Why identity is important to your quality of life
Everybody has a unique sense of self, or identity. Our identities capture complex factors including the roles, relationships, characteristics, values, commitments, behaviours and associations about ourselves that combine to paint a picture of who we are. Social systems and power structures also shape our identities1. Whether or not we live with bipolar disorder, a solid sense of identity is important for health and wellbeing. At the same time, as our situations and life experiences change, our identities also change and grow.
We understand the world through the lenses of our identities, based on the beliefs and experiences that make us who we are. In this way, our identities can become more set over time. For example, if you have an identity that includes being a helpful person, you may be more likely to see a situation as an opportunity to be helpful and needed, making you feel more helpful. Or if part of you identifies as an outsider, you may see the same situation as uninviting and avoid it, making you feel like even more of an outsider. In this way, when our sense of personal identity is overly negative, unstable or uncertain, it can become confusing and difficult to set personal values or establish stable roles and relationships. How we see ourselves internally can shape who we are in the real world.
How bipolar disorder creates challenges around identity
Bipolar disorder can present many challenges around identity. Some people living with bipolar disorder have described the onset of the condition as a disruption in their life story and identity2. For these people, being diagnosed with bipolar disorder altered their life course and required them to take time to think about and re-evaluate their sense of self2. This disruption may be even more critical when symptoms of bipolar disorder first start in youth, when a sense of identity is still being discovered and solidified. But no two people have the same journey. While some people describe identity difficulties caused by their diagnosis, others report positive changes, seeing their bipolar disorder as a transformative or life-altering process2.
One particular challenge is if your identity becomes entirely based on one aspect of yourself, while undervaluing or ignoring other aspects of yourself. When you struggle with this, you may view yourself in an overly narrow way. In the case of bipolar disorder, you may experience this when you define yourself primarily by your illness: “I am bipolar” or “I am mentally ill”. Research shows that adopting this kind of ‘patient identity’ can make you feel powerless and negatively impact your quality of life3,4. A healthier and more empowering option may be to see bipolar disorder as only one aspect of who you are, so that the condition does not capture all of you3,5: “I am a parent, a friend, a web-designer, an animal-lover, who also lives with bipolar disorder.” You have strengths, roles, characteristics, values and goals that go well beyond your bipolar disorder. However, there can be times, especially when coping with a mood episode, when focusing almost solely on managing your bipolar disorder can be an effective strategy to regain health and wellness.
While developing a sense of identity is a personal process, social factors from the outside world can also place this ‘illness identity’ on you2,5. Social stigma can affect your sense of identity if people treat you differently on the basis of negative stereotypes about a bipolar disorder diagnosis. Structural stigma can also reinforce an ‘illness identity’ if organisations impose barriers or restrictions on you on the basis of your diagnosis (for example, if a workplace limits your opportunities for career advancement after you disclose a bipolar diagnosis). These kinds of actions can contribute to self-stigma, where you identify with stereotypes and negative beliefs about mental illness.
Another common challenge is that the mood turbulence (those out of control ups and downs) of bipolar disorder can make it more difficult to establish a stable sense of self6. One of the symptoms of depression is how it distorts your thoughts to view yourself in an exaggeratedly negative way, ignoring your gifts and accomplishments. This creates a “negative identity” based upon what you unrealistically see as inescapable and continual failures and weaknesses. If you rise into a hypomanic/manic state, you may view yourself in an exaggeratedly positive way. In that manic state, you may struggle to distinguish between your true capacities and the beliefs about your capabilities that are fueled by your mania, or between your true priorities and the ones that suddenly seem important. You may also engage in behaviours that are out of character when hypomanic/manic, which may be difficult to reconcile with your view of yourself.
Building a stable sense of identity takes consistency and commitment to certain values over time – but bipolar disorder can involve dramatic changes in your feelings, thinking and behaviour which can strain your ability to maintain consistency. The bottom line is that it may be hard at times to distinguish between your true identity and the changing symptoms of bipolar disorder7, but that you can, with practice and commitment, develop insight into who you are, versus what aspects of your behaviour come from the symptoms of bipolar disorder.
