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    Driving While Bipolar

    There was a demo of a video car racing game at the mall the other day.  I became fascinated by the reactions of the people who were trying it out. I stayed around for a couple of hours and did an informal study of the phenomenon.

    I watched almost 100 people drive into walls and other cars. I asked 25 of them what they thought was the reason for so many crashes. Almost to a person, they said it was the fault of the car. Although they sat in seats that were identical to those in a race car, they said it was too twitchy, loose in the corners, and was nothing like driving a real car.

    I was ready to conclude that the game was not very good when a man came along who drove incredibly fast without crashing at all. I asked him his secret. He said that he had taken driving lessons at a race track and practiced often in a real race car. He concluded that the game was very realistic and those who thought otherwise were trying to compare it to a normal car. He said the problem is they didn’t know how to drive — and the game was not at fault.

    If you took the same 100 people to a race track they would all end up in a wreck. It would be pretty absurd to conclude that it is the fault of the car. But most people make a similar conclusion about bipolar and get upset when someone like myself challenges the assumptions. We blame the vehicle (in this case the brain) and “prove” it is defective because it works differently from “normal” people.

    I have been teaching people to (figuratively) “drive” while bipolar¬† for about ten years now. I see a huge difference in those who have had training and practice compared to those who continue to blame the condition for the way they handle it. Like the skilled race car driver, my conclusion is lack of training is the problem, not the condition.

    “Wait a minute,” you might say, “we have all kinds of training for depression and bipolar.” If you think about it, the only training we have is how to put on the brakes and park our brains in the garage. The current standard of care as defined by the National Institute of Mental Health (NIMH) is to minimize symptoms with the ultimate goal of removing them altogether.

    The NIMH did a multi-year study called STEP-BD. Included in their research was an analysis of recovery “defined as having only two symptoms of the disorder for a period of at least 8 weeks, during the 2-year follow-up period.”1 Although very specific as regards time range and number of symptoms, you will find that no matter where you look, the definition of recovery has removal of symptoms as a central element.

    There are countless studies that “prove” bipolar and depression are illnesses, but none of them have studied people who know how to “drive”. The conclusions are on par with the people who think the video game is at fault. They take people with no training for anything but making it go away and watch them drive off a cliff.

    Dr. Larry Davidson, one of the foremost authorities of recovery in the mental health field, defines recovery as: “being ‘in’ recovery — even while they remain disabled;” “being ‘in’ recovery despite the presence of an enduring mental illness;” and “the ability to live a fulfilling and productive life despite a disability.”2 We are being sold a solution that says “make the best of a horrible situation” when some of us have found the game to be perfectly fine.

    Unfortunately, the STEP-BD study mentioned earlier concludes with, “according to the researchers, these results indicate that in spite of modern, evidence-based treatment, bipolar disorder remains a highly recurrent, predominantly depressive illness.” “Recovery” is not a permanent condition; it is a temporary condition with a high probability that the symptoms will return, precipitating another crisis.

    The STEP-BD study proves that it does not work, yet they conclude that “this finding may indicate that complete symptomatic remission, i.e, the absence of all symptoms, should be the goal of treatment, as it is in non-bipolar, major depression.” Albert Einstein said that the definition of insanity is doing the same thing over and over again and expecting different results. It is amazing that modern day researchers are living up to Einstein’s definition while looking for a solution to the problem of mental illness.

    It is time for us to acknowledge that some of us have learned how to drive WHILE bipolar and start focusing on what we do instead of trying to make it go away.

    1. Perlis RH, Ostacher MJ, Patel J, Marangell LB, Zhang H, Wisniewski SR, Ketter TA, Miklowitz DJ, Otto M, Gyulai L, Reilly-Harrington N, Nierenberg A, Sachs GS, & Thase M, “Predictors of recurrence in bipolar disorder: Primary outcomes from the Systematic Treatment Enhancement Program for Bipolar disorder (STEP-BD).” The American Journal of Psychiatry (2006), 163:2, 217-224
    2. Larry Davidson, Ph.D., “Remission and Recovery in Schizophrenia: Practitioner and Patient Perspectives,” and “Personal Accounts: Us and Them;” along with his book, Living Outside Mental Illness: Qualitative Studies of Recovery in Schizophrenia.
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