Relationships

PLEASE TELL ME IT'S BIPOLAR

 

CONSIDER THIS:

• "Do all bipolar people lie or is it just my husband?"
• "My boyfriend is bipolar and is coping with heroin."
• "Is this an episode, loving another man not my husband?"
• "My husband is bipolar and every time we talk he always tells me I'm attacking him."

This is a sampling of queries that frequently arise on HealthCentral, where I used to contribute as an "expert patient." Are you beginning to spot a pattern?

First, let me say that these people and others are asking in good faith. They are going through hell. They are at the end of their rope. They are desperate for answers.

But I am also reading into their questions the type of answer they wish to hear, namely:

Yes, bipolar is the cause of [your husband's lying, your boyfriend's drug habit, your own infidelity, your husband's inability to discuss issues with you, and on and on]. Bipolar is a highly treatable illness, and with the right treatment these problems will all go away.

If only ...

These days, bipolar is copping a bad rap for no end of inappropriate behaviors. I think a lot of it has to do with the raised awareness of bipolar. Now, when people encounter behavior they don't like, the prime suspect is bipolar. Ironically, raising awareness may have raised stigma.

Inevitably, when responding to these questions, I point out that a mood disorder is very different from a personality issue or a personality disorder. Yes, there may be a connection. Yes, a mood episode obviously influences behavior. But first, it pays to make a separation.

To start, a mood disorder is morally neutral. Fluctuations in mood have nothing to do with one's personal character or values. Hitler may have had bipolar, but he was going to invade Poland, anyway.

On the other hand, there are complications. Hitler imprudently invaded Russia with winter coming on. Were it not for his unbalanced mental state, it is possible to imagine a far different outcome to World War II.

Psychiatry makes a very clear distinction between mood disorders and personality disorders. To vastly oversimplify, a mood episode is seen as "uncharacteristic" of an individual's baseline behavior. With a personality disorder, outrageous behavior is seen as embedded into an individual's make-up. With the former, the perception is that meds will quickly resolve the issue. With the latter, we see a far more problematic future.

Thus, you can see the logic in the desperate pleas of my readers. Please tell me it's bipolar, they seem to be saying. Then with a quick fix my abusive husband will become loving, my selfish wife will become considerate, my egotistical boyfriend will become understanding, my indifferent girlfriend will become caring.

 

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Unfortunately, my correspondents almost always describe behavior far more indicative of a personality disorder than a mood disorder.

The bottom line is a loved one should not have to distinguish a bipolar episode from a personality disorder or just plain inappropriate behavior in the first place. Hurt is hurt, no matter what illness or condition or character defect you assign to it, and no one - for any reason - should have to put up with this type of abuse. But the people I hear from are willing to give their partners a second chance, to work with them, to help them. To give the relationship a chance.

If only, if only ...

Alas, I have to tell them probably not.

Reviewed July 15, 2016

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