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How do you know where the person ends and the illness starts?


How do you know where the person ends and the illness starts?

How do you know when a person is speaking out of illness or their true selves? How do you ever know this? Where do you all go to learn more about the illnesses your loved ones have? What are the most comprehensive and detailed sources? Not just the standard medical sites.

Senior Contributor

Re: How do you know where the person ends and the illness starts?

Hi @Debil

There is a lot of information out there and finding good practical information on the internet can be like looking through a haystack for a knitting needle. Like other forum members I have posted a few links to youtube talks or articles I have found helpful  on the "what's new" tab. 


I think what you are asking is similar to where the person ends and alcohol takes over if someone starts drinking and the answer to that is variable - whilst generalisations occur, there are a lot of individual attributes too.


The answer to the question is really knowledge of the person and what they were like pre- episode.


When the psyche is out, the initial aim is to reduce psychosis, ascertain cause and return to stabilty.  Often a patient is unaware that there is a problem (as can be the case for patients with deficits caused by brain injury). Carer collaboration is vital in giving information regarding pre-crisis behaviour.  A carer gives better information if they have some understanding of a condition. For example, once I found out about hypomania, I could tell the pdocs about the enthusiastic behaviours my husband had began to demonstrate were actually a symptom (I later found out he replicated one of these on the ward and could say that this was the type of behaviour that had emerged).


I am wondering when asking the question if you are referring to 'bad behaviour' . There are things that patients can do when manic that are not so forgiveable than the things they tend not to do when depressed. 


If you think of the alcohol analogy, it is again similar - some who drink to excess pass out and sleep (akin to depression), others are happy (akin to mania, hypomania) whilst others behave bizarrely (akin to psychosis). Reckless behaviour can be due to a patient being overly happy or behaving in a bizarre manner they see as perfectly normal to them but are not to anyone else.   If someone has behaved badly when they are drunk and are sorry, people usually find a first offence easier to forgive but if that person continues to drink and as a consequence behave badly, generally people are less forgiving.  


It is far more complex than this as the reasons for  assaults on the psyche are varied and poorly understood. But as with drinking too much alcohol,  if a patient has had psychosis and has displayed out of character behaviour,  separating this from their usual personality can be difficult. It is not helpful though to attribute all negative behaviour to MI, we all have character flaws.   From what I can tell, if a patient actively engages in treatment, those around them are more likely to be able to feel they can support them, even at times when they are not doing so well. 


Hope this helps.


Re: How do you know where the person ends and the illness starts?

Thank you so much Darcy. Is there a way I can personal message you? I am feeling nervous to expand on things publicly but I do want to get some help. Or do I phone the helpline?

Re: How do you know where the person ends and the illness starts?

I guess I can ask, if the person makes decisions in the post psychosis phases, but they want to hold to them? So, big decisions. Decisions involving other people in their lives. I did some more googling and discovered that running away and leaving your loved ones is not atypical for bipolar. I guess what I was wondering, does this desire and decision prevail? Or does the person generally 'return' to their old feelings and decisions once they're feeling better? Or are we to respect their choices during this time as we would any other time, and acknowledge and deal with that? I don't want to be disrespectful to another person and their life choices, but how do you know which is real and which is the illness speaking? 

These decisions are not entirely outside of the persons realm in the past, having happened a few times before. But we never knew about the illness and perhaps this was related? I don't want to unfairly discount the person's autonomy in making their own life choices either.

It's tricky.

Community Manager

Re: How do you know where the person ends and the illness starts?

Hi @Debil,

I'm Margot, one of the Community Managers. Nice to meet you 🌻

I just wanted to jump in here as I noticed you had a question about private messaging on the forums. It makes sense that some things are tricky to talk about publicy. Unfortunately we don't have the capacity for private messaging and it's important that members don't share personal contact information. As you can imagine, anonymity of our members is really important and it helps us to keep our community safe.If you'd like to know more, you can read more about our community guidelines here.

Oh and if you'd like to talk more about things one on one, you're on track with saying, the helpline or a service like Lifeline 13 11 14 is a good way to go. 

I hope that makes sense. Good on you for reaching out @Debil. Great to have you on the forums 🐼


Re: How do you know where the person ends and the illness starts?

Thanks Margot. I tried the helpline and hopefully will receive a call back at some point. 

I have been thinking more about my question and what I can say, and I am also wondering about personality things too. So using the analogy of the alcoholic, a little bit of alcohol can make a person feel less inhibited and aspects of themselves can be more comfortable to come out. Yet too much alcohol and the person goes into territory that doesn't really reflect their 'true' selves.

Is this similar with bipolar? If the person appears to have a few 'new' attitudes or speaks very openly about their opinions on people and these opinions are things you never knew before, are they real? In some ways I've thought that the person hasn't any longer got that social/frontal lobe conditioning that we all tend to filter our comments and actions through. Is this typical of the bipolar experience?

Senior Contributor

Re: How do you know where the person ends and the illness starts?


Feel free to ask - if you put an @ at the beginning of a name (as I have done with you) this tags and a message will come through to alert the person you have tagged.


I can only give you my experience - Mr D thought that being homeless and living off charity was desirable.  He ended up interstate, I don't know what the professional opinion was at the time (not BP), I still cannot reconcile treatment given to any diagnosis but he spiralled down to psychotic depression. Treatment for this was aggressive and did lift him out of psychosis, he ended up over medicated, not suicidal but said he was feeling no better. At this point I was scared and confused as one of his attempts had the potential to harm us both.  He was repentant but I was not in a place to assess if his character was affected.  In any event his meds were reduced far too quickly in my view and he relapsed. Had a long stay in hospital (mainly due to an attempt). During this time he was once again treated aggressively on a treatment order - I voiced concerns and one of the pdocs told me to look things up and I thank God he did. I found out about hypomania and that the behaviours were symptoms - by passing these onto the pdoc his diagnosis was changed and thankfully he has been relatively stable.  His crisis period was over 2 1/2 years.


So - in answer to your question - there is a before and after which is sometimes hard to quantify - some may be side effects of his meds.  His personality is essentially the same, he is still the kind, caring man I love. What has changed is some demonstrations of tenderness are absent, he was a generally enthusiastic person - quite possibly cyclothymic -  now motivation and decision making are impaired.  He does not understand the medical side of things and needs help with that.  Since being stabilized he has not wanted away and has not felt suicidal.  A necessary change to meds has seen moments of hypomania so hoping for some tweakage at next pdoc appt. 


As a carer the self education made the most difference. I should point out that when I learned I changed my way of thinking, responded better, became more compassionate and our relationship improved so much - it is the best it has been in years. 


Re: How do you know where the person ends and the illness starts?

This is so wonderful to hear Darcy. You're such a caring woman.



Senior Contributor

Re: How do you know where the person ends and the illness starts?


Can I gently encourage you, when things are in crisis it is hard to see that things can ever be OK again.

It is possible to live well in spite of a diagnosis. There are parameters required for this to happen but there is hope. 

Community Elder

Re: How do you know where the person ends and the illness starts?

The question you asked @Debil shows a strong level of love and care.  

@Darcy's replies are hard won over many years.  

Knowledge always helps, but each person and relationship is unique.

There is definitely hope.  Join us on the hot choc thread.  Different people live with different scenarios and are able to contribute all sorts of good things.

Take Care Apple


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