“Acceptance doesn’t mean resignation. It means understanding that something is what it is and there’s got to be a way through it.” – Michael J. Fox
I self-diagnosed with bipolar disorder mere days into my very first manic episode. I’d had unipolar depression for three years and during that time I had read a book on mental illness which included a chapter on bipolar disorder. I read this chapter solely out of curiosity, but retained the information, which enabled me to make the self-diagnosis several months later. Upon this realization, I immediately contacted my GP to inform her that I had mania, and she suspected my diagnosis was correct. It was obvious in less than a five-minute phone call that I’d had a profound shift in speech and personality. And I was talking so rapidly she had to tell me to “shut up” to get a word in edgewise. I was already firmly in bipolar disorder’s grip. I was hospitalized later that day.
During this very first full-blown manic episode, I never once asked, “Why me?” I immediately accepted it and that I would also have to take medication for the rest of my life, even though I knew I would dislike doing so. I could have warred against bipolar disorder, but the symptoms were too pronounced to deny. My acceptance was made easy by the fact I was able to recognise, in retrospect, that I’d had many undiagnosed episodes of hypomania and huge rages since my late teens. I may have also been so accepting because I was familiar with mental illness after having lived with depression for three years. I was thirty-five at the time and had weathered some of life’s challenges which cultivated resiliency. Most people with bipolar disorder are diagnosed in their formative teen years or early twenties when they are ill-equipped to deal with life’s harsh blows, when life is supposed to be carefree, and when they believe in their invincibility. In my situation there was also considerable mental illness in three generations of my mother’s family, so I wasn’t surprised when I was dealt a bad hand.
Even though I disliked having to take so many pills and have complained about the efficacy of the medications and their side effects, I knew I would be uncontrollably sick without them. Bad things happen to people every day; especially as they age. It just happens, unfortunately. We only have to look around to know this. The question to ask is, “Why not me?”
Moving toward acceptance is a step-by-step process we all adopt at different rates, taking years for some. A period when we may forgo treatment. It’s a road that is neither wide nor straight with no traffic signs to guide the way.
Barriers to accepting bipolar disorder are sometimes beyond our control, like socioeconomic status or whether we have bipolar l or ll. Individual factors like self-stigma, substance use disorder, lack of support and resources, physical health and concerns about confidentiality can also determine how well we accept it. Acceptance is about acknowledging that bipolar disorder exists within us, a life partner so to speak. A fact we cannot change. And no amount of denial will erase it from our lives. Ultimately, it’s about having to take medications for life and make certain lifestyle changes.
If acceptance is not present, adherence to the medication regimen can become problematic with symptoms continuing to persist. Acceptance is transformative and comes with many benefits for an illness that does not give us many breaks. It puts us at an advantage by moving us closer to our goal of living well with the disorder. It also promotes growth and change, which in turn results in less suffering and more inner peace. These are good reasons to pursue acceptance even though it can be a lonely and onerous journey for some.
Despite my initial acceptance, I later found myself running on uneven ground with bipolar disorder always at my heels. In those days my hatred of the disorder was complete. The next two decades post-diagnosis brought seemingly consecutive mood swings that were oftentimes severe. I fought back by becoming a student of bipolar disorder to learn how to better manage it. Education and understanding are invaluable tools leading to acceptance, which is why we have to educate ourselves about this complex disorder.
Life changed in an instant for many of us with just nine words: “You have bipolar disorder: an incurable and lifelong affliction.” Hearing there is no cure, and that it can be only controlled, is devastating for many people, especially if their symptoms are severe. It’s a gut punch as the diagnosis often arrives decades before we expect sickness to visit us in the autumn of life.
It took many years post diagnosis to recognize I had a choice in how I perceived and responded to the particulars of my bipolar disorder. I noticed that once I started living well with it, its curability became a moot point. It did not matter so much if it could not be cured because an illness that is well controlled—symptom free with minimal side effects—is a pretty good outcome.
