Michael Pipich || Owning Bipolar

today we have Michael Pippach on the podcast. Pippach is a licensed marriage and family therapist and has treated a wide range of mental disorders and relationship problems in adults and adolescents for our thirty years. Michael is also a national speaker on bipoor disorder and has been featured on radio and print media on a variety of topics. His latest book is called Owning by Poor How patients and families can take control of bi poor Disorder. Michael, really

great chat with you today. Thank you very much for having me, Scott. It's a pleasure to be here. Glad to hear that this is a topic that we have not covered yet on the Psychology Podcast, so I think it's it'll be a great service to our listeners. So five, is this statistic true that five percent of the population suffers from bipolar disorder or about three hundred and fifty

million people worldwide. Well, depending on what research you take a look at, I've reviewed research that suggests anything from one to two percent, although we up to five percent, and I think the more recent data suggests that as we get better at identifying bipolar disorder, that number will probably hold out. And so if you take five percent of the population worldwide, yeah, that's that comes out to

three hundred and fifty million people thereabouts. And you know one and twenty people that you that you meet over of course a day, or pass on the sidewalk likely has some form of bipolar disorder. I mean that's a big deal, geez. So I want to really talk about this though. When you say has bipoor disorder, I mean, all these things are just labels at the end of the day. I mean there's a constellation of characteristics that

you know go underneath those labels. But you know, there was no like ten commandments from God saying like this person has bipolar this person doesn't, you know, So I'd love to hear your thoughts on how you define bipolar and what you see is some of the main characteristics of it. Absolutely, I think it's important to talk about it, particularly because the more that we as a larger community

discussed by polar disorder. I think even though that's very important, and that's a big reason of course that I wrote the book, and you and I have had this conversation today, but we know that, particularly when it comes to psychological terms and particularly certain mental disorders, it becomes risky to kind of use it in casual conversation. Somebody said, you know,

I think she's really bipolar. Not meant to be a diagnostic suggestion, but kind of just to talk about characteristics in a way that again is kind of casual, but may turn out to be demeaning and in itself identify. I think, Scott, when we talk about what is bipolar disorder and how to distinguish it, I think it's important to talk about at least a little bit of the

history of what had historically been called manic depression. And we have evidence dating back to the ancient Greek physicians that chronicled patients that had these extreme mood swings as mania and depression, or maybe described as melancholy and so forth through the ages, but only recently did we describe it as bipolar disorder, and exactly what that term suggests.

There are two extreme poles of emotional experience. Just as we kind of think of the globe as having a north pole and a south pole, and that represents the furthest points on the globe, and bipolar disorder, we're talking about the furthest points of a mood state where a person experiences very extreme periods what we could describe as mania very precisely and also somewhat generically, because there's other

forms of it, such as hypomaniu and so forth. But those symptoms include a very expansive euphoric type of mood state that's consistent over a period of time, not something that somebody necessarily experiences very quickly in relation to something that wonderful that's happened in their life, but because of a certain biochemical neurological change, they experience a persistent type of either euphoric expansive mood suggesting of feelings of grandiosity

and just wonderfulness to the possibility of very irritable, dysphoric type of mania, and alongside those symptoms either way, whether you have euphoria or dysphoria or some combination of that. During that period of time, there is often a decreased need for sleep, where the individual doesn't really necessarily try

to sleep or want to sleep. But in the case of somebody who's experiencing mania, they don't want to sleep, They want to stay up, and they want to do all kinds of different things, and under the umption that they're hyper productive or hyper creative. Alongside those symptoms, it

is pressured speech, flight of ideas. It says, if they become experts and all kinds of different issues and then feel like they have so much to give in that moment and try to through various activities, experience a sense of productivity and output that they can't in any other

time without that mood state. Also, and I think most notably, they can experience very high levels of impulsive drive, which may turn out to be very harmful kinds of activities like shopping sprees or hyper sexuality and other kinds of discretions. Is that what happens to me every time? That's what

happens to me every time I go to the Apple store. Yeah, But if you have a drive to go to the Apple Store for several days in a row and exhaust all of your financial means on all kinds of gadgets and stuff that that, of course you would need necessarily. That's probably indicative more of something that would be we would describe as asthmatic. On the other side of that pole is a profound sense of depression again that lasts

