Denial, they say, is not just a river in Egypt. It is also said to be one of the most difficult things to overcome in accepting a notion we don’t want to hear, anything from the death of a loved one to a mistake we may have made, or even an illness we’ve been diagnosed with that might have a particularly harsh connotation. Bad news, it seems, is easier to ignore than accept… and for those that have been diagnosed with bipolar disorder, denial is often the first roadblock that springs up.
What interests me most is a time further down the line. After acceptance has happened (which can take anywhere from days to months to years for those with bipolar disorder) there often seems to be a relapse into that same denial at a later time. What I’ve been thinking about the last, well, couple weeks to be honest (I’ve been trying to write about this for a while), is this question:
What makes the notion of bipolar disorder so difficult to accept?
What is it that makes it so easy for someone with bipolar disorder to slip back into denial about having the illness? It is one thing? Is it many? I don’t think anyone really knows the answer, but I’ve brainstormed a few ideas of where it might come from.
Invisibility – Unfortunately, there is no easy, straightforward way to diagnose bipolar disorder. Something that is seen by one doctor might not be seen by the next, and diagnosis requires a certain amount of perception; on the part of the patient (perception of their symptoms), the doctor (perception of the patient’s symptoms), or on a third party (a parent or friend’s perceptions of the patient’s symptoms).
Since these symptoms may be entirely internal, or happen when others aren’t around, or the doctor may have only seen the patient in a depressed state (without having seen anything else) -well, the whole thing can be messy. I know many people (including myself) who were initially diagnosed with depression or another illness before bipolar disorder, and the information required to make a bipolar diagnosis may take years to show itself. Even if a doctor picks up on it at that time, it could take years before a patient begins to recognize it in themselves.
And, after so long a time, finally receiving a bipolar diagnosis might leave the patient questioning themselves and the doctor that diagnosed it. Is the doctor’s perception correct? Why did it take so long to come to this conclusion? And what if my own perceptions of myself are incorrect? Maybe it isn’t bipolar disorder at all.
Perception of an invisible thing (which isn’t even a thing but a series of feelings and actions) is a tricky business. After all, is a completely un-knowing person more likely to be convinced of the existence of wind over the existence of something that can only be perceived from time to time over a long period by one or two people?
The Norm – There is no guarantee that there will be enough evidence for those apart from the patient to perceive bipolar disorder, and unfortunately there is not a guarantee that the patient will even perceive an issue.
I would say that most people are so used to how they function and how they were raised that they don’t think twice about how they think or function. If you are living with bipolar disorder and have been for a long time, your actions may not seem odd, your thoughts or thought process might not seem odd, they may be familiar and comfortable. When that is the norm, it can be difficult to see why there is any problem. If there is no problem, why change anything?
Blinders – I don’t know if this happens for everyone with bipolar disorder, but I’ve spoken with several people who have experienced this (as I have). The emotions I experience are so intense and convincing that I feel perpetually stuck living from one moment to the next. Each moment is so intense that it becomes its own entity, completely cut-off from the other moments I have had/will have. It is as if each episode comes with a set of blinders, and when depressed there is nothing but depression. When euphoric there is nothing but joy. It becomes very hard to see the “bigger picture”.
This element in particular is the main reason I would guess so many people stop taking their medications suddenly, or suddenly deciding that since they feel amazing, they must not have bipolar disorder.
Mood charting is one of the few things I have found that helps with this, and will let me see a long period of time with no immediate mood affiliation. If anything, it has helped me accept the fact that I have intense mood swings because what I see on the page both shakes off all blinders from mood to mood and the invisibility of bipolar disorder by making something tangible and visual.
Ambitions – This isn’t relevant to everyone, and many people with bipolar disorder are able to hold steady jobs or reach the goals they wish to achieve. Unfortunately, being ambitious is one of the main reasons I have experienced a denial relapse (and have several times) because I don’t know when to pull back.
My expectations for myself are the same as before bipolar disorder was an issue, and though that isn’t realistic for me (as things have not only worsened but I have no supportive medications) I have a hard time knowing what I can and can’t do. Nothing makes me believe I can shake off bipolar disorder like a good challenging opportunity, especially if there is a chance I will make good money off of it.
I am in a situation where I need to set some limitations for myself, but that isn’t the norm for me. Failing to make a change here will probably ultimately lead to continued relapses in denial.
Existence Stigma – Denial relapse can be particularly easy when someone who is ignorant, but important to you, tells you that mental illness doesn’t exist, or that it is something that people “make up”, or that being stronger, talking less, and thinking happy thoughts will eradicate all of your symptoms.
It could be anyone, a relative, significant other, maybe even someone on TV, but being told that your illness doesn’t exist enough times could potentially leave you believing it.
I am someone who is all for looking at different types of treatments or philosophies around mental illness, but encouraging people not to get some kind of help and denying the issues entirely is something I can’t stand.
This is something I have come across, and I can sadly say that at one time in my life I totally dodged treatment because my boyfriend at the time told me that there wasn’t anything wrong with me and “love” would make everything better. When young and manic, that made perfect sense to me, and I found myself back in the denial relapse.
Flaw Stigma – There is also the belief that having something like bipolar disorder means that you have a large character flaw, and you can probably see how that might make one second-guess a diagnosis. If being told that having bipolar disorder made you un-likable, you may not want to admit to anyone, not even yourself, that having bipolar disorder was a possibility.
Treatment Stigma – Sometimes fear of treatment deals the ultimate blow, and there are so many misconceptions about what treatment means for mental illness that the notion can be confusing and overwhelming. Some might believe that treatment involves being locked up, or being given medications without consent, or being shocked without consent.
Usually the view of treatments for mental illness are that they are hell. While many people have absolutely no problem at all, it is true that other people struggle. Unfortunately the alternative tends to be a worsening condition, requiring more treatment once that denial relapse wears off.
So what makes the notion of bipolar disorder so difficult to accept?
I think the answer is a little different for everyone. In the last ten years, I’ve been guilty of falling victim to at least half of the things on this list, if not more, and that’s what troubles me I guess. Somehow, after ten years I still find myself slipping into a place of denial… and to claim that I haven’t would be an almost bigger lie. I thought by considering the reasons, I might find a clue in avoiding another relapse.
Did I miss anything? Have you ever found yourself believing that there is nothing wrong, that you suddenly woke up and don’t recognize the illness you’ve been told you have? What has brought about a denial relapse in your life, if you’ve had one?