“The first time I had to purchase psych meds, I was in my small home town. The pharmacist came outside warning me to buy the pills in the next town, or people would be gossiping behind my back in a nasty way. He meant well, but I was floored. I was diagnosed bipolar one 25 years ago, and I just can’t see the stigma lessening. I think many more people have an awareness of the various mental illnesses these days, but they just don’t understand or empathize. The discrimination and judgemental attitudes remain, along with mockery, etc. One psychiatrist that treated me for ten years, a great guy, told me to not tell anyone I had this disorder because they would never look at me the same way again. Time has proven him right. Personally, I’m not ashamed of my unfortunate diagnosis and think the stigma factor is ridiculous and insulting.” —- Angela.
Angela’s experience has clearly shown the prejudice against sufferer of bipolar disorder. People do not understand the abnormal behavior because they do not have knowledge about this psychological disorder. Bipolar disorder is also known as manic-depressive illness, which patient experiences cycling between extremely manic and deep depressive for no obvious reason. A rapid cycler of bipolar disorder is a person who can be ultra-excited and deeply depresses the next in the same day. The symptoms occurring on every patient are not certainly the same. Some of them experience majority depression episodes while some experience the manic and depression episode equally. It is also normally associated with disturbance in sleep and appetite, isolation, delusion and hallucination.
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Some examples of symptoms of bipolar disorder are described below.
Symptoms of mania or a manic episode include:
Symptoms of depression or a depressive episode include:
Mood Changes
1. A long period of feeling “high,” or an overly happy or outgoing mood
2. Extremely irritable mood, agitation, feeling “jumpy” or “wired.”
3. Behavioral Changes
4. Talking very fast, jumping from one idea to another, having racing thoughts
5. Being easily distracted
6. Increasing goal-directed activities, such as taking on new projects
7. Being restless
8. Sleeping little
9. Having an unrealistic belief in one’s abilities
10. Behaving impulsively and taking part in a lot of pleasurable,
high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.
Mood Changes
1. A long period of feeling worried or empty
2. Loss of interest in activities once enjoyed, including sex.
3. Behavioral Changes
4. Feeling tired or “slowed down”
5. Having problems concentrating, remembering, and making decisions
6. Being restless or irritable
7. Changing eating, sleeping, or other habits
8. Thinking of death or suicide, or attempting suicide.
(adapted from http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml)
Likewise, in the case studied (scenario 5), the patient had the symptoms of bipolar disorder, which are no sleep, weight loss, refusing to move out of the house, neglecting his friends, constant talking and acting funny, and even having a delusion of being famous. The symptoms of bipolar disorder have occurred on him, which are disturbance in sleep and appetite, isolation, delusion and hallucination. Hence, he is diagnosed to be suffering bipolar disorder and was given electric shocks by doctor as a common treatment to this mental illness.
What causes a person to suffer from bipolar disorder? Linkage between bipolar disorder and genetic factor has once been found but the studies were not consistent. However, strong evidence suggests that environmental factor play a significant role in causing bipolar disorder. For example, the patient in the case studied is believed to experience stress events during his childhood.
It is quite surprising that a long list of celebrities, including Ned Beatty(Artist), Buzz Aldrin (astronaut), and Robert Boorstin (special assistant to President Clinton) are found to be experiencing bipolar disorder. However, some specialist found that bipolar disorder has also been associated with creativity, goal striving and positive achievement, which means people can get a higher achievement by having these “advantages”. Hence, in the list mentioned earlier, most of the famous people with bipolar disorder are artist or musician. Maybe it can explain what people sometimes say, artists always have odd temper.
Do not underestimate the risk of bipolar disorder although cases of bipolar disorder were often seen around us. This is because this common mental illness actually can cause suicidal ideation. According to a research done by University of Washington, one out of 3 people who suffered from bipolar disorder, has attempted of suicide or complete it. The annual mortality rate of this mental illness is about 0.4%, which is 10 to 20 times more than normal people. Therefore, high attention should be given and treatment has to be applied as soon as possible to control the disorder well.
