Living with bipolar I: what is it REALLY like?

This is particularly noticeable at international conferences; experts provide a fascinating insight about new developments and progress in the management of bipolar I but when a patient takes centre stage, there’s a sense of the here and now. Suddenly what doctors believe or know to be true is translated through the mouths of the experienced and our understanding is deepened.

What patients describe is somehow more terrifying than the audience anticipate; for a moment you might be fooled into thinking that his/her journey with bipolar I has been relatively okay. But then comes that break in the voice, a poignant pause or a tear in the eye and suddenly it’s apparent that this patient speaker has been on a rollercoaster journey more befitting a horror movie.

The hospital admissions, the mood extremities, the self-loathing, feelings of anxiety, irritability and agitation, the once not knowing what was happening to him/her, the battle with reaching the optimal treatment regime and finding support, the estrangement from “friends”, the misdiagnosis, the suicide attempts. About two-thirds of patients also report feeling depressed during an episode of mania¹ which is particularly worrying because suicide attempts are more likely during mania with depressive symptoms.²

Successful attorney and patient with bipolar I disorder Terri Cheney from Beverly Hills says:  “I’m always looking for someone to express what I’m feeling and can’t put into words, particularly with mania with depressive symptoms; that’s my current quest, to find other people who have been through this who know what I’m talking about when I say I have to break something and don’t look at me like I’m crazy.”

Involving family and friends

Having a good support network is vital for patients with mental health issues. As Terri Cheney describes in one of her videos (you can find the links at the end of this article): “When I came out with my book, there was this miraculous understanding and support and empathy and now I have a support team rather than people that I’ve alienated. It’s like people have really rallied and come to my rescue so now when I’m suicidal I know that I can tell people and not go that far down the path like I did before so it’s amazing to me what the effect of disclosure has been with my relationships with other people.”

Involving family and friends is also important in terms of visits to the clinician. “Who knows you better than your loved ones. They are so well equipped to explain to the doctor exactly what he needs to know,” says Cheney.

For the clinician, it’s often very difficult to diagnose bipolar I disorder based on an initial visit, typically because the patient’s self-awareness changes with mood and it becomes difficult to translate the experiences and moods into symptoms identified in the DSM or other scales. For instance, what might appear to a patient as confidence and clever ideas for a new business venture might be a pattern of grandiose thinking and manic behaviour that close friends and family acknowledge to be uncharacteristic.

The symptoms of anxiety, irritability and agitation are another example of symptoms that might go unrecognized: The patient might be more focused on feeling frustrated, for example, than looking inward and so may not be a reliable reporter. Involving loved ones helps to achieve objective impressions, as well as providing that all-important support to help people with bipolar I maintain well-being.