“Denial is an unconscious defense mechanism used by those faced with a painful reality. It is an automatic reaction in an attempt to reduce anxiety by denying thoughts, feelings, or facts that are consciously intolerable. It is common for those who are diagnosed with a life-long illness to go through periods of denial.”

In my experience, many people suffering from bipolar disorder go through a stage of denial, or waver back and forth between acceptance and denial. The idea that they have an incurable mental illness is so large a concept to grasp that many simply find themselves unable to wrap their heads around it. It’s also a diagnosis soaked with stigma that conjures a common stereotype of the delusional, psychotic manic-depressive.

Some people do suffer from psychosis, this is true, and often delusions and mania can stand in the way of accepting a diagnosis because they can confuse the sufferer into believing there is nothing wrong. In this case, a person may need to bottom out before they can address issues of mental wellness. But for those who have sought evaluation and received a diagnosis, it may be helpful to understand that diagnosis doesn’t suddenly make you ill. You are the same person post-diagnosis that you were pre-diagnosis.

A diagnosis only provides a way to discuss the illness in common language so that consistent treatment and eventual wellness may follow—without effective treatment, a symptomatic person will still exhibit symptoms of illness regardless of whether they accept the idea that they are ill. In some cases, the illness may worsen due to the absence of appropriate treatment. Plus, if anything, rejection of an accurate diagnosis reinforces stereotypes of the mentally ill as delusional and psychotic because these perceptions are validated by unstable or erratic behavior.

Mental wellness requires a great deal of honesty. A patient must be honest with herself and her doctors in order to follow a treatment plan. It is a crucial element of self-perception and progress. Denial allows a person to blame others for his or her problems. Denial is incompatible with accountability, and accountability is necessary for effective treatment.

People who suffer from deficiencies in mental and emotional wellness may have problems with self-control but personal accountability is not about self-control, let’s be clear. The two are separate and different. In the throes of illness, a person may find herself unable to refrain from destructive behaviors, however, it does not lessen the person’s responsibility to behave in ways that are compatible with respect for self and others. Just because a person cannot control herself today doesn’t absolve her from a responsibility to work toward controlling herself in the future. We have a responsibility to refrain from infringing upon the rights of others as we exercise our own rights. You cannot control others, just as you do not want others to attempt to control you. You must find a way to control yourself.

Acceptance means understanding that no one can fix you—that’s your work and no one can do your work for you. People who believe that others owe them, manipulate them, deprive them of happiness are people who don’t understand self-esteem or personal accountability. We cannot control what other people do to us, how they feel, how they feel about us, how they act upon us. We cannot even control how we feel. The only thing that is within our own realm of control is our own actions, our responses to stimuli. Through self-controlled action we can find a way to feel good about ourselves no matter what anyone else does or says.

Mental wellness is all about developing healthy actions and responses to positive and negative situations. No one has the power to deprive us of happiness; we deprive ourselves of happiness by responding to negative situations in unhealthy ways. This is not to say that people cannot act in ways that make us feel bad, but if we can develop improved coping mechanisms, that bad feeling is transient instead of consuming.

The corollary to this idea that no one can deprive us of happiness is that no one can make us happy (we cannot be responsible for anyone else’s happiness, either). Our happiness is no one else’s responsibility; blaming others for shortcomings in this respect is an exercise in poor judgment and alienation. In particular, no one can “fix” our lives for us. Change comes from within and through a directed personal effort to improve our responses to things both good and bad. We have to want change and we have to invite change. We cannot passively expect change to happen to us or to be imposed upon us. If we continue to put other people in charge of our happiness, we will find ourselves constantly disappointed and resentful. It is tantamount to self-sabotage and is incompatible with acceptance, treatment, and progress.

Why is acceptance important? You can’t get effective treatment without it. Why is treatment important? A lot of manic people don’t understand why mania should be treated because, in the moment, they don’t often feel sick. They may feel high, happy, energized, creative, brilliant. First, there is always the threat of the backlash, the very Newtonian law that what goes up must come down. Additionally, manic highs often distort self-perception, allowing us to believe ideas that are not strictly true, and engage in behaviors that may feel good but are destructive in nature. It’s a thin line between genius and delusion; between thinking you’re doing well and good, and believing you are truly the second coming of Christ.

Treatment is important because there is a threat that untreated mental illness can lead to a worsening of symptoms over time. Episodes of instability may become more frequent or severe as each episode reinforces the instability over and over. The idea of a “kindling” effect is the heart of the idea of bipolar disorder as a progressive disease. Without effective treatment, many bipolar sufferers get worse over time, not better. This disease is not one that tends to go away on its own; you won’t outgrow it.

The only way to feel better is to want it, to be willing to work for it, and to accept responsibility for it. That means that denial, while common, has no place in mental wellness.

References:
Read, K., and Purse, M. (2006.) The “Kindling” Model in Bipolar Disorder. Retrieved on April 17, 2009 from http://bipolar.about.com/cs/brainchemistry/a/0009_kindling1.htm

Read, K., and Purse, M. (2007.) Denial – A Common Defense Mechanism. Retrieved on April 17, 2009 from http://bipolar.about.com/b/2007/08/20/denial-a-common-defense-mechanism.htm

Sullivan, C. (n.d.) Denial to Acceptance – The 5 Stages. Retrieved on April 17, 2009 from http://www.bipolarworld.net/Bipolar%20Disorder/Articles/art2.htm