Bipolar disorder may be lifelong, but stability, self-knowledge, and meaningful goals can still shape a fulfilling life.
Key Takeaways
- Recovery can mean building a fulfilling life while managing bipolar, not eliminating every symptom.
- Adjusting goals and expectations can help you protect stability and build a life that still feels meaningful.
- Therapy, meaningful routines, and skills from MBCT or DBT can support long-term stability.
- Catching early warning signs like irritability or sleep changes can help prevent a full mood episode.
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Wouldn’t life be divine if you received your bipolar diagnosis after your very first brush with depression or hypomania, started on the proper medication immediately, and never had to experience symptoms or survive another mood episode after that?
Unfortunately, that’s not how things tend to play out. Fixing your sights on that mystical utopia may actually prevent you from living your best life.
Why ‘Recovery’ Can Feel Complicated With Bipolar
The truth is that even the fundamental triad of effective medicine, psychotherapy, and self-care isn’t magic. Yes, managing bipolar requires comprehensive, consistent effort on all fronts — but even then, mood episodes may erupt.
Complete treatment adherence and an impressive array of coping skills can’t always prevent symptoms such as anxiety, impulsivity, and depression from sneaking through from time to time.
That’s why talking about “recovery” from bipolar can be confusing. After all, the traditional medical definition is an absence of symptoms, or re-establishing levels of health and activity equivalent to a person without the condition.
“I don’t really care for the term,” says Laurie T., who was diagnosed with bipolar 1 disorder in her mid-twenties. In her mind, “recovery” equates with “cured” — not something that applies to brain-based disorders.
“This is a chronic illness. Forever and ever,” Laurie points out. That may sound harsh, but she’s quick to add: “It can be manageable if you have the right education, support, and encouragement.”
Yet there is an alternate view of recovery, one that is closer to how the term is used in 12-step programs. This more holistic version emphasizes management, maintenance, and self-actualization.
Shifting Expectations Can Support Stability
In March 2012, the U.S. Substance Abuse and Mental Health Services Administration (SAMSHA) issued a new governing definition of recovery for programs under its purview: “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”
For Laurie, a deeper understanding of how to live her best life with bipolar has been a long time coming. She’s now learned more about triggers, preventing episodes from returning, symptom recurrence, and lifestyle adaptations. Before, she explains, “I thought if you take your medicine, you’re all good.”
Through the years, it was painful when bipolar disrupted her ability to work full-time and travel. Now, she’s no longer measuring herself against what she can’t do. She has redefined what achievement looks like for her: maintaining a level of independence.
“One thing I learned late — don’t look to your family or society for your success,” says Laurie, who has also been managing debilitating medical conditions.
“I’m successful because I get up in the morning. I do the best I can every day. I help others the best I can. I just do things differently.”
Managing Chronic Bipolar Symptoms
Support groups and mental health communities can help ease the path to accepting the chronic nature of bipolar and teach you how to weather breakthrough symptoms and mood shifts.
“Sometimes it helps to meet other people who are living with bipolar illness who are delightful people living fulfilling lives,” says clinical psychologist Laura Smith, a senior clinical psychologist at the Center for Clinical Interventions in Western Australia.
As part of embracing the stability journey, individuals who are dealing with bipolar typically have to make compromises in daily life to safeguard their sleep, limit stressors, and otherwise prioritize their well-being.
When it comes to jobs, for example, it may be necessary to seek accommodations, such as avoiding the night shift or reducing travel. Lengthy commutes may be a deal-breaker.
“Most of the usual stressors seem to do with overstimulation, irregularities in daily patterns, becoming too tired or overstressed, a lack of self-care, or overworking,” says Ian Anderson, MD, a professor emeritus of psychiatry at the University of Manchester in the United Kingdom.
Compromise applies to the bigger picture, too.
“Goals might have to change as you adjust your life to cope with bipolar,” Dr. Anderson notes.