consistently over a period of time. Diagnostically, it has to be at least two weeks for it to qualify as an episode of major depression. So again, bipolar disorder is something that is experienced in these extreme mood states where an individual can again experience and have to live with very severe consequences of their behavior, which often can be uncharacteristic of who they are and what they typically do when they're not in those mood states. Okay, so that's

a really good caveat there at the end. Thank you for outlining that. Now there are different gradations. I'm not fully up on everything, but there's like bipolar one, bipolar two. Isn't there like a mild or form of bipore where you have more of the mania than the pres and that's classified as something Is this right? Well, there's three basic types, and within those there are certain qualifiers that we see in the DSM that kind of helps us

to sort of specify varieties along a continuum. But those three basic types are bipolar one disorder, bipolar two disorder,

and then cyclothymia. I guess you can almost describe that as bipolar three, though people don't technically use that term, but we really look at mostly bipolar one and bipolar two, and bipolar one basically is diagnosed when an individual has a history, not necessarily in the present moment, but some history at least one episode of mania in their life where they have those symptoms that I just spoke of, but they have it for at least seven days in

a row. Sometimes it goes on much longer than that. The only caveat there is that if they are hospitalized and treated intervened at some level, that could interrupt that seven day period, but that would be considered diagnostic by board one. Bipolar two sometimes people and I think we used to think this way, but this idea is changing that bipolar two is sort of a lesser form of

bipolar one, sort like bipolar light, if you will. But we don't really think of that quite in those terms, Bipolar two is diagnosed if there is at least one hypo manic episode, which are all the symptoms that I just spoke of, but a shorter duration. They could be at least four days in length, or either as a consequence of a shorter duration compared bi polar one, or just because the consequences may not be as fully actualized

as you might see bipolar one. Hypomania by itself as a single episode is typically looked at as less consequential than what you would see in what sometimes people call full long mania on that bipolar one side. But people with bipolar two not only have to have that one episode of hypomania, but they also have to have one episode of major depression, which is not a part of

bipolar one diagnostically. So because people with bipolar two are only considered having that diagnosis, they have a period of depression along with diypomania, we no longer think of it as a lesser form of the disorder, because the depression itself may be very, very devastating. People with bipolar two can suffer many many consequences of their disorder, and including

a very high rate of suicide. Potential jicks. What are the rates of suicide in people who have been diagnosed with bipolar Yeah, so we know that that bipolar in general, bipolar one and two and its variance collectively, individual that has some form of bipolar disorder is at least twenty times more at risk for suicide than any population, at

least twenty percent. There's some research and in the DSM five itself, it does mention that one fourth of all deaths by suicide may be attributable to bipolar disorder itself, and in this country alone, that's over ten thousand lives lost. Everyone. Well, let me ask you a question. What's the breakdown of people who have commit suicide in a manic state versus

a depressive state. I often get asked that question, and it always compels me to kind of look more deeply into the research to see if in fact there are

differences there. So, the best that I can understand, and in working with people with bipolar disorder who have expressed suicidal ideation, my best answer to your question is that it really can occur in any mood zone across that single spectrum, from the very worst form of media and by the way, in bipolar one, you can have psychotic features associated with your manic episode, hallucinations and delusions and

so forth. So from the very worst form, which is a psycho type of mania, across the board to the very worst form of depression, which we would probably expect to be the most pernicious time for anybody, particularly with respect to self harm and suicide. Still, I think that suicide potential and an individual bipolar can occur at any point across that spectrum, even when they're not in a

severe mood state and more of a baseline position. And I think the reason for that god is that very often would people sort of their moods sort of retreat to that middle round or that baseline zone, especially when they're not in treatment, they can become aware of the damage that they might have enacted as a result of these extreme mood events and become more aware of it. So it's not as if few I'm baselines, so I'm

feeling great now, I'm not suicidal. They may be that might be their moment of reflection when they've seen the damage that has been created as they as they've kind of gone through either of those mood events. So I think that again that suicidal potential exists across those mood states and somebody that has bipolar disorder. Wow, well, this