The treatment to bipolar disorder is normally delayed because of several reasons. One of the main reasons is that bipolar disorder is hardly diagnosed even for mental health professions, as the symptom is not that obvious. The first symptom of bipolar disorder usually appears during childhood or early adulthood, as well as, the first few episodes is usually depression. As a result, patients of bipolar disorder are often misunderstood as overactive children or just suffering a normal major depression. The treatments are therefore delayed by failing of diagnosis. On the other hand, people feel ashamed to be with the mental illness. Most of the sufferer are unwilling to tell others about their trouble or even do not want to admin to have the disorder. Thus, they do not seek for a correct way to overcome their problem. This is because of the society prejudice against the mental illness which has been mentioned in the beginning of the essay, which is also what very unfair to the patients.
Treatments and therapies in different methods have been exposed by mental health professions. In this essay, two therapies have been chosen to be discussed.
Humanistic Therapy : Person-centered therapy and Gestalt Therapy
Based on scenario 5, Humanistic therapy is also another therapy which can help the person. In this therapy, therapist will focus on conscious, subjective experiences of emotion and people’s sense of self. Humanistic therapy emphasizes the importance of the choices made by individuals and the potential to change one’s behavior. The two most common therapy styles based on humanistic theory are Carl Roger’s person-centered therapy and Fritz Perls’s Gestalt therapy, both primarily insight therapy.
Rogers purposed that anyone has a real self and an ideal self. Real self is defined as how people see their actual traits and abilities whereas ideal self means how people think they should be. The person will be happier and more well adjusted due to the closer the real self and ideal self match up. However, in order to have this two self-concepts match, people have to receive love, warmth, respect and affection without any conditions attached. If the above conditions are not met, their ideal selves will be determined by those conditions and become more difficult to achieve, resulting in a mismatch of selves and unhappiness.
Rogers’s therapy is very nondirective as the person actually does all the real work, whereby the therapist only assists the client. Later, his therapy is now called person-centered therapy because the person is truly the center of the process. During therapy, therapist will try to listen and understand how things are from the client’s point of view. They will always check that understanding with the client if unsure. The client will also be treated with respect. In other words, Rogerian therapist plays a role of a gardener and the client plays a role of a plant. The plant will only start to grow if the right soil, proper water and light are provided by the gardener. If the therapist and client can have a proper sort of relationship with one another, this would be better in promoting that client’s growth.
Rogers therapist is required to be honest when interacting with clients. Therapists must keep the contents of therapy private and confidential in order to create a level of trust between therapist and client. This is very important as clients are only able to share their inner experiences with their therapist if they trust their therapist. However, trust is not the only element which enough to get growth moving properly. The sheep-dog style, is also the matter of helping to herd the client towards the emotional problems that the client is facing but doesn’t want to deal with it yet. The reason for this to occur might be the clients do not want to talk about them as they are painful, embarrassing, shames and guilt. Therefore, therapist is designed to help their clients in dealing with their painful emotions which they tried to avoid.
There is also another humanistic therapy based on Gestalt ideas is called Gestalt therapy. Fritz Perls who believed that people’s problems often stemmed from hiding important parts of their feelings from themselves. The person might try to hide their personality behind a false “mask” of socially acceptable behavior if their personality is in conflict with what society says is acceptable. The person will experience unhappiness when the inner self does not match the mask. This is clearly proven by a story called Dr Jekyll and Mr Hyde. Dr Jekyll is a well known doctor, young and well educated man. Besides having many friends, he also has a friendly personality. However, he lived a life as what accepted by the society and hid his true self behind a false “mask” of the society accepted behavior. Later on he drank a potion of his own creation and is transformed into Edward Hyde who is smaller, cruel and evil person, representing the hidden side of Dr Jekyll’s nature. When he is Mr Hyde, he is able to anything without worrying about the society acceptance of his actions. The transformation of Dr Jekyll into Mr Hyde occurs due to the unhappiness which experienced by Dr Jekyll when the inner self does not match the mask.
Gestalt therapist actually leads clients through a number of planned experiences, with the goal of helping clients to become more aware of their own feelings and take responsibility for their own choices in life. These experiences might include a dialogue that clients have with their own conflicting feelings where they actually argue both sides of those feelings. Therefore, a technique to help clients to overcome this problem is called the “empty chair”. The client will image someone they are in conflict with and describe and visualize the person as though he or she is actually in the room, sitting on the empty chair. Once the visualization appears to be solid, the client is encouraged to start talking to the visualized person in the empty chair, revealing all the things that the client is unable to say in reality. Through this therapy, the clients are able to see things from the other person’s point of view.
