CME Article

Implications for Psychiatric Care of the Word ‘Recovery’ in People with Bipolar Disorder

Erin E. Michalak, PhD; Rachelle Hole, PhD; Cindy Holmes, PhD Candidate; Vytas Velyvis, PhD Candidate; Jehannine Austin, PhD; Barbara Pesut, PhD; Sharon Hou, BA

  • Psychiatric Annals
  • May 2012 - Volume 42 · Issue 5: 173-178
  • DOI: 10.3928/00485713-20120507-04
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Abstract

CME Educational Objectives

  1. Understand what “recovery” means to people with bipolar disorder (BD).

  2. Describe the difference between the traditional medical definition of “recovery” and the definition of recovery identified by people with BD.

  3. Discuss the importance of quality of life in relation to the concept of recovery as it relates to BD.

Bipolar disorder is a challenging psychiatric condition characterized by complex and varying symptoms, courses and outcomes. This complexity is compounded by differing understandings of recovery, from no hope of recovery to clinical recovery characterized by a linear diminishing of symptoms to personal recovery characterized by meaningful quality of life. These understandings have profound implications for individuals living with bipolar disorder, and yet, we know little about the meaning of recovery from their perspective.

The purpose of this study was to use qualitative research methods to determine what the term “recovery” means in a sample of Canadian individuals living with bipolar disorder (BD). Three focus groups, including 13 individuals who self-reported as being diagnosed with bipolar disorder type I or II, were conducted to better understand the meaning of recovery. Focus groups were digitally recorded and transcribed. Transcripts were coded manually and analyzed thematically resulting in four dominant themes.

Participants suggested “rethinking the language of recovery” was important because of the implied expectation that they would be cured, which was not a reasonable option from their perspective. Instead, they recommended “shifting the framework” toward wellness, quality of life, and managing BD. The “art of managing BD” consisted of a range of sophisticated self-management strategies such as getting exercise, taking medications, and accepting support from family and friends. Learning about one’s self, illness and emotions was critical to this management. This learning was characterized by “understanding the journey,” which entailed gaining a sense of self, accepting loss, and letting go of stigma. Recovering the identity that characterized the self prior to the onset of BD was in many cases not seen as realistic. Rather, participants were in the process of transforming and rebuilding a new identity. This necessitated dealing with the many losses associated with BD, and making critical decisions about which limitations would be accepted and which would be rejected. Letting go of stigma resulted in allowing self-disclosure, which in turn reduced isolation. Education played a key role in reducing internalized stigma.

Four important practice implications arose from this study. Firstly, it is important to find a language of recovery that reflects the complexities of living with a chronic mental health condition. Secondly, quality of life should be given priority in the treatment process. Short, well-validated scales are available to facilitate this exploration. Thirdly, emphasis should be placed upon the capacity of people living with BD to self-manage their condition. A variety of techniques and tools are available to assist clinicians. Lastly, a collaborative therapeutic relationship is fundamental to enabling individuals to rebuild a sense of self and lower the stigma associated with living with BD.

Insights such as these into the meanings of recovery are essential to high quality care. Individuals in this study provided complex and nuanced understandings of recovery that were meaningful in relation to their lives. However, it is important to note that this was a small sample, all self-referred and not ethnically diverse. Research is required to further our understandings of recovery in more diverse populations.

AUTHORS

Erin E. Michalak, PhD, is Associate Professor, Department of Psychiatry, University of British Columbia, Canada. Rachelle Hole, PhD, is Assistant Professor, School of Social Work, University of British Columbia, Canada. Cindy Holmes, is a PhD Candidate in Interdisciplinary Studies, University of British Columbia, Canada. Vytas Velyvis, is a PhD Candidate, York University, and Director of Research, Ontario Shores Centre for Mental Health Sciences, Canada; Jehannine Austin, PhD, is Assistant Professor, Department of Psychiatry, University of British Columbia. Barbara Pesut, PhD, is Assistant Professor, School of Nursing, University of British Columbia, Canada. Sharon Hou, BA, is Research Coordinator, University of British Columbia, Canada and CREST.BD.

The authors have disclosed no relevant financial relationships.

Address correspondence to: Erin E. Michalak, PhD, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1; email: .erin.michalak@ubc.ca

doi: 10.3928/00485713-20120507-04

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