Bipolar revisited

A copy of John McManamy’s Living Well with Depression and Bipolar Disorder caught my eye on a bookshelf recently. Published in New York just over ten years ago, it is written in an accessible style, covering most, if not all of the features of bipolar disorder, what we do and don’t know about it and the condition’s physical aspects. The book also includes suggestions for recovery. A former financial journalist, McManamy used to be a bipolar sufferer himself. His book is based on a considerable amount of research and with the benefit of personal experience.

But for all this, as McManamy himself says, ‘the cause and workings of the illness remain a mystery to science’. Since this is also true in so many cases of ‘straightforward’ non-bipolar depression it is not surprising that what seems to be this more complex version remains hard to fathom.

As with all instances of medically unexplained conditions we should not ignore the powerful role of the unconscious mind here. In the same way that the physical body has a healing mechanism, so the mind has its own developmental and defence systems. For example, it is just possible that the manic phase of bipolar is our mind’s defensive reaction to the assault of the depressive phase. The fact that bipolar sufferers lack the ability to regulate the extent of this reaction – resulting in manic episodes – may have its roots in early environmental influences (for example, the quality of attachment to our early caregivers).

As for the depressive phase, McManamy’s book notes that despite appearances depression is not a passive state and that it has in fact been described as aggression turned inwards. This may point to severe self-esteem issues and an inability to view oneself with a balanced sense of value. Certainly depression can bring an overwhelming sense of being disconnected and irrelevant, with no motivation to relate to the outside world, which itself appears to make no sense and have no purpose. Thus one’s very existence can seem pointless. This is not a nice place to be.

This is not helped by thoughts that aspects of one’s condition might in some way be inherited or genetic. And yet whilst there is evidence to show that bipolar disorder can run in families, this again may be more the result of environmental factors (e.g. behavioural influences within a family) than any hard wiring from birth or genetic defect. More positive environments and relationships subsequently are likely to counter these earlier negative influences.

Conversely, for all its extreme unpleasantness there are aspects of bipolar that sufferers may find themselves willfully hanging on to, consciously or not. In one of McManamy’s case studies the sufferer says that the condition ‘is such an integrated part of my being that it is impossible for me imagining trading it anymore than I could imagine trading my voice’. When the condition seems to be so bound up like this with one’s sense of identity the thought of giving it up can feel like a threat to the ‘self’ we have become so familiar with.

In some cases, therefore, untangling the condition from our identity can seem so difficult. And yet experience shows that it can be done – with time, support and belief.

This article follows an earlier post on bipolar disorder published here on 21 April 2015.