Hi Making it clear that my diagnosis is not Bipolar Disorder but Complex PTSD with BPD, as a result of some discussion a few weeks ago here i went and asked two of the people who work with me in my care plan 'What was the NHS's response to Bipolar Disorder?'
This is what they said, and i think is quite tied in to your question, Charlie -
...... I had my weekly session with one of the sets of psychotherapists this morning. At the end of it i asked her a few things about Bipolar Disorder specifically (rather than my stuff - borderline personality disorder, which is what she sees me about). The key part about speaking to her in particular is that she is Head of Psychological Therapies for the (Gloucestershire Partnership) Mental Health Service Trust. She heads up the entire county team of psychological therapies provision, and i think it is fair to say she knows this stuff thoroughly, but importantly she is also involved in planning of delivery of these services as part of the national development of the response to users of mh services, ie she knows what is current thinking and how these services are being developed as a health strategy... i know her views on what a mh trust should be capable of doing, and what trusts 'national' aims and expectations are, including those in London.
In rough terms (and i'm sure you already know most if not all of this ,but crucially may not have put it together in this order or interpret it this way)...
.....4 meds and 'talking' therapies can work together
5 talking therapies can be effective, either with or not with meds
6 in particular behavioural work based on responding to the change in mood/thoughts/behaviour assessed by the sufferer herself can CHANGE the OUTCOMES of events/situations
The point about (6) is that it is the experience someone has that defines their quality of life.
In a way, because Bipolar Disorder has a strong physical neurological component, as you say, it doesn't matter so much that they have the disorder, it's the effect
it has on the persons life that matters. so it follows from this two things...
it becomes a meaninfgful and real response to instigate changes in thoughts/feelings/behaviours in their own right so the person has a more acceptable experience
of their conscious life, and second, perhaps quite important to you [someone i was writing to] in how you descibe your current life events, the person's behavioural responses to the broader issues they face (ie bus fares or phone calls) are more effective... this is because 1 they would be feeling more in control of their reactions to stressors
and 2 they would be 'in a better place' to deal with those external stressores eg unhelpful CPNs.. and their lives would begin to increasingly become more 'smoothed out', in a virtuous upward circle. Don't mistake me, they would still have Bipolar Disorder, but the experience
of being in the social environment would begin to become better.
I do believe there is a substantial difference between this portrayal and the idea of 'thinking your way out of the shit', as it were, or somehow magically 'changing how you perceive things' and 'just getting it together'.
And the second inquisition for my long-suffering health care team brought this ...
Since I spoke to Alex S, the psychologist, on Thursday, I’ve also had my 2-weekly meeting with my named worker, Louise. She is a CPN, but more-so these days the manager of the community mental health day centre here, which is where she fits into my life.
I spent about ten minutes of the half hour talking with her about working with Bipolar Disorder (BD). I asked her ‘What is the aim of therapeutic intervention with a client/patient with BD?’
This was her response, in pretty uncompiled form, from my journal I wrote later in the day, at home:
‘What is the aim of therapeutic intervention with a client/patient with BD?’
The aim would ultimately be to reduce symptoms that interfered with functional day-to-day living
To reduce negative impact of mood shift on person’s life i.e. dysfunctional circumstances/difficulties of situation e.g. job retention etc.
To cause no harm, and to remain on client’s agenda whilst still developing choices for client
To bring more choice/control to client’s life
To do this by the client responding to her mood shifts with behavioural actions based on the cognitive understandings (of the client)
Medication is not a pre-requisite. Newer drugs are available in place of Lithium and/or anti-psychotic drugs [I know you know this]. ‘Frequent cycling’ has its own sets of issues. However, even so, there is a small window when the precursor to mood shift is cogniscent to self/others around (partner, friends, health workers etc.), and THIS is the opportunity to work for reduction of mood change. A person may choose to go into either mood shift (up or down) because doing so is attractive to them. It is IMPORTANT the person recognises this is a choice, and also the reasons why they might ‘permit’ mood change to occur. (This is the part that cognitive therapies can act on. Adjusting outcomes of mood shift is the behavioural component).
This is Louise’s view of it, based on many, many years of training, and community and ward experience.
I would be interested to know how much sense or resonance this has with people with Bipolar Disorder. Is it an attractive proposition to contemplate?