The 6 Step Process

As someone who is diagnosed with Bipolar 1 Disorder, I believe there could be great use for a step like program similar to that of AA or NA. However, as we are not (generally) alcoholics, the rules and steps would have to be fitted to the condition. I have followed the 12 steps in a traditional Step Study, and they did help me tremendously in moving past my current struggles. However, I had a hard time relating with parts of it because I am not an alcoholic. I was replacing “alcohol” with Bipolar and while it served its purpose for the most part, I was still relatively disconnected from the process. So, in light of that, I took the time to analyze around that and made a step guide that follows those same set of rules, shrunken slightly to make them easier to do in the moment and conformed them to Bipolar Disorder. While I would not call this “Bipolar Anonymous”, a better working title would be simply: Bipolar Living – A 6-Step Process. While the 12 Steps of Alcoholics/Narcotics Anonymous serve to help maintain sobriety, these steps I have made, serve to help manage any possible fallout due to mood swings, as well as provide a solid foundation for deep introspective self understanding. Ultimately, this will guide us on a path to “Stability”.

Before I can move on to the steps themselves, I must answer a question. “What is stability?”

Stability is the point at which a person with Bipolar Disorder no longer suffers from uncontrolled mood swings. They may still have periods of low or high mood, but they are nowhere near as impactful, nor would they be considered fully diagnosable. An example would be someone who thinks they are manic. They meet the symptom criteria and as far as that criteria is concerned, they are manic. However, they only feel this way for 3 days, after which their mood levels out. In this instance, because Mania requires at least 1 week of continuous symptomatology, they were not actually manic. They were simply dealing with an elevated mood. Also, I should point out, even at 3 days, they would not be considered Hypomanic either, as the requirement for that is 4 days of continuous symptomatology. The same can be said for Depressed mood lasting any less than 2 weeks.

The statement above of “uncontrolled mood swings” should not be taken lightly. If you are medicated, in therapy, have a support group, and are trying to better yourself, but still find yourself bouncing between the same old habits and mood swings, there's obviously a flaw somewhere in your line of support. The best recommendation would be to talk with your therapist and/or psychiatrist to determine the best course of action to help return you to longer lasting stability. In AA, a person with this type of behavior would be called a “Dry Drunk '', they're following the

12 steps, they aren't drinking, but the obsession to drink is still there. For someone with Bipolar Disorder, while there may be no such obsession, there is likely an unmet need or a struggle in their life that is interfering with their ability to adequately handle their emotions, that they may or may not know about, and are not doing anything to change it.

Now with that said and out of the way, I can move to the steps themselves.

1. Accept that we do in fact have a disorder, and that it is one that affects the mind. This acceptance should also include a willingness to use medication and various forms of therapy as tools in managing said disorder.

2. Acknowledge that we can not fight this condition alone, long term, even medicated: Thus, find either a spiritual connection or a connection with at least one person, someone whom you can confide in, preferably who shares in your struggles of Bipolar Disorder.

3. Take a Full Mental Inventory of your life. Determine your struggles, weaknesses, strengths, and goals; the why of doing these steps. Then, work to manage them progressively moving forward.

4. Create a list of the people you have hurt during your episodes and make amends to them whenever possible, unless doing so would result in harm to yourself or another.

5. Actively inventory as often as you feel necessary to avoid further hurt, miscommunication, or other struggles. This will make maintaining a higher quality of life much easier.

6. Use these steps to try to help others with Bipolar Disorder through their problems. This is a condition shared by many, and as sufferers, we are many. If we stand to help each other, Bipolar Disorder will not ruin as many lives as it currently does.

Now, I am going to break the steps down individually and provide examples where I feel necessary. These breakdowns will help those who may be unfamiliar with certain terms I have used above. I will do my best, as I have thus far, to keep things as simple as possible to grasp the understanding that this condition affects attention span.

Step 1:

The first major thing to change the steps to fit the needs of someone with Bipolar

Disorder would be the very first step.

We are not powerless against our disorder.

