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Joseph C. Carey
Prof. Intawiwat
English-112-07
13 July 2016
Essay- Final Draft

Disability vs. Functionality in Bipoles: A Strategy Guide

1. The Lead-In
Amy Winehouse, Robin Williams, and Marilyn Monroe all had it and suffered tragically,
while Edgar Allen Poe, Virginia Woolf, Vincent van Gogh, and Friedrich Nietzsche all had it and
are considered to be quintessential paragons in their respective fields ("List of people with
bipolar disorder."). Frank Sinatra, Nina Simone, Brian Wilson, and Britney Spears were all
diagnosed with it and had to awkwardly confront it in the public eye; Mel Gibson and Axl Rose
both notoriously have it and are considered to be inhumane narcissistic jerks ("List of people
with bipolar disorder."). It truly does take all kinds. The it here is bipolar disorder, formally
known as manic depression, an illness characterized by fluctuating hyper-elevated and morbidly
low mood swings. It is a chronic mental illness that affects a sizable population of adults here in
the US and across the world, and in a 2008 report, the National Institute of Mental Health
announced that almost six million people in the United States have bipolar disorder at some
time in their lives (qtd. in Chang-Calderon 4).
The silver lining is that bipolar disorder is treatable, though not presently curable. It can
potentially be sent into remission, but it is very rare that there is no relapse at some point. The
symptoms are more commonly dealt with on a daily basis, and the first and most difficult step for
most is admitting that something is wrong. Next is obtaining a medical diagnosis and beginning a
medication regimen. As illustrated by the list of famous personalities above, the possible
outcomes then become as diverse as the people diagnosed with the disease. Each of their lives

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will be an incessant sequence of struggles between disabilities coming from the disease and
functionality stemming from strategies employed to combat it. Leonardi et al. defined disability
in the medical journal, Lancet, as a difficulty in functioning at the body, personal or societal
levels, in one or more life domains (qtd. in Sanchez-Moreno et al. 2). These disabilities are
present in all aspects of patients lives, and successful functionality will be determined by how
resolutely strategies are applied. Functionality is loosely defined as a persons ability to perform
the tasks of daily life and to engage in mutual relationships with other people in ways that are
gratifying to the individual and others, and that meet the needs of the community in which the
person lives (Murray et al. 2). Zarate et al. offer a simpler concept and define functionality as
the capacity to work, study, live independently and engage in recreational activities and
interpersonal relationships (qtd. in Sanchez-Moreno et al. 2). In reality, each responsible adult
diagnosed with bipolar disorder will define the concept in accordance with their own
circumstances.
Successful strategies for functionality are as frequent and diverse as the disabilities they
were designed to combat. The path of life a patient chooses will inevitably determine what
hurdles need to be met, and there are proven strategies that can be employed and adapted for
each individuals circumstances. A number of these were designed by educated mental health
professionals, while others were devised in the trenches by diagnosed patients. This wealth of
knowledge is readily available for utilization from doctors, books, internet sources, and support
groups. Therefore, it becomes obligatory for responsible adults with bipolar disorder to seek out
and employ any and all pertinent and judicious strategies to help establish successful
functionality in their lives.
The body of this paper is focused on a selection of strategies aimed at creating the
aforementioned successful functionality. Broad topics such as lifestyle choices, career
achievements, and personal relationships will be touched on, as well as more specific themes

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such as sleep, exercise, jobs, education, romance, and others. Additionally, a thorough analysis of
the disabilities that create the need for these success strategies is included. In a discussion of this
nature, certain terms are appropriately used to great extent. In consideration of this prevalence,
for the remainder of this paper BD will be substituted for bipolar disorder and bipole will
be substituted for person diagnosed with bipolar disorder.
This is what I believe to be true. This is what I learned in the hospital. You have
to do everything you can, you have to work your hardest, and if you do, if you
stay positive, you have a shot at a silver lining.
(Silver Linings Playbook)
2. Disability vs.
BD is a formidable mental health issue and the range of disabilities it can cause in
patients can be quite severe. Aside from the dramatic but seldom violent mood swings, there are
other challenges that must frequently be met. First of all, the stigma that follows bipoles around
is groundless in most cases as they are habitually thought to be coercive bullies, narcissists, or
offensive jerks (Tracy). These prevailing misinformed impressions allow people to badly
mistreat bipoles, or even worse, to condescendingly use the kiddie-glove treatment on them.
Unfortunately, this occasionally leads to over-compensation which can prompt self-isolation into
hermitage or result in an all too common suicide.
In the survey that Sanchez-Moreno et al. supervised, the data identified 3 preeminent
areas of disability in their participants that were damaged by BD: work functioning; social
function; family functioning (2). As many as 30-60% of their patients had a considerable
disability in one or all 3 of these areas (Sanchez-Moreno et al. 8).Work functioning, an area
where BD disability is arduously overcome, centers around a patients adequacy in obtaining and
retaining gainful employment. Unfortunately, long-term successful careers are a challenging