The Gestalt therapist actually confronts the client’s own statement. For example, if a client complains about the tenseness in his hands, the therapist will direct him to talk about how he feels, not how his hands feels. Once the client realizes that the tenseness is of his own creation, he is able to control it and choose not to be tense. Therefore, Gestalt therapy is also another therapy which can treat the person in scenario 5.
Group Therapy : Family Counseling, Self Help Group
Based on scenario 5, there are a few therapies which can help the person. Group therapy is one of them. In this therapy, a group of clients with similar problems are able to gather and discuss problems faced by them under the guidance of a single therapist. The presence of others who are going through the same kind of emotional difficulties can be comforting as well as provide the opportunity for insights into one’s own problem by hearing about the problems of others.
Family counseling is a form of therapy under group therapy in which the family members are all participating in the therapy. The family members participating may include grandparents, aunts and uncles and in-laws. The family members are able to get their needs heard. This therapy also enables them to learn ways of better interaction with other members. The goal in family therapy is to discover the unhealthy ways in which family members communicate and interact with each other and change them into healthier and better interaction.
There is also another form of therapy under group therapy which is called Self-Help Groups. However, this therapy is different from family counseling where in this therapy, there is no therapist in charge. These groups are usually formed around a particular problem. There are countless smaller support groups for nearly every condition imaginable and they are free to provide the social and emotional support that any group session can provide. Instead of having leaders, Self-Help Groups have volunteers to lead individual meetings. So the person who is in charge of organizing the meetings is also a member of the group with the same problem as all the other members.
Group therapy is encouraged because it is lower cost as the therapist can see several clients at one time which cost lesser than individual therapy. It also enables therapist and the person to see how that person interacts with others.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (or cognitive therapy or CBT),one type of talk therapy, that used to solve problems related to dysfunctional behaviors, emotions and cognitions by a systematic way. This therapy is based upon a combination of basic cognitive and behavioral research. It can help the patient in changing how he thinks (‘Cognitive’) and what he does (‘Behavior’) and these changes will help the one to feel better. Different with some of the other talk treatments, it concentrates on the ‘here and now’ difficulties and problems. It is a way to improve one’s state of mind now by focusing on the factors of his distress or symptoms in the past.CBT has been shown to help with many different types of problems such as bipolar disorder, depression, anxiety, stress, panic, bulimia, phobias (including agoraphobia and social phobia), obsessive compulsive disorder, and post-traumatic stress disorder. CBT also helps people who have problems with anger, a self low opinion or physical health problems, include fatigue or pain.
A usual ‘everyday example’ of selective thoughts or beliefs about the same experience and their resulting emotions might be the case of an individual being passed up for a job. He might believe that he was passed over for the job because of his inadequacy. In this case, he might totally become depressed, and he might be less likely in finding for another similar job in the future. On the other hand, if he believed that he was spared as the other examinees was singularly strong, he might feel disappointed but not depressed, and the experience possibly wouldn’t discouraged him from finding for other similar jobs.
During CBT, clients usually meet with their therapist for 5 to 20 times a week, or fortnightly sessions. Every session will last around 30 to 60 minutes. During the two to four sessions, therapist will check that the clients if they can use this sort of treatment and clients will find that they feel comfortable with this stage. Then, therapist will also ask clients some questions about their past life and background. Although this therapy focuses on the ‘here and now’ problems, clients still need to talk about their past so that can understand how it is affecting them now. Clients can decide what they want to deal with in the short, medium and long term during the therapy. The client and his therapist will commonly start the therapy by agreeing on what to discuss within that day.
There are also some problems may come out during treatment. CBT is not a quick doctor. A therapist is just like a personal trainer who giving the client advisements and encouragements but not doing it for him. When one is feeling down, it can be difficult to focus and get motivation. So, facing an overcome anxiety, one need to confront it though that may let him feel more anxious for a while and a good therapist will arrange the sessions so that the client can stay in control. Length for a course is not fix as well. It may just need 6 weeks or can also be 6 months. It definitely depends on the problem of client and how it is working for the client.