Set Reasonable, Reachable Goals
Letting go of goals that are wrapped up in your identity isn’t easy. Nor is the process of figuring out a new path to fulfillment. Anderson recommends working out what you have control over, what you can’t control, and determining reasonable, reachable goals for yourself.
“Make the best of the situation you’re in and strive for something attainable,” he advises.
When people’s original goals are out of reach, psychotherapy helps them process feelings such as grief and anger as well as identify new paths, says Francis M. Mondimore, MD, of Johns Hopkins Medicine in Baltimore.
Changing your narrative, reinventing yourself in some way, is an important part of psychotherapy,” he notes.
Bipolar might upend the life you envisioned having, but, Dr. Mondimore says, “Let’s look at how you can function the very best you can.”
As Laurie found, it’s critical to step away from dwelling on bipolar as something that limits you. Instead, focus on what you are able to do. Keep swinging, keep chipping away at your goals — although what those look like may change — and, above all, be gentle with yourself.
In short, you can navigate your way through the curves bipolar throws at you and into a fulfilling, meaningful life. Read on to see how three people have managed.
The Road to Greater Understanding About Bipolar
Jared D. was beginning his final year of Bible college in Kansas City a few decades ago.
“I had really big dreams of doing ministry … Perhaps going to another country, perhaps having my own church,” recalls Jared.
All that went sideways early in the fall semester. He left school during a month-long episode of sleeplessness and racing thoughts, returning home to Southern California. Thus began a winding journey with bipolar 1 disorder that included various doctors and combinations of prescriptions.
He was eventually able to graduate from college, then bounced around different jobs for several years until a dire episode of depression with psychosis landed him in the hospital for the first time.
“I didn’t start doing therapy until I was in the hospital [for] five months,” Jared says. Between therapy and his stay at a long-term facility after the hospitalization, he became far more educated about bipolar.
Acceptance and Ongoing Growth
Jared works for a small marketing company creating websites and producing virtual tours. He used to crisscross the United States for his job, but the constant travel eventually led to a severe mood episode. As a result, he stepped back from that part of his duties.
“I had to let go of a lot of expectations in order to accept my diagnosis … I have to accept it in order to live a decent life,” he says. He strives to “keep growing and learning all the time, and to try and be as alive as possible.”
Jared has had short stints in the hospital since his first stay, but surviving the worst lows keeps him grounded in gratitude. He says conversations with professionals and peers, as well as church support communities, help him move forward.
“I have a really great relationship with my psychiatrist right now, supportive friends, and NAMI,” he says, referring to the National Alliance on Mental Illness (NAMI). “I need to be around people I connect with.”
He’s channeling his impulse toward ministry into a podcast called Louder Now. He describes the podcast as making a “loud noise” about mental health in the context of faith, looking at these challenges from both a scientific and Christian perspective.
“I still think about it, but I don’t have tunnel vision,” he says of his original dreams about becoming a minister, then adds: “I’m not ruling that out.”
Reflecting on Life’s Journey
Retired nurse Eileen P. has a philosophical perspective on the turns her life has taken — both before and after her bipolar 1 diagnosis at age 40.
“I no longer have any regrets,” says the Florida woman who once was set on earning a PhD before turning 30. “I have my master’s and I am happy with that. What I didn’t get to do, I wasn’t meant to do.
“Everybody has a plan, I do believe. I hadn’t intended to join the Air Force, but then I met my husband there.”
The mother of three — she was pregnant with her youngest when she had her first manic episode — credits the comprehensive treatment she received at a military hospital, group therapy, her husband’s support, and an understanding family with her ability to readily accept her diagnosis and adjust her expectations.
Understanding that there is no cure, that bipolar is an illness that must be managed daily like diabetes, helps Eileen accommodate the necessary tweaks in her routines and aspirations. Catching early signs and symptoms of a mood shift plays an important part in minimizing disruptions and avoiding unwelcome consequences.