There are medications and various types of therapy available to help treat and manage it. However these can come at a heavy cost, especially if the disorder impacts your ability to work (either completely disabling you, or preventing consistent

sustainable income). This is why having an adequate support group, low cost medication management, and/or sliding scale therapy is almost paramount. While these conditions do not have to be met in order to follow these steps, they will make the process much easier, because they bring about longer lasting and more fulfilling stability between mood swings. I will say, the one requirement to going through these steps, is that before they should even be applied, one should be working towards mood stability for them to serve their purpose fully. This is further explained during making an inventory and dealing with the prospect of bias; though even then, I do provide a way around whether one is stable or not during the process.

Step 2:

Secondly, another hurdle for trying to use a typical 12 step program as a base, is the need for a higher power. While having a belief in a higher power, “God as we understand him/her/it,” is certainly something beneficial on a spiritual/religious level, it is not something that everyone with this disorder may be able to adhere/relate to, nor need; such as an atheist, an agnostic, or a polytheist. Instead, I believe a more adaptable version of the statement could be something as simple as allowing yourself to be open to the ideas of someone outside of yourself. After all, when in crisis, or even dealing with mild symptoms, it can be far too easy to feel alone or disconnected, because your family and friends may not fully understand your position.

But that's ok.

Not everyone has Bipolar Disorder and those that do will be able to explain very clearly the struggles they have had; trust me on that. To someone without those struggles, they can listen, but the full relation/connection can't be made. That is what these steps, in theory, hope to fill: that void in connection. This is where the idea of a 'Sponsor' in AA serves to have a more experienced person in their sobriety as a guide of sorts to help you on your way, while you adapt to and learn the steps, so that in time, they become second nature to the alcoholic.

This is an idea that can be difficult to transfer over to the idea of Bipolar, as the ramifications of relapse for Bipolar are much easier due to the mental instability the condition brings. Sure, an AA Sponsor might relapse, and a Bipolar individual may slip while managing their illness, but the difference lies in the fact that prolonged remission of bipolar disorder is generally harder to come by. That is not to say it is impossible. I myself have a person I would refer to as something of a “sponsor” and it is a relationship which I sought out for the betterment of both my mental health, as well as the person who shares in my struggle; it provides a two way street where both individuals have equal ability to express themselves, but not as a typical Sponsor/Sponsee relationship like in AA/NA, where one is seen as being “ranked higher” than the other, but rather as equals, both dealing with the same disorder and

more than likely, very similar struggles. This understanding should provide a flexible and comfortable amount of empathy from both parties, creating a connection of trust and commitment to better their lives.

My view on how to find a Sponsor-like figure or other assistance is simple. Always seek out alternative assistance; the internet is a wonderful tool when used with purpose. For example, if there are no in-person Bipolar Support Groups physically near you, try to find one online. I joined one myself and it's made a world of difference, because I've learned two major things.

1. I am not alone. This is a condition that millions of people share. We can help each other and I'd almost say we have an obligation, or desire deep down to do so.

2. There are many different types of ways to handle this condition. Even these steps are not one size fits all. There are various ways of getting through trying times. I've recently started to learn Non-Violent Communication; a style of using language that takes responsibility for one's actions, without casting blame or judgement. It's ultimate goal is to attain peace through understanding. This is actually something which correlates with step 4 heavily, and if used in conjunction with it, can make the process much more effective.

Step 3:

Continuing on, thirdly, the idea of a personal inventory is crucial in the 12-step program. Actually, it is by far the most important part of it, and I believe it should be included here as well. However, the 12-step guide has you list your resentments, fears, and guilts. These negative qualities are to be looked at after and let go. This is a strong process, and while I agree with the idea of the inventory, I don't believe it is a model that accurately fits people with Bipolar Disorder. We can come to hate, fear, and shame not only others, but ourselves for little to no reason, let alone actually acting out an action to bring about the feelings. The main reason I decided to not use this as the inventory system is that the 12 steps are based around successfully treating an addiction. Addiction has been proven to be based on personality. Bipolar Disorder is a mood disorder. It can certainly affect our personality, but our personality is not the root issue. Emotional instability is our issue; how we handle our emotions.