How you can take action
The aim is to develop a stable, positive identity that keeps you in touch with the full range of your values, abilities and roles, rather than focusing only on limitations placed on you by bipolar disorder8. Here are a few steps you might take to help you develop and maintain a healthy sense of self:
Try to develop a sense of self beyond your illness. Human identities cannot be reduced to just one aspect, and many of your characteristics are not related to your bipolar disorder. To explore this, you can try making a list of your characteristics (values, roles, strengths and abilities, interests, priorities, habits, etc.) in two columns. First, list the characteristics which you perceive to be related to bipolar disorder, such as “I suffer from rapidly shifting mood”, or, “sometimes I go on impulsive spending binges”. Second, list characteristics that are not part of bipolar disorder, such as, “I’m a teacher”, “I value my culture”, or, “I come from a family of strong women.” Once you have created your list, review it as a way of reminding yourself that you are much more than ‘bipolar’. In this way, bipolar disorder can be seen as “something I manage, not who I am”5.
Some people with bipolar disorder report that this condition has given them unique life experiences and enhanced abilities9. For these people, bipolar disorder felt like an important part of their identity that they would not want to give up entirely. Everyone is different in terms of how they relate to bipolar disorder as part of their identity: some people may think of it as a negative, some a positive, and many people have experienced a bit of both. Depending on your experiences, it may be perfectly valid and helpful to also reflect on how positive parts of your identity relate to bipolar disorder.
Some self-management strategies like mood monitoring can make you very focused on the parts of yourself that might be negatively affected by illness10. These strategies are very important for staying well, but it can be helpful to supplement them with types of self-monitoring that draw your attention to valued parts of your identity. There is some evidence to suggest that using the CREST.BD Quality of Life Tool can be helpful in developing a sense of identity beyond illness11. A series of interviews were conducted with people who had used the QoL Tool, and a number of people reported that this helped draw their attention to strengths and establish a more well rounded sense of identity. We all have things that we struggle with, and we all have things that we are good at or areas of life in which we are flourishing – the QoL Tool can be a useful reminder of all these facets of your identity.
Think about the privileged, as well as the marginalized, parts of your identity. Many of us have essential (intrinsic) parts of our identities that give us minority, or marginalized, status, for example: “I live with a disability”, “I am a visible minority”, “I am a gender variant person”, “I am an Aboriginal person”. But often we give less thought to the intrinsic ways in which we hold power, or privilege. For example: “Does my sexuality give me the freedom to hold hands with my partner and feel comfortable in most situations?”, “Do I come from a loving and supportive family?”, “Do I hold an advanced degree?”, “How does my skin colour affect the way I am treated?” Learning about an identity that you don’t hold can be an interesting and powerful exercise in getting to know your own identity more deeply, as well as in relating to others12.
While you are more vulnerable to persistent mood states like depression or mania, you still have day-to-day or moment-to-moment changes in emotions, just like everyone else. You can be excited or happy without being manic, or sad and frustrated without being depressed. Teaching yourself and others to help tell the difference between normal changes of emotions throughout the day from mood episodes can be very important to feeling supported and validated by others. Cognitive behavioural therapy can help you develop awareness of what fluctuations in emotions are healthy and appropriate given the circumstances, and promote more balanced and realistic thoughts about changes in mood state13.
When exploring your different characteristics, see if you can be gentle and accepting with the parts of yourself that you would like to change or that are not in line with who you’d like to be. Being critical towards yourself causes unnecessary hardship. Being kind to yourself can help to give you strength and can even help you make changes for the better. Identify negative messages you may be giving yourself about your bipolar disorder, like “having this illness means I’m flawed”. These kinds of internal messages can be the focus of Cognitive Therapy, which helps individuals to identify negative thoughts that are unrealistic, unfair, unhelpful or self-stigmatising, to challenge these thoughts and to replace them with thoughts that are more realistic, fair and helpful14,15. Mindfulness practice can also help you identify self-judgements and practice a gentler way of relating to yourself. Remember that friends, family members or healthcare providers can help you to challenge negative thoughts and come up with more realistic and helpful ones.
All of the above strategies can help you build a stronger sense of identity, which can help make you more resilient in coping with stigma. There are additional actions you can take to manage the impact of external sources of stigma on your identity and quality of life.
If you have friends or family members with stigmatising views about bipolar disorder that are negatively impacting your quality of life, you may want to reflect on the level of contact you would like to maintain with them. Another strategy is setting firm boundaries around the kinds of language or behaviour that you find unacceptable. Sharing accurate and non-stigmatising information (like the CREST.BD Bipolar Wellness Centre) with your friends or family may help them re-evaluate any misconceptions about bipolar disorder. In some cases, family therapy or psychoeducation might be most helpful at shifting attitudes and learning skills to discuss bipolar disorder in a healthy way16,17.