“I know myself better now. I know my triggers, and I have coping mechanisms,” she says. For example, she is someone who is not normally irritated, so if she finds herself getting easily annoyed, “something is going on. I had better look at it and address it.”
Setting New Goals and Protecting Sleep
Given that Violette K. works in the theater business, there are seemingly endless opportunities for drinking and partying.
“It’s hard when I’m around other people and socializing. They don’t have to be careful like I do,” says Violette, who has a bipolar 2 diagnosis. When she has to exit early to stick with her sleep schedule, “it’s hard to make that call in front of other people.”
Maintaining her stability also shapes her work choices.
“I find I turn down a lot of creative projects,” she reflects. “I had an opportunity to work on a production, but when I looked at the schedule, the tech week before the show was all late nights.”
That sensible acceptance sits worlds away from her attitude after she imploded at college, tanking her plans to become a professional violinist. At the time, she felt her life was ruined. She credits a dialectical behavior therapy (DBT) program with helping shift her perspective.
“I was depressed at first,” Violette recalls of the early days after her diagnosis. “Then I realized I could still try to build a life worth living.”
She reasoned that when she did experience depression again, the life she’d built would help her ride out the episode. And when she does experience episodes in either direction, she has a three-stage plan she crafted and ran past her therapist.
“If I have a hypomanic episode, I have a whole list of what I need to address,” she explains. So far, she hasn’t had to go past the first action level: ‘Usually if I sleep enough, it stops.’”
There’s no knowing whether Violette would have succeeded as a concert violinist, or whether that lifestyle would have proved satisfying. Instead, she welcomes the balance she has found.
“Before I had my first bipolar episode, I was high-achieving … I was also perfectionistic and very hard on myself. I have done a lot of work on that,” she says.
Sometimes Violette wonders if she has swung too far in the other direction in terms of not having lofty goals. Then she reminds herself to be grateful that her life is on track.
“I think I’m okay with living a perfectly average life,” she muses. “I am genuinely happy now.”
Personalizing Strategies That Help
Getting to know what triggers your symptoms and developing strategies to help minimize their occurrence — and impact on your life — takes patience, but is doable and important.
The “stress vulnerability model” recognizes that some individuals have more susceptibility to developing mental health conditions and that stress often triggers symptoms.
“The stress piece of the stress vulnerability model is very amenable to intervention,” says Mondimore.
Learning to manage stressors and minimize disruptions from mood symptoms may involve adding to your coping skills, increasing social support, and participating in meaningful and/or pleasurable activities.
“Useful coping strategies are as individual as the person’s life,” says Mondimore. “It depends on what they are managing.”
Behavioral Approaches That Can Boost Well-Being
Smith emphasizes the importance of early detection and prevention of mood shifts.
“The core of our bipolar group program [at the Center for Clinical Interventions] is the development of an action plan for identifying and responding to early warning signs of mood episodes and for maintaining stable mood,” says Smith, whose research specialties include improving self-management of bipolar symptoms.
Keeping depression from escalating often presents a challenge. Cognitive behavioral therapy, including mindfulness-based CBT (or MBCT), can be especially helpful in targeting the negative inner narrative that feeds depression. One randomized study of 410 people found that mindfulness-based CBT had better treatment outcomes for depression than traditional CBT. Dialectical behavior therapy also offers tools to address self-talk.
“For depression prevention,” says Smith, “We work with people to increase rewarding activity in their lives, what we sometimes call ‘behavioral antidepressants,’ and to challenge unhelpful ways of thinking about themselves and their situation.”
Editorial Sources and Fact-Checking
- Strauss C et al. Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-Help Compared With Supported Cognitive Behavioral Therapy Self-Help for Adults Experiencing Depression: The Low-Intensity Guided Help Through Mindfulness (LIGHTMind) Randomized Clinical Trial. JAMA Psychiatry. 2023.
UPDATED: Printed as “Winning at Life,” Winter 2022
