Recovery from Bipolar Disorder

This Extended Story has been written by one of the members of Mind and Soul to describe her journey but also to offer some advice that has been helpful to her. Stories can be powerful ways to convey factual information with a personal touch - a combination of reliability and validity. It explores what the name 'manic depression' means, how to get well and stay well and how it relates to our faith and our understanding of ourselves as people and children of God.

It was also updated in 2018 to add her experiences of bipolar in later life.
 

Outline - please scroll down to see full text

 

What does Bipolar or Manic-Depressive Disorder mean?
An introduction to what the terms mean and how they can be conceptualised

What a breakdown feels like
What are the symptoms of depression and mania? What do they actually feel like? What happens just before a break down

What might lie behind a mental breakdown?
Precipitating factors (the last straw), Stress, Personality, God's grace

Is this disorder 'for life'?
Is it for ever? Do we just need to 'learn to live with it'? Is there life beyond bipolar?

Some things that are helpful for recovery
From a severely depressed phase, from milder depressive phases, from a severely manic phase, from euphoria or mildly manic phases

Things that hinder recovery
There are things that can stop us getting better. Sometimes these are oour own doing, but they can also be the work of others

What to do when a breakdown threatens to repeat itself
What to do if you fear you are going high or dipping into a low

Resources for learning how to sustain mental health
Getting better isn't enough - it's also vital to know how to keep well

How Scripture makes sense of my experiences
The Bible is the source-book for all we need to know. It gives hope and offers advice

How philosophy helps untangle our understanding of personhood
A discussion of how an understanding of philosophy can help us understand our world and the place we have in it

Biploar Disorder in an older person
An addition from Ruth about her experiences in 2017/18
 

Main article

 

What does Bipolar or Manic-Depressive Disorder mean?

A tendency in some people to swing from very low to very high mood states. Moods may be quite manageable and resolved before they incapacitate, but bipolar disorder really refers to depression and mania that go well beyond normal and require treatment of various kinds. Either abnormal state may be severe or mild, and how they are best treated very much depends on that. I use the term 'disorder' rather than illness, because self-help plays a much greater role than in physical illnesses, and a re-ordered thought process can solve the problem, though this is not an easily-won process. In fact, it's hard! but becomes easier with practice. This is not to say that drugs don't work. They do. Our body is from one point of view chemical in its make-up, and all medication changes our body chemistry. It is to say that one doesn't therefore have to assume that chemical changes cause mood swings. It could be the other way round. Or, that chemical changes and mood swings simply occur hand in hand, in response to our attitudes and emotions.

What a breakdown feels like

Severe Depression

In my case, firstly my concentration went and even the smallest decision became difficult to make. I shuffled papers on my desk at work, unable to deal with any one of them, and was sent home. At home there was little I felt able to do, and a mental numbness set in and with it a sinking feeling in the pit of my stomach. I became extremely anxious and cried bitterly and often. Negative thoughts increasingly filled my mind to the point where I hated myself. (Sufferers of a more extravert personality may hate not so much themselves as others.) To fill the time, as all tasks seemed difficult and I was putting off as much as possible, I tried to read novels, but the characters in them had such vibrant lives that they made me feel even worse about my own seeming inabilities. I tried going for walks, but my negative thoughts dominated and spoiled the experience. I made myself do practical things despite the numb feelings, but often just paced up and down as if caged, or sat and worried, or tried to sleep. I didn't have sleep problems, although many sufferers from this condition do. How to deal with my condition was a dominant concern. I was afraid of making things worse if I pushed myself too hard. I thought that if I could work out how this had happened to me it would help, but just trying to think of my past life, which now looked a total failure, brought me to despair every time. Everything looked completely bleak and I despaired of ever feeling right again. As a believing Christian, I realised that my whole attitue towards myself was totally the opposite of what God wanted but felt powerless to do anything about it. Praying made no difference. I wanted all the time to talk about my state but hesitated to pick up the phone or take up friends' time. When I did, it brought relief, but this lasted a very short time. This was because I was again alone with my paralysing thoughts. After eight months of suffering and getting nowhere, I became psychotic at night. There was a thunderstorm and I believed that whenever it receded God was leaving me for ever. I didn't know where to put myself. I couldn't have taken my life, even if I had had the courage to do so, because I knew I couldn't escape from God, and I believed he would have turned his back on me permanently. I imagined some kind of outer darkness and alone-ness for ever. I writhed in mental agony. In the morning I couldn't make out why I had thought this.