CREST.BD also recognises that we have an important role to play in reducing social and structural stigma through education and advocacy that replaces myths and misinformation about bipolar disorder with accurate information, and research about the most effective ways to fight stigma.
- Hankivsky, O. (2014). Intersectionality 101. SFU Institute for Intersectionality Research & Policy/Public Health Agency of Canada. Vancouver: SFU.
- Lally, S.J. (1989) “Does being here mean there is something wrong with me?” Schizophrenia Bulletin, 15: 253-265.
- Fernandez ME, Breen LJ, Simpson TA. Renegotiating Identities: Experiences of Loss and Recovery for Women With Bipolar Disorder. Qualitative Health Research. Published online June 6, 2014. doi:10.1177/1049732314538550
- Mansell W, Powell S, Pedley R, Thomas N, Jones SA. The process of recovery from bipolar I disorder: a qualitative analysis of personal accounts in relation to an integrative cognitive model. Br J Clin Psychol. 2010;49(Pt 2):193-215. doi:10.1348/014466509X451447
- Michalak E, Livingston JD, Hole R, Suto M, Hale S, Haddock C. ‘It’s something that I manage but it is not who I am’: reflections on internalized stigma in individuals with bipolar disorder: Chronic Illness. Published online February 28, 2011. doi:10.1177/1742395310395959
- Ironside ML, Johnson SL, Carver CS. Identity in bipolar disorder: Self-worth and achievement. Journal of Personality. 2020;88(1):45-58. doi:10.1111/jopy.12461
- Inder ML, Crowe MT, Moor S, Luty SE, Carter JD, Joyce PR. “I actually don’t know who I am”: the impact of bipolar disorder on the development of self. Psychiatry. 2008;71(2):123-133. doi:10.1521/psyc.2008.71.2.123
- Yanos PT, Roe D, Lysaker PH. The Impact of Illness Identity on Recovery from Severe Mental Illness. Am J Psychiatr Rehabil. 2010;13(2):73-93. doi:10.1080/15487761003756860
- Folstad S, Mansell W. “The Button Question”: A mixed-methods study of whether patients want to keep or remove bipolar disorder and the reasons for their decision. J Affect Disord. 2019;245:708-715. doi:10.1016/j.jad.2018.11.025
- Bendegem MA van, Heuvel SCGH van den, Kramer LJ, Goossens PJJ. Attitudes of Patients With Bipolar Disorder Toward the Life Chart Methodology: A Phenomenological Study. Journal of the American Psychiatric Nurses Association. Published online November 3, 2014. doi:10.1177/1078390314558420
- Morton E, Hole R, Murray G, Buzwell S, Michalak E. Experiences of a Web-Based Quality of Life Self-Monitoring Tool for Individuals With Bipolar Disorder: A Qualitative Exploration. JMIR Ment Health. 2019;6(12):e16121. doi:10.2196/1612
- Goodman D. Promoting Diversity and Social Justice: Educating People from Privileged Groups.; 2001. doi:10.4135/9781452220468
- Searson R, Mansell W, Lowens I, Tai S. Think Effectively About Mood Swings (TEAMS): a case series of cognitive-behavioural therapy for bipolar disorders. J Behav Ther Exp Psychiatry. 2012;43(2):770-779. doi:10.1016/j.jbtep.2011.10.001
- Jones SH, Smith G, Mulligan LD, et al. Recovery-focused cognitive-behavioural therapy for recent-onset bipolar disorder: randomised controlled pilot trial. Br J Psychiatry. 2015;206(1):58-66. doi:10.1192/bjp.bp.113.141259
- Richardson T, White L. The impact of a CBT-based bipolar disorder psychoeducation group on views about diagnosis, perceived recovery, self-esteem and stigma. the Cognitive Behaviour Therapist. 2019;12. doi:10.1017/S1754470X19000308
- M’Bailara K, Minois I, Zanouy L, et al. [Therapeutic education: A lever to change perceptions of bipolar disorder in family caregivers]. Encephale. 2019;45(3):239-244. doi:10.1016/j.encep.2018.11.004
- Baruch E, Pistrang N, Barker C. Psychological interventions for caregivers of people with bipolar disorder: A systematic review and meta-analysis. J Affect Disord. 2018;236:187-198. doi:10.1016/j.jad.2018.04.077