The Noncompliant Bipolar Patient

Imagine your greatest hopes, dreams, and highest pleasures all in one place. Imagine that you’ve spent multiple years and countless hours working towards attaining this peak experience. You’re certain that it will be your greatest achievement, and something that will change the way that you live going forward. You don’t yet know exactly how it will feel, but you know this is the right path for you. Everything about your journey and struggle feels “right”. You’re just about to cross the finish line. 

Then, bam. It happens. You achieve everything. You are in complete and utter bliss. You are euphoric. Your whole life now makes sense within the context of the grander picture. You understand god. You understand the universe. You understand your place within the universe. You shed your ego. You shed your fears, your guilts, your anger. You are fully living in the moment. Your awareness is on the next level. You sense things before they happen. You have achieved a level of euphoria and tranquility that you never before thought possible. You are happy, you are healthy, and you feel more alive than at any point in your life. You did it. You accomplished your hopes and dreams, and found heaven-on-earth. 

But….

But then, after six months of the decidedly greatest time in your life, you start to come back down. Your euphoria slips back into apathy. Your fears slowly creep back. Your guilt starts to show itself again. Gradually, that gray blanket of depression envelopes you, quieting your previous thoughts and energy, and seducing you into isolation and sadness. You are depressed, and you need help. 

Fast forward a few weeks, and you have a diagnosis of bipolar I with delusions. You are prescribed mood stabilizers, and told that what you experienced was considered mania, and that you can never achieve that feeling again, because it could lead to your death. You are told that now you’ll be more stable, more “normal.” Just go on with your life, go to therapy, and you’ll be alright. 

What!?!

I just spent years trying to achieve euphoria, enlightenment, spiritual oneness with the higher power, bliss and escape from all guilt and fear, and now I’m being told that I can never again achieve this or it will kill me? The best feeling of my life will never be experienced again? Sex and romantic love pales in comparison to this feeling. So now I am left to live a boring life without the highs that made it so meaningful? I’m left to make meaning out of the leftovers. I accomplished the greatest moment in my life, only to find that it betrayed me, and it was ripped out of my hands even quicker than it was given to me. All of that work, the hours of counseling, the hours of meditation, the spiritual cleansing, all for naught, now that I can’t experience that feeling ever again. 

So, feeling as though my soul has been ripped from my body, leaving a shell of a person behind, I trudge forward with these comforting “mood-stabilizers.” The only problem now, is convincing myself to stay on these meds for the rest of my life. 

These meds, however, affect my brain. They decrease my attention, and slightly impair my short-term memory. So, not only do they prevent my highs and my lows, they also make it more difficult to use my brain. It’s no wonder then, why so many bipolar patients take their meds sporadically, if at all. 

Imagine telling a monk who has achieved enlightenment, that enlightenment will lead to his death, and he needs to take these pills that will keep him alive. The monk looks at you puzzled. “We will all die,” he says. “Without enlightenment, I do not want to live. You have failed to convince me to take these pills.” Exactly. Why would someone with bipolar want to let you take away the most pleasurable and enjoyable parts of their life? Without that euphoria, life loses its meaning. I’ve had great sex and great love, but they both pale in comparison to the experience of manic spiritual enlightenment. So, I’m supposed to find meaning in a life that is a fraction of the intensity and joy that it was before. 

The real problem I suppose, is that I can’t forget my experiences. I can’t hit the reset button and simply start experiencing sex and love as if for the first time. If my pleasure capacity is like a rubber band, it has been stretched, and can’t re-shorten. It is loose, and now the everyday pleasures have little to no impact on me. I am virtually numb to daily activities, like living life with a condom on my brain. Everything is dull and diminished. So how do you tell a person like this to go live a happy life when they’re not allowed to experience the only thing that really gave them pleasure? 

The current way that we are treating bipolar isn’t working well. We know this because of the nearly 20% suicide rate in patients with bipolar I. We know this because nearly 50% of bipolar patients don’t take their meds regularly. We are failing because we’re not factoring this loss into our equation. We aren’t helping these patients experience the grief of losing the greatest feeling and experience that they’ve ever experienced. We also are not acknowledging the identity crisis that occurs when you rip away the former identities that each bipolar person has. There is the semi-regular identity, the depressed identity, and the manic identity. After meds, all three of these are gone, replaced by a dull, muted, anesthetized version of the person, but without any of his three identities. That is a deep loss that is not acknowledged. The person feels lost, adrift in a sea without any buoys. He recognizes little about his present self, and there are no stable identities to which he can cling. He doesn’t know where to go, because his previous path that brought him euphoria was a dead end. Now, he must create a new path into the black sea, without any idea where it will bring him. Will he ever be able to experience euphoria again? Will he be able to create a new identity that feels comfortable again? These are deep and existential questions that need to be addressed if meaning is to be found in the life of a medicated bipolar patient. 

The hard reality is that living without meaning and without purpose is nonsensical. And if the answer to “where is my meaning?” can be found by discontinuing one’s medications, then time and again the bipolar patient will choose to do so, if only to taste the sweet intensity of euphoria, meaning, and purpose that seems so distant in the murky sea of existential confusion. 

Currently, our answer to the bipolar problem is to remove one’s identity and purpose to save their life. But in exchange, they receive a life devoid of meaning. I see it as a failure of our current treatment, and hope that the future can provide an improved solution for these troubled humans.