Milder Depression

Finding it difficult to work, building up a black picture of one's situation and worrying excessively. Consciously or unconsciously needing support beyond the usual. I.e., finding it helpful to look up a good friend and discover a more positive way of looking at the situation; this may be necessary repeatedly over some weeks until this has been practised together with more effective behaviour, and stability has been restored.

Severe Mania

In my case, feeling happy and confident developed into feeling I could do anything - far more than I had thought possible before. I had very big ideas; despite how they came across to others at the time, they have not all proved wrong, but they have not proved as easy to fulfil as I in my abnormally euphoric state believed. I felt able to work faster and accomplish more and more, and frustrated that people didn't go along with my ideas. Shopping was all-too easy! The less those close to me took an interest in my ideas and the more they became angry, the more impatient I became, which in turn drove me into a state of greater excitement and activity. By now my brain felt tightened - almost as if in a vice, and the rest of me felt light - almost as if my feet were off the ground. Eventually I started doing less and resting more - something for which I had long felt the need - but colleagues, friends and family did not see this need. At the same time I started seeing and hearing things that seemed very strange; this was of course due to my having reached a psychotic state. For example, I retreated from my house guests, but 'saw' them downstairs through the pattern of my bedroom carpet. Another time, taking a leisurely bath, I heard my husband drive off to work, but then 'heard' him reverse back in and leave again several times. Enforced hospitalisation and hefty medication put an end to the above. However, the first time I became manic it was for a different reason. I had reached only the stage described in my second paragraph and developed a terrible rash and took to my bed feeling ill; the GP diagnosed an overdose of antidepressant and changed it at once to something much milder which brought things under control fast.

Milder Manic phases

With a manic-depressive tendency people may experience what I have described in the first paragraph above or even the second, and switch suddenly into depression without reaching the psychotic stage. They will not suffer as much but may not recognise the danger of that or a sudden switch occurring. Overwork or over-excitement in those who tend towards instability through the the ambivalence in their make-up ( a mixture of great self-confidence and underlying insecurity), are situations that should ring warning bells.

What might lie behind a mental breakdown?

First of all I would like to issue a warning. While you are severely depressed do NOT try and figure out why. You will not succeed and your pre-occupation with problems will make your condition worse. Do not let friends or therapists or spiritual advisers make you do this either. Also, in my case, prolonged prayer made me feel much worse. This has become known as the 'downward spiral', which means that thinking about problems when you are in an abnormal state of mind makes you think about more problems which drag you down further and further. Deliberately replace such thoughts with practical little occupations, which you can manage if you persevere and take comfort from their achievement. When you have recovered from your incapacities, that is the time to look back and work on the why's. And there will be many rather than a single one.

Precipitating factors

For me, being in a situation where I have taken on more than I can handle may make me panic and seize up or freeze in fear of not being able to master the situation. This has occurred on returning to work after a wonderful holiday or after working to a deadline on one thing and then coming back to facing all the other things that have been put aside meanwhile. I sometimes describe this as a 'crash' because it happened so suddenly and unexpectedly the first time. It has also happened after a period of doing really well at work but in my excitement over what was being achieved I took on too much. Then, when the situation became complicated and I realised something was going badly wrong, I 'crashed' into debilitating depression.

Stress

For whatever reason - and many reasons can be found in the section below - an accumulation of self- and other-imposed expectations in a multiplicity of areas can become too great to handle. One may not realise this until it is too late, especially before a first breakdown.

In my case I was trying to complete a doctorate without a supervisor (my husband's career meant we moved too far away from my university for me to qualify for one), while starting a very demanding new job (in which I had little support from my team leader), helping my husband organise courses overseas, overseeing my husband's private work at home, endeavouring to carry out church eldership duties, and bringing up two children (though they were wonderful and we always had a Christian au pair who cared for them like a sort of big sister). Maybe all that in combination accounts for the severity of my breakdown, and I hope few others will make my mistake of holding on to so many challenges at once!

