In this last installment, Ed reflects on Kay Jamison’s autobiographical account of living with bipolar, discusses the use of medication, and then revisits the case study of “Diane” whose story was introduced in part 1.
An Unquiet Mind
(New York: Vintage, 1995), 219 pages.
A good autobiography invites you into another person’s world, then reveals both the beauty and the blemishes of the humanness of that world. Kay Jamison’s book does this masterfully. Jamison is a psychologist, an expert writer about moods, and a world-class researcher on the faculty of UCLA and Johns Hopkins psychiatry departments. She writes about bipolar fluctuations because she has personally been affected by bouts with it. Along with her more technical writings, she has written popular books about mania and creativity. She has also written about suicide. An Unquiet Mind is a must-read for anyone dealing with bipolar tendencies.
When I am high I couldn’t worry about money if I tried. So I don’t. The money will come from somewhere; I am entitled; God will provide. Credit cards are disastrous, personal checks worse. I bought twelve snakebite kits, with a sense of urgency and importance. I bought precious stones, elegant and unnecessary furniture, three watches within an hour of one another (in the Rolex rather than Timex class: champagne tastes bubble to the surface in mania), and totally inappropriate siren-like clothes. During one spree in London, I spent several hundred pounds on books having titles or covers that somehow caught my fancy: books on the natural history of the mole, twenty sundry Penguin books because I thought that it could be nice if the penguins could form a colony. (p. 74)
Like all good stories, this one has complexity and unexpected paths. For example, Jamison was surprised when her personal story became a story about love. During her crises there was always at least one devoted, understanding, and loving friend who provided a safe harbor. Love was not always enough, in itself, to pull her out of the depths or down from the heights, but it softened the blow of bipolar and changed her more than she had realized at the time of the events.
Jamison takes the traditional line on bipolar: medication and therapy are essential. Some might suggest that her story is an advertisement for Lithium. One of her aims is to get people to take their medication. But don’t dismiss her writing too quickly. Such zeal makes sense when you watch her on or off medication. Medication clearly puts boundaries on her manic-depressive extremes. While it is always difficult to precisely identify the effects of medication, and someone could always find other variables that incite emotional ascents and descents, Jamison is persuaded that medication spares her and others much grief. Her personal distaste for Lithium and its accompanying emotional restraints makes her support for its effectiveness all the more persuasive.
A final note. Biblical counseling needs to grow in its use of case studies. Too often we create a caricatured, two-dimensional person at the service of a particular principle. Jamison’s book is a paradigm for the next generation of case studies. In it you will find a three-dimensional, messy life that will engage you in a conversation with a real person.
This literature on bipolar raises many questions and observations for biblical counselors, as good secular literature should. The most obvious question has to do with psychiatric medication. The literature is resolute in its commitment to medication, but biblical counselors are, at best, uneasy with the use of medication. The tension between these two positions creates an opportunity for biblical counselors to listen to others, and then continue to refine our application of Scripture to this important discussion.
Is it wrong to take psychiatric medication? Within the biblical counseling movement, the answer has never been an easy yes or no. Here are three broad positions commonly seen.
First, among those who lean toward no medication ever, most acknowledge that Scripture contains nothing as bold as “thou shall not take psychiatric medications.” They explain the wrongness of medication with the following explanations:
- Medication can be taken with the wrong motives.
- An unbiblical worldview is often swallowed with the medication.
- This approach bypasses God-ordained means of sanctification.
The problem is not so much with the medication per se, as it is with the person’s heart.
Those who hold a more moderate view believe that though medication is wrong, it is not the worst wrong. It is like smoking cigarettes or drinking an occasional glass of wine. Some Christians believe that these activities are wrong, but they aren’t in the same class as murder, thievery, or sexual misconduct. Whenever someone says psychiatric medication is “wrong,” biblical counselors must carefully evaluate and define the nature and definition of that wrong.3
A second position within biblical counseling says that we must focus on what is clear in Scripture. That includes the pride and unilateral decisions inherent in most mania, the reckless spending and sexual behavior that so often express it, and our calling to erect walls between the manic person and dangerous behaviors. When the mania burns out, there is much work to do with the family and other relationships. Since our attention is consumed with these matters, and we don’t consider ourselves experts in this area, we put psychiatric medication in the wisdom class rather than the immoral class. We encourage the person to make decisions by seeking counsel from those who have experience with medication.
A third position could be biblically argued that those with bipolar symptoms should be urged to consult with someone about psychiatric medication. If he or she decides to take the medication, then it should be taken as recommended. The motivation could be love: to bless family and friends, all of whom have been hurt and alarmed by the manic symptoms. Also, medication could be viewed as a means of erecting walls that help with self-control. Medication can’t change the heart and infuse godly self-control, but it can serve as a restraint during chaotic times.
Here is one possible trend among biblical counselors. As we accumulate more experience with bipolar, we notice that medication helps fewer people, and hurts more, than commonly known. But when medication does limit the highs and lows—and there are certainly people for whom it does—we welcome its benefits. Biblical counselors never rely solely on medication. It certainly is not enough to support anyone’s hopes. Instead, if a person takes psychiatric medication, move toward this person because he or she needs the body of Christ to meaningfully point them to the wisdom of God.
These possibilities with medication do not apply to children. Very few biblical counselors have spent enough time with children, before and after medication, to observe its long-term benefits and possible side effects. What is known about the physical effects of the medication in adults is more than enough to scare most parents into considering alternatives to medication. Without this critical experience, caution is the norm. It is hard to imagine a biblical counselor ever encouraging bipolar medication for children, even though it seems like a wonder drug for some. Scripture is dense with parenting guidance, and that will always be the priority.