is really really important stuff. I'd really like to hear about your three phase approach to treating patients with bipolar because you argue that it goes beyond the usual treatment that's centered on getting patients on meds and keeping them there. Could you maybe talk a lot about that approach? Yeah, absolutely, I'd be happy to. So can I explain this in Owning Bipolar for patients and families to better understand those

particular treatment needs. But I think again it's you know, these are kinds of things that I think it's important to understand community wide, and hopefully treatment professionals can also adopt some of these this framework and the objectives contained

within it. So the three phase approach is centered around the medical stabilization by polar mood swings, with the centerpiece of the treatment being medications and how those medications are first prescribed and then monitored towards kind of setting an ideal place for any individual with bipolar disorder, knowing that everybody has different kinds of medical needs and different body chemistry and so forth, requiring you know, whatever medications are

most appropriate for them, but like you said, it's not limited to that. Now. I found if I can just say this quickly and then I can talk about the spaces kind of is a little bit of the background.

I found that before I delved into this research and began constructing these three phases, that the predominant treatment approach for many years, particularly since lithium kind of hit the scene in North America during the nineteen seventies and early eighties, was that because the medication lithium and then later other mood stabilizers were so effective, it seemed to for a lot of people to just replace the need for talk therapy,

which was largely ineffective before those medications were made available. And I think a couple of generations of therapists since then really have not gotten the training necessary to look at it more comprehensively in terms of what's necessary for the treatment overall bipolar disorder. So, having said that, the

three phases begin with the pre stabilization phase. That's the first phase that's marked by some sort of crisis related to bipolar disorder that's being presented to treatment, and sometimes that's not really so noticeable as bipolar symptoms themselves, but some sort of crisis. It might be a crisis in the relationship of financial, work related problems, or health related problems.

It's not unusual for me to get referral from the court system from an attorney that believes that the client has gotten in trouble, probably and maybe repeatedly, and may have some sort of mental illness that's striving that very

often that could be bipolar mania. In that pre stabilization phase, there may be other presenting issues, of substance abuse being a big one as well, by the way, but that's the time when if any evidence of mood swings, either by that individual's personal history or through their family history. Since bipolar is genetically weighted pretty heavily, we find the possibility of bipolar then other treatment needs are essentially set

aside in favor of really assessing for bipolar disword. And during that prestabilization phase, not only is there a crisis going on that needs that attention an assessment towards the possibility of a bipolar diagnosis, but we also expect during that period of time prestabilization that there to one extent another is the defense or coping mechanism femial of denial, not dissimilar from what you see with substance abuse disorders

and sobriety and addiction recovery. People who have bipolar disorder very often don't want to give up the perceived beneficial aspects of such as creativity and productivity and energy and feeling really alive. But also so at a deeper level, they may fear giving up what they have always experienced as an offset to depression and lethargy and lack of

productivity and low self esteem. So very often, to one extent or now, they are a person who's going to want to guard that and guard against any possibility by poor diagnosis and the suggestion of treatment and so forth. So there's a lot of fears that go hand in hand with that particular phase of there or any of those fears founded, like do you find that when you treat people does their aliveness go away? Well, you know, that is a very important piece of treatment that is

addressed as we go through those other phases. Okay, so I'll just stop talking and listen to your phases now. But I mean, it's an excellent question, and it is something that you know presents itself. I think in one way or another in that prestabilization phase, you know, if okay, so if I do have this problem, and if I

do get treatment, what's going to happen to me? So it is something that we kind of begin to take a look at in that pre stabilization phase, but really focus on as they go through stabilization, which is the second phase. So as we address that with the individual in that particular phase, we also, if possible, try to bring in one or two at the minimum, family members loved ones that the patient is identified as being somebody

close to them in their life. Obviously, if it's a child, it would be a parent, or two depending on their circumstances. Certainly for individual who's married or in an intimate relationship,

it would be their partner, spouse. For an older individual, maybe a caregiver, perhaps an adult child or sibling, but hopefully some family member that can be an entrusted and somewhat observational type of position relative to that individual and begin to help them with education too, because very often those individuals can be in some level of denial too, not so much in terms of their experience and the consequences of my Polard, but of the diagnostic label itself