Personality factors

Here we have to look at both style of upbringing and genetic characteristics. Upbringing which is both loving (without smothering) and strict (boundary-setting to a reasonable degree) is ideal preparation for maturity, but when it is also highly guilt-inducing we may have a problem. This works in different ways in combination with the personalities with which we are born. Some can ride the storm and even rebel, while others may at times crumple. In my case, I was 'born serious' I am told, and from earliest memories I was eager to learn. The latter was reinforced by my family which had, through historical circumstances, suffered displacement and loss of opportunity, so that much was expected of me. I was comfortable with it and enjoyed learning and striving for good results. It gave me confidence, sturdy determination in fact. I also wanted to please my loving and generous parents. Being a latecomer and the only girl in our family, I was also very cherished and over-protected in my early years. This on the one hand gave me self-confidence but resulted in not being at ease with my peers when I started school; furthermore, the behaviour of children towards my being the child of parents who came from an 'enemy' country, never mind the fact that they had left in flight, added to the fragility of my self-confidence. Nor was it helped by the fact that I had to change schools and try to make new friends eight times, four of them at the other end of the world, and travel alone as a teenager to Germany for many school holidays (my parents having accepted a missionary call back to that country, while I stayed at my boarding school in England). Also, my mother was habitually very shocked when I didn't follow her guidelines, and I really began to doubt my ability to make independent choices. Fear of her reaction if I strayed literally or morally brought about, I can see now, quite a strong separation anxiety. Fear of her anger towards me for failing to meet all her needs and standards was always present. I often felt indignant and, increasingly, angry, but if I showed this it made matters worse. Perhaps you can imagine the frustration. Other factors behind bipolar disorder could be Jewish-ness, for both genetic and historical reasons. On my father's side my ancestry is entirely Jewish (the reason for my parents' and brothers' refugee status before I was born). My mother often drew my attention to the tendency of my father and other Jewish people to be 'Zum Himmel hoch jauchtzend oder zum Tode betruebt'; it's one of those German sayings that spoils in the translation, but describes being almost ridiculously happy one minute and crashing into desperate sadness the next. It isn't true of all Jews of course, and it is true of many non-Jews as well. I also have the impression that among severely depressed Christian the disorder is more often bipolar than not. There can be a misapprehension about what Jesus requires of us as Christians which, in a sensitive person, can result in trying too hard; it was never meant to be like that! The Bible throughout teaches a wonderful balance, though on a narrow path that will not always be easy to follow and requires toughness; children must be helped to develop this along with all the other marks of a Christian. Perhaps the basic make-up of a personality which tends towards manic-depressive swings, is the tension between being ambitious and determined to be successful, yet sensitive enough to be capable of crumpling under failure or disappointment if in a highly-stressed state.

God's grace

After my first breakdown, with which I suffered for at least eight months, I recovered fast and found I had gained more confidence socially than I had ever had. Having enjoyed this for some weeks I suddenly remembered that a few months before I had broken down I had prayed that God would teach me just this, for a specific purpose in his service, whatever it took. Ever since, although I would not wish it on anyone or want to go through that dreadful experience again, I have thanked God that he let it happen to me. It gave me a new desire for and delight in spending time with people. However, it took a few more, milder breakdowns to teach me other things, and I am sure there will be more to learn though not through breakdowns, but I really don't want to pray that prayer, possibly invoking drastic measures, again!
 

Is this disorder 'for life'?

I am convinced that it is not, and that the biggest predisposing factor is the expectation, which may be inculcated by others, that it has to be for life. In other words, you are labelled as A Manic Depressive, rather than someone who has the tendency to become manic or depressive, but also the ability to learn how, not perfectly, but better and better to overcome it. "Learning to live with it" is defeatist; it is not a condition that benefits from such pessimism. One reason is that underneath the weakness seen in a breakdown there is a strong and determined personality, and regaining this strength is important. Also, I believe it is vital for growth to see in this disorder (as in everything in life) the skirmishes that Satan persistently endeavors to make on the kingdom of light'. Which is not to say that treatment on other levels than the spiritual cannot play an excellent part. They can, and should be used with gratitude to God that, in the wider picture of things, insights into medication and psychological treatments have been gained. Usually the conclusion of a talk with Christian friends who are paralysed and afraid and want my help, at the end of a time of sharing with each other is, 'The only way out is out!' combined with 'You can do it!'. The latter may sounds unbiblical to some, but it is a wonderful corrective to the notion believed by many Christians, that dependence on God is not consistent with any reliance on self.
 