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prospect for bipoles and less than 50% of the adults with BD disclosed having a reliable job
(Sanchez-Moreno et al. 4). Interactions with coworkers and management, as well as societal
encounters as a whole, are universally affected by BD. Moreover, once a patient has been
affected by a bipolar episode, manic or depressive, the normal levels of societal functioning are
never again fully attainable. The 3rd area, family functioning, involved issues of caretaking
responsibilities, an issue which created frustration on both sides of the struggle. However, the
most damaged aspect was unquestionably spousal relations.
The venerable adage, love is fickle, must surely have been coined in response to a
torrid bipolar love affair. They can get messy, since the effects of the illness inside the
relationship are potentially borne by both partners. As a result, there are sadly some individuals
who think that any person diagnosed with BD should be flat out excluded from any and all
romantic endeavors (Tracy). A bipoles mood changes can occur within a day, and regrettably
these continued and repeated turnabouts can cause cumulative damage that inevitably dooms a
relationship. Also, recurring unemployment inevitably leads to financial difficulties which can
cause a split in unity, while shameful but necessary hospitalizations can cause patients to
withdraw from their significant others. Additionally, indispensable lines of communication will
invariably break down in some way. Bipoles suffering an episode may find themselves with the
inability to be cognizant of others issues or simply unable to make sense of body language cues.
Ultimately they may lose the capacity to functionally listen as a result of past damage or
medication side effects. Whatever the reasons may be, the failure of bipolar marriages is
pervasive and toxic. In a 2004 article published in the medical journal Psychological Medicine,
Mitchell, Slade, and Andrews affirmed that men and women suffering with BD are much more
inclined to separation than the general public (qtd. in Sanchez-Moreno et al. 5). Likewise, studies
have shown that up to 90% of bipoles end up getting divorced at least once in their lives
(Rodriguez and Bass).

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Further critical disabilities evident in bipoles include sleep impairment, substance abuse,
and physical health concerns. Tragically, sleep impairment of some nature is consistent with all
forms of BD. Consequently, a responsible sleep management strategy is integral to any sustained
functionality, but conversely, mismanagement can be calamitous as it affects all aspects of the
disease. Mania is commonly associated with a diminished urge to sleep, and vice versa, little or
no sleep can incite mania and the risk-taking behaviors linked to it. Depression, on the other
hand, corresponds to a heightened desire to sleep as well as instances of insomnia. Either degree
of sleep complication cripples bipoles ability to think, reason, and remember properly. In order
to compensate for their sleep disabilities, many bipoles attempt to self-medicate with stimulants
and sedatives like alcohol, nicotine, caffeine, sugar, or illicit drugs. In a 2008 report, the National
Institute of Mental Health disclosed that there is a higher than average rate of alcoholism and
drug abuse among the bipolar population (qtd. in Chang-Calderon 8). These levels of substance
abuse, both legal and illegal, tend to substantially and adversely affect a persons physical health.
Simultaneously, sleep impairments also negatively influence factors such as obesity, diet, and
exercise which can lead to and exacerbate those same physical health concerns. A recognized
doctor in the mental health field, Prof. KRR Krishnan, suggested in 2005 that BD is associated
with a wide range of medical problems, with the most common being cardiovascular disease,
diabetes mellitus, and thyroid disease (qtd. in Harvey, Talbot, and Gershon 6).
3. vs. Functionality
Functionality with BD can come in a multitude of forms and varying degrees of success,
therefore a sensible strategy must be accompanied by hard work, confidence, and the resolve to
stay the course. There is no singular strategy that can account for all persuasions of the disease,
but there are some devices that have been employed repeatedly over a span of time and are easily
adaptable to any number of dispositions of BD. Modest triumphs against the illness can

