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There exists what I’d like to call the PHFBP, or the professional, high-functioning bipolar patient.
When looking at the PHFBP, it would appear that he faces few problems. He is compliant in his treatment. He is successful in his job; he may be married and have children; he has friends, and in essence, he is happy. For the therapist, this patient might be called "the model patient." In reality, although this patient is seen as a "model" patient, he still must cope with several, important life issues. (I know because I’m a PHFBP and have been one for several years.)
The issues are as follows:
1. Do I really need to take my meds?
Medication is a sticky subject. It’s usually visible, either sitting out or in a cabinet, just sitting there for any nosey guest to come along and read the bottle. Medication also can put on the pounds, like around 50. It’s a hassle to take it every day. A nuisance. Life would be much easier without it. Wouldn’t it?
2. Should I "come out" in my family, the neighborhood or at work?
I really want to tell people, but I’m afraid of the after effects. Will they lose trust in me? I feel like an imposter, like I can’t truly be myself. Who am I, really?
3. Can I take (normal and not-so-normal) risks?
I know that if I go to New York City, it might set me off. But I love New York City. There’s no other city like it. Should I go?
4. How do I cope if I start to get ill?
Who will watch my child? Can I work if I’m delusional? I’m in remission now, but there’s no cure to this thing. What will happen if I get sick?
5. Should I marry?
Who would want to marry me? How can I trust a total stranger?
6. Should I have/raise children?
Will I pass the illness to my child? Will children be too much stress? Will anyone let me adopt?
7. How much responsibility can I handle at work?
I love what I’m doing, but I feel like I’m on a tightrope, like I might fall off at any minute. Should I ask for a promotion or stay where I am? Will more work make me sick?
8. How does my illness relate to my spirituality?
I once thought I was Jesus. Does this make me closer or farther from God? If I can’t get out of bed to go to church, will I be pardoned?
9. Will I become seriously ill again?
I can’t go back in the hospital. Someone will find out. I hate how in the hospital you can’t lock your door. Will I survive another hospitalization?
10. Should I be proud of myself?
Does my sickness make me stronger than the average person? If I show the world how well I am, will the sickness come back and bite me in the butt?
Yes, I know what you’re saying. "Life isn’t perfect." This is true. And this is my message for today.
Life isn’t perfect.
You can be a model patient, but you can still live precariously amidst numerous difficult issues.
All we can do is our best with what we are given.
I'm a PHFBP.
Are you?
Add a Comment56 Comments
Hang in there. It's nice to hear from a fellow high-functioning bipolar patient.
September 9, 2009 - 5:56pmThis Comment
I have Bipolar 2 and OCD. I have a doctoral degree and am very successful in my job. I know there are others out there like me. All I ever hear about is the limitations of this disorder. There are many people who are successfully treated and stable. There needs to be more research on differences in how people cope with this disorder. It really is a spectrum disorder with some individuals being very mildly impacted and others more severely impacted. I think part of the stigma comes from an emphasis on those that are more severely impacted. We are not all as fragile as what you read. I've even read articles saying people with Bipolar can't work and that they should be forced to take medication. It's really very condescending. Some people would have us steriled!! Come on we are thinking, intellegent people with the same rights as others. Don't lump us all into the worse case scenario. No wonder so many of us stay in the closet about our bipolar.
April 11, 2009 - 7:08pmThis Comment
I appreciate your candour. My experience has been that with care it is possible to maintain an even keel and to avoid episodes for the most part. Since my diagnosis and a slow,painful climb out of a post-psychotic depression, I have, in fact, come to feel pretty much fine. I allow myself to feel mild elation, but am careful enough to avoid hypomania and depression.
I write, make visual art, and even moved abroad a mere two years after having hit rock bottom.
Initially, I found the books on bipolar disorder extremely disheartening, because there really was a focus on worst-case scenarios, as you say. Where are the examples of people like me in the literature, people who take their meds carefully, and function just like everybody else?
On the other hand, I have found that my openness on the subject of bipolarity has been met with a fair degree of support, and I do believe that the stigma of having a diagnosis is decreasing over time. After all, well-managed bipolarity needn´t be necessarily more troublesome than a bout of depression, and most people suffer at least somewhat from anxiety or depression at some point in their lives, even if they haven´t required a diagnosis.
It may be that bipolarity is a very broad symptom of living in a world with too much stress and rather lopsided values. Yes, bipolarity is chemical, but, as biological beings, shouldn´t we respond to factors like honking horns, pollution, violence, indifference, cruelty, etc. with sensitivity? Part of the success of mentally healthy people is that they can shut these things out. But can we afford to shut out these things? I suspect further that it is an actual sensitivity to one´s surroundings, the spectrum of positive and negative elements of one´s environment, that leads to strong emotional responses, which, of course can be hard to bring into balance. It can be too much for the nerves to let too much perceptual chaos into one´s mind, but I strongly believe that the problem of bipolarity is as much metaphysical as physical, that is, by bringing questions and thoughts on chaos and order into alignment the chemistry of the brain may follow suit.
Meds help, but the greatest medicine is the substance of the thoughts we choose to create, deny, etc. A sentence like this is vain and insufferable when a person is in the middle of distorted thinking. I know this from first-hand experience. On the other hand, tangled thinking can become clearer, and more healthy and positive over time.
May 10, 2009 - 7:25pmThis Comment
Here's to our health!
April 14, 2009 - 12:21pmThis Comment
WOW. I was just thinking the other day "How is it that I was diagnosed as having bipolar disorder and I'm not as severe as the descriptions of people who have BP? Am i TRULY bipolar?" Your description of PHFBP described me perfectly. I know there are different ranges of bipolar. I knew I wasn't severe yet I also knew I wasn't OK or "normal".
Thanks for writing this!
March 30, 2009 - 5:21pmThis Comment
Also, just to add another thought..... it's rare to find a psychiatrist who's willing and able to do any talk therapy -- typically they write a prescription and off you go. However, psychiatric nurse practitioners often spend a lot more time with their patients and get into the talk therapy side, in addition to prescribing medication, which can be a real life saver. Sometimes it's a challenge for people to juggle a psychiatrist for meds and a psychologist for therapy. Just wanted to throw out that option as one that works well for some people.
March 30, 2009 - 4:46pmThis Comment
Anonymous: I feel for you. I agree with Kristin. You might need to look for a good confidential support group to join. Also, on my bad days, I often call my psychiatrist for support. You might do that. If you don't see a psychologist, I suggest getting one. They're invaluable. I can call mine any time I need her. I call her about once a week.
Take care and write tomorrow to let us know how you feel.
Laura
March 30, 2009 - 1:29pmThis Comment
I started to come undone today at work. I moved three years ago across the country to my childhood home and have not told anyone I am bipolar. In the past I suffered through episodes which left me hospitalized and felt the stigma from my co-workers. I vowed no one here would ever know. And while, I do hold it together pretty well, every once in a while I feel a bit "wobbly" but totally lack the support system to deal with it.
I have a great job I love but I am afraid I will end up running away.
March 30, 2009 - 1:11pmThis Comment
Since you don't have a support system in place, would you be willing to look into joining a local support group?
March 30, 2009 - 1:19pmThis Comment
Anonymous: I don't have the problem you describe. When I'm manic or depressed, I feel closer to God. I don't feel that he's against me.
My suggestion would be to get close to God through prayer when you're healthy.
God loves you. When you're healthy you know that. Try to keep that in focus.
It sounds like you do have a relationship with God.
March 28, 2009 - 6:07pmThis Comment