Some things that are helpful for recovery

From a severely depressed phase

Friends who showed me love and respect. They visited me and treated me as if I were normal, conversing about things other than me. A few close friends who came round and gave me a spot of practical help; two whose opinion I very much valued, encouraged and then challenged me with a few kind but firm words, to try and make at first just one, and then more everyday decisions for myself. They didn't know it, but this directly dealt with 'learned helplessness' which is the state into which I had slipped. You have difficulty doing things so you feel afraid you'll not be able to do anything and give up. Picking smaller practical activities and concentrating on completing each instead of relapsing into worry. Having company. Going out socially even though I didn't want it or felt unable to contribute to the conversation, and trying to concentrate on the interests of others and not think about how inferior they made me feel as I had none! People who said 'it will get better', even though I didn't believe them. The church being there for me every week, even though I felt at least as numb and frightened when attending as for the rest of the week. Reaching the point, after two psychotic nights, of asking to see a different psychiatrist (in fact a Christian of whose character people spoke highly, hoping he would take my Christian thought-life seriously and not just dismiss it as a symptom, after which I would, I believed, feel safe doing whatever he advised). Hospital. I had feared and postponed accepting admission to hospital, because my work experience in a large mental hospital for chronic sufferers had convinced me that if I went in as a patient I would never get out. However, the wonderful reception unit to which I was sent had features which cured me fast: Care - I no longer had to try to provide meals etc. and could relax.
Stronger medication than given while at home. The male nurse who took my worry seriously and said 'six weeks is the average stay in this unit'. A challenge to take up occupational therapy if I 'wanted to get out'. Beautiful grounds in which to wander (and a lovely time of year!). The company of several other women with whom to compare experiences of depression; their marital problems in particular were much worse than mine and they were isolated and without church fellowship. I was able to help put that right for one and kept in touch for a while with two.

From milder depressive phases

The expectation of a quick 'lift'. I refused to accept that recovery needs to take a long time. I took faithfully took medication as prescribed, but learnt I didn't need to wait for it to work before I tried to wrestle with my difficulties. Taking Lithium for as long as advised, though requesting and given permission to stop (gradually) after maybe a year or two of stability, to see if I had learned enough to manage without the medication. Lithium helpfully knocks off the more extreme highs and lows, but while taking it I knew that my mind never functioned at its best. The advice of a nurse-counsellor who taught me a) to look at my past in a positive way and b) that being angry at times was OK, but going on being angry was not. Realising that though ambition and drive to solve problems were gifts, I had been using them to an unhealthy extreme.

Discovering that it was of worth to achieve a little, rather than pushing myself so hard I reached that state of ability to achieve nothing. Going to a mature married couple, together with my husband, to describe a problem I had, and getting from them a sympathetic hearing and a balanced perspective. In recent years, the insight that hormonal factors may have played a part in my first breakdown and with the enthusiastic support of my GP experimenting with HRT; it has made a great difference to my ability to think clearly, and has been the 'icing on the cake'. It may be a crutch which I could learn to do without . . . . For further constructive ideas, see sustaining mental health and scripture.

From a severely manic phase

I'm not sure one can pull back on one's own. In my case what helped, though it humiliated me, was being put in a car, taken to hospital and heavily sedated by Haloperidol for two days, after which I awoke to complete sanity.

From euphoria or mildly manic phases

Recognising the danger, which is much more difficult than with depression because at the beginning of such a phase one feels so particularly well and at ease with the world. One symptom that is perhaps easier to register than most, is spending more than usual. While others can enjoy such a phase and exploit it without going out of control, some of us need to be wary. A kindly spoken word by a colleague or friend, such as 'remember to pace yourself'. Recognising that one is becoming impatient with others and irritable. Taking adequate breaks of relaxation or change of activity. Cutting out or postponing some objectives, and putting some in a diary for another day or week - learned from Steve Chalke's 'Time Management'.
 

Things that hinder recovery

From a severely depressed phase

Being told 'it will take a long time'. Two well-meaning wise, older ladies once told me over coffee that I 'might have to go away for a very long time'. In the event my longest spell in hospital was three weeks and the only other was three days. Refusal by others to discuss one's symptoms as reflecting real problems, even though they were exaggerated in my mind. Being addressed in a manner that suggested I was incapable of any normal comprehension. Being kept on the same medication for a long time though I was getting no better. Being given medication only and no counselling or offer of counselling by others. Waiting to get better, instead of occupying myself or trying in a small way to serve others. Believing that because I was basically worried and unhappy, it was inappropriate to be happy on occasion and even smile or laugh!