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assuredly increase a bipoles self-worth, but broader victories should ultimately drive each
patient as this volatile illness affects every facet of their lives.
The comprehensive study of High Functioning bipoles by Murray et al. revealed 6
corresponding themes: sleep, diet, rest, and exercise; ongoing monitoring; reflective and
meditative practices; understanding BD and educating others; connecting to others; enacting a
plan (5). High Functioning is characterized here as a patient who continually behaves in a
manner that is socially defined as successful, despite a historical diagnosis of BD (Murray et al.).
In order to bolster their continued functionality, it is critical that bipoles have some working
knowledge of BD and impart that information to all the significant people that make up their
world. Also, it is imperative that these functional bipoles be able to consciously register mood
fluctuations and the triggers that cause them. Surprisingly, a compelling number of those studied
by Murray et al. admitted to journaling their mood fluctuations as a means to their success (6).
Dinia, a successful bipolar management professional, confessed that keeping a journal helped
me in retrospect to kind of look back and understand what it was that I was dealing with because
one of the things that would always happen to me is that I would go along and Id be fine, fine,
fine, fine, fine and then suddenly, boom, crash....And when I went back and I looked at what I
was dealing with, it really reframed it for me (Chang-Calderon 80-81). Furthermore, having a
readiness plan in response to some future trigger allows a bipole to conceptualize and document
a plan of attack that can be invoked whenever a looming episode is threatening their
functionality (Murray et al. 12).
Sleep management is one of the prime elements in determining functionality with BD.
Quality of life is directly proportional to the amount of solid restful sleep a bipole secures as are
enhanced thinking, memory, and emotional functions. Adherence to patients internal 24-hour
clocks and natural circadian rhythms- those that promote wakefulness during daylight hours and
encourage the need for sleep when there is no sunlight- is necessary and beneficial to both

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mental and physical health. Additionally, mental health professionals and a noted national
support network, the Depression and Bipolar Support Alliance, universally agree on the positive
impact that a wholesome nutritious diet, a steady measure of physical activity, together with
gaining the requisite degree of quality sleep can be on a bipoles well-being (qtd. in Wheeler and
Bass).
Regular exercise regimens tailored to each individual bipoles comfort zone present
comprehensive benefits and are routinely employed as a means to successful functionality.
However, they should not be used in place of other treatments such as medications or therapy,
but in conjunction with them. While some may find that the mind-focusing meditative activities
of Tai Chi and yoga adequately stimulate patients anxieties. Continued study has shown that an
outdoor aerobic approach is significantly more beneficial than weight training, or other
disciplines, for active bipolar adults (Wheeler and Bass). In comedic fashion, Russells Silver
Linings Playbook accurately exhibits the benefits of an exercise regimen, as the bipolar
protagonist, peculiarly clad in a black garbage bag, routinely uses rigorous physical activity as a
fundamental defense against BD and a means to success. However, it is not currently evident
whether or not it can avail or comfort a manic bipole. Regular exercise can help prevent
episodes of bipolar depression, but its unclear if it can prevent or improve a manic moodpatients have reported both positive and negative effects of exercise on mania (Wheeler and
Bass). The Depression and Bipolar Support Alliance advocates for a system of strategies aimed
at novices, encouraging them to begin a workout routine. Bipoles are instructed to Pick a form
of exercise you enjoy....Start slowly and work up to a healthy frequency....Consult your doctor
before beginning....Find an exercise buddy (qtd. in Wheeler and Bass).
Occupational success with BD is a particularly volatile functionality to realize, but with
due diligence and adaptable strategies, it can be achieved. Before any big career-related steps are
taken, though, mental balance and self-confidence must be harvested from within. Apart from