So, with that in mind, I devised a different inventory. An inventory that characterises the individual as a whole, rather than simply attempting to only remove faults. It is one that breaks away from the Disorder and attempts to look at the stable individual's mind, allowing them to look inside themselves and reflect. This version of inventory involves four to five* columns. Listing one's strengths (positive qualities), weaknesses (negative qualities/faults), struggles (current adversity in life; as well as resentments/guilts), and goals (aspirations). By listing these four columns, it allows the individual to see a complete breakdown of their life at the moment. It lets them see

the negative aspects of their lives, but also counters that negativity with the positive traits they possess and the goals they can use those traits to attain in the future.

Following along with the 12-step model, this is much more effective when put down on paper. *However, I also suggest a fifth category: 'other's views'. The Big Book for AA, as an example, states that it is your job to make your list. You shouldn't seek the validation of others. The list should come entirely from inside yourself. This is something that I agree with. The list should be done on your own, it should come from you, Bipolar Disorder however, creates a problem that none of the Anonymous 12-step programs take into account:

Bipolar Disorder leaves the door open for a vast amount of Bias in this step. Speaking from experience, attempting to do a personal inventory is a very mentally taxing action. If you're not already stable, and able to sort your columns without much mental effort, it can be very easy to slip into a depressive episode and start doubting yourself and only thinking of weaknesses; likewise, it can be equally easy to slip into a mania and only see yourself as someone of utmost perfection. Both of these mindsets are obviously not the stable, true self. This is why I think it is imperative to also take into regard the 'opinions' of those close to you, of your already written out sections (meaning after you've already written the inventory) and have them take part in your inventory. Note that I wrote “opinions''. The people you are consulting should not be writing any part of your inventory. This will allow you to discuss these traits with the people you trust and will also help to keep your mood and thoughts balanced while trying to organize them. It gives you the added benefit of being able to determine just what your true flaws are vs. what your biased (manic/depressive) flaws are. The people you're consulting can help point out whether you wrote something that you do while manic or depressive, and while they may be problematic, they should be moved to the struggles category, so that you can work on them in a positive manner.

Then we move on to the section where in AA/NA, or just about any other 12-step based program, that they would ask their higher power to remove these “character defects” and “act as if” they have been taken. As stated above, a higher power is not necessarily the best word here, but the action is still a good cause to look towards. The old phrase “fake it til you make it,” rings very true here. Not acting on those negative traits or impulses and actively working to strengthen the positive ones will not only make you a better person, but it will help you achieve a higher quality of life.

After you've gone through your inventory and determined your strengths and weaknesses, as well as your struggles and goals, it is important to categorize them in such a way that they are easily worked on, ie. you should label/number your struggles, strengths, etc., in the order of severity that they are impacting your life. This gives you a clear path of what to work on first, because it's very likely that the first big issue, once fixed, may clear away one or two below it. Working on your issues in this way serves to help you move towards the quality of life you wish to obtain. HOWEVER, it is important to realize what is and is not obtainable when going through your inventory;

both financially, physically, and mentally. This again, is why having other people take part is so important. They serve to keep you grounded.

As an example; if your conditions have kept you from working, and your goal is to return to full time work, with no problems in mood, as if your condition simply no longer exists; being off your medication, and you want to be able to do this in a month's time, you are setting yourself up to ultimately fail. AA's saying “one day at a time” is still very much relevant for Bipolar Disorder as well. Focus on the short term, and find a path that works for you. Then start to shift to the long term.

Now I will use myself as an example; I want to work full time and support my household. I want to be productive and consistent. I want to “always” be there for my family and “never” let them down. These are all valiant, positive desires, but if I attempt to act on all of these thoughts at once, without giving myself the opportunity to adjust and react to the ups and downs that come with life, let alone Bipolar Disorder, I'm only going to end up writing these same things the next time I make my next inventory; which will end up making me more likely to become depressed because I'll think that I failed at my goals, but only because I didn't 'take it easy' first. Also, take note of the quoted words, always and never. These words act as false positives. No one is perfect, thus no one is always available. No one is never going to make mistakes. We are human and we do still have lives to live after all. We're simply wanting to make the quality of our lives better. Striving for perfection is only guaranteeing failure. Strive for progress.