and what needs to be done for it. That's particularly true I think with parents when the conversation begins about what's going on with their child, and I would expect that so working through denial requires education, addressing their particular fears, and also breaking down symptoms so that we don't get just caught into this idea of bipolar disorder is a bad thing when individuals very very often want to protect

certain aspects of it. So we kind of break down those symptoms between the perceived good and the obvious bad, if you will, and whatever makes the greatest amount of sense to that individual and that family to begin to say, hey, you know what, there is a treatment for these particular pieces of what you suffer with, so that you don't have to suffer that any So as we move from previous stabilization, we move together collaboratively into the second phase,

which is stabilization, and where medications are a big part of the conversation. But it's not just about medically stabilizing the mood in the individual of bipolar disorder. This is also about helping the family stabilize. Maybe that stabilization requires therapy and support, and maybe there's been so much trauma suffered by a family member or family members as a result of bipolar disorder that they may need their own

therapy as well. But there's sort of a comprehensive stabilization that requires medication on a medical level but also on the social and familial levels to really begin to repair the damage that may have been done by bipolar disorder. And that stabilization phase is it can be a very rough time for people. Sometimes you get somebody on medication, perhaps lithium or an anti compulsion or whatever, and they do very well and there's no parent side effects and

it makes it easy for everyone. But as you probably know, that doesn't always happen. Sometimes there's some trial and experimentation that has to go on during that period of time, and it can be very frustrating, and people can feel like giving up sometimes, particularly if they're experiencing some side effects, even if they're common side effects that can be easily resolved with and attention. But these are all very pertinent issues and important for people to work through collaboratively and

in a therapeutic context. It's not just about sending a patient to a doctor and the doctor is going to prescribe and all of me, well, there are so many issues contained with that and owning bipolari. I do spend time talking to the family members as well as the patients to make sure that everybody feels like they're a part of the process and whatever pain they're suffering, whatever

they've gone through, is relevant and can be addressed. And so as medications and the whole stabilization process begins to take shape, we eventually move to that post stabilization phase, that third phase, and that postabilization phase can be a very long period of time of treatment because it really does represent a lifelong chronic illness management type of model, and recognizing in particular a couple of features that I

think are very very important to address. And the first of all, a person's identity, their sense of self can really change as a result of bipolar treatment for the better, we would think. But remember that if bipolar is a genetic disorder, which we believe it is, it's something that

that person is carried throughout their life. As a result of that, they have seen the world themselves and others through that bipolar prism of extreme mood events and so reshaping how their brain handles emotional regulation, while again we would expect to be a good thing, represents a real drastic change and how that person again perceives self in others, and like you suggested earlier, how they will see their own creative process, their own intellectual process, and what those

perhaps repercussions are for the long term. So we have to talk about that creative process and a person's ability to organize themselves in a more consistent fashion rather than relying on manic energy to do kind of the work

for them. And so there's a whole change and identity, but there's also changes in family dynamics that have to be addressed during that post stabilization phase, which includes how the person with the bipolar condition and the loved ones around that person interact and talk about ongoing bipolar issues

without making bipolar the centerpiece of their life. Because people with bipolar like to think that as they go through treatment that they're starting to experience life more authentically and more in terms in relation to the reality of life around them. So it's not as if they're going to just stay in a baseline mood zone forever. Thanks to treatment, they're going to experience joys and sorrows and frustrations and anger and a whole range of what I think makes

life colorful and sometimes enjoyable, but sometimes grief stricken. So when a person with bipolar who's on a good management schedule and process through post stabilization gets really angry about something, particularly something a loved one is doing, they don't want to think that the first thing the loved one is going to look at them and say, are you off

your meds? Instead, be able to have a conversation about what those feelings are in real time, with an occasional review in terms of how bipolar may kind of reassert

itself in one way or another in their life. So these are some that I think of the highlights of that three phase approach that again I talk about in an ring bipolar, and that I really stress when people come through that treatment process that medications alone are not the answer, but a combination of medications and that ongoing therapeutic process and conversation with loved ones and supportive individuals to make a real comprehensive life management a program for