During the process, therapist may keep asking the client questions. This action aims to help the client to identify his individual patterns of thinking, emotions, bodily feelings and actions. With that, the therapist will help the client to carry out how to change the unhelpful thoughts and behaviors.
However, it is always easy to say but harder to do. So, after the client has identified what he can change, therapist will have ‘homework’ for client to practically do those changes in his daily life. With the situation, the client might start to convert an unhelpful thought (and upsetting thought) to a more helpful (and more realistic) one that he has developed in the therapy. The client will recognize that he is unwilling to do something that will make him feel worse but something more helpful. During every meeting, the client can discuss how he has carried through since the last meeting. The therapist will also give helping with giving suggestions to any of the tasks which seem too hard or seem no much helping for client. Therapist will not request the client to do anything that the client don’t want to do and the client can decide the pace of the treatment and what he will and won’t try. The point of CBT is that the client can continuously practice and develop his skills even after finishing the treatment time. This makes the symptoms or problems not easy to return again in the future.
Justification
Cognitive behavioral therapy (CBT) is the chosen therapy to treat bipolar disorder. We think it will work successfully because it is an action-oriented and two-way therapy. Patient in scenario 5 faced conditions such as falling into deep depression, refusing to move out of the house and neglecting his friends. In CBT, the patient is trained in new skills like communication, assertiveness and social interactions. Besides, in that difficult situation, the patient was often feeling down and hard to get motivated. CBT is highly effective as it empowers the patient by giving him an active role during the therapy process. The therapist who acts as a personal trainer will encourage the patient and give him advice. Therefore, the patient will not be over-dependant on the therapist. In scenario 5, the patient could not bring himself to the reality which he thought he would be famous in Honolulu by selling his paintings there. CBT will be useful in handling such situation because its patient is taught to identify thoughts and situations which stimulate his or her anxiety, and to view them more realistically. The therapist guides the patient through the step-by-step process of facing and successfully dealing with it. The eating disorder faced by the patient in scenario 5 which causing him to lost weight can also be treated by CBT. In the treatment of CBT, one of the important goals is to raise the patient’s consciousness of his eating behavior by means of self-monitoring. Therefore, CBT improves the overall functioning of the individual.
Gestalt therapy is another chosen therapy in treating bipolar disorder in scenario 5. It has been considered having high possibility to work successfully at the end of the therapy. The patient is taught to deal with the present rather than the absent which the individual in scenario 5 requires it very much to overcome his problems. He will stop the imaginations and unnecessary thinking, meanwhile learn to experience reality. The therapist will lead the patient to bring out his hidden past and what he has been unable to express before, and help the patient to cope with it. In scenario 5, the individual faced social problems like refusing to move out from his house and neglecting friends. Therefore, Gestalt therapy would work as it includes training in awareness, in improving the individual’s contact with himself and his environment. Besides that, it also helps the individual to gain a greater sense of freedom in his life and deal with the stressful events. Furthermore, Gestalt therapy is also a trusted therapy because it is widely accepted by many therapists, who evidently find Gestalt ideas useful in their work.
Family counseling is one of the alternative therapies which will work successfully in treating bipolar disorder. All the family members of the patient play a vital role in helping the patient to deal with his emotional and physical problems. The patient usually spends most of his time at home, thus family is the greater support to the patient and also the one who can hear what his needs are. Family members also often have to cope with the patient’s serious behavioral problems. Hence, they need to have good communication with the patient to change him healthier and positive. Other than meeting with therapists, interaction between family members and the patient is seemed to be relatively important.
In conclusion, there are 3 therapies which are able to help the patient in scenario 5. Those therapies are cognitive behavioral therapy, gestalt therapy and family counseling therapy. Cognitive behavioral therapy can help the patient in changing how he thinks and what he does. This change will help the patient to feel better. Whereas in gestalt therapy, gestalt therapist uses a very directive approach to lead the client through a number of planned experiences for example the “empty chair” technique with the goal of increasing self-awareness. Lastly the family counseling therapy enables the patient to improve his communications with his family members, learn ways of solving arguments and disagreements and also increases the feelings of intimacy and emotional closeness. There is no perfect cure for bipolar disorder. However, the patients can live a normal life and have their illness being control if the right medication is being applied.