From a milder depressive phase

Too much discussion of my problems. Being asked frequently how I was. The anxious concern of those close to me. Too much rest and too little fighting to replace my distressing thoughts with others. In my case, Cognitive Behavioural Therapy (CBT), though it is a school of thought that deals with the truly human and which I therefore admire. It probably had the wrong effect on me because I had at that point reached the tail end of the last spot of mild depression for many years, been through enough and worked out enough for myself by then. Sitting in the garden on a glorious day, starting by feeling very positive and going through a CBT workbook, brought back regrets about failures and floods of tears. The crying wasn't healing - putting the book away for good was. I am aware that the only thing that will resolve them will be when, maybe not until the resurrection to life on the new earth in some cases, I have opportunity to put them right. Meanwhile there is comfort in knowing that God isn't reviewing my failures and I shouldn't dwell on them.

From a severely manic phase

Warnings without sympathy. Not having responsibilities reduced or shared. Not being encouraged to rest or take time out. From euphoria or mildly manic phases. Pursuing all one's objectives at once and cutting out breaks, holidays, quiet times. Making arrangements that will utilise every space in the diary.
 

What to do when a breakdown threatens to repeat itself

If you fear a 'low' is developing...

A good example of this is feeling flat in the morning; everything seeming meaningless, so even the smallest decisions are difficult to make. This is the way ahead that prevents the feeling lasting more than a few hours. I pray briefly, and have increasingly been able to have faith that I will be helped quickly. Then I recall, from experience, that this is happening because I have more to do than can possibly be done in the timescale I have set myself. Because this happened in such a drastic way and with such dreadful consequences once before, I am in fact shutting down in panic! To deal with this, I lower my sights and plan to do much less that day, to be kind to myself and maybe do something just for someone else, and to achieve small tasks until I am up to speed again. I don't tell anybody how I am feeling at this stage, because their resultant anxiety, and the act of rehearsing my feelings, are not good for me, and I know from experience that if I deal with it in the way I am describing it will not last long anyway. Nor do I allow myself to continue thinking 'Help, this is going to be a disaster!' and feeling sorry for myself; this is completely off-limits. Instead I concentrate on a practical or easily organised task and get it done. I tell myself afterwards that I am pleased to have completed something (even though it felt like pushing a bus!) and turn to the next task with a little more courage. Such self-rewards make each successive task or occupation easier and, by the afternoon, meaningful and joyful again. I 'count my blessings', i.e. thank God for everything I have that is good, as I plod on. To those who have not suffered imbalance, this may seem normal procedure. To someone who has, dips in mood ring alarm bells and actions have to be taken calmly and deliberately. The very act of remembering what works is more difficult than normal.

If you fear 'going high'...

As when depressed, but for different reasons, I lower my sights and decide to do less. I endeavour to do things more deliberately and steadily, ask people to lend me a hand with certain things, and make myself remember that this haste is not what God requires of me. I remind myself to 'wait upon the Lord' and work on being kinder to myself and those around me.
 

Resources for learning how to sustain mental health

In thinking about the bigger picture during the very long intervals between manic or depressive phases when I have been well, I have had the advantage of being able to work things out on the basis of my studies and my findings as a research psychologist. Themes around child-rearing, theories about learning, motivation and personality, and some knowledge of neurophysiology have all been helpful to some extent, from whatever school of thought.

My breakdown has given me an experience of clinical psychology for which I am grateful. Having chosen a research rather than a clinical career, through qualms about being free to be sufficiently true to scriptural principles in clinical practice, I did still feel the need for better knowledge in that area. This was so in spite of the fact that I worked closely with practising psychologists and other colleagues in Departments of Psychiatry and Criminology, but that isn't the same as having clinical responsibility. So I am really grateful now that I have been to both extremes of thought disorder, and over time learned how to take responsibility for one patient (myself!).

I have also had the advantage of having been a Christian life-long and privileged to know and love much of the Bible. Testing out my experiences against the theories of my trade, and both against Scripture, has been wonderfully strengthening and reassuring. Scripture is the bedrock of understanding but for me, going through a valley that has the shadow of death has been necessary as well. I have been asked how I have found what I have learned as a psychologist to be consistent with Scripture. That is a big question, as the most helpful answer lies within philosophy, the discipline which links all the others and it is outside the scope of this offering.

Between them, reformational theology and philosophy have enthused me more and more over time, in enabling me to appreciate both the Bible story - God's story in which we are players who have its light to shed on our path, and the multifaceted, intertwined riches and coherence of creation. This undergirds whatever understanding I have of my profession. My family is now a huge strength. People are so important to our well-being, and however small our family, each member is a gift to be treasured and/or a relationship to be nurtured. If we have no family, members of God's family can be just as close to us.