Step 4:

Now come the hardest parts of the 12 steps to transfer over. Not because they are unusable for Bipolar Disorder, but because admitting fault and working to right wrongs is a difficult subject for just about anyone. Throw depression or mania into the mix, and it can become a very painful ordeal. This is a step that REQUIRES you write the wrongs you've done and to whom. Now, for the purpose of Bipolar Disorder, I have added to explain why (to the best of your ability; episodes aren't always so easily remembered). However, I want to stress that the way you present this information is as important as the information itself. You must take responsibility for your own actions. You can't fault, judge, or blame anyone else; this defeats the purpose of admitting fault in the first place. It will also make whomever you're talking to less likely to acknowledge your efforts to better yourself and the relationship. If you were Manic and said something hurtful to your wife, or were depressed and made an offhand statement about how you wished you were dead, that can hurt your family and scare them. It can also make them angry, because they simply may not understand. But you should explain it plainly, without exaggeration. Leave as little room for miscommunication as possible.

Some amends to make may be things like these below:

“He has a wife, a job, a home, a family that loves him. How could he possibly be suicidal?” - Depressed Example from distraught wife.

“Why in the hell did you go buy $700 worth of new guitar equipment?” - Manic

Example from angry father.

If these behaviors are frequent enough and people are trying to help you, but your conditions simply are too much for them to handle, they can actually start to internalize that and wonder if they have done something wrong, when in reality, it was simply a miscommunication between yourself and them. It is important to make sure they understand that the actions taken were of your own fault, whether Bipolar induced or not.

I don't say this to make anyone feel stupid. The statement you are about to read may be difficult to comprehend. Reread it a few times if necessary.

When you sit with those you've hurt, you are seeking to make amends. This can be in the form of an apology, but you are not trying to get them to accept any apology.

This can be a strange way of thinking, especially for someone with Bipolar Disorder. “If I hurt them, why wouldn't I want them to forgive me? Then why am I even apologizing?” You can not force someone to forgive you. Rather, by admitting your wrongs and actively moving forward and positively from them you are showing the people you've hurt that you are working to not be that same person; that the person that hurt them may be a part of you, it is not the only part of you. You are seeking to earn their forgiveness, rather than simply asking for it.

Acceptance of a wrong and thus forgiveness, is much easier gained when others see you actually trying to make things better. Simply saying “I'm sorry” is like trying to put tape on a crack in a windshield that you caused by throwing stones (saying something hurtful). However, if you actually take the time to have the windshield fixed (prove to yourself and the hurt individual that you are seeking to make things better all around; not just for yourself), it sends a much more powerful message.

Step 5:

The next facet to the steps is that after the amends are made, you should continue this process (for this instance, steps 3-5), even when things are good. The same is true here.

Many may ask, “Wait, if things are good, why should I keep inventorying?”

Well, in return, I ask, “Should we stop taking our medicine just because we feel good? If a doctor gives us antibiotics, do we stop taking them because we feel better even though we have 3 more days to go?”

No, we shouldn't.

Constantly ensuring you are following a progressive path with least harm at its focus will ensure that your relationships not only last, but they will be more fulfilling; be it marriage, your parents, grandparents, or even neighbors. These relationships can be cornerstones for a happy life and making sure if we harm someone, that we fix it right away, will show them that we care and are trying to be strong, independent people. Following the ideas of nonviolent communication, a language of understanding, one way we can navigate conflict when it arises, and it will, is to make sure that we can express our feelings or observations in a way that does not cast judgement or false feelings.

