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Exploring Bipolar disorder: Individual processing of self reflection

Amanda Barr

Touro University Nevada

OCCT 523

January 14th, 2010

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Introduction:

Bipolar disorder is characterized by periods of excitability or mania and alternating periods of

depression. The course of mood fluctuations between mania and depression are both biological

and psychosocial in nature (Blairy et. al, 2004). Individuals with bipolar disorder navigate

psychosocial factors like roles, thoughts and emotional states as these intertwine to shape the

individual behind the disorder. Research has been looking at the organization of a self concept

in individuals with bipolar disorder and provides interpretations of personal attributes and self

perceptions that gravitated toward an unstable condition in relation to levels of function (Ball

et.al, 2003). Over time an underlying schema emerged as a person explored their self concept

using their philosophy for interpreting and reacting to their environment. Also noted is that

research of individuals with bipolar disorder tends to show extremely positive or extremely

negative organization with possible longstanding alteration in personality and the processing of

self perception (Power et.al, 2002). The use of internal processing can be applied to

occupations, interests and how a person conducts self reflection. The past and present

reflection of changes can include social experiences or what they see in their future self (Ball

et.al, 2003). According to Sadler, the acceptance of a person’s disorder originates from their

peculiar adjustments in the acceptance of one’s self. The purpose of this study was to view the

perspectives of individuals with bipolar disorder as displayed their processing skills and function

wellbeing on a daily basis. The proposed research question evolved from viewing the daily life

skills of living with bipolar disorder to do individuals with bipolar exhibit healthy (positive

perspectives) or self defeating (negative perspectives) of themselves?

Methods:

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The participants in the phenomenological study were 3 female individuals with bipolar disorder

who were convenience sampled from a local mental health facility. The individuals were in

agreement to share their personal stories during a interview session conduced on the Touro

campus. Prior to the interview session, initial information was gathered about the group of

individuals from Jo Anna Rios, who is their consumer advocate at SNAMHS in Henderson,

Nevada. A brainstorming session was conducted to formulate interview questions and these

questions were administered in a randomized format during the interview session that involved

participant observation and audio recording. The audio recordings were then transcribed to a

word format by the first year occupational therapy students. Data analysis was performed by

making a physical copy of the transcription, transposing hand written notes into margins, as

well as interview quotes highlighted in color specific themes. The information was read multiple

times and further processed for quality of content and the noted corresponding theme was

determined.

Results:

On a daily basis individuals use cognitive processing to make sense themselves and their

environment. An individual can either execute their thoughts and choices based on positive

perception or negative perception. How a person organizes and displays these thoughts is

unique each person and can further assist healthcare professionals in understanding their

underlying psychosis. In response to feeling a state of being normal the women in the study all

voiced differing interpretations that ranged from more positive to more neutral. Claudia in

particular displays a positive perspective, as she relates herself to others in social context and

chooses to avoid defining herself within a socially imposed label. Rather she projects herself as

having flaws but is content and is able to determine the best environment for herself.

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I think I’m just as normal as you. I don’t label myself as crazy because I don’t

think I am, I’m just as smart as you are or anyone else. I get pissed off and things

like that but I try to stay in a cool environment peaceful and cool. (Claudia)

The visualization that Ellie provides is very clear within her thought processing; she is decisive

about her surroundings and feels other’s emotions. Her statements are directed toward a

positive perspective that provides her with uplifting thoughts that take form in the use of the

word, joy.

For me normal is being able to (sounds kind of silly), I love to notice things like a

flower, or the way a tree is growing, or a way a child looks at her mom—anything

like that—and feel the joy inside. (Ellie)

On the contrary, Vicki voices her past experience with substance use as a reminder about the

self defeating behaviors she had prior. Vicki does not directly describe the self defeating

behavior, but the view of her past self in comparison to her current self appears to be a struggle

with neither a positive nor a negative perspective. The middle of the road perspective may be in

account of her more recent diagnosis and her continued development of positive cognitive

thinking. For her, abnormal is a state of being clean and showing emotion is a side of her that

appears to be an area of growth. She relates herself to others by connecting how her feelings

are that people are not normal. She provides a positive reflection for how being different is

what sets each of us apart from each other.