that individual, for the family for long term success. I appreciate that you know there's some research in the creativity literature suggesting that relatives of those who have full blown bipolar tend to show increased levels of creativity. Kay Redfield Jamison has written a little bit about her own personal experiences with bipolar and creativity. What do you what do you make of the hypothesis that that perhaps these traits in a sort of water down version might be in

a manageable version conducive to creativity. Well, what I have really found in my therapy work with people with bipolar disorder is that I believe that the creative process is it is something that that essentially develops, maybe to some extent with regard to these mood extremes, but only on a perhaps on an energy or motivational level. So for example, any one of us can we can probably think of something that we're particularly good at. Okay, hopefully we can.

I would think we all have gifts and whether these things are kind of in the more traditional or classic idea of creativity, like people who are artistic or musical and that sort of thing. But I think creativity in general is basically the ability to solve problems from a unique perspective. It's basically how we solve a problem outside

of maybe again a more conventional means. And if we kind of take that point of view for a moment, I think we all have gifts where we can look at things or actually certain things and affect outcomes in a creative way, in a special way, and in a way that we kind of maybe have our own process or our own signature apply to that. And when I do that, I think it helps to kind of take it out of the realm of what we typically think about it better. Very creative, eccentric people and particularly those

who may have had a bipolar disorder. And we can name some very famous people who would believed to have bipolar disorder, including and so then go Mozart, Abraham Lincoln, Winston Churchill used to describe his bipolar as his black dog.

So these very well known, obviously great leaders and great thinkers and who've produced the creative output in one way or another, in ways that it's hard to imagine for us in your immortals, if you will, you know, we tend to think of those kinds of individuals as having some sort of special process, maybe related to their madness, you know, that whole fine line between genius and meness.

But what I have found is that in sort of the ordinary, if you will, everyday person who may be suffering bipolar disorder, they still rely on that manic energy as fuel for that process. And what I help them to try to understand very basically is that there's a difference between the process itself and the fuel for it.

And I realized that that's maybe somewhat controversial, and there might be some people who disagree with that, and that's fine, but that's my approach for the people that I work with.

And when we separate the pieces of the creative process and we're less confused about that energy and motivational piece as being the process itself, aside from the necessary skills and practice of those skills and refinement of those skills, whatever they are, within that creative process, then we can see that perhaps we're just relying on bipolar media to kind of do the work for us, rather than reinventing an organizational plan and a real scheme so that people

who do have these creative gifts can learn to refine them and practice them in a more consistent way rather than just in these peaks and values depending on what their energy level is relatives for their bipolar experience, well, I do appreciate that response, and I'm thinking about, like specifically what aspects of It's mostly the menia that is linked to the creativity, although I guess depression can be linked to certain forms of certain stages, like when you

need to really focus and narrow your attention, but when you really want to generate lots of ideas and things. You know, you find sometimes that the personality trait hypomania is linked to diversion, thinking, what do you make of that personality trait, hypomania. It's not bipolar, it's just like

a continuum that we're all on. Well, I think that's an excellent point, and in fact, if we can just for a minute kind of go back to the sort of clinical diagnostic concept where hypomania is concerned as a part of a bipolar two diagnosis. As you recall, I mentioned a moment ago that to have bipolar two as a diagnosis you have to have at least one hypomanic

episode and one major depressive episode. So if you remove the depressive aspect, then according to the DSM, you can have hypomania through your life and not really have a bipolar disorder. Now, you may have some problems associating. But I think again from a diagnostic standpoint, there's sort of

a wink and a nod towards this. From a sort of a personality or character logical standpoint, that there are people that do have these moments a periods of intense energy and as a result of that intense output, And again it's kind of a fine line between you know, is that genius or madness? Is that something that is acceptable or something that can be problematic? And it kind

of lies on that fine line. But I think, at least most recently in the DSM five, there's sort of that acknowledgment that, yeah, there are people and I think you're kind of suggesting that that have a trait that's more embedded in their character that maybe causes them fewer

problems compared to those who meet that diagnostic criteria. And it's in the complete constellation of all those symptoms that they can have a functioning life and there may be some problems along the way, but again, nothing that kind of rises to a level of what we would call a mood disorder that requires specific treatment and specific care. Right.

