
Speaker 1: created some very severe behavioral problems and damage to our finances,
Speaker 1: our relationships, et cetera. But if we can, if we
Speaker 1: can own this together, we can recognize it and own
Speaker 1: it together. We can find a pathway to good health
Speaker 1: on a lifelong basis. And I think the other thing
Speaker 1: to understand about owning bi polar is that because it's
Speaker 1: a chronic mental illness, essentially, you know you can't beat it.
Speaker 1: You know there's no cure for it. And I think
Speaker 1: whether it's psychological or physical, or however you categorize illnesses
Speaker 1: in general, you know there's there's a compunction on all
Speaker 1: of us to beat back whatever it is we have
Speaker 1: and beat it and win. And that's not the approach
Speaker 1: that I think that serves people with bipolar disorder very well. Instead,
Speaker 1: it's about taking, like you said, responsibility for it and
Speaker 1: responsibility for lifelong care together with your support system, and
Speaker 1: by working that together over long haul, then it doesn't
Speaker 1: have to rule your life and dominate your life. It
Speaker 1: doesn't have to be the center of your life anymore.
Speaker 1: It can be on the periphery as long as we
Speaker 1: recognize that it needs ongoing care. I like that. Can
Speaker 1: you give some tips on how you can support a
Speaker 1: family member who has bipolar from the family member's perspective,
Speaker 1: you correct correct if you have a loved one or
Speaker 1: even a friend, right, I think you know in that
Speaker 1: pre stabilization phase. It can be very difficult, obviously, and
Speaker 1: if anybody needs a reference point, they can again kind
Speaker 1: of look at people with substance use disorders and how
Speaker 1: you know, you want to kind of get to that
Speaker 1: loved one and say, hey, you know you've got a
Speaker 1: problem you're ready to take a look at, and you
Speaker 1: know that at some level or another you might be
Speaker 1: met with some resistance in that denial. But I think
Speaker 1: that first of all, it's important for loved ones, family
Speaker 1: members to obtain education in terms of what it is
Speaker 1: that we're dealing with together, and you might wind up
Speaker 1: having more education and more understanding in this case about
Speaker 1: bipolar disorder than the person with the condition or even
Speaker 1: some treatment professionals who may to start to be a
Speaker 1: part of that process. So that awareness and understanding can
Speaker 1: be very empowering itself, because you know what you're talking to.
Speaker 1: You're not always talking to that individual, you're talking to
Speaker 1: bipolar disorder and the denial that very often comes with it.
Speaker 1: So again, education is very very important, and awareness is
Speaker 1: very important, and there's a lot of misinformation out there,
Speaker 1: so it's good to go to really good sources. From there,
Speaker 1: I think it's if it's at all possible to have
Speaker 1: another loved one on your side, so to speak. It's
Speaker 1: a powerful combination. I don't recommend that you go out
Speaker 1: and find ten family members and try to convert them
Speaker 1: into what it is that you're that you're thinking about,
Speaker 1: but if you can find one or two other family
Speaker 1: members or friends to help you and guide you as
Speaker 1: you confront the bipolar disorder in that person that has
Speaker 1: the condition, that can be also very empowering and very supportive,
Speaker 1: so you don't feel like you're acting alone. Good And
Speaker 1: then when you speak to that individual, you always remember
Speaker 1: that we can be firm and direct about these problem
Speaker 1: areas while maintaining our love and compassion for the individual,
Speaker 1: knowing again that bipolar is not their fault but ultimately
Speaker 1: shared responsibility and taking care of that going forward. And
Speaker 1: if I can just just kind of add one more
Speaker 1: piece to that as that person does go through pre stabilization,
Speaker 1: through stabilization, into the final phase of post stabilization, I
Speaker 1: think that family member walking with that person side by
Speaker 1: side is very important. But it's also I think equally
Speaker 1: important that the family member, as I kind of mentioned earlier,
Speaker 1: feels like they have their therapy and support along the
Speaker 1: way too, so that they feel edified through that process,
Speaker 1: particularly when things may not be going in a positive
Speaker 1: direction right away, and build a conversation with their loved
Speaker 1: one of how they can work on long term success together.
Speaker 1: That sounds wonderful. And I just want to come back
Speaker 1: to this point that you know, I mean, is there
Speaker 1: a correlation between like bipow and immorality? I mean maybe
Speaker 1: there isn't. Right, So, like, just because you have bipower,
Speaker 1: just even though you have these up you know, these
Speaker 1: these highs, it doesn't mean that in those highs you're
Speaker 1: more likely to do bad in the world, right, Like,
Speaker 1: isn't it possible to have mania to like, you know,
Speaker 1: want to make their old a better place? Just out
Speaker 1: of control? Certainly that could be the intent of the individual.