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that, due to BD stigma, selective disclosure to coworkers and management has become a
necessary precondition for professional success (Chang-Calderon 76). Also, well-defined job
requirements and other aspects of employment should be kept safely within patients ability to
manage them so that vulnerable bipoles do not overextend themselves. Furthermore, the
successful bipolar management professionals surveyed in Chang-Calderons dissertation all
revealed comparable multifaceted approaches to their accomplishments; the common themes
were work flexibility, maintaining well-being, managing the illness, lifestyle choices, and
professional choices (72-83). If at all feasible for bipoles, becoming their own boss can
potentially solve the multitude of conflicts created by unfortunate bipolar episodes simply by
allowing for flexible work schedules and the ability to re-shape those schedules as needed.
No marriage is without its own troublesome drawbacks- particularly those beleaguered
relationships plagued with BD- however all are certainly capable of being successful if both
partners are prepared, adept at working together, and each maintains communication as their
principal consideration. Furthermore, these couples need to recognize a communication
breakdown when it occurs, and finish an argument when it happens rather than allowing it to
hang toxically over the relationship. When necessary, therapy involving both partners should be
fully utilized and those periods of peace, wellness, and harmony should be duly acknowledged. It
is in these times that bipoles should repair any damage caused during an episode and also
demonstrate how their partners can help take control of the situation in moments of crisis.
Partnering with spouses to assist in recognizing when symptoms are triggered is invaluable to
both bipoles and their willing significant others. Robyn, a volunteer in the Murray et al. study of
High Functioning bipoles, recalls that my husband is really important because he will notice a
depressive episode coming on before I will and he can tell by my body language (7). Moreover,
in her article, Tracy stresses the importance of bipoles being fully conscious of the disease within
the confines of the relationship, and adamantly defends the legitimacy of bipoles being engaged
in love and intimacy.

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4. The Wrap-Up
Bipolar disorder is a perennial mental health issue for both patients and the world as a
whole. In a 2001 report, the World Health Organization recognized bipolar disorder as 1 of the
top 10 sources of disability on a global level (qtd. in Sanchez-Moreno et al. 1). On an individual
level, the disability may actually be perpetually unyielding. For it is now believed that most
adults with bipolar disorder are experiencing the illness all the time, but are able to cope and
function to varying degrees of success (Sanchez-Moreno et al. 6). Sadly, that is a lot of time
spent struggling with the disabilities of bipolar disorder and further time devising successful
functionality strategies to combat them.
Ultimately, the global community must continue to cope with the illness using the best
that modern medicine and mental health professionals have to offer. The stigma must be
eschewed and all efforts shaped to reach full inclusivity of medicated and functioning adults;
success should be a communal goal. Family, social, and work functionality should be
encouraged, but true success ultimately comes down to each individuals struggles. Will a patient
allow the negative trappings of their disease to create unwilling casualties out of the people they
love? Will the inevitable fallout from a manic episode be the final nail in the proverbial coffin?
Or will that next weeks-long bout of depression lead to another stint in the hospital? The daily
disabilities that present themselves can either become the banner headline of a life story or
merely a footnote; each patient alone decides for themselves. Consequently, the judicious and
deliberate strategies that a responsible adult with bipolar disorder employs concerning lifestyle,
occupation, marriage, etc., can and will determine their successful functionality in life.
It means you know what I'm gonna do, I'm gonna take all this negativity and use
it as fuel and I'm gonna find a silver lining, that's what I'm gonna do. And that's no
bullshit. That's no bullshit. That takes work and that's the truth.
(Silver Linings Playbook)

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Works Cited
Chang-Calderon, Marie E. Successful Management Professionals with Bipolar Disorder. Diss.
Alliant International U, 2012. Ann Arbor: ProQuest Dissertations, 2012. ProQuest
Central. Web. 17 June 2016.
Harvey, Allison G., Lisa S. Talbot, and Anda Gershon. Sleep Disturbance in Bipolar Disorder
Across the Lifespan. Clinical psychology: a publication of the Division of Clinical
Psychology of the American Psychological Association 16.2 (2009): 256277. PMC.
Web. 26 June 2016.
Murray, Greg, Melinda Suto, Rachelle Hole, Sandra Hale, Erica Amari, and Erin E. Michalak.
"Self-management Strategies Used by High Functioning Individuals with Bipolar
Disorder: From Research to Clinical Practice." Clinical Psychology & Psychotherapy
Clin. Psychol. Psychother. 18.2 (2011): 95-109. UBC.ca. John Wiley & Sons, Ltd., 21
June 2010. Web. 28 June 2016.
Rodriguez, Diana, and Pat F. Bass, III, MD, MPH. "Bipolar Disorder and
Relationships." EverydayHealth.com. Everyday Health Media, LLC, 26 June 2012. Web.
27 June 2016.
Sanchez-Moreno, J., A. Martinez-Aran, R. Tabars-Seisdedos, C. Torrent, E. Vieta, and J.l.
Ayuso-Mateos. "Functioning and Disability in Bipolar Disorder: An Extensive
Review." Psychotherapy and Psychosomatics Psychother Psychosom 78.5 (2009): 28597. ProQuest Central. Web. 17 June 2016.