So I've seen that too, and you know, I feel like the whole DSM is moving towards a more dimensional model of all these disorders, recognizing that we're all in a continuum somewhere, as opposed to either you have these things or you don't. So I think that's going to be probably the way the future of psychiatry. Yeah, and I don't know if that makes it easier for us clinicians are more difficult. Yeah, that's really good. It's so nice to be able to go look up symptoms and

just check boxes and say, ah, there it is, you know. Yeah, but it doesn't and why. That's certainly helpful, and I think it's relevant more often than not, it doesn't always. I think, as you're implying here, it doesn't always give us sort of the full story of that individual's complete profile and what their experiences may be. Yeah, that's a good point. So you're saying, you know, there's hope here

that one can live with bipolar and thrive. And I'm trying to understand this phrase own bipolar, so as part of being able to thrive, part is part of it, kind of an acceptance, is that what you're getting at with that, you know what, that's a big part of it right there. Yeah, and sort of contemplating the overall

theme of the book and eventually it's title itself. It just made sense to me, particularly in our kind of current culture and our parlance of everyday life, not to not to say you have to own it in any kind of jarring sort of way, but as a reminder first of all, that bipolar disorder is a genetic disorder, which means it's nobody's fault that one. That's your fault. Well, it's it's the fault of their DNA. You know, we

don't choose that any action. Yeah, yeah, that's still their cause, right actually, And you know, and I recall presenting these and community presentation ones said you know, it's it's not the result of bad parenting, and and somebody chimed in, like what you just did and said, well, you know, can I curse my answert? And I said, well, you're welcome to do that, But it wasn't their fault either. It's just evolved. Yeah, responsibility is not the same thing

as blame, exactly. That's exactly correct. So we know that it's not an excuse, it's an explanation bipolar disorder that it can make a good person do bad things. Very simply, and can I make a bad person do good things? I think that it could take somebody that has maybe certain narcissistic or antisocial traits, if you will, and make that even worse. But I think it's important to understand that while you know, some people with characological disorders like narcissism, unknown,

antisocial or sociopathy, can also bipolar disorder. I just think it's really important for us to understand as a large community that the vast majority of people with bipolar disorder do not have those consistent kinds of personality deficits or flaws. That they're everyday people, just as people without bipolar disorder can be good people or maybe not so good people,

or whatever the case might be. But I think it's important to those individuals to understand that as a matter among other things destigmatizing the disorder, but also for family members likewise to look at their loved one and say, Okay, I can understand that this is a disorder that has created some very severe behavioral problems and damage to our finances, our relationships, et cetera. But if we can, if we can own this together, we can recognize it and own

it together. We can find a pathway to good health on a lifelong basis. And I think the other thing to understand about owning bi polar is that because it's a chronic mental illness, essentially, you know you can't beat it. You know there's no cure for it. And I think whether it's psychological or physical, or however you categorize illnesses in general, you know there's there's a compunction on all of us to beat back whatever it is we have and beat it and win. And that's not the approach

that I think that serves people with bipolar disorder very well. Instead, it's about taking, like you said, responsibility for it and responsibility for lifelong care together with your support system, and by working that together over long haul, then it doesn't have to rule your life and dominate your life. It doesn't have to be the center of your life anymore. It can be on the periphery as long as we

recognize that it needs ongoing care. I like that. Can you give some tips on how you can support a family member who has bipolar from the family member's perspective, you correct correct if you have a loved one or even a friend, right, I think you know in that

pre stabilization phase. It can be very difficult, obviously, and if anybody needs a reference point, they can again kind of look at people with substance use disorders and how you know, you want to kind of get to that loved one and say, hey, you know you've got a problem you're ready to take a look at, and you know that at some level or another you might be

met with some resistance in that denial. But I think that first of all, it's important for loved ones, family members to obtain education in terms of what it is that we're dealing with together, and you might wind up having more education and more understanding in this case about bipolar disorder than the person with the condition or even some treatment professionals who may to start to be a

