A level playing field: an illusion?

by Peter J. Dorsen M.D., LADC

It’s been a fair amount of time since I have connected with the blog but am more than ready to do so. The last entry had to do with “ a level playing field,” and whether someone with bipolar disorder can ever return to a place they were at before they were diagnosed and adequately treated.

With a number of additional fiery accusations, I said categorically “yes.” But I have been mulling over my opinion almost continually since I entered my earlier opinion. Between then and now, I have experienced at least one bout of depression and may even have experienced at least one episode albeit brief of hypomania. I usually know about the depression. I actually get irritable. I discussed my emotional state with my psychiatrist and in a collaborative fashion, I began taking a higher dose of Depakote, the anti seizure medication for my bipolar 2 disorder that has served me well of late.

Things all settled back to emotions as usual and the constipation, probably the only physiological manifestation of my mental disarray, vaporized. My ability to deal with day-to-day challenges with my wife and her stepsons improved. Any issues with my sometimes testy students seemed to be of less consequence to them and to me. Perhaps I was showing more tolerance to everyday challenges on all fronts. I doubt this was La belle indifference but more that I was once again properly medicated.

I am not aloof how significant is my interaction with my loved ones or with the students whose tuition goes toward paying my salary. However, that I was once again subject to emotional “issues” even while properly medicated made me look more objectively at what I had written and almost believed as gospel. I don’t doubt that some of my opinions could well have been an element of denial:”I don’t really have a debilitating mental illness,” I insisted. How could I? It’s adequately treated and I am euthymic. Sure, in the same article, I had also taken a poke at psychiatrists in general as drug pushers perhaps even wagged dog-wise by a pharmaceutical industry anxious financially to get a return on their investment after developing all those designer psychotropics.

Recently, the mother of an often oppositional defiant young man still working through grief and PTSD after losing his father in his mid teens, told me an interesting story. Her son thinks anyone wanting to mentor him isn’t genuine. Likewise, he opines, any professional taking on the challenge wanting to guide him along “has to be” motivated by the financial aspect of such a relationship.
However, so much about our patient-therapist relationships get guarded by professionally mandated restraints. For instance, I cannot communicate with my psychiatrist by e-mail. I cannot talk to my psychiatrist directly. I must go through his nurse clinician if I have a problem or if I need medications earlier. This disturbs me. My psychotherapist, a well-meaning MSW therapist tried to categorically explain away this communication pattern as what happens when someone(me) is dealing with a system. My response was certainly testy, “ If we don’t question the system, we will be corrupted.”

There are certainly symptoms and signs that early mania or hypomania, the opposite emotional process to depression, is in motion: am I becoming hypermanic? Here is when taking an inventory by yourself or with the help of a loved one makes sense. How am I sleeping? Am I fairly abruptly needing dramatically less sleep? Am I more edgy with my wife or associates? Am I flying off the handle over seemingly smaller issues? There are co-occurring issues: did you resume drinking or drugging? Then there’s the angle of sexuality. Some is normal, inappropriately more is not.

This addition to the blog is not meant as an apology for what I have said previously but I want it to represent a dramatic reappraisal of how my disorder works. Bipolar disorder sneaks up on you. It wiles you into believing that you don’t own it. I am offering a different message today. We can hope for as level a playing field as compliance with effective medication will allow or by how much an uncontrollable and latent genie inside us will reemerge or fluctuate autonomously. Genuine cooperation with our treatment process may determine a pinnacle we can accomplish despite a chronic illness. I do not eliminate the value of questioning how care is delivered. The studies confirm that collaborative decisions about medications and psychotherapy improve outcome.

A “level playing field” may have some ruts and bumps as those of us with bipolar disorder reconnoiter our opportunities. So, I suppose, I must now say no to my earlier premise that now appears somewhat of an illusion. In my own case I sheepishly admit that all is not as smooth sailing in our perceived “recovery’ as I might have hoped. I have alluded to hints of reemerging depression. It is not unusual that mania and hypomania resurface. Perhaps, we can identify either end of the emotional yo-yo of our illness more quickly and with help collaboratively return to that illusory “level playing field” once again.