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Silver Linings Playbook. Dir. David O. Russell. Screenplay by David O. Russell. By Matthew
Quick. Perf. Bradley Cooper, Jennifer Lawrence, Robert De Niro, Jacki Weaver. The
Weinstein Company, 2012. DVD.
Tracy, Natasha. "Should People With Bipolar Be In Relationships?" HealthyPlace.com.
HealthyPlace.com, Inc., 11 Feb. 2014. Web. 26 June 2016.
Wheeler, Regina B., and Pat F. Bass, III, MD, MPH. "Exercise Can Help Bipolar
Disorder." EverydayHealth.com. Everyday Health Media, LLC, 5 Apr. 2010. Web. 27
June 2016.
Wikipedia contributors. "List of people with bipolar disorder." Wikipedia, The Free
Encyclopedia. Wikipedia, The Free Encyclopedia, 4 Jul. 2016. Web. 6 Jul. 2016.

Reflection
Entering into the peer-review session of our final projects, I was equally anxious and
confident about having my finished product critiqued by my classmates. I believe three of them,
or possibly four, each read a portion of my paper. There is understandably no feasible way
anybody could have read all of it in the time allowed; its quite lengthy considering the task we
were assigned. Regrettably, I didnt receive any constructive criticism from my fellow students
that I couldve used, nor any negative feedback that would have at least provided me with a
jumping off point. While I appreciate the kind words and positive assessments, those werent
necessarily the intended results that our in-class assignment was supposed to produce. I knew
full well that my paper could be improved upon. So keeping that on mind, I decided to consult

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my most honest and worst critic- myself. That little voice inside my head had no problem
condemning and disparaging the piece while letting me know full well just what needed
enhancement or renovation.
As I alluded to above, it boiled down to length. While certainly well above the pages
allotted for it, my piece wasnt fundamentally superfluous or awkwardly redundant. I had simply
ended up writing a paper for a different assignment. I was, and continue to be, exceptionally
proud of what I originally produced- like a pregnant author giving birth to his first creation.
However, I knew well and good that I needed to take the axe to it; I knew I had to self-edit. Not
surprisingly, in the heart of my reflection on the original draft, I speculated on not having that
particular skill in any reasonable fashion. So I set about addressing the complexities and attacked
each section individually: the introduction, the conclusion, and the two body segments. There
was no set goal or specific amount of words that I was hoping to remove, just the objective to
remove all that I could without damaging the substance and integrity of the paper. I made sure
when first composing the piece to avoid repetition as much as possible, but initially felt that there
were just a few salient points that related to multiple topics and opted to put those in. However,
in my need to reduce, I sliced those redundancies off with the rest of the fat, and rewrote around
their absence. I was also able to cleave off minute details, though valid and gratifying in the
extended version, they were simply clogging up the streamlined flow of this new installment.
It wasnt pretty. I played the part of reluctant executioner the entire time. There were
several moments where I simply called bullshit on myself, but on each occasion I was
somehow able to rein in my ego and toil on. My wife certainly helped- talk about partnering with
your spouse to recognize triggers. She knows all too well where my head can take me. All in all,
I was able to scale down the whole composition by nearly 700 words, a full two pages worth.
The result is a sleek and fast-reading essay on bipolar disability and functionality. In reality, I
believe I actually came closer to my original proposal with this second effort. Not that its stiff or

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sterile, but it offers uncomplicated factual information without a lot of creative spunk. I wont go
as far as claiming that one edition is better than the other. They are simply two separate papers
written in response to two independent assignments. Considering only one of those tasks was
actually given, this second draft was a necessarily abridged interpretation of my theme. I
resolutely stand behind it and am equally as proud of this creation as I am of the original version.