part of that process. So that awareness and understanding can be very empowering itself, because you know what you're talking to. You're not always talking to that individual, you're talking to bipolar disorder and the denial that very often comes with it. So again, education is very very important, and awareness is very important, and there's a lot of misinformation out there, so it's good to go to really good sources. From there, I think it's if it's at all possible to have

another loved one on your side, so to speak. It's a powerful combination. I don't recommend that you go out and find ten family members and try to convert them into what it is that you're that you're thinking about, but if you can find one or two other family members or friends to help you and guide you as you confront the bipolar disorder in that person that has the condition, that can be also very empowering and very supportive,

so you don't feel like you're acting alone. Good And then when you speak to that individual, you always remember that we can be firm and direct about these problem areas while maintaining our love and compassion for the individual, knowing again that bipolar is not their fault but ultimately

shared responsibility and taking care of that going forward. And if I can just just kind of add one more piece to that as that person does go through pre stabilization, through stabilization, into the final phase of post stabilization, I think that family member walking with that person side by

side is very important. But it's also I think equally important that the family member, as I kind of mentioned earlier, feels like they have their therapy and support along the way too, so that they feel edified through that process, particularly when things may not be going in a positive direction right away, and build a conversation with their loved one of how they can work on long term success together.

That sounds wonderful. And I just want to come back to this point that you know, I mean, is there a correlation between like bipow and immorality? I mean maybe there isn't. Right, So, like, just because you have bipower, just even though you have these up you know, these these highs, it doesn't mean that in those highs you're more likely to do bad in the world, right, Like, isn't it possible to have mania to like, you know, want to make their old a better place? Just out

of control? Certainly that could be the intent of the individual. You know, A lot of times I find that people that go through their extreme mood events, in particular mania, carry with them, at least on the unconscious levels, certain desires and fears and wishes of all kinds, and that power and that energy takes over during mania can really push out a lot of those desires and fears from the unconscious into behavioral expressions of one sort. Or another.

While I think it's important to bear in mind that, like we said, bipolar media can take a good person and have them do bad things or at least, you know, things that may be destructive to the things in life that are ultimately important to them. Certainly, a lot of people can feel when they're in the throes of that uphoric mania like they can do anything and that they can save the world, and they have a very special mission that they're going to announce to the whole world.

The underlying wish or desire or gift or skill when we talked about creativity may certainly be sincere and may be real and authentic in its sort of raw state, if you will, But you're right, I mean, it can really get out of hand and out of control, even

if that person is if you will, well meaning. Very often what happens, though, when that person is in that uphoric state and they have so much to give and they feel like they have a special mession for the world, very often because of their behavior will be met with resistance, and that becomes extremely frustrating. And that's often when that mania turns from the euphoria to that extreme level of

irritability and agitation. They just feel like everybody around them doesn't get their special purpose, and so that underlying mission or purpose or skill goes unsatisfied. And one of the things that I think we can expect through the three phases of bipolar therapy is the good that you suggest that people do possess can be affected and presented in the lives of people around them in a well expressed and organized way through that proper care. That's very interesting.

I'm thinking of the narcissism literature that have some recent research I've conducted showing you know, there are these two forms of narcissism that exist, grandiose narcissism and vulnerable narcissism. Those who tend to to be more extroverted tend to display grandiose, exhibitionist form of narcissism, whereas those who are more introverted tend to have this vulnerable, like grandiose fantasies

in their own head kind of form of narcissism. But we recently published preer with publishers of The Manual Jock showing that the higher your scores on the grandiosity the grandiose narcissism scale beyond a certain threshold, like seventy five percent threshold, you're actually more likely to then start to

experience the vulnerable symptoms concurrently. And we think that's an important paper because these two forms of narcism have tend to be treated as though you're they're two completely different kinds of people. But it seems like, you know, there is this level of grandiosity where you start to become much more vulnerable and actually think that you're a worthless human being. You're much more vulnerable to the opinions of

others and things. And I'm wondering, I don't think anyone's done the study, but how does that fluctuation between grandiose and volment narcism map onto the fluctuations that you've seen bipolar I think that'd be an important clinical question. Yeah,