We can all strive to gain understanding about what Scripture is telling us, how all-encompassing the good news really is, our experiences of suffering, and our positive learning experiences in the specific areas to which we are called and life events we encounter. The Spirit of Jesus helps us to do this. However, some of us have more personal baggage to dismantle than others before we gain sufficient insight to apply what we believe to our own individual needs.

Finally, on a more light-hearted yet profoundly sustaining note, the dear friend who said, 'out of the blue' as we were happily setting off on an outing together, 'God wants us to enjoy life you know!' brought home God's fundamental purpose in creating the world. It's not always easy for some of us, and it's often difficult for all of us who empathise with the many who are suffering from tyranny and its consequences. But it doesn't make the world a better place if we refrain from delighting in God's good gifts.
 

How Scripture makes sense of my experience.

Image-bearing. Being treated with dignity, and as if able to comprehend most things normally even while unbalanced, likely to be fine betweenwhiles, and recover fully at some point, is vital because we are made in the image of God. As such, we need encouragement to live out that privilege as much as possible. Being allowed to suffer but then being restored. The book of Job is a favourite of mine. But Scripture often speaks of learning through suffering.

Sinking low like Nebuchadnezzar but then coming back. He was reduced to the behaviour of an animal - humiliated to the point of scarcely being human. I often realised I was functioning at a really low level, and this is probably why at such times a behavioural approach (i.e., not relying on explanations while functioning poorly at more uniquely human levels, but instead treating myself with small rewards for certain activities), which works so well with animals, is one of the best. When I did not manage to function even at that level, I had to rely on physical treatment, worked for me in severe manic disorder.

'Let go and let God' does not seem to me to deal with how Scripture sees us. 'Let God' is always vital, but it seems to me that we have always to be on our guard, even when we are relaxing and enjoying God's good gifts. Satan is still on the prowl. We can easily misuse God's gifts if we relinquish the use of our minds and drift. It is only in death that we let go completely - a victory for Satan were it not for the resurrection of the body that is to come. The saying that 'God helps those who help themselves' is a little closer to the teaching of Scripture, though neither is a saying of Scripture.

Doing things even when we don't feel like it, which is much harder when we are depressed. Keeping God's commandments is not an option; it is what brings shalom for us and our children and children's children. God's admonishments are not for some people but for all, and they suggest that we are capable of carrying them out and must spend our lives learning to do so. He gives strength when we move forward in obedience, however small our steps.

God's commandments and admonitions are balanced by His compassion and provision for our failure to reach his standards. This is especially a comfort at those times when we are weak and incapacitated, and motivates us to pick ourselves up and try, with the help of his Spirit, to serve Him better time and time again.

The second part of Jesus' summary of the Law - to love (with all its implications) my neighbour and, equally, myself. These have often been played down in the teaching I have received from evangelical wing of the church, in its anxiety about underestimating God's sovereignty and grace, and about swinging too far in the direction of 'do-gooding'. It is exciting to see signs of a more balanced theology springing up in very many quarters. Obeying the command to love strengthens us in times of health, and if we do so as best we can in times of weakness as well.

The restoration of all things. The coming of God's Kingdom of justice and true freedom, that Christ has achieved and is achieving, gives me the greatest hope, and encouragement for continuing in well-doing and not growing faint. Jesus' miracles and amazing manner with everyone show us what he can achieve with us. There's much more, of course, that needs to be said. There are endless riches to discover for our growth in the Word of God and in the unique lives and the time he gives us.
 

How philosophy helps untangle our understanding of personhood

I wrote the following in the last section: “Sinking low like Nebuchadnezzar but then coming back.  He was reduced to the behaviour of an animal – humiliated to the point of scarcely being human.  I often realised I was functioning at a really low level . . . “

There are two conflicting views of the person that most psychologists, when they are thinking philosophically, reject.  On the one hand there is a ‘monistic’ perspective that reduces the human being to the physical aspect.  (This can be referred to as philosophical materialism and often leads either to behaviourism or some form of genetic determinism.)  On the other hand, there is a perspective that can be called ‘dualistic’ which we often associate with the philosopher Descartes.  On this view we are minds-in-bodies and the mental and the physical are understood as being completely different substances.  This view is sometimes referred to as ‘the ghost in the machine’.
 
The approach which I prefer is in striking contrast with these two dominant perspectives that still prevail in unguarded psychological interpretations of research findings.  A non-reductionist, pluralist philosophy seems to me much truer to life.
 
