Some call it "state specific memory," but after 10 years and thousands of interviews I prefer to call it "bi-cycling delusion." It is the delusion that comes with the bipolar cycles and a primary reason people remain in disorder even with the best intentions.
Bipolar is a cyclical condition. We cycle through depressions and manias, sometimes reaching intensities that cause a crisis for us. We also periodically cycle into remission. It might be easier if the cycles were predictable, but for many of us they are completely random.
For far too many of us, each cycle has a state-specific delusion that keeps us from moving toward bipolar in order. We all know about delusions that come with intense states of depression and mania, but it is the delusion that comes with remission that holds many back the most. It fools them into thinking they have bipolar under control when in reality they are just in one of the cycles.
I met John five years ago. His parents were concerned that he was delusional about his recent episode of mania. When I talked with him about it, he was not in denial about it happening, but said it was a one-time event and he would rather not think about it. This is certainly understandable given his hospitalization and the stigma surrounding mental illness. I didn't think he was being delusional about it, but he was hoping it was never going to happen again.
After the third time he was hospitalized he admitted he had a problem and took our workshop with his parents. He was pretty excited about the ideas, but at 19 he was not willing to do the work it takes to get his condition in order. I didn't see him again for a couple of years, but heard from his parents that he had been hospitalized once again in the interim.
I met with him a few days before his 21st birthday and he seemed awfully manic. I pointed it out, but he wrote it off as excitement about his reaching the age where he could go to bars. Unfortunately, he spent his birthday in the hospital after getting picked up by the police for being out of control. He never even had the chance to start his planned drinking binge.
I have seen a similar story play out so many times that it is not surprising to me, nor to most people who have been around bipolar for a while. The delusion of mania can be very strong and the person is often in no position to do much about it. It works the same with depression.
John called me several times a day from the hospital and I visited him as often as I could. He hated being trapped there and wanted me to get him out. I told him the only way out was to convince the doctors that he was under his own control, which unfortunately took a few weeks to accomplish. He swore every day that as soon as he got out he would do whatever it takes to never end up there again.
I called John the day he was released and suggested we get started right away. I wish John had started working with me that day, but he was overtaken by the delusion that comes with remission. He said, "I am in recovery now. I don't need help anymore." He is convinced he has it all under control this time.
This kind of delusion is understandable after the first episode, but after five hospitalizations I hoped John would finally wake up. I am powerless to convince him of the delusion, but can only hope the next cycle into mania convinces him to finally do the work.
When I first met Steve it was another repeat of John. He was delusional about his remission and said he knew how to manage his condition with exercise and meditation the next time it comes. A few weeks later, he began the cycle into intense mania and I told him he needed to reel it in or he would be back in the hospital within a week.
I knew it was already too late by the time I met Steve, but it is all too common that people seek help when they are least capable of using it and refuse help when they could benefit from it the most. The most productive time to master depression and mania is when you are inside your comfort zone or just slightly outside of it, which for most people is during remission. The least productive time is during an intense cycle when the only thing you can do is hang on and hope to survive.
Steve lost control and ended up hospitalized again seven days later.
But, this time was different. When Steve got out, he was not in delusion about his remission and was willing to do whatever it took to avoid another crisis. He started working on getting bipolar in order while he was thinking clearly enough to grasp the concepts and gain the insights.
Within a few months, Steve was beginning to expand the range where he could function well. He was able to recognize his state while in it, take actions as necessary to lower the intensity when it was too far outside of his comfort zone, but was also showing himself and those around him that he could be highly functional at intensities that previously would spiral out of control.
Steve still has occasional intense episodes, but catches them early and takes action before they become a crisis. He also works to improve his understanding every time he is in remission as well as when the intensity is within, or just slightly outside of, his expanding comfort zone.
The secret to Steve's success was to understand the cyclical nature of bipolar -- remission is a natural part of the condition and is the perfect opportunity to work on mastering the next cycle before it happens. Bi-cycling delusion can interfere with this important insight and keep bipolar in disorder, but you can get bipolar in order if you choose to do the work while your mind is in the best shape to do it.
Do you have bi-cycling delusion? Do you waste remission pretending the next cycle is not going to happen? Or do you seize the opportunity to gain skills that will help during the next cycle?
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