A positive mood cannot be too positive : How to utilise positive and negative clinical psychology in bipolar disorder

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Abstract

The received wisdom about bipolar disorder is that mania represents a period of mood and associated features that are so positive, they cause severe clinical problems (e.g. Giovanelli, Hoerger, Johnson, & Gruber, 2013; Gruber, 2011; Gruber et al., 2008). Interestingly, there is also a view that bipolar disorder itself can be a positive experience that forms a key part of people’s identity (Jamison, Gerner, Hammen, Padesky, 1980; Lobban, Taylor, Murray & Jones, 2012). I will present a contrary view to both accounts, that I believe results from a lack of clear distinction between (1) hypomanic experiences, which I propose are relatively common in the general population and within diverse mental health conditions other than bipolar disorder to various degrees, and (2) bipolar disorders themselves, that are defined by their dysfunction. I will review evidence that many people appear ‘vulnerable’ to bipolar disorder because of their hypomanic experiences yet never develop it; these people are ‘red herrings’ in the research literature because they are expressing an apparently normal personality trait. Likewise, studies that attempt to identify what is distinctive in people with bipolar disorder from other psychological disorders are chasing the same red herring – a personality trait rather than a dysfunctional process. And it is no surprise that people with bipolar disorder appreciate this underlying personality trait with its qualities of creativity, optimism and sociability. I will propose that the hypomanic trait is not what maintains the disorder. It is the processes that all disorders share in common - transdiagnostic processes (Harvey, Watkins, Mansell, & Shafran, 2004) - that make them a disorder, not the features that discriminate between disorders. This take on bipolar disorder frees us up to appreciate how positive psychology can help people with bipolar disorders to flexibly pursue positive experiences and life values without the risk that the mood will be ‘too good’. There are other risks of course that will be discussed. Yet, I propose that it is often the fear of feeling too good that maintains the disorder, especially the persistent feelings of helplessness and alienation that build up from the chronic disengagement from life goals. The work on building the positive can take place in tandem with equally valid work on addressing ‘negative psychology’ that is manifested in processes such as persistent self-criticism, aggression, catastrophic thinking, and longstanding suppression of emotional and interpersonal problems from awareness. Through weaving together these strands of positive and negative psychology, people with bipolar disorder can rejoin the road to recovery by accepting and utilising the wide range of adaptive positive and negative moods that the human condition has to offer.

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