Once when I was struggling with a depressive episode I went to a counseling appointment and told my counselor how discouraged I was. I felt so frustrated that I was depressed, it felt like failure to me. It seemed like I had climbed a mountain, learning how to live well, and now I was all the way back down at the bottom. I was frustrated and angry because in my mind I thought I had to start all over again.
My counselor responded to me with one of the most profound insights that I had been given into the treatment of my disorder. She said that treating bipolar disorder follows the same pattern as the addiction recovery cycle. She showed me a diagram of the addiction recovery cycle and explained that becoming depressed isn't failure, it is just a shift in where I was in the cycle.
It is important to understand that these stages do not necessarily always occur in this order, and sometimes you can be in more than one stage at a time, and even regress to a previous stage. But understanding the stages and the basic progression is important to learning how to view your bipolar disorder in a healthy way.
Understanding the stages of the recovery cycle will help you better understand your disorder and have a healthier outlook on your personal responsibility for selfcare. Learning how to apply the recovery cycle to yourself will help you to stop feeling like you have failed when you have manic or depressive episodes and choose to accept more responsibility for yourself and your disorder.
Stages in the Recovery Cycle
Precontemplation
In this stage you don’t recognize or acknowledge that you have a problem. This can occur before diagnosis, but often continues after diagnosis, too. Prior to my diagnosis I had a feeling for a few years that there was something wrong, but I didn’t really know what it was. I spent a lot of time feeling like my mood swings were my fault, a lack of self-discipline.
After diagnosis there were many times when I went through periods where I questioned my diagnosis. Often at the beginning of a manic phase I would start to feel happy and productive and I would think things like, “maybe it really was all in my head, I don’t have bipolar disorder and I don’t need medication. I’m fine.”
In this stage you may also feel angry that you struggle with bipolar disorder and feel like you shouldn’t have to work so hard to feel well, so you aren’t going to try at all. You may feel hopeless, like there is nothing you can do about it anyway, so why try. You might feel like you should be able to take care of things on your own, you don’t need anyone’s help, you can take care of yourself. Or you may like the feeling of mania, and not want to lose that exhilaration, rush, creativity, etc. that you get when you are manic.
Contemplation
In this stage you recognize and acknowledge that you have a disorder that needs treatment. It is just the beginning of the process, though, you know you need assistance but may not be fully committed to the journey yet. This could last for a while because it can feel scary to seek a diagnosis or to admit that you need help. There is also fear that there may not be any relief for you. Because of negative stigmas associated with bipolar disorder, it takes a lot of courage to reach out for support.
Preparation
In this stage you are committed to changing and you are ready to get help. This looks like making an appointment with a doctor or a mental health counselor, or reading a book on mindfulness meditation. Each time you recognize the need for a new tool or step you enter this stage.
Action
This stage is when you take action, when you apply what you learned in the preparation stage. This is when you start to see and experience change. This stage can be challenging when you first enter it, because you are trying something new. It is really important to have support from others who will encourage you and cheer you on as you choose each day to keep trying.
Maintenance
You enter this stage when you have established habits and patterns that help you live a healthy, balanced, and productive life. One of the challenges I experienced in this stage the first few times I entered it was anticipating the next manic or depressive episode. I was so used to the cycle that steady consistency sometimes caused me to feel anxious.
This is one of the reasons that it was so helpful to me to learn about this recovery cycle. I learned to stop dreading potential interruptions, and instead viewed it as an opportunity to learn and grow. There is no cure for bipolar disorder, but with consistent, persistent effort you can get to a point where you go long periods of time, sometimes years, without any serious episodes of mania or depression.
Relapse
This is just what it sounds like. It is a recurrence of the mania or depression that throws off the new routine. Your response to this will determine where you land in the recovery cycle. The more you learn about your disorder, the more you recognize that it is a disorder and not moral or personal failing that causes you to relapse, the sooner you can work your way through the stages of recovery back to maintenance.
I have also found that the more times I make it to the maintenance stage the more faith I have in myself that I can get there again. I know the way back, and so I can pick myself up, dust myself off and keep moving forward. I never enter precontemplation anymore.
Personal Responsibility
Understanding the recovery cycle has taught me that I am responsible for myself and for treating my bipolar disorder. I acknowledge that I have bipolar disorder, and I accept that I will have it for the rest of my life. If I do not acknowledge and accept that, I risk hurting myself and those I love the most–my husband and children.
Understanding this recovery cycle has helped me to view my disorder in a healthy way. Relapse is not failure, it is just a shift of where I am in the cycle. This understanding has been a significant step on my journey to living a healthy, balanced and productive life.
The Path to Wellness is Not Linear
The analogy that I used earlier of climbing a mountain to represent my path to wellness is really not accurate. In fact, that analogy is counterproductive at best, and damaging at worst. The idea of climbing a mountain is a linear path, which means that if you get manic or depressed while you are working to learn to live well, you get knocked back down to the bottom. It reminds me of the game Chutes and Ladders where if you are unlucky enough to land on the wrong square you slide backwards on the board, sometimes to the very beginning.
One of the greatest benefits of discovering the recovery cycle is understanding the nature of bipolar disorder better–in a more realistic and productive way. There is no cure for bipolar disorder, just like there is no cure for type 1 diabetes. It is a medical disorder in the body that you can learn to manage so that it minimizes the impact on your life. But it will never go away completely. The goal is to learn to proactively manage your disorder within the Preparation-Action-Maintenance-Relapse stages of the cycle.
As you learn and practice using the resources and tools necessary to live a healthy, balanced, productive life, your transitions through the stages will be easier and the skills you develop will improve. As you implement the tools and gain experience with those skills you will gain confidence in yourself and your ability to recover when you experience a manic or depressive episode. You can also learn to spend greater periods of time in the maintenance stage of the cycle.
If you are ready to begin your journey to mental and emotional wellness, I invite you to sign up for my free guide to creating a personal Mental Health Emergency Response Plan. This is a fantastic resource to help you manage your relapses in a way that will minimize the impact on you and those you love. It will also help you develop a plan to move out of relapse and back into wellness. There is hope and there is help. I hope you will join me on this journey to living well with bipolar disorder.
