I have witnessed first hand the bootstrap conundrum. There is a prevailing attitude in our country that people who have problems need to learn to pick themselves up by their bootstraps, snap out of it, and “just do it.” A typical bipolar response to this attitude, however, is “how do you pick yourself up by your bootstraps when you don’t even have any boots?”

Bipolar disorder is a debilitating, sometimes devastating illness. The symptoms for some people can be severe, even unbearable at times. Worse, it impairs our judgment and leaves us with the impression that irrational thoughts and behaviors are reasonable. In this way, it’s difficult to expect someone to snap out of something they don’t understand and don’t have the tools to remedy.

For some people, the bootstrap conundrum is a cop out, a way to absolve themselves of accountability for their actions. “I’m sick and I can’t help myself, so you should accept it and let me get away with it.” This response is a very slippery one. Some people do truly suffer from impulse control problems, or are deeply mired in depression and cannot at this moment control their own lives in healthy and productive ways. They are sick. For this reason, we have emergency psychiatric services and a thriving mental health industry. But most manifestations of bipolar disorder are eminently treatable and relief from symptoms can be profound. I think it’s very faulty logic to jump to the idea that just because one is sick, one cannot help oneself.

Working around this mentality is another exercise in reframing. Yes, in one sense a person “can’t help himself” because he is unable to control his feelings and is deeply distressed by them or deluded by them. Mania and deep depression can be quite debilitating and confusing, they can make a person feel helpless to swim against the tide, one way or the other. It doesn’t mean that there is no way for these people to truly help themselves lead healthier and more productive lives. Instead of continuing to look at the situation as “I am sick and helpless” we have to try to think of it as “I am sick and I need help.” Then, we must go and find it.

There are many options for treatment of the disorder, but they all involve work. When you have no energy or you’re flying high on an agitated manic high, it is difficult to conceive of doing the things that are necessary to foster mental wellness. Yet, it is still the bipolar person’s responsibility, to himself and to the public, to do so. I do not accept the bootstrap conundrum as the impasse some others perceive it to be. If you’re not wearing any boots, you have to walk barefoot until you find some.

If you do not have the will to get up off the floor and walk barefoot, then you have to find help even if it’s someone to carry you. Inpatient services, intensive outpatient therapy, disability, ECT, whatever it takes. Some people, even after availing themselves of all the interventions available, are still incapable of self-control or continue to experience severe symptoms of profound mental illness. In those cases, it’s possible for a person to be too severely disabled to be responsible for him or herself. Take a look at Britney Spears. Her father has conservatorship because a court determined she is incapable of good judgment, sound behavior, and realistic perspective. If you fall into that category, then relinquishing some freedom in order for others to help you, may be the best you can do.

Sometimes, though, it takes extreme measures to set one’s feet on the path to wellness, and it’s not a lack of boots but a lack of will (and the encouragement of unwitting enablers) that keeps people unshod. I know that that lack of will is part of the disease; if a person is so far gone that she can’t muster some small survival instinct to energize herself to advocate for herself, then it’s time to call in the big guns and seriously consider intensive inpatient care and disability.

We cannot help how we feel, and some of our feelings are strong, tumultuous, and downright frightening. They can be overwhelming. But when those feelings turn into destructive action, we cannot hide behind our disorder and ask people to accept bad behavior. We are ultimately responsible for our deeds. Those who act out because they are severely symptomatic and not competent to make decisions lose the right to be free in society. We may not prosecute those people as criminals, but it is the ultimate accountability to be admitted into a criminal psychiatric facility for forced intensive treatment. At the very least, it protects the public welfare.

It is our responsibility to seek treatment, preferably before crisis rips our world apart. It is our responsibility to follow a treatment plan, even if it takes a thousand modifications. It is our responsibility to make healthy choices that support mental wellness, such as abstaining from self-medicating with recreational drugs and alcohol, or depriving ourselves of sleep. If it can’t be done independently, it should be done with help and if necessary, it should be done in a safe inpatient setting. We owe it to others to exercise our rights as citizens of a free society in a way that does not infringe on the rights of anyone else. We owe it to our families not to expect acceptance for abusive behaviors. We owe it to ourselves to do everything in our own power to be well and live a content life.

It starts with honesty. Being honest with ourselves that our feelings are more than we can manage alone and that our actions require intervention on some level. Being honest with others that we have a problem beyond our own limited means with which to cope. Being honest with health care providers if we are sabotaging our own wellness with drugs, alcohol, or risky behaviors.

We have a responsibility to educate ourselves about this disorder, about its various manifestations, about various treatment options, about coping mechanisms. We have a responsibility to seek treatment from a qualified mental health professional and not to give up if the first doctor is a poor fit. Be your own advocate, keep searching and shopping for a doctor who is on board with what you need and is available to help you in whatever way you need. Ultimately, we are responsible for our own happiness and well-being and if it comes down to it, before any act of self-annihilation, we owe it to ourselves and our loved ones to dial 911. If we feel too sick to be in control, we must give honest, real answers to the emergency room staff to get the help we need, even if it is imposed from the outside. These things are not negotiable because the alternatives are too devastating to consider.