This is a lightly edited version of something I wrote in response to someone I know online who was wanting perspective. I always learn something in these exercises, myself.
My main diagnosis for insurance purposes is Bipolar Disorder II, which was diagnosed when I was in my late 30s. I’d been mis-treated for Major Depressive, when treated at all, since early adolescence. Along the way, I picked up labels for Obsessive-Compulsive Disorder, Anxiety Disorder – Not Otherwise Specified, Impulse Control Disorder – Not Otherwise Specified, Anorexia, and I’m not even sure what else. I pretty much sampled all the non-personality disorders at one time or another. If Asperger’s had been well known in the time and place I was young, I probably would have picked up that label, too.
Some things labeled as psychopathology (meant technically, not pejoratively) are known to mostly correspond to physiological differences. In most cases, the question of “which came first” is unimportant to the person having the experience, because the physio and psych aspects reinforce each other in a feedback cycle. From what I know, schizophrenia is well established as this type; bipolar is, as well; and many instances of unipolar depression (especially the recurring types).
I go through all that to talk about my perspective on what some scientists and clinicians call “caseness.” I am not a clinical psychologist or psychiatrist, but I am educated on related topics. The labels have a purpose, but labels are not people in this any more than in any other. One of the purposes of labels and concrete diagnoses is to indicate (or contraindicate) specific treatments. Another is, as I alluded to, to convince insurance companies to pay for those indicated treatments. One of the places they can interfere is by this accrual of labels I’ve described. Analogy to kink: There are het dom cis-female tops out there. There are also bi poly genderfluid dominant bottoms. A simple label might be more helpful for garnering some understanding of the former, probably less for the latter. *(The analogy is just that — no person is simple, just some are closer to our prototypes than others.)*
A good or great clinician uses labels when they’re helpful, but moves away from them when they’re not. This perspective has helped me draw on the treatment and development path that helps me manage. Some things from the labels: Bipolar has certain physio correlates that usually respond well to some drugs (mood stabilizers) and poorly to others (SSRI antidepressants). And that’s been a lifesaver to find out — SSRIs actually can exacerbate bipolar, especially Type II. But the case that I need to present to a psychiatrist or talk therapist is far more nuanced than that. I not only need to know how to minimize the mood swings, but also how to adapt to what the constellation of symptoms brings to my day-to-day life, and what the drug cocktail does as well.
Not everything is hunky-dory. I take multiple heavily-sedating meds daily. That’s life-limiting. I can’t go to a show in the evening, because chances are good my eyes will shut by 9:30, if not 8:30, no matter what I do. If I’m taking a long drive, or even watching a movie in the afternoon, an energy drink is probably needed to get through. I live in South Carolina, but break out in a sweat above about 68 degrees, and get feelings like heat exhaustion when moving around in 82 degrees. I could re-balance the meds to have greater, or at least smoother, physical well-being, but it would be at the risk of more and/or more hazardous mood swings. I could experiment with different classes of meds that could show less of that side effect profile. But regardless, bipolar is a lifelong diagnosis. It doesn’t get cured. It can, with a lot of hard work, a little luck, and the right support, be managed.
I’ve got a good psychiatrist, a great internist, and have had many helpful (and a few less than helpful) therapists over the years from different specialties, as well as having a fantastically supportive owner and wife. I’ve put in the hard work, and I’m at a balance point of my choosing. The problems still have to be managed. Sometimes I go manic and need to curb spending impulses and commitments. Sometimes I go depressive and need to curb grumbling and quitting impulses. Sometimes the cutting urges come back, and I need to take an anxiety med and be held by my wife, or put in our straitjacket for a few hours (it really does help calm me). Sometimes larger-scale changes need to be made: I’m probably going to need to go off antipsychotics in the near future, as the side effects are starting to accrue in a worrisome fashion. But I’ll do it with full awareness of what I am doing and why and with the right personal and professional support.
That, to me, is managing.