Awareness of illness
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Awareness of illness

Q: I have a friend who has been diagnosed as bipolar. My question is, assuming that a person knows what his diagnosis is, would he be aware of his illness when he's in either the depressive or manic state, or does the illness state preclude awareness of that person for his illness?

Dear Val --
You have put your finger on one of the most striking and frustrating features of bipolar disorder: "loss of insight".  This is a feature of both the manic and depressive phases of the illness.  I've seen some people who can tell when they're "getting" manic, and take steps to reverse that trend (meds, contact friends to monitor, contact doc's), but many people don't see it.  And on the depressive side, the incredibly dark negative view of the world seems totally accurate to the person at the time.  I've not had much luck with "cognitive" efforts when a person has a true bipolar depression: they just can't see the world differently.  i.e. you can't really make much of a dent in their depression by trying to point out to them that maybe things look so bad because they're depressed.  Very frustrating for both the patient and those who try to help.

So, yes, for some but not all, the illness does seem to "preclude awareness".

Dr. Phelps

Published November, 2000

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