Right now I’m in an abnormal state of being clean, because normal to me is me

going out there and using. Okay? Me, not using is not normal. Okay, sitting up

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here, me crying is not normal. I don’t think there is normal. I honestly don’t. I

think everyone is their own individual. And not to be funny I don’t think anyone

is normal. Everyone is different in their own unique way. (Vicki)

The theme of positive organization and thought processing is evident in how each woman is

forward thinking in their perception. They are capable of see beyond their disorder and accept

comfort in the person they are. This moves each woman’s focus toward displaying a more

positive outlook. Vicki’s example of “working with myself” pulls into account her perceptions of

continued effort toward making change. She is able to see herself beyond her past experiences

and provides determination to reinforce that she will get through this rough patch that is her

current emotional state.

I’m working with myself if that makes any sense. I’m working with myself

everyday to better myself. I’m trying to go back to school and challenge myself

to brain activity. You know learning and that will snag up…. But I’m doing this. I

gotta. I’m 43, it’s time to grow up for me. (Vicki)

For Claudia, she explains a more positive than negative self reflection. The statements of

needing to stay in a stable place and be at ease with herself places value in her feelings of

independence. She provides herself with reinforced positive thoughts that she can and will be

in control as she finds meaning in being her own advocate.

The main thing for me is to keep myself from getting upset … [to] stay stable,

that helps keep me stable and at peace and ease with myself and no doctor or

no psychiatrist can really do that, that’s the main thing for me. (Claudia)

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Ellie provides a fluctuating cycle of providing the positive thoughts as well as a negative view

when using the word “hate” to describe her feeling about school. Ellie is quick to transitions to

how her thinking changed due to her exposure to assistance in her diagnosis.

I do have goals. I am learning to be a better person. I want to go to some kind of

school, which I hate. I’m dyslexic. That thought or the ability to even think about

wanting to do that was never present before. (Ellie)

Discussion:

The results of the qualitative study provide descriptive account in regards to how

individuals have varied perceptions regarding their organization and self-reflection. The

occurrence of different responses among the participants provides limits in the extent of

applying the results toward other individuals with bipolar disorder. Research by Power et. al,

(2002) spoke of the instable nature of the types of thought organization and how it is can be

impacted by over-exposure to specific experiences from any past or current positive or negative

experiences. Other research suggests that the way an individual perceives their self perspective

can shape their ability to process information to the full extent of their capabilities (Ball et. al,

2003). The results suggest that there are neither extreme positive or extreme negative

perceptions regarding personalized responses from the three female individuals with bipolar

disorder. Each participant’s perspective appears more neutral in organization and can be

related to the current functional state of wellbeing during the time of the interview.

Based on the study conducted, the interview method of qualitative research is unique

and detailed in content. The sample size, prior knowledge of medication adherence and

participant’s attendance in group therapy sessions could have impacted the results of the

study. The observer’s perception of the coded content is an external factor that could alter the

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overall results. Therefore further research should include greater measures to solidify rigor in

the analysis of data, with such options as member checking, intended exposure to longer time

immersion among the participants, and multiple observers for data comparison could clarify

any connection with positive self perspective and the functional wellbeing of individuals with

bipolar disorder.

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References

Ball, J., Mitchell, P., Malhi, G., Skilecorn, A., and Smith, M. (2003). Schema–focused cognitive

therapy for bipolar disorder: reducing vulnerabitliyt to relapse through attitudinal

change. Australian and New Zealand Journal of Psychiatry, 37, 41-48.

Blairy, S., Linotte, S., Souery, D., Papadimitriou, G.N., Dikeos, D., Lerer, B., Kaneva, R., Milanova,

V., Serretti, A., Macciardi, F., and Mendlewicz, J. (2004). Social adjustment and self-

esteem of bipolar patients: a multicentric study. Journal of Affective Disorders, 79, 97-

103.

Brown, T. (2009) Collecting and Analyzing Qualitative Data. [PowerPoint slides]. Retrieved from

blackboard https://bb-tun.touro.edu/webapps/portal/frameset.jsp?tab_id

Power, M.J., de Jong, F., and Lloyd, A. (2002) The organization of the self-concept in Bipolar

disorders: an empirical study and replication. Cognitive Therapy and Research, 26 (4),

553-561.

Sadler, J. (2007). The psychiatric significance of the personal self. Psychiatry, 70 (2), 113-129.

Salkind, N. J. (2009). Exploring Research. (7th ed.) Upper Saddle River, NJ: Pearson Prentice Hall.