I’ve been a psychotherapist for 20 years, during which time I have had the good fortune to work with many people to support their recovery from a broad range of mental distress. Here I’d like to share with you the story of Kevin; one of the people who taught me a lot about resilience and the complexities of bipolar, mental health in general and, ultimately, the capacity of therapy.
Kevin was in his mid-30s when he first came to see me for help with what he described as ‘emotion dysregulation’. Unlike the overwhelming distress experienced by many people who seek out therapy, Kevin was functioning reasonably well in all areas of his life. He had a stable home and job, supportive friends, and appeared to be in good physical health.
Meet Kevin: The Man Behind the Mask
When Kevin first walked into my office, he was the epitome of a professional success. Suited up like a well-groomed Disney prince, he had a winning smile and grip that said he could outbeer the chief of police. A rising star in his company’s marketing department with his quick wit, self-deprecation and sales abilities, Kevin was, like any confident salesman, the personification of accomplishment. His office mates and clients admired him for his intelligence, charisma and, of course, all the deals he closed.
But to see, week after week, another Kevin, who was suffering from severe mood swings and losing control of a precision-engineered image he had created for public consumption, was more insidious still.
The Two Faces of Bipolar Disorder
Bipolar disorder, characterised by extreme swings between manic highs and depressive lows, is a huge problem for many people. What’s intriguing about Kevin’s experience is the way he managed to conceal it from his colleagues. With the help of medication and careful management of his own comings and goings, he could cultivate a positive and productive persona at work, while going quiet with the extreme emotional turmoil at home.
During our initial sessions, Kevin described his experience:
It’s like having two entirely different lives, he told me. During the day I am ‘Kevin the Achiever’ – always on, always smiling. But as soon as I get home and take off my work clothes, I start to fall apart. The mood swings are utterly exhausting. I’m terrified that one day I will run out of steam.
The High-Functioning Paradox
Kevin’s high-functioning bipolar disorder is not particularly unusual, but it can go unnoticed. Sometimes referred to as ‘high-functioning bipolar disorder’, this can both complicate diagnosis and hinder treatment.
For many of them, like Kevin, the need to maintain professional decorum can also exacerbate their illness. Too often, people with mood disorders spend all of their emotional energy keeping up the pretence of good health. And, by the time they get home, they might be more susceptible to a bad mood.
Unmasking the Struggle: Kevin’s Journey in Therapy
These were some of the important things we learned from Kevin, as we grappled more deeply with how he struggled over time.
The Toll of Compartmentalization
The way that Kevin was drawing a line between his working life and his private life was having a major impact on his wellness, but this responsiveness was a short-term solution that would become unworkable, and ultimately ameliorating rather than tackling his condition.
The Fear of Stigma
In fact, one of the main reasons that Kevin didn’t enter treatment earlier was fear for his career: ‘the stigma of having mental health issues in the type of work environment that I was in was a big, big issue’. Employment in the workplace can often be a source of solace for people. But high-functioning bipolars, in particular, find themselves vulnerable to the threat of stigma at work, often using this threat to avoid treatment altogether.
The Exhaustion of Masking
Keeping up the ‘masking’ of his true emotional state at work was getting harder and harder, and Kevin said it felt ‘more and more, every day, it feels more cumbersome’. It actually was more cumbersome: every time he had to hide his depression at work, his mood swings got worse when he was alone.
The Impact on Relationships
The disease came at the cost of Kevin’s personal relationships. His mood swings and the ‘instantaneous energy’ he had to ape to feed his work persona left him with little to offer in his personal life.
Therapeutic Approaches: Integrating the Two Kevins
Our therapeutic journey focused on several key areas:
Acceptance and Self-Compassion
An important first step was to assist Kevin in accepting his diagnosis while learning to be compassionate towards himself. Building on the concept of self-compassion that we have written about previously, we spent time together reimagining how Kevin discussed and thought about bipolar disorder. From being perceived by Kevin as a weakness that needed to be controlled and hidden, we worked to formulate a view where bipolar disorder became something that Kevin needed to learn about and care for.
Mood Tracking and Trigger Identification
We helped Kevin put in place a broad-based mood-tracking system, whereby Kevin could peruse a list of his unfortunate mood cycles and triggers to better identify where he was headed before it was too late. He could then study the behavioural routine he would need to galvanise himself out of the abysmal ditch. A portion of our practise together involved sponsoring students in behavioural change. Any student would understand a set of specific ‘just-in-time’ techniques to switch gears.