Speaker 1: You know, A lot of times I find that people
Speaker 1: that go through their extreme mood events, in particular mania,
Speaker 1: carry with them, at least on the unconscious levels, certain
Speaker 1: desires and fears and wishes of all kinds, and that
Speaker 1: power and that energy takes over during mania can really
Speaker 1: push out a lot of those desires and fears from
Speaker 1: the unconscious into behavioral expressions of one sort. Or another.
Speaker 1: While I think it's important to bear in mind that,
Speaker 1: like we said, bipolar media can take a good person
Speaker 1: and have them do bad things or at least, you know,
Speaker 1: things that may be destructive to the things in life
Speaker 1: that are ultimately important to them. Certainly, a lot of
Speaker 1: people can feel when they're in the throes of that
Speaker 1: uphoric mania like they can do anything and that they
Speaker 1: can save the world, and they have a very special
Speaker 1: mission that they're going to announce to the whole world.
Speaker 1: The underlying wish or desire or gift or skill when
Speaker 1: we talked about creativity may certainly be sincere and may
Speaker 1: be real and authentic in its sort of raw state,
Speaker 1: if you will, But you're right, I mean, it can
Speaker 1: really get out of hand and out of control, even
Speaker 1: if that person is if you will, well meaning. Very
Speaker 1: often what happens, though, when that person is in that
Speaker 1: uphoric state and they have so much to give and
Speaker 1: they feel like they have a special mession for the world,
Speaker 1: very often because of their behavior will be met with resistance,
Speaker 1: and that becomes extremely frustrating. And that's often when that
Speaker 1: mania turns from the euphoria to that extreme level of
Speaker 1: irritability and agitation. They just feel like everybody around them
Speaker 1: doesn't get their special purpose, and so that underlying mission
Speaker 1: or purpose or skill goes unsatisfied. And one of the
Speaker 1: things that I think we can expect through the three
Speaker 1: phases of bipolar therapy is the good that you suggest
Speaker 1: that people do possess can be affected and presented in
Speaker 1: the lives of people around them in a well expressed
Speaker 1: and organized way through that proper care. That's very interesting.
Speaker 1: I'm thinking of the narcissism literature that have some recent
Speaker 1: research I've conducted showing you know, there are these two
Speaker 1: forms of narcissism that exist, grandiose narcissism and vulnerable narcissism.
Speaker 1: Those who tend to to be more extroverted tend to
Speaker 1: display grandiose, exhibitionist form of narcissism, whereas those who are
Speaker 1: more introverted tend to have this vulnerable, like grandiose fantasies
Speaker 1: in their own head kind of form of narcissism. But
Speaker 1: we recently published preer with publishers of The Manual Jock
Speaker 1: showing that the higher your scores on the grandiosity the
Speaker 1: grandiose narcissism scale beyond a certain threshold, like seventy five
Speaker 1: percent threshold, you're actually more likely to then start to
Speaker 1: experience the vulnerable symptoms concurrently. And we think that's an
Speaker 1: important paper because these two forms of narcism have tend
Speaker 1: to be treated as though you're they're two completely different
Speaker 1: kinds of people. But it seems like, you know, there
Speaker 1: is this level of grandiosity where you start to become
Speaker 1: much more vulnerable and actually think that you're a worthless
Speaker 1: human being. You're much more vulnerable to the opinions of
Speaker 1: others and things. And I'm wondering, I don't think anyone's
Speaker 1: done the study, but how does that fluctuation between grandiose
Speaker 1: and volment narcism map onto the fluctuations that you've seen
Speaker 1: bipolar I think that'd be an important clinical question. Yeah,
Speaker 1: I think that's a that's a fascinating point. And how
Speaker 1: that may in some way, you know, intersect with that
Speaker 1: bipolar mania experience, you know, particularly on when we think about,
Speaker 1: you know, beyond the symptoms themselves that we that we
Speaker 1: identify and diagnose on an objective level, Now, what is
Speaker 1: the subjective experience of that individual? I think that's that's
Speaker 1: so important. I talked about it in Bipolar that you know,
Speaker 1: people feel something. It's more than just the behavioral expressions
Speaker 1: and the impulsivity that can get them in trouble and
Speaker 1: so to speak. But what's going on inside of them,
Speaker 1: you know, particularly when they're in the throes of media,
Speaker 1: And I think what you're kind of talking about, you know,
Speaker 1: even though that's about narcissism, that is more pervasive in
Speaker 1: an individual that has a personality disorder compared to bipolar disorder,
Speaker 1: which is episodic. That is to say that they may
Speaker 1: act very narcissistic when they're manic, but we would expect
Speaker 1: that to diminish as them as that mood episode diminishes. Nonetheless,
Speaker 1: I think that their experience may be very much the same,
Speaker 1: and there are individual differences with respect to extraversion versus introversion.
