Why Accepting a Diagnosis of Bipolar Disorder Is So Difficult—and What Actually Helps
One of the biggest challenges in treating bipolar disorder is actually accepting the diagnosis. Because, of course, if you don’t believe you have an illness, you won’t focus on managing it.
Psychotherapist Sheri Van Dijk, MSW, RSW, has run a group for individuals with bipolar disorder for over a decade. When she starts teaching the skill of Radical Acceptance, about 95 percent of her clients say they’re currently struggling or have struggled with accepting their diagnosis.
Because acceptance is hard. And it’s hard for various reasons.
It’s hard because acceptance entails grief and loss. “[T]here is a loss of what the person expected for their life that they think they might not achieve now, given this extra challenge they’re facing,” said Van Dijk, who has a private practice in Newmarket, Ontario.
There’s also grief and loss about changes in lifestyle, such as taking medication, eliminating substances and not being able to work while achieving stability, she said.
People might not want to give up what they perceive to be the positive parts of manic episodes, “which can make them feel great, alive and very creative,” said Michael G. Pipich, MS, LMFT, a psychotherapist who specializes in mood disorders in Denver, Colo. It can be hard to accept that this euphoric experience is actually part of a mental illness, he said.
“For many, it’s the only way for them to get anything done before they get depressed again. So they will often deny there is any kind of problem, or sometimes even find blame in others to deflect responsibility for owning their bipolar disorder.”
People also struggle with acceptance because there are no tests to “prove” the diagnosis, Van Dijk said. “Complicating matters further, if an individual sees two psychiatrists, they may receive different diagnoses.”
This is one reason why Van Dijk tells her clients that it doesn’t matter what they call what they’re experiencing, because “bipolar disorder is different for everyone.” “Putting a label of bipolar disorder doesn’t change the person’s experience; they know what symptoms they’ve been having and what the issues and problems are they’re dealing with.”
Sadly, it’s hard to accept any kind of mental health diagnosis because stigma is so prevalent and persistent. People often feel ashamed and fearful about how society will view them with their diagnosis, Pipich said.
But even though acceptance is difficult, it’s still absolutely possible—and so is leading a meaningful, fulfilling life with bipolar disorder.
First, it’s important to validate your concerns. For instance, according to Van Dijk, you might tell yourself: “Of course it’s difficult for me to accept this, because it makes my life more difficult, I face challenges others don’t, it’s scary….”
Below, you’ll find other ways to accept your diagnosis—and how loved ones can help.
Understand what acceptance really is. Acceptance isn’t liking something, or even being OK with it, said Van Dijk, the author of several books, including Calming the Emotional Storm: Using Dialectical Behavior Therapy Skills to Manage Your Emotions & Balance Your Life and The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder.
Acceptance is “acknowledging that this is reality.” Can you acknowledge that you’ve been given a diagnosis of bipolar disorder?
Learn everything you can about bipolar disorder. “We all can fear what we don’t understand,” said Pipich, author of the new book Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder. As humans, we tend to fill the gaps in our knowledge with our own worst nightmares—and with horror stories we’ve heard from others, he said.
Pipich often tells people, “while you don’t have to fear a bipolar diagnosis, you certainly can fear what an untreated bipolar disorder might do to your life.”
Reconsider what the diagnosis means. “Having a bipolar disorder diagnosis is not a curse,” Pipich said. “It’s an opportunity to get the help you need.” It’s an opportunity to improve your mental and physical health. It’s an opportunity to compassionately care for yourself. It’s an opportunity to improve your relationships and your life.
Break acceptance into bites. In other words, instead of accepting “I have bipolar disorder,” find something small that you can accept. According to Van Dijk, you might accept: “Right now my mood is lower and I have to take meds,” “I am struggling with anxiety,” “I am having problems with substances,” “I have to increase my self-care,” or “I’m more irritable and lashing out at the people in my life who I care about.”
Focus on right now—versus the future. Instead of thinking about what bipolar disorder holds for the future, again focus on what you can accept right now. After all, things change. Van Dijk shared these examples: “I’ll never work again” can become “I can’t work right now”; “I have to take meds for the rest of my life” can become “I need to stay on my meds at least for the time-being.”
Make a list. It’s natural for people to flip-flop with acceptance, said Van Dijk. “For example, someone might accept they have bipolar disorder, and then when they realize that this will prevent them from pursuing a specific career they’ve always dreamed of, they go back to fighting the reality.”
It’s also common to go through stages, she said: After denying the diagnosis, a person accepts it and starts treatment. When they feel much better, they no longer think they have an illness, so they stop taking their medication and become unstable again.
“When you go back to not accepting anything, you keep working on turning your mind back to acceptance,” Van Dijk said. She suggested creating a pros and cons chart, asking yourself: “What are the pros and cons of accepting my diagnosis and not accepting my diagnosis?”
Write a letter to yourself. Sometimes Van Dijk has her clients write a letter to themselves when they’re stable. They might write a letter to their depressed self, providing support and encouragement: “[Y]our mood will change, you won’t be depressed forever, you have to stay on your meds and go to your appointments, it will get better, etc.”
For Loved Ones
“Loved ones are a valuable resource in bipolar acceptance,” Pipich said. But they, too, can struggle with acceptance. Some think bipolar disorder is an excuse for bad behavior, and that accepting the diagnosis means accepting all those negative behaviors, he said. Some fear that the diagnosis will be a label that follows their loved one, “doing more damage in the future than the disorder can do itself.”
This is why it’s important for loved ones to get educated, as well, and to find professionals who specialize in treating bipolar disorder. It’s also critical to bring all your questions and concerns to your sessions, Pipich said.
“Many times, I see a family with different opinions and different levels of acceptance. So attending educational sessions, for example, can help to unify the family towards a single acceptance strategy. With a solid background of knowledge about bipolar, you can begin to collaborate together with treatment pros, not just remain in fear of what a bipolar diagnosis is all about.”
When you better understand bipolar disorder, you also can remind your loved one that it’s not their fault that they have an illness, Pipich said.
According to Van Dijk, one of the best ways loved ones can provide support is by asking: “What can I do to help?” Often people will need you to listen to them in an “accepting, understanding, non-judgmental way.”
Sometimes, they’ll need more hands-on help. Van Dijk shared these examples: A person over-spends during a hypomanic episode, so a loved one holds onto their credit card until they’re more stable. A person isolates themselves during a depressive episode, so a loved one joins them on a daily walk. A person has substance issues, so a loved one drives them to AA meetings and counseling sessions.
Pipich stressed the importance of being positive and encouraging about treatment. “[A]void disparaging statements about doctors, therapists, medications, and other aspects of bipolar treatment.”
He also emphasized consistency. “A person’s journey through bipolar stabilization has its ups and downs, and in some cases, plenty of them.” Your loved one might even seem like they’re giving up. Which can leave you feeling discouraged and wanting to give up, too. This is when it’s vital to remain resolute in supporting the treatment goals, and seeking your own therapy can help, too, Pipich said.
Some researchers believe that up to 5 percent of the population has some form of bipolar disorder, he said. “That’s about 350 million people worldwide. Accepting your bipolar diagnosis definitely means you are not alone.” And it also means that you will get better.