This in no way means that bipolar-like experiences are absent in children. If anything, emotional fluctuations, in the extreme, are more apparent in children than in adults. Also, this doesn’t mean that all children respond to godly parenting. They don’t. There is no question that there are parents in most every church who are overwhelmed with an out-of-control child, and there are no easy answers or homework assignments for these parents.
I will close by revisiting “Diane” whose story began this article.
By the time you become involved with Diane, she is already taking medication. Any evaluation of that decision is certainly not the most important issue at this moment. Much more critical is that she has just seriously betrayed her husband, and he is both broken and angry. Can this marriage be reconciled?
Begin with the person. Listen to Diane. Observe. What is her experience? What is she doing? Thinking? Feeling? Sometimes Scripture initiates, other times it responds. Either way it intends to shape the way you think about everything. Gather initial information from Diane or her family. Then let Scripture propose tentative ways to think about the problem. (I say “tentative” because of weaknesses in our understanding, rather than ambiguity in God’s point of view.) A dialogue will ensue, in which we seek to refine our understanding of the particulars of Diane’s life.
Diane’s betrayal of her husband through adultery is obvious. Regardless of the provoking circumstances, this act cannot be pinned on anything other than her own heart. Neither the wild fluctuations of mania, Satan himself, nor her husband’s contribution to the argument can coerce one into breaking marital commitments. Diane intuitively understands that. She feels guilty and quickly acknowledges her wrong. Scripture clearly addresses adultery. Before her hospitalization, Diane would get irritable, angry, even enraged, whenever someone did not support her wild ideas. Scriptures clearly addresses anger. James 4 explains this situation. Diane wants something. She craves getting her own way. Others hinder her from getting it. A discussion with Diane about holding more loosely to her “wants” is appropriate. Unchecked desires become idolatrous and provoke vengeful responses.
Mania and anger share a common bond. They both exhibit relentless pursuit of desired ends. But Diane shows no sign of willingness to release her desires. She either dismisses you as one without vision, or doesn’t seem to hear you at all. Wait. This is the right track to pursue. It is right and relevant, but so far, with Diane, it is not effective. Pastoral care must be both right and effective.
Is Diane hardhearted? That would be a logical conclusion, and there might be truth to it. But let’s say you are a novice in interpreting bizarre behavior. You know you are on terrain where there are many different opinions, so walk carefully and cautiously. If you pursue her hardheartedness, you must be certain. It leaves you no other place to go. Also you have good reason to believe that confrontation may well provoke her to greater anger and agitation. Furthermore, if that becomes the premier explanation for her behavior, and her family adopts that view, the results could be full-blown disaster.
Continue to explore. Diane’s story illustrates a premise that will always hold up when you meet an extreme problem not clearly addressed in the pages of Scripture: behind the bizarre and unusual is the normal and commonplace.
Try to understand what happened with Diane. She is, no doubt, feeling guilty and confused. As her story unfolds, she reveals that she has never been sexually unfaithful to her husband before, and she has never entertained such thoughts. She remembers the argument with her husband, and she remembers her dramatic exit. After that, everything feels like chaotic pieces. But now she is committed to doing whatever she can to reconcile and protect her marriageHer husband is reeling, but he is willing to work on the relationship. Nothing can take the sting out of the betrayal, but he believes that his wife was not highly intentional in her adultery. He is not sure what to think about the diagnosis of bipolar, but he believes that it is, in some way, a mitigating factor.
Diane’s confession certainly pushes the reconciliation process forward, but her husband is concerned that the mania could emerge again with the same results. This is a reasonable concern. Medication is no guarantee against future manic swings, so you allow Scripture to add important detail.
Whatever mania does, it can only act like a temptation, not the power that coerces you into foolishness. So the task is to become more alert to this particular temptation and more equipped to do battle with it. There are plenty of temptations with mania. For example, the highs invite Diane to be absolutely confident in what she thinks, wants, and demands. There are no uncertainties at those times, and no listening to the wisdom of others. So, one of Diane’s tasks is to grow in humility before the Lord, and as a result, before other people.
Diane must make the James 4 passage her own. During her emotional escalation, Diane wants something—she craves getting her way— and others hinder her from getting it. In other words, the diagnosis of bipolar alerts us to certain unique temptations. Diane, like the rest of us, wants what she wants (the normal and commonplace). During times when she is emotionally more stable, this comes out in occasional marital conflicts. But during her bipolar swing everything is exaggerated, including her anger. Her behavior becomes more bizarre.
This gets you started. Along the way you might go online or read one of these books as a way to get more understanding about an experience that is hard to describe. Mania is a unique temptation, and you want to be as prepared for it as possible.
What causes the manic swing? We don’t know. But one of the beauties of Scripture is that it guides us in doing helpful ministry even when we don’t know the precise causes and influences on a person’s particular struggles.
Whenever biblical counselors encounter new problems, it is a natural time to develop better application of Scripture. Mania is one of those new problems. Since we are certain that Scripture is infallible and sufficient, there is absolutely no threat to our biblical foundations. But, since we are fallible, we must come to the process with humility that listens to one another and even listens to voices outside our tradition. What we anticipate is a course where Scripture accounts for reliable observations and speaks with greater depth than any biblically unaided approach.
* * * * *
This article was originally published in The Journal of Biblical Counseling, Summer 2007 (Volume 25:3).