For example, when humans wink ironically, we cannot reduce this activity either to the physical (i.e., materialism) or to the mental (i.e., dualism).  The ironic wink demonstrates an aesthetic (fun) dimension or aspect of human activity.  Crocodiles blink, but don’t imagine they’re winking; it doesn’t imply any humour in the situation!  In this example all the lower aspects apply, more or less; the kinetic (movement) one is perhaps the most defining one.
 
Aspects or dimensions, characteristic of any and every entity, were distinguished by the Dutch philosopher Dooyeweerd (1894 - 1977) and are highly valued by many Christian scholars today.  Each aspect is at work, either actively or passively and in varying importance, in every thing, every animal and every person.  For humans these merit consideration when trying to come to grips with psychological breakdown: beliefs (the faith aspect), values (the juridical), attitudes (the ethical), relationships (the social), playfulness (the aesthetic), speech (lingual), reasoning (the logical), constructivity (the formative or historical), perception and emotion (the sensitive).  All of these characterise all humans and are obviously subtler than the blanket notion of ‘mind’.  They deserve exploration when depression or elation get out of hand.  Though not unique to humans, there is also a place for the biological, the physical, the kinetic and the quantitative aspect, all of particular significance in the medical model.
 
In addition, we can well think of ourselves as ‘hearted creatures’.  In line with biblical thinking, Dooyeweerd held the heart to be the centre of a human being, the point of concentration where all the different dimensions or aspects come together and cohere.  Combining these ideas, of the heart and of many dimensions, allows us to affirm both the unity and the diversity of [us] complex human beings.  This way of speaking is faithful to the biblical revelation and also resonates with our appreciation that human beings are complex, but held together by the hearted nature of our existence.
 
So what have the aspects to do with bipolar disorder?
 
It’s helpful to consider each aspect in turn, but let us start with the economic: Now, for a person who has broken down, especially if depressed, the economic aspect of his life will probably mean he does not feel like buying anything!  So in this respect he is not truly functioning positively, as the subject in charge of his life.  But it will of course still cost to feed and clothe him, and pay his regular bills such as rent, i.e., in this respect he finds he is frighteningly the object of these realities about which for the time being he can do nothing.  When he is ‘high’, on the other hand, he may be enthusiastic about making purchases or laying expensive plans.
 
Or take the aesthetic aspect:  When depressed the arts will seem lacklustre to her, but when ‘high’
she will be able to delight in pieces of art and music, fashion and interior design, God’s designs in nature and so on.
 
Or in terms of the lingual aspect, he will lack vocabulary, unable to find topics worth talking about and shirk company – while when ‘high’ he will be voluble, creative with words, etc.
 
What perhaps matters to us most is the pistic (faith) aspect of life; in this regard she may actually lose her faith in, say, the resurrection, the new earth, her own salvation, even in God himself.  But on recovery she may feel as sure as we can be that all these things are true and a cause for rejoicing.  Note that I have used the word ‘recovery’, not ‘high’, and at this point I need to mention the difference between those two concepts.  In bipolar disorder, there is a point at which we are well.  This may be considered as touching the ground while on a swing.  I mean a tangible swing as in a garden or a playground!  Or it may be pictured as the area between the latitudes of Cancer and Capricorn – much broader or longer-lasting.  It may last years.  In the normal phase the functioning of the aspects can of course be described in a similar way, but within normal limits!  It may be helpful to think of the normal distribution or Bell Curve.
 
As Christians we are well aware of our sinfulness and sometimes of our giftedness by God.  And sure enough, the theory of aspects bears this load in both directions – the extremes of ‘low’ and ‘high’.  This way of looking at our behaviour is normative in our more usual use of the term.  The bipolar sufferer knows that both depression and elation are not right, but can be helped by regarding his or her behaviour as an affliction rather than a sin – to me this brings some relief when I am down, and less of a sore conscience if I feel unable to do anything other than read a novel.
 
To summarise, all the aspects have their place in the life of the bipolar sufferer, but when ill, take on more extreme significance, one way or the other, than in the mentally healthy person.  How much, and which aspects are dominant, either positively or negatively, varies between unique persons and over time (the amazing story of personhood, personality and individual differences).  Why, when we consider any one sufferer’s personal history, bipolar extremes have come into play, is another story.
 
It is a joy when one is functioning at the best of one’s abilities and can appreciate factors at work at every level and see one’s problems in perspective.  Scripture wants that for us.
 