For example, If I told someone I felt ignored, this is not the correct way to express how you feel. Being ignored is not a feeling, it is an opinion. Thus, sharing this opinion in a negative way, will be sure to have negative consequences. Rather, if I told them, “I think you are ignoring me and I don't like feeling hurt by you,”, this then leaves the other person more likely to explain their side of the story and may make them more willing to come to an understanding compromise. Using this type of thinking can also help us maintain a better understanding of those around us, making it easier to phrase ourselves.

It's not always what you said, but how you said it that means the difference between a pleasant, positive conversation and having to now make amends.

Another section I would like to add to step 5 is something rather simple, but crucial for our disorder. We must develop healthy coping mechanisms. But first, what is a coping mechanism? A healthy coping mechanism allows you to channel any energy you have, be it negative, or positive, and do something constructive with it. This can range from drawing, painting, coloring, or putting puzzles together, to reading, writing, or even building something. Anything that changes the headspace you are in, so you can reapproach the situation you were dealing with earlier in a new light. Even positive situations may require coping to manage changes in mood. Perhaps your significant other just asked you to marry them and you're over the moon with joy. This is a wonderous, joyous occasion to be sure, but it could be very easy to slip into a mania and the consequences that could have, especially on two people who are now newly engaged could have disastrous consequences. So managing that influx of energy and emotion is a crucial part of managing bipolar disorder.

Examples of negative coping skills are things like punching walls, slamming your fists on tables, throwing/breaking things, or anything that can cause harm to oneself or another unintentionally. I will admit, I've fallen victim to all of these negative traits and have worked very hard to stray away from them. We as humans are not perfect creatures, so do not expect yourself to never handle a situation poorly. If it happens, simply acknowledge the act, and make the amends then and there. It's likely to be dropped by anyone else involved, so long as nothing was broken; in which case you may have to then take financial responsibility.

Step 6:

Finally, the last 2 steps of the 12 step program basically say that you should seek out, or help any alcoholic that needs it, using those steps as a guide. The same should be done for Bipolar Disorder. This is a Disorder that not only ruins lives, but it takes them as well. We should strive to help as many people as we can, where possible. Now, that does not mean that we should put OURSELVES in a position of jeopardy. Our own mental health must come first, because we're no good to anyone else, if we're no good to ourselves. That is not a selfish belief, it's purely based on survival.

I'm sure you've seen the phrase “quality of life” many times in this list. That's no mistake. While the 12 step program offers the chance at a “spiritual awakening”, this list offers no such guise. Instead, it simply offers a practical way of living based on those same 12 steps. It is purely a way of mentally categorizing and maintaining the thoughts and actions we, with Bipolar, face in our day to day lives. Am I saying you can't undergo a spiritual awakening with these steps, no. In fact, I'd hope that one could. But All I'm hoping for is something much more simple; reaching a quality of life that many would call “being at peace”. Hopefully, we may all find it, as even I myself strive for it, and will continue to strive for it. Not to be negative, but to add a sense of a realism to a mostly positivity filled journey, I feel obligated that I should share a piece of somewhat grim information: Peace will not last forever, because life will always bring new adversity to face. That being said, I wholeheartedly believe that between these steps, psychiatric intervention, a strong support group, and a clear goal in one's mind, I believe all of us can overcome that adversity. Every. Single. One. Of. Us.

Yes, we have [a] disorder, but we can restore ourselves back to order.

Lastly, this is more of an addon, but I feel it's necessary to state, because it drives home why I'm such a firm believer that we need other people to take part in managing our condition; whether it be family, friends, coworkers, or even someone you met in a Facebook Bipolar Support Group who introduced you to a new type of thinking. Managing Mania and Depression can be a very tiring, painful process, but over time the symptoms do become easier to see. But bare in mind, other people; if they know what to look for, (and you should sit with your support group and show them the symptoms of Bipolar Disorder early on) will generally notice changes in your behavior before you will. Don't be afraid to ask them to watch out for you. A strong support group is by far the BEST tool we can have in our arsenal.

Best of luck and well wishes to all. May these steps serve to help at least one other person to attain “peace” for any period of time and they will have served their purpose.

Brent H.