The myth that we can't is the worst of all.

The diagnosis of mental illness is the most dangerous time for many of us. Overwhelmed by fear, confusion and the numbing effect of over-medication, we are vulnerable to messages that can have long-term negative consequences. It was during my first months after diagnosis that I fell victim to the messages that perpetuate the myth that we cannot change our condition.

As I was trying to make sense of what was happening to me, I was given a list of the most offensive comments anyone could say to the mentally ill. I’m sure you’ve heard of at least some of them. Examples include: “snap out of it,” “you can do anything you want to if you just set your mind to it,” “get a grip,” and the supposedly worst one of all, “pull yourself up by your bootstraps.”

While those who rail against such statements are well-intentioned, the result is quite the opposite. Rather than encouraging those with mental conditions, the implied meaning that we can’t rise above a certain level of mediocrity only feeds self-loathing, low self-esteem and the feeling that we can’t change our lives.

Expanding the depression and bipolar comfort zone.

Understanding the role of comfort is critical for getting Bipolar IN Order. To do so, we must measure comfort at each level of intensity for both mania and depression. When we compare comfort levels to awareness, understanding, functionality, value, and the time before escalation, we find the optimal intensities where bipolar is an advantage in our lives.

In any aspect of life, those who only seek comfort are consigned to mediocrity and boredom. Those who judiciously step outside their comfort zone and challenge themselves are the ones who learn and grow. This is equally as true with mania and depression.

The best growth, though, happens just slightly outside the comfort zone. Too far outside and the lack of comfort can cause you to shrink instead.

Too many times, bipolar people step too far outside their comfort zones and find themselves at an intensity of depression or mania that is far beyond their control. Many of them become so frightened by it they hide inside their comfort zone hoping to remain there the rest of their lives. They accept a diminished story of their lives because they believe they have no other choice. They fear one wrong step will rapidly escalate back to an uncomfortable and out-of-control state.

Many bipolar people say they are "high-functioning," but most of them mean they function OK when in remission and cannot function when things get too intense. How well one functions during depression or mania defines the difference between Bipolar Disorder and Bipolar IN Order. At every intensity, functionality influences the comfort of everyone involved and whether they see value in the experience. Functionality should be the central focus of any approach to bipolar instead of simply trying to make it go away.

Many think intensity of depressive or manic episodes is the determining factor in functionality, but evidence contradicts such belief. Far more important are awareness and right understanding as outlined in the previous articles in this series. With enough education and practice, intensity becomes far less relevant to functionality than most people believe.

Understanding Depression and Bipolar Disorder can take many forms. Functionality-based understanding is central to getting Bipolar IN Order.

When I first started putting together the protocol for assessing depression and bipolar disorder, I was working with a professor of Psychiatry to make sure the ideas were sound. His advice was to combine both awareness and understanding in the graph to keep it simpler. I am glad that I did not take the advice.

Awareness and understanding are different in ways that matter. Expertise might help someone understand why things happen, but does not necessarily lead to increased awareness. An expert on sex, for example, may be totally unaware that his wife is having an affair. It takes awareness (covered in the first article of the series) to know what is going on whether you understand the phenomenon or not.

It turns out that understanding is more related to functionality (covered in the next article) than awareness. You may be completely aware that you are sitting in a car, but unless you understand how to operate it you cannot drive.

Understanding is not just about knowing the physical, mental, emotional, spiritual, social, and career/financial aspects and their implications, it also includes knowing about the tools. You need to know how the tools work, have proficiency in using them, and understand which ones to use at each stage of bipolar - the disordered stages of Crisis, Managed, and Recovery, and the IN Order stages of Freedom, Stability, and Self-Mastery. I call this functionality-based understanding.

Too many people think those who cannot function are the ones we should be listening to. Those who only know bipolar disorder and have not created Bipolar IN Order in themselves or others have no understanding of what it takes to make it happen. They can learn, but many times their beliefs limit their willingness to do so. They keep insisting it is not possible to be highly functional with bipolar and refuse to consider the evidence that contradicts such beliefs.

Awareness of depression and mania is key to getting Bipolar IN Order.

You can live in the same neighborhood for thirty years and still have little idea of what is going on there. You can shop in the stores, eat in the restaurants, talk with the neighbors, and feel that you know the community very well. But there are still more things going on than you know about. You simply never knew to look for them or were never taught how.