When I look at the tools in my arsenal, self-reflection is one of the more potent and helpful after the quartet of good mental health: sleep hygiene, diet and exercise, taking all medications as prescribed and keeping all psychiatric appointments. It has been much more powerful for me than certain tried-and-tested therapeutic techniques like progressive muscle relaxation, mindfulness, diaphragmatic breathing or meditation. It also helped me put my illness into perspective and enabled me to endure what I thought I could not endure.
I began to examine my inner thought processes twelve years ago which caused a significant shift in how I approached bipolar disorder, resulting in recovery. Self-reflection helped me think and react rationally, enabling me to map out strategies for wellness and monitor and evaluate their success. In this manner I was able to respond to bipolar disorder in a reasoned way instead of failing to act, which is what I had been doing up until that point. Sleepwalking through life, always relying solely on the medications to promote stability, oftentimes without success, as I was jolted from one mood swing to another. This practise of responding logically propelled me from a place of fear to a position of strength and empowerment.
Try to talk openly with your psychiatrist or doctor to discuss possible barriers to acceptance or adherence to your prescribed medication. For example, perhaps you have issues in your life that preclude acceptance or have been given a drug that gives you cause for concern. Instead of discontinuing the medication on your own, share your apprehensions with your psychiatrist as they may be able to prescribe another drug with fewer side effects that might make you more inclined to accept your diagnosis and the need for medication for life.
A good psychiatrist will collaborate with you. They will listen with respect and without judgement, will validate your opinions and feelings, and will problem solve with you in accordance with your wishes. My current psychiatrist taught me “radical acceptance”, a skill that helped me accept things the way they are with an emphasis on moving on; a laborious process when my life was in a shambles. It also teaches that pain is part of the human condition. My psychiatrist spent hours working through this pain with me—when I was guilty of stagnation and wishing my life were different—to prevent it from morphing into prolonged suffering. I think radical acceptance is a powerful tool in the management of bipolar disorder as it helped me accept certain painful situations I was not prepared to accept.
As I age, I have mellowed and slowed down: becoming grateful and happy by being content with what I have, savouring my hard-won resiliency, and developing a certain mastery over bipolar disorder and making peace with it. And finally, becoming philosophical about my existence. The finiteness of life will do that to a person in their third and final act. I often reflect on what it is like to be a 67-year-old woman who has bipolar disorder in the broken world we live in today: covid-19, climate change, hospital bed shortages, war in Ukraine, Fentanyl crisis, rising cost of living and homelessness. Unfortunately, I have had more feelings of unease and fear in the last few years from external influences than at any point in my lifetime. I counteract these feelings by living a day-to-day existence because the past has been unsettling, and the future holds no promises. I also continue to manage my bipolar disorder by taking my medications even in times of wellness. Some people discontinue their drugs once they obtain stability, only to relapse. And I remain vigilant. After twelve years of living well with bipolar disorder, I am always on the lookout for a switch in mood and that unforgiving cold northerly wind.
I have observed that some people go through life without much torment and others do not. I do know I can’t waste one speck of energy looking at the “Instagram perfect” lives of the people around me—who appear to have less misery than me—because that won’t change my life for the better. It will only make me wretched. Instead, I have learned to look at the people who have far greater sorrow and suffering than I will ever know—like the courageous Michael J. Fox battling devastating early-onset Parkinson’s disease for over thirty years with grace, dignity and strength—and watch how they manage.
Now I know that will change my life.
Louise Dwerryhouse, a retired social worker, who worked in Canada and the UK, is an advocate, and mental health blogger on “lived experience” living in Vancouver, British Columbia. She was diagnosed with bipolar I disorder late in life, over 30 years ago at the age of thirty-five, and has been living well with the disorder for 10+ years. She writes to those alone, frightened and traumatized by volatile mood swings such as she had in her early days post-diagnosis. Louise tries to lead by example, by sharing her journey to recovery, showing it is possible to live well with the disorder. Her dream is to see a society centred on acceptance, inclusion and less stigma in her lifetime.