The easiest way to understand this class of disorders is to think of severe mood swings. We all have variable moods to some extent, but bipolar disorders describe extreme highs that would put us in danger (such that we're speedy and sleepless and engaging risky behaviors like overspending, sexual promiscuity, grandiosity that overestimates our abilities, etc.) alternated with extreme lows that would take us out of the game (such that we’re having depressive episodes, frequently calling out of work, isolating from friends and family, etc.).
Without minimizing the often devastating personal and interpersonal outcomes of mindless behaviors during a mood extreme, it's important to consider the inherent, if unanchored, strength and richness of the bipolar client's changing emotional weather. While it is conventionally appropriate for a psychiatrist to diagnose and treat (hypo)manic-depressive cycles with mood-stabilizing medications, I submit that unusual and overwhelming sensitivity is at the core of the bipolar client's inner experience, and that courageous awareness can and must be cultivated during treatment by the non-prescribing therapist.
People who are physiologically regulated, who can relax in response to building emotions - like the sky holding all the seasons and any kind of weather - can ride the naturally fluctuating moods that accompany changing personal and interpersonal experiences with bravery and openness, rather than controlling or arguing with them. They don't cling destructively to good feelings and situations or react destructively against bad feelings and situations. All along the way from good to bad and back again, more mood-stable people can meet change with sensitive awareness and courageous compassion -- toward themselves and others -- and learn from what's arising inside and out. Sounds great, right? Yet this is hard for most of us! And it’s especially hard for the bipolar-diagnosed client.
Therapy with me explores the tragic logic of bipolar-diagnosed clients shunting then unleashing what are essentially authentic and trustworthy feelings. Feelings, whether deemed positive or negative, are useful if not crucial to relate to early, plainly, often; when they are dammed, they go dormant to depression and will eventually explode forth in rage or mania. For the bipolar client, the more vulnerable aspects of feelings and situations -- the in-between where there's lots of subtlety and uncertainty -- are uncomfortable, often described as boring/pointless, and therefore bypassed/ignored to powerful extremes. With insight and training in mindfulness and awareness practices, mood swings slow down, subtle and strong feelings can be met, and sensitivity to sad and joyful experiences can manifest in courageous and healthy expression.
Good therapy will encourage mood awareness and balance via insight-producing discussions with a trauma-informed provider, as well as contemplative and behavioral homework geared toward getting the client’s body and mind reasonably grounded during times of agitation, and constructively active during times of low energy. Emotional regulation begins with a more subtle and sophisticated understanding of physical and emotional sensitivity than has been previously taught, modeled, and experienced. It takes practice, patience, safety, courage, and at times a sense of humor to learn more about misunderstood aspects of strong moods and difficult situations. And it really can be done.