Speaker 1: Like you said, you suggested that sort of grandiosity versus
Speaker 1: vulnerability perhaps, and I think that people that experience bipolar,
Speaker 1: at least at that level, probably have very similar types
Speaker 1: of experiences in that way. Sure, yeah, it'll be very
Speaker 1: interesting for the future research to do that. So, but
Speaker 1: can people find an aliveness to the same intensity that
Speaker 1: they do when they have bipolar I'm not sure you
Speaker 1: really answer that so I think there is, among other things,
Speaker 1: a redefinition of what being alive is all about. That's
Speaker 1: a good, very good point, you know. Yeah. Again, if
Speaker 1: you think of an individual who has seen himself through
Speaker 1: that bipolar lens and that's when their experience by large,
Speaker 1: then that's how they've defined what it is to feel
Speaker 1: alive or what it's like to feel dead inside, you know,
Speaker 1: through Once a stableation is achieved again at that medical
Speaker 1: neurological level, I have an opportunity to work through those
Speaker 1: changes with that individual over period of time, and with
Speaker 1: time and opportunity and therapeutic interaction, that person begins to
Speaker 1: see themselves differently, and I think as a consequence that
Speaker 1: they see life different And again, what it is to
Speaker 1: be alive is a more consistent thing. And there are
Speaker 1: moments of joy and there are moments of sorrow, but
Speaker 1: you don't have to rely on extreme intensity to feel something.
Speaker 1: You can feel things and experience things in a more consistent,
Speaker 1: more authentic way. So I mean, I think that that's
Speaker 1: a big part of what it is to adapt to
Speaker 1: that new identity. Well, that's such an important point. So
Speaker 1: your book concludes with personal action and helping others so
Speaker 1: can you describe both of those elements, So what is
Speaker 1: the personal action you can take, and then how can
Speaker 1: you help others with this knowledge. I'm really glad you
Speaker 1: brought that up, because I think that the highest level,
Speaker 1: if you will, of owning bipolar is reaching out to
Speaker 1: help others. And I talk about that in the context
Speaker 1: that everybody is, of course entitled to their privacy, and
Speaker 1: I'm not saying that everybody becomes an advocate on social
Speaker 1: media and have a million followers or whatever. I mean,
Speaker 1: you don't have to necessarily help others with the bulmart.
Speaker 1: Some people are meant to do that, and some people
Speaker 1: do it very quietly, perhaps in their communities, in the workplace,
Speaker 1: in their schools and their churches, in their neighborhoods. But
Speaker 1: at one level or another, I think, no matter how
Speaker 1: that's expressed, when a person does go through that experience
Speaker 1: of owning bipolar, it's inevitable that they're going to come
Speaker 1: across people that have bipolar disorder or some mental illness.
Speaker 1: There's going to be some recognition in the community and
Speaker 1: people around them, and then maybe people they know, maybe
Speaker 1: total strangers, but they're going to recognize something that looks
Speaker 1: all too familiar to their own experience, and at that moment,
Speaker 1: in one way another, if we reach out to that
Speaker 1: individual that maybe in some way, shape or form crying
Speaker 1: for our health and in a way so listening our
Speaker 1: attention by virtually the fact that we've recognized that and
Speaker 1: we can offer some attention either listening to that individual,
Speaker 1: maybe making a referral to that individual saying you know,
Speaker 1: this sounds very familiar to something that I went through
Speaker 1: or my loved one went through, and offering that connection
Speaker 1: with that person could save a life. Remember, if it's
Speaker 1: my polar alone may cause up to over ten thousand
Speaker 1: lives lost just in the United States, let alone worldwide.
Speaker 1: So if we can really reach out and be unafraid
Speaker 1: to do that and share our knowledge and our experience
Speaker 1: in some way, then we've helped another person. And again
Speaker 1: that's achieving that highest level of what it is to
Speaker 1: really own the condition owned bi polar and share with
Speaker 1: people that wisdom and knowledge that they can pay forward
Speaker 1: eventually to somebody else someday in their lives. I love
Speaker 1: that at the end of your book you say, don't
Speaker 1: be afraid you are not alone. Thank you so much
Speaker 1: for being on the podcast. Today Michael and enreally for
Speaker 1: the important work that you're doing to help save lives
Speaker 1: and help them help lives thrive. Thank you so much
Speaker 1: for having me Scott, it's been a pleasure. Thanks for
Speaker 1: listening to the Psychology Podcast. I hope you enjoyed this episode.
Speaker 1: If you'd like to react in some way to something
Speaker 1: you heard, I encourage you to join in the discussion
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