Cognitive Behavioral Therapy (CBT)
The CBT techniques – which taught Kevin to check his beliefs, hypotheses and reflection against more realistic ones – proved very useful at helping him identify and moderate the negative thought patterns that accompanied his depressive states, and that were characteristic of anxiety. CB was doubly popular as it also addressed the cognitive distortions characteristic of depression.
Mindfulness and Stress Reduction
Given the very elevated stressfulness of Kevin’s job, we also recommended that he incorporate mindfulness practices and stress-reduction techniques into his daily routine to help keep his feet on the ground with regard to the very high and low mood states of his manic and depressive episodes.
Medication Management
We were able to work with a psychiatrist to come to the correct pharmaceutical cocktail to stabilise his extreme mood swings. It took time and skill to get right, but medication became a crucial part of his overall care strategy.
Work-Life Integration
Instead of holding his work and personal lives separate, we explored approaches to integrate his work and home-self, in developing culturally appropriate means of communicating his needs at work and setting boundaries.
The Turning Point: Embracing Authenticity
However, it was only when Kevin clicked that he had reached the moment to disclose the reason behind his symptoms to his direct line manager that things truly began to change. For Kevin, this was the scariest thing of all.
To his surprise, Kevin’s superintendent was helpful and worked out an arrangement that softened the edge of the stress Kevin was under. Beyond its immediate impact in reducing Kevin’s stress, the experience helped confirm his burgeoning understanding of the power of authenticity and vulnerability.
Lessons Learned: Insights for Therapists and Individuals
Kevin’s trajectory provides valuable lessons for both mental health professionals and for people with bipolar disorder:
The Importance of Holistic Treatment
If we are to have an effective treatment for bipolar disorder, especially for the high-functioning kind, it must include a psychological as well as a biological solution.
Challenging the Stigma
Kevin’s case serves to remind us that there is still a great deal of work to be done in terms of combating stigma, particularly with respect to professional settings. Wholesale, open conversations and education can lead to workplaces that provide greater support for those who struggle with mental health issues.
The Power of Authenticity
Compartmentalisation might be a good coping skill in the short term, but what typically helps people with bipolar live normal lives in the long term is a kind of authenticity; in being comfortable in being their real selves, in an integrated way.
Recognizing High-Functioning Bipolar Disorder
High-functioning patients with bipolar disorder do not always earn their doctors’ daily attention, and they don’t always present with the classic symptoms of mania. Mental health professionals need to be aware of both the subtle symptoms of this unusual group of patients, and the therapeutic approaches that are best suited to help them.
The Role of Support Systems
For Kevin, this experience emphasised the importance of building a strong support structure around him, both at home and at work. Encouraging patients to develop networks of support in their lives can be a key to recovery and maintenance.
Kevin Today: A Story of Hope and Resilience
In the course of our work together, which is ongoing, Kevin has made tremendous strides. His bipolar disorder is not curable, but he still maintains a very high level of functioning, backed by a wealth of effective coping strategies and a stronger sense of self.
Today, Kevin has kept his career and become more open about living with bipolar. He’s open with his staff about his mental health, and has dedicated himself to becoming an advocate for employee wellbeing, and speaks openly about his own experience, and what he’s learnt about himself through his illness.
Conclusion: Embracing the Whole Self
And Kevin’s path from a ‘split self’ to a coherent, ‘unmasked’ person illustrates the multifaceted nature of living with bipolar, and the potential for therapy to mend brokenness and create a brighter world for all of us. We must make efforts both in our personal and professional lives to ensure a place where others can feel truly, completely themselves.
Our responsibility in mental health profession is not to treat only the symptoms of our clients. Alongside our clinical work, we must facilitate a network of deep integration of all aspects of a person’s identity. This is the avenue to resilience, self-acceptance, self-forgiveness and authenticity in living which holds the key to a fulfilling life. I will never forget Kevin. I will always remember the possibilities of human spirit and a humane, holistic mental health care that stands in the way of undermining his resilience.
I share my experience in the hope that it provides inspiration to fellow practitioners and people experiencing mental health challenges alike. Your next physical and verbal expression is waiting to be revealed, so share the smile.