The police that work in the area know about crimes that go on right in front of you. The pest control people see things in the restaurants that might shock you if you knew they were there. Everyone from the woman in the plumbing shop to the guy selling pot (maybe even out of your own house) see things going on that you do not. The preacher knows about the spiritual goings on and the neighborhood doctor sees all of the injuries and illnesses.

When a thief sees a saint all he notices is his pockets. We all only see the things we have been trained to look for. As Paul Simon famously sang, "We all hear what we want to hear and disregard the rest."

The same thing is happening in the depression and bipolar worlds. Many doctors and therapists only see it as a disease or disorder, family members see behaviors, and people with depression only see pain and suffering. There is so much more going on that none of them have been taught how to see. I have been teaching all three groups for almost fifteen years and am amazed how little awareness there is about very important details until I show them were to look.

Exploring the relationship between value and functionality in bipolar disorder.

Assuming you are not deeply depressed right now, try to remember the time when you were in the deepest depression of your life. Can you see any way it might have changed your life for the better? Did it make you more sensitive to the feelings of others? Are you better at helping others during their difficult times because you have had the experience yourself? Are there things you learned from being deeply depressed? Are you a better person because of the experience? What is the value in having been through it? On a scale from one to one hundred, how would you rank the value in having been deeply depressed?

These seem like unusual questions to some people. Wouldn't we be better off trying to forget our depressions and get on with our lives? Can't we just hope that depression remains in the past and we never have to face it again? Ignoring past episodes may sound like a better approach, but refusing to take a hard look at depression or mania leaves us ill prepared for the next time it comes. Unfortunately, if depression or mania happened before, it is likely to happen again.

Looking at how we value depression and mania is an important part of any assessment; a part that is sorely missing in most protocols. The laundry list of symptoms in most assessments belie an incorrect assumption that the items are all seen as negative.

We have been asking the above questions (and many more) for several years now and have learned a great deal about the role value plays in depression and mania. Although our data is not yet extensive enough to make final declarations, there are many surprising trends that are too important to delay sharing.

Depression in self-mastery is often seen as a rich spiritual experience.

A recent question on our Depression and Bipolar Advantage LinkedIN Group brings up a point that needs to be addressed if we are to fully understand depression: What are some of the positives about having experienced bouts of depression? Since most people assume there are none, it is important to put it in perspective.

The "dis-abled"argument is central to bipolar disorder.

Stigma, medication, treatment options, recovery, patient rights, and physiological basis are some of the most discussed topics regarding bipolar. There are, of course, many other interesting aspects to debate, but it is hard to find any discussions about bipolar that do not include one or more of these central topics. While it has been very healthy to debate all of them, there is an underlying assumption that must be addressed too.

The paradigm that all of the above topics are based on is that we are incapable of remaining in control when mania and depression reach a certain intensity. We are therefore not responsible for our behaviors when manic or depressed. Because it is not possible in those states to choose better ones. This creates the goal of removing bipolar from our lives (at least at higher intensities) and the debate is about how it is best done. Much of the debate about medication, for example, is about alternative methods to achieve the same goal of reducing intensities of mania and depression.

But, what if we could be highly functional while manic or depressed?

What problems has bipolar or depression caused for you? What did you try for solutions? Did they work? Can you imagine what you would learn if you asked those three questions to 4,500 people? We don't have to imagine; we already did.

But we didn't stop with just three questions. We asked them what they thought were the important details that we should specifically ask to dig deeper into each of the three main questions above. They helped us refine the questions so that they best represented what people who actually live with bipolar and depression want to know.

Have you gone to your doctor excited about a tool or outcome only to be met with a smug reply about it not being legitimate because it is based on 'anecdotal evidence'? Has he then turned around and told you to take a pill that was never studied for depression or bipolar, but was tested and approved for something completely different? Has he told you to take a combination of meds because he has found the combination works for many of his patients?

The odds are extremely high that the meds you are currently taking were prescribed 'off label', meaning the whole reason the doctor prescribed them is based on his own anecdotal evidence. What she is doing is using anecdotal as an excuse to not consider your choices while telling you that her own anecdotal evidence is why you should take the cocktail that has never been tested for us to use. That is the worst form of hypocrisy and we should stop letting the doctors get away with it.