Daily Archives: February 9, 2012

Is Therapy Pointless for the Unmedicated Bipolar Patient?

Kind of in conjunction with yesterday’s post, I want to take things back about a year before my quest for trying out modern medicine for the second time.

I was un-medicated and working a full time job in the fashion industry. “Yikes” is about the only way I can put it. That is a rather unforgiving industry, and though I was being pushed past my own limit by the horrendous actions of a couple of bad apples, I was somehow managing to hang on by a thread. My plan of attack was to find a good therapist that could weather the storm with me in an attempt to ride it out.

Unfortunately that plan crashed and burned.

I attempted to cultivate relationship with three different therapists, all of whom dumped me in one way or another.

I use the word “dumped” because there are few other words to describe sitting in the waiting room at my designated time, only not to be fetched by my associated therapist. With no call or explanation, beyond this:

The benefits of therapy are not significant enough for our relationship to continue if you plan to remain unmedicated.

Yep. Therapy, denied. Unless I was willing to also find a psychiatrist and take whatever I was prescribed, none of those therapists were willing to see me on a weekly basis. And mind you, was paying them.

I’ll admit, at the time, I really took it personally. What, I was somehow able to navigate roughly 60 hours a week of work but was suddenly too “crazy” during the hour I was in their office to be able to help without some kind of sedation? My seeming “non-compliance” with the psycopharmalogical world meant I would also reject listening to their perspectives, even though I sought them out? Ridiculous. I assumed I must be farther gone than I had originally thought.

Then, I was furious at these women. Didn’t they get into this field to help people? What, do they only take the easy cases? Why wasn’t anyone willing to rise to the challenge, if I was so nuts? And why were they all so flaky and blowing me off that way, didn’t they think I could handle an actual mature conversation?

So I gave up.

And I don’t have any desire to work in the fashion industry anymore.

There was a third explanation, a third possible reason for these interactions that I was completely unaware of until the Bipolar Disorder in Focus conference two weeks ago.

A woman there gave a presentation on the benefits of psychosocial therapy, and included a number of studies done on the subject. At the end, she said something that made all kinds of bells and whistles go off in my head:

There have been no studies on the impact of psychosocial therapy without the use of medication, in regard to the treatment of bipolar disorder.

HA!

There it is, there’s a big ol’ hole in our knowledge there. Would therapy alone be beneficial to those with bipolar disorder? Technically, since it hasn’t been researched, we don’t know.

I just want to take a second to point out that I realize the last couple posts may have seemed a little anti-drug, and I don’t want people to take that away, and nothing else.

It isn’t that I’m anti-drug, I am just pro-knowledge.

It isn’t that psychological medications are bad, they’re actually quite good for a lot of people. Personally, though, they do not react well with my body. I have a very sensitive body chemistry, which makes taking most of the medications that are out there for bipolar disorder today impossible. Clearly this has made things pretty difficult, especially when trying to find someone like a therapist, because they seem to have a pre-conceived notion of what will or wont help me.

Thankfully since that terrible time I had, I’ve found a therapist who is quite wonderful and doesn’t drive me absolutely bananas.

Anyway, since hearing that there hasn’t been much to tell us if therapy would help without the drugs (which, spoiler alert, I spent roughly seven years unmedicated so I can tell you it does), I decided to do a little snooping around online myself.

I contacted The Royal College of Psychiatrists‘s library in London to gain access to one of their publications (notably The Psychiatrist) which is available to (you guessed it) those working in the field of psychiatry for free, and pretty much everyone else for a modest fee. To my surprise, they allowed me free access to the article I wanted based on the fact that I am a patient. UK, you’ve just gained some favor in my book!

I try not to go all citation-crazy on this blog because as soon as medical jargon starts getting thrown around, I know a lot of folks lose interest. It can be hard to understand at times, and I usually find myself thinking, “alright, well what was the point of that?” It isn’t that I discount intellectualism, but I do try to write to a broad audience of people. I’d like to include a couple excerpts today though, so you can see exactly what I’m referring to, straight from the horse’s mouth. Or the horse’s keyboard, anyway.

The specific piece I was curious about is entitled, “Psychological Therapies for Bipolar Disorder: addressing some misunderstandings”, and is actually a letter published (by the original authors of a study) in reply to a letter published about the authors’ originally published work. If you can follow that. Right. (See, that’s why I usually don’t venture here!)

The excerpts I have pulled are authored by a team led by Steven H. Jones, Professor of Clinical Psychology, Spectrum Centre for Mental Research, Lancaster University, UK, including Fiona Lobban, Anne Cooke, Warren Mansell, Kim Wright and Joanne Hemmingfield, at the Spectrum Centre for Mental Research, Lancaster University.

We do not argue against the use of medication treatments, but we do discuss the fact that they are not necessarily helpful for everyone and that choice in relation to this, as well as other forms of treatment, is an important consideration. We accept that the evidence for psychological interventions is based mainly on participants who are currently receiving medication as well. This could mean that the sole ingredient offered by psychological interventions is an increase in adherence, but this is no more proven than other possible explanations. P.433

Be sure to replace “psychological interventions” with the word “therapy”, if you feel so inclined, because that is what they’re basically saying. The last sentence suggests there may be others who believe that the only reason therapy is helpful for bipolar disorder is to keep patients on their medications, but that the idea is not more proven than any other ideas of what therapy adds to the mix.

…there are no drug-free studies of psychological interventions in bipolar disorder. Such studies prove an enormous challenge, given the present readiness to prescribe. However, it is encouraging that psychological therapies appear to be superior to medication in the long term for a range of other psychiatric disorders, including unipolar depression, post-traumatic stress disorder and panic disorder. Nevertheless, our approach sees a key role for medication in services, particularly in situations of acute risk, and for clients for whom the benefits are clear. P.433

I find this portion incredibly encouraging. There are obvious situations where medications are necessary, but the fact that therapy is superior to medication (in the long term) for a number of other psychiatric disorders should be some indication of the potential for success with bipolar disorder.

…we provide extensive reports from large numbers of people with bipolar disorder, reporting on how they have learned to cope with their mood swings. We regard such evidence as primary rather than secondary in the pursuit of a scientific understanding of emotion regulation and how it becomes a problem for many people, just as early psychiatrists utilised a phenomenological stance in building their initial categorisations of mental illness. P.433

All I can say here is: awesome. I feel so often that the focus seems to be on eradicating symptoms, but I personally would rather just be better able to cope. I believe bipolar disorder does offer some benefits, and mere eradication usually includes both the benefits and the drawbacks. How better to gain a better understanding of how people cope than to talk to them? Seems deceptively simple, no?

So, just a little nugget, there. After going to that conference I am hungry for more science, more research, and more medical professionals I can actually agree with. It is important to me that I can feel hopeful about what is being done in the mental health field, even if it is only occasionally, and the politics here in America have a tendency to stifle that for me, to some degree.

I also wanted to take the time to say that I really do believe that a partnership with a therapist can do wonders. Medicated or not, as long as you’re willing to be open, honest, and receptive, it really shouldn’t  matter. And if someone tries to give you flack? Me and these 6 psychiatrists, we’ve got your back!