I think that's a that's a fascinating point. And how that may in some way, you know, intersect with that bipolar mania experience, you know, particularly on when we think about, you know, beyond the symptoms themselves that we that we identify and diagnose on an objective level, Now, what is the subjective experience of that individual? I think that's that's so important. I talked about it in Bipolar that you know,

people feel something. It's more than just the behavioral expressions and the impulsivity that can get them in trouble and so to speak. But what's going on inside of them, you know, particularly when they're in the throes of media, And I think what you're kind of talking about, you know, even though that's about narcissism, that is more pervasive in an individual that has a personality disorder compared to bipolar disorder,

which is episodic. That is to say that they may act very narcissistic when they're manic, but we would expect that to diminish as them as that mood episode diminishes. Nonetheless, I think that their experience may be very much the same, and there are individual differences with respect to extraversion versus introversion.

Like you said, you suggested that sort of grandiosity versus vulnerability perhaps, and I think that people that experience bipolar, at least at that level, probably have very similar types of experiences in that way. Sure, yeah, it'll be very interesting for the future research to do that. So, but can people find an aliveness to the same intensity that they do when they have bipolar I'm not sure you really answer that so I think there is, among other things,

a redefinition of what being alive is all about. That's

a good, very good point, you know. Yeah. Again, if you think of an individual who has seen himself through that bipolar lens and that's when their experience by large, then that's how they've defined what it is to feel alive or what it's like to feel dead inside, you know, through Once a stableation is achieved again at that medical neurological level, I have an opportunity to work through those changes with that individual over period of time, and with

time and opportunity and therapeutic interaction, that person begins to see themselves differently, and I think as a consequence that they see life different And again, what it is to be alive is a more consistent thing. And there are moments of joy and there are moments of sorrow, but you don't have to rely on extreme intensity to feel something. You can feel things and experience things in a more consistent, more authentic way. So I mean, I think that that's a big part of what it is to adapt to

that new identity. Well, that's such an important point. So your book concludes with personal action and helping others so can you describe both of those elements, So what is the personal action you can take, and then how can you help others with this knowledge. I'm really glad you brought that up, because I think that the highest level, if you will, of owning bipolar is reaching out to

help others. And I talk about that in the context that everybody is, of course entitled to their privacy, and I'm not saying that everybody becomes an advocate on social media and have a million followers or whatever. I mean, you don't have to necessarily help others with the bulmart. Some people are meant to do that, and some people do it very quietly, perhaps in their communities, in the workplace,

in their schools and their churches, in their neighborhoods. But at one level or another, I think, no matter how that's expressed, when a person does go through that experience of owning bipolar, it's inevitable that they're going to come across people that have bipolar disorder or some mental illness.

There's going to be some recognition in the community and people around them, and then maybe people they know, maybe total strangers, but they're going to recognize something that looks all too familiar to their own experience, and at that moment, in one way another, if we reach out to that individual that maybe in some way, shape or form crying for our health and in a way so listening our attention by virtually the fact that we've recognized that and

we can offer some attention either listening to that individual, maybe making a referral to that individual saying you know, this sounds very familiar to something that I went through or my loved one went through, and offering that connection with that person could save a life. Remember, if it's my polar alone may cause up to over ten thousand lives lost just in the United States, let alone worldwide.

So if we can really reach out and be unafraid to do that and share our knowledge and our experience in some way, then we've helped another person. And again that's achieving that highest level of what it is to really own the condition owned bi polar and share with people that wisdom and knowledge that they can pay forward eventually to somebody else someday in their lives. I love that at the end of your book you say, don't be afraid you are not alone. Thank you so much

for being on the podcast. Today Michael and enreally for the important work that you're doing to help save lives and help them help lives thrive. Thank you so much for having me Scott, it's been a pleasure. Thanks for listening to the Psychology Podcast. I hope you enjoyed this episode. If you'd like to react in some way to something you heard, I encourage you to join in the discussion at thus Psychology podcast dot com. That's the Psychology Podcast

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