Doomed or Can We Reach a Level Playing Field?

My blogmate, Tim Kuss, recently emphasized accepting one's mental illness-in our case, this is bipolar disorder-just as much as building and maintaining sobriety. You know, it's worked for Tim, I daresay, and for me especially since we both have been clean and sober for an impressive amount of time, take our medications deliberatively, and “take an active role in the design and delivery" of our care.

I really love Mathew Mattson and Sue Bergeson of the Depression and Bipolar Support Alliance (DBSA)'s remonstration that "the ultimate goal of treatment should be to engender hope." However, sometimes I wonder how that can actualize if we realize that we will continue to always have a chronic illness that will be there to haunt us especially if we do not walk the straight and narrow.

Dr. Jeffrey L. Sussman, in The Primary Care Companion to the Journal of Clinical Psychiatry, waxes profound when he notes, " The goal of treatment (for bipolar disorder) has changed in recent years from one of symptom abatement to one of recovery; that is returning patients to their level of functioning prior to the onset of illness."

Mover and shaker psychiatrist, Dr. Nada Stotland, allude to "moving beyond symptomatic recovery to also encompass functional recovery" She advocates ways to make this happen: (1) She wants “ policy and system changes to facilitate recovery.”
(2) She asks for “ improved funding for recovery-oriented care.” (3) She wants “implementation of recovery-oriented, collaborative care models that bring together psychiatrists and primary care providers.” Lastly, (4) She wants the “dissemination of improved tools for monitoring changes in symptoms and level of functioning.

Mattson and Bergeson emphasize that “the ultimate goal of treatment must be recovery” and that “consumers should take an active role in the design and delivery of their own care"

I want to dig deeper because I am not convinced the majority of practicing clinicians buy into this view. Many behavioralists, I suspect, focus on the "flavors" of one or the other presentations of bipolar disorder: are you manic and depressed, just a little off the wall, or rapidly cycling between ups and downs? The DSM IV has a diagnosis that fits you.

There are plenty of naysayers who would suggest that there is a greater tendency to define and treat in this New Age of twenty-minute Psychiatric visits. Is there a fiscal relationship between the plethora of psychotropics on the market and how many the average bipolar patient now takes? Does the tail wag the dog? Has "pushing" psychotropics to whatever extent supplanted interactive psychiatry?

Is there a financial impropriety based on the incredible profits engendered by so many medications? Have psychiatrists literally been "bought out" by the mega pharmaceutical companies?

So what is the incentive that anyone with bipolar illness will actually ever "get better?" I am not advocating that the bipolar patient as soon as they feel good again stop taking their medications. Sussman advocates utilizing an effective treatment team. I heartily agree with him and feel, to the bottom of my soul, that collaboration between the patient and physician is crucial. Such an approach demands mutual communication between physician and someone with bipolar disorder. Also, collaboration between primary care providers and specialists (psychiatrists, psychotherapists) is proven to have better outcomes.

Those lucky enough to have been treated collaboratively admitted better attitude about taking their medications and how bad they felt. They also just functioned better. Here again, these innovative psychiatrists are directing our attention toward returning to a level playing field; that is, somewhere before we began our struggle. Is that possible?

We circle around to the question whether someone like myself with known bipolar disorder can ever function normally again? "But you demonstrate compromise of executive and cognitive function on psychometric testing," they may tell you. However, the same psychologist may have performed testing under less than ideal emotional circumstances or under stressful conditions possibly contaminating the results.

In summary, it is my opinion also that a bipolar patient, collaboratively with appropriate medications from a perceptive yet vigilant psychiatrist and a knowledgeable therapist with co-occurring issues in check (anxiety, alcohol and drugs) CAN return to a level playing field.