My thanks to
- Andrew Basden, Emeritus Professor of human factors and philosophy in information systems at the University of Salford and to
- Mark Roques at the Thinking Faith Network (formerly WYSOCS).  At www.mark.roques.com he writes about worldview and the role story-telling can play in evangelism
and to
- my husband, David Hanson, who like me is an amateur philosopher, but has always been ahead of me in the game.
www.wysocs.org.uk
www.markroques.com 
 

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Bipolar Disorder in an Older Person

I stand by all I wrote above in 2008 except for one question and my answer: “Is this disorder ‘for life’?  I am convinced that it is not.”  Now I am not so sure!   We need to wait and see at the end of a life.

In 2008 I had grounds for optimism; I had been totally free of depression for seven whole years and felt good, organizing a school of Christian Studies and seeing through the conversion of our barn into a down-sized home.

In 2009 everything changed!  I had a breakdown and was hospitalized.

This was the sequence of events that led to it.  Our lovely daughter and her kind husband gave us all their airmiles, urging us to take a holiday after the efforts of moving out of our big house (having them move in)and settling in a little flat for a year until the barn was ready.  I chose Dubrovnik as our destination.  There was a lot at stake as I felt I wanted the gift to be used wonderfully well.  However, a number of things turned out to be disappointing.

By the time we got back to St. Pancras I was so low that I couldn’t choose where to have lunch or what to have.  Matters were made worse later that day when I was reminded that we had arranged to meet our son at another station, and he and his little daughter had waited for us for an hour before giving up.  A stupid failure on my part!  You know, when I think back over the years to my first breakdown when I was 34, I think failures are my biggest precipitators.

Nw why I take things so hard can be explained by the things explaine in the section above entitled “What might lie behind mental breakdown”..

From down I went downhill, finding it difficult as practice manager to help my husband wind up his business for 2010 when we both retired.  I became unreasonably anxious about money in view of the expense of building work on the barn, and I began to pace up and down the living room at speed.  The doctors took over and I was admitted to hospital. I was shocked to find myself at 68 to be on an “older persons” ward!  Was I old?  I was in fact the youngest on the ward.

I spent only three weeks there and came out much better in terms of anxiety, but I have yo-yo‘d through repeated phases of deep depression and mild mania since, until the present, 2018.

So it is true, in my experience as well as in psychiatric understanding, that it is harder to recover in older age.  My youngest, jolliest aunt became depressed after the death of her husband and never recovered.  However, for a reformational Christian and a psychologist I have tools with which to fight my way out of each depression and thank God that it has been possible each time so far.  Again, you can refer to a section above called “Some things that are helpful for recovery”. 
  
Symptoms become harder to fight in older age.  In my experience - and I know it might be different for others of you - my depressive phases have been more horrible that pre age 60.  Death is that much nearer, which adds to a Christian’s anxiety the thought of the judgment for one’s sinful, negative thoughts and the eternal consequences.  But there is also the loss of employment, of demanding and enjoyable achievement in voluntary work, and the frustration/envy of seeing younger people still pursuing these occupations confidently.

When deeply depressed, I am ashamed to say, I neglect myself and the house to a shocking degree.  I hate to do anything practical, and fill my days with doing puzzles in order to try and distract myself from the black thoughts. Latterly I have been able to read novels instead.  I can think of no conversation whatsoever, and especially dread Sundays because of refreshments-time when I cannot cope with meeting friends and their well-meant questions. Hymn singing is difficult too, as I even lose my faith and cannot honestly sing many expressions of trust etc.

Mind you, in recovery from each ‘down’ period I find the confidence and wonderful clear thinking as good as when I was younger!  I am so thankful to God that he keeps giving me second chances; each time it is easier to use them and at last I feel ready to resume my research career in psychology.   I have to admit that God has been teaching me through all these nine years, despite my dreadful lack of trust.   If only I need not go down again!

One thing I have at last learnt: bipolar disorder has a virulent physical aspect.  So next time I go down I am not going to be as hard on myself as heretofore!  Perhaps it will help me move forward faster if I look on myself as unavoidably sick and in need of a little pampering!?
 
Not too much pampering though!  As the Apostles, especially Paul and James taught, fighting evil is paramount in our efforts for the Kingdom.  To me it seems as if, when in deep despair, I am lumbered with Satan on my back and I have to beg God to remove him.

I should like to hear comparisons of your experiences with mine - please comment below.