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.
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Perhaps the biggest surprise is that once someone goes through the process of answering questions and rating their awareness, understanding, functionality, and comfort at various intensities of depression and mania, they often rate the value of having been through deep depression pretty high. It seems that just asking the questions is enough to plant the seeds of tremendous growth. Before being taught tools and plans for better outcomes, they have already begun to understand the difference between liking the experience and seeing value in having it.
When designing the functionality assessment, I expected most people to see little or no value in deep depressions, but possibly higher than normal value in shallow ones. My idea at the time was the artists and writers would see value in depressions that were low enough to give them a creative spark, but not deep enough to debilitate them. Was I ever wrong. Most people who have been through only the assessment process see shallow depressions as a minor annoyance with less value while finding great value in the deeper depressions, as already mentioned.
Mania, of course, has been the opposite. People see tremendous value in low manias and no value at all in the intense manias that get them in so much trouble. They enjoy being high, but recognize the negative impact it has on their relationships, careers, and other aspects of their lives.
It gets really interesting when we look at the relationship between how much people value the experiences and how well they understand and function during them. Those who value the experiences and search for meaning in them function far better than those who only seek to make the experiences go away.
Not surprising are the answers we hear when we ask about present states. While people can see value in having been through an intense depression, for example, they do not value having another one today. They do want another mania, though, which is a major contributing factor in the failure of remission as the end goal of treatment for bipolar disorder. Understanding the role of value in all states needs to be part of treatment and goal setting too.
Mindfulness is a popular tool for treating bipolar disorder and value is a major part of it. Central to the concept is to see everything without judgement. Many people believe such an approach reduces everything to a valueless experience, but nothing could be further from the truth. Mindfulness is about seeing every moment as highly valuable.
From the perspective of mindfulness, we suffer when we place different values on our experiences. Our preference for pleasurable moments is what makes us resist those that are painful. Such resistance is the cause of suffering, not the intensity of the pain. When we develop mindful equanimity, every moment is equally beautiful and we find tremendous insight in each part of the experience.
The insight gained from equanimity leads to the ability to function highly and find comfort no matter the outward or inner environment. The Bhagavad-Gita advises us to "Perform your duty without attachment, remaining equal to success or failure. Such equanimity of mind is called Yoga." In other words, learn to find value in every intensity of depression and mania so you can start on the path to ending the behaviors that are in disorder.
