Do you suffer from bipolar disorder? Do you have anyone in your family who is bipolar? We need to know how to deal with it. Let’s review a few concepts about bipolar affective disorder.
About 1% of the general population suffers from bipolar disorder. It occurs more frequently among first-degree relatives, when one of them has had or is experiencing this suffering. Bipolar disorder generally begins between the ages of 18 and 20, affecting men and women equally. Bipolar disease is as the name says: bi-polar, that is, it has two poles. At one moment the person has euphoria, and at another moment, depression. Euphoria is at one pole and depression is at the opposite pole. A bipolar individual can be euphoric for a few months, agitated if left untreated, and then go into a depressive situation, with or without the normal interval between one phase and another.
There is bipolar type 1 and type 2. The main difference between one type and the other has to do with the severity of the episodes or crises. Bipolar type 1 has a severe euphoric phase, while type 2 has a milder euphoria. When a person is in the euphoria pole of bipolar disorder type 1, they often experience complications at work, school, and relationships. In some cases internment may be necessary. Bipolar type 1 people have periods of deep and long-lasting depression, which alternate with periods of very high, irritable mood, which we call mania or euphoria. The main symptoms of bipolar in the euphoric phase are: irritability, mood exaltation, euphoria, decreased need for sleep, talking too much or running over, great distraction, flight of ideas, that is, the person keeps talking about many exaggerated plans and changing ideas constantly. There is also a demand for compulsive pleasure activities, such as spending more money than you have. The bipolar in the euphoric phase also has a grandiosity, that is, he has an exalted posture, as if he were a king or a god who can do everything.
In order to be diagnosed as bipolar in the manic or euphoric phase, this high mood must not be the result of substance use, or any medical illness.
In the depressive phase, the person with bipolar disorder presents five or more of the symptoms, one of which has to do with depressed mood or loss of pleasure, or interest in that person they liked, in which they were involved. So the symptoms are in the depressive phase: sleeping too much, or having insomnia, loss of energy, weight loss or gain due to appetite change, feeling of worthlessness, excessive guilt, decreased ability to concentrate, marked indecision and preoccupation with death, with suicide. In severe depressive episodes, the patient may contemplate suicide, or has already attempted suicide.
The euphoric or bipolar phase oversteps the boundaries of social life and disrupts relationships, and the agitation can turn into physical aggression. That’s why it’s important to consult a psychiatrist to prescribe medication that controls this. Often family members and medical staff are the targets of this aggression. The treatment of bipolar disorder should be done with a psychiatrist or psychologist, with the family being oriented on what to do to help. In euphoric crises, it’s no use talking, nor taking to the psychologist or psychotherapist. Medication is the priority treatment to try to get the person out of the symptoms of agitation, which prevents a productive dialogue. However in the depressive phase, in addition to medication, psychotherapy helps to improve.
There is no single theory about the causes of bipolar disorder. Some claim that the conscious area and the unconscious area can conflict, causing behavior changes. Failure to resolve these conflicts would actually be the cause of various mental illnesses. In the case of depression, there are theories that say that the person develops depressive symptoms as a manifestation of anger against himself.
One of these theories explains that parents with unhealthy behavior, who are inconsistent, that is, sometimes happy, sometimes angry and nervous with their children, without a good expression of affection towards them, who are driven by their selfish needs, create an unpredictable and hostile environment throughout childhood. As a result, the child feels alone, confused and helpless, and ultimately angry. But the child knows that his parents are his only means of survival. So out of fear, love and guilt, the child represses the anger towards the parents, who act badly towards him, thus turning the anger against himself and the thought of being despised arises in his mind, and he then starts to believe that he is an unlovable and bad person.
And at the same time, the child strives to present perfect behavior, acceptable to parents, as a way of compensating for the weaknesses that he perceives, and which becomes unacceptable to demanding and neurotic parents. So the child feels caught between the child he finds unacceptable and the one who needs to act perfectly to get his parents’ love. As a result of this conflict, the child becomes “neurotic,” or prone to experiencing exaggerated feelings of anxiety and depression. A constant feeling develops in the child’s mind that he is not good enough, no matter how hard he tries to get it right. This neurotic need to please, accompanied by a failure to do so, can spread throughout the child’s life, so that he or she may begin to feel an unhealthy need to be loved by everyone, peers, family, co-workers, and others.
So, the goal of psychological treatment, which is psychotherapy in the psychodynamic approach, can help the child, now an adult, and suffering from depression or symptom, to obtain information about the mistaken foundations of his belief in his own badness and inadequacy, so that the need to punish himself and to be perfect diminishes. It is interesting that, for example, the husband who had a childhood in which his parents were too critical of him, who belittled him, did not show praise and affection, this boy grows up, becomes an adult, and marries a woman who repeats the role of his parents, belittling him, not valuing anything about him. A wife with a selfish, attention-sucking posture favors the emergence of depression in her husband.
In adult life, the person who had an emotionally painful childhood, having suffered due to the bad behavior of the parents, will have difficulties in their relationships with other people, besides their own spouse. For example, he may have a colleague or boss at work who repeats the derogatory role of parents, causing sadness in the sensitive individual. So imagine for a moment how painful it is for the individual who had a childhood lived with parents who did not know how to value him, and who in adult life interacts with a group that devalues him, criticizes more than praises, and on top of that still lives in a work environment with a similar situation, of being devalued. Difficult, isn’t it? So we can say that in depression, whether it’s bipolar disorder or not, there is an ongoing struggle that depressed people face in trying to maintain emotional contact with the important people in their life.
Some depressed people suffer because they feel dependent on relationships with others, and they grieve over the threatened or actual loss of that relationship. As a healthy affective bond between their parents and them was not formed in childhood, feelings of helplessness and weakness arose. These people experience intense fears of abandonment, and they struggle hard to maintain direct physical contact with the gratifying object of need.
So if you have a bipolar family member who is in the euphoric phase, you need medication to control this difficult attitude. If you are in the depressive phase, psychotherapy is very important along with medication, depending on the degree of depression.
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Dr. Cesar Vasconcellos de Souza is working as a psychiatrist and international speaker. He is author of 3 books, columnist of the health magazine “Vida e Saúde” for 25 years, and has a regular program on the “Novo Tempo” TV channel.