Rappler’s Life and Style section runs an advice column by couple Jeremy Baer and clinical psychologist Dr. Margarita Holmes.

Jeremy has a master’s degree in law from Oxford University. A banker of 37 years who worked in three continents, he has been training with Dr. Holmes for the last 10 years as co-lecturer and, occasionally, as co-therapist, especially with clients whose financial concerns intrude into their daily lives.

Together, they have written two books: Love Triangles: Understanding the Macho-Mistress Mentality and Imported Love: Filipino-Foreign Liaisons.

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Dear Dr. Holmes and Mr. Baer:

I think I am bipolar. All the YouTube videos and textbooks describe symptoms that I have had since the day I was born. Since as far back as I can remember.

I don’t think It is something I am ashamed of, but I do not want many people who know me knowing I have it.  In the office, everyone knows. That’s the reason my bosses and officemates think I cannot handle the work. It hurts me. But it is true, I think. I cannot work anymore; the stress is too much.

I am overwhelmed by work. I think medication might help, but it is too expensive.

Can you really cure yourself of bipolar even if you take no medicine? Would you know of any techniques or non-medical treatment I can use?

Z

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Dear Z,

Thank you for your message.

Bipolar disorder is both difficult to diagnose and difficult to treat. It can take years for medical professionals to reach the correct diagnosis and then there is the often painstaking process of finding the most effective of the many drugs available to stabilize the patient. The problem is that each person reacts uniquely and it is frequently a matter of trial and error.

Not all those with bipolar can work, so you are fortunate that you can, even if it is a burden. If your current job is too stressful, perhaps you can find another that is more aligned with your capabilities. 

Lack of financial resources precludes you from following a medical solution to your problem. I cannot opine on whether your YouTube-assisted self-diagnosis is correct since you give no indication what your symptoms are. 

However, if self-help is the only option available to you, then perhaps you should consult a homeopathic doctor for guidance. If all else fails, the internet is full of advice, but be aware that not all of it is necessarily correct.

I am sorry to be the bearer of ill tidings but there is no magic bullet for this most intractable disorder, as I am well aware having spent the last 23 years with a fellow sufferer. Dr. Holmes will undoubtedly have more encouraging advice.

All the best,
JAF Baer

Dear Z:

Thank you very much for your letter. There are no laboratory tests to diagnose bipolar disorder (BiPD), and since its symptoms overlap with other psychiatric disorders, it can often be misdiagnosed. Kay Redfield Jamison, Professor of Psychiatry at the Johns Hopkins School of Medicine and author of Touched with Fire: Manic-Depressive Illness and the Artistic Temperament, says “The average length of time between a person’s first episode and getting the correct diagnosis is eight years.”

However, the longer I stay in clinical practice, the more I realize that “diagnosis, schmiagnosis.” What’s really in a name anyway? You are in deep, emotional pain, so let’s see what we can do to help (1) relieve that present pain and (2) minimize the possibility you get hurt this way again. 

I do not mean to completely denigrate being diagnosed by a psychiatrist. It can help make treatment options much clearer. But scientific evidence backs up the “diagnosis schmiagnosis” theory that the line between different mental health conditions is not hard and fast. It is, in fact, rather hazy. As Dr. Plomin, a behavioral geneticist at King’s College London, says: “individuals with mental disorders often have symptoms of many different conditions  either simultaneously or at different times in their lives.”

Medication can help many people diagnosed with bipolar disorder. It helps me tremendously and even if I’m not exactly jumping for joy at the thought, I will probably need to take meds the rest of my life.

I know only one person with bipolar disorder – let’s call him Al – who has been able to manage it without medication. It is not an easy journey, even now, after eight years without meds, but he is able to do it with grit, humor, determination…and a rather large degree of vanity. He will be the first to tell you that the major reason he stopped meds is he hated what they were doing to his skin. So he upped stakes, moved from NY City, where he was a Broadway actor in high demand, to a sleepy city in the Midwest, and became a drama teacher in a suburban high school. His success is so rare that his psychiatrist is writing a book on him.  

The above book will be focused on a single clinical case study, Al’s. That is because, as Dr. Michalak, Professor of Psychiatry at the University of British Columbia, says: “There’s very little research evidence for people successfully managing bipolar without medication…the number of people who are able to manage the condition without medication is probably very small.… It’s extremely hard work in terms of the amount of monitoring and self-care that’s needed to manage mood and safety. It’s quite a herculean task.”

But if even one person like Al can do it, others can, and that person may well be you, Z!

You have several things going for you: First, you are healthy and secure enough to let people know you have a mental disorder – even if there are some people you wish still didn’t know. You are competent enough to have a job that, even if difficult, you have not been fired from. Can you speak to your bosses and/or colleagues and figure out how together you can work to make office life less stressful? Less seemingly overwhelming? If talagang wala (there’s really nothing you can do), then maybe resign and look for another job? Even if less well-paid but with systems in place (formally or, more likely, informally) so you can care for yourself better?

Second, you seem determined to manage your disorder, and that is always a plus. What are the things that seem to stabilize you right now? Things that lift you up when down, and calm you when overly enthusiastic/stressed? What other activities/endeavors might have the same effect? Meditation, exercise, nutrition, journaling, yoga, and cognitive behavior therapy all have evidence-based research to show they help.

I hope some of our suggestions help, dearest Z. If not, please feel free to wire us again? My very best wishes, plus a wish that you keep on searching and trying, my FMCF (fellow “mentally challenged” friend).

MG Holmes

– Rappler.com

Please send any comments, questions, or requests for advice to twopronged@rappler.com.