I have written before that you can sort of, a little bit, manage bipolar disorder without medication. There are a few proven treatment strategies that do work to manage bipolar disorder and keep you out of the prescription line at the pharmacy.
Nevertheless, I’m still a big believer in medication. I believe that if your life is out-of-control because of bipolar disorder, then medication is probably the best thing for you. I believe that if you’re in pain because of bipolar disorder, then you should be seeing a psychiatrist. I believe that if your functionality is compromised by a disordered brain, then you should be looking at a medical solution.
But does this mean that people with uncontrolled bipolar disorder should be forced to take medication?
People with Bipolar Disorder are Different
Bipolar disorder is not one thing – bipolar disorder is a whole lot of things all clumped together. You only need to have a percentage of the known symptoms in order to qualify for the diagnosis of bipolar disorder and people experience different symptom sets. Some people get manic, others get hypomanic. Some people get psychotic, some people don’t. Some people attempt suicide, some people become catatonic. And so on. Everyone is different.
Severity of Bipolar Differs
And so are severities. Bipolar doesn’t come in one severity level. The symptom impact has to reach a certain level for diagnosis (it must significantly impact functioning or quality of life) but not all bipolars are created equal. Some people with bipolar have to go on supplemental security income assistance – they cannot work – while others maintain employment. Some can’t manage themselves well enough to stay off the streets and others maintain a mortgage and car payments just fine. Bipolar severity varies dramatically.
Medication Choices in Bipolar Disorder
And so, depending on your specific symptoms and their impact on your life, your choices around treatment are going to differ. I would say that if you’re experiencing psychosis (the presence of delusions and hallucinations), you should be on medication, period. I would say that if you’re too depressed to bathe or leave the house, you should be on medication. I would say that if you’re in financial and personal ruin due to uncontrolled manic episodes, you should be on medication. And I would say that there are a lot of other clear cut examples of people who absolutely need to be on medication.
But should anyone force the issue?
I’m afraid not.
Bipolar Medication is a Personal Choice
See, while I’m very experienced with bipolar disorder and I think I know what’s best in many cases, these cases are not my life and I can’t dictate what people must do. I can dictate what I must do, and that is all. I don’t have the right to tell others what is best for them. I can have an opinion, but ultimately, the choice must be theirs. Except in cases where the person is a danger to themselves or others (or they’re underage), it must clearly be their choice.
And there are two reasons for this. One is simple freedom. We live in a free country (many people do) and no one can dictate to us what we must ingest. No one can tell us what to do and if we want to lie around in our own illness demonstrating crazy at every turn, then that is our right. If we want to be floridly psychotic and live on the street, then that is our right. If we want to be so depressed that we do nothing but stare at the wall all day, then that is our right.
I would say these are poor decisions, but we have the right to make them. Just because we have a mental illness that doesn’t take away our right to make bad decisions. People without a mental illness make them all the time.
And secondly, medication should, whenever possible, be a choice because it just plain works better that way. When a patient feels like he is in control of his treatment, the outcome is better. Studies show this. When you force medication down someone’s throat it just makes sense that the outcome would be worse.
Can You Manage Bipolar Without Medication?
And yes, I think a very small, minority of people can manage their bipolar disorder without using medication. I think it is possible. These are non-severe cases that respond well to non-pharmacological methods of management. These people will still have to do something to manage their illness, but a very tiny number might get away with minimal or even no medication.
And even if life not on medication isn’t perfect, it’s their choice to live that way. Maybe we think that there is room for improvement and that meds could be that improvement. That might be so, but all our lives have room for improvement and it’s always our choice as to how to go about getting that improvement. And our pressuring someone to take meds really isn’t going to help the situation.
I learned a very long time ago that no one can take responsibility for a person’s mental health except himself and I also learned that we need to respect that if there is to be any peace. We can disagree, we can even think we know better, but until you’re in that person’s brain, in the very soul of their being, you can’t know what really is best for him. So take a step back and consider how you would feel if someone tried to thrust consciousness-altering substances on your life and respect that is just not what everyone wants.