Narrative analysis: Alternative constructions of bipolar disorder

In the conventional view of bipolar disorder, life-long treatment with pharmaceuticals is assumed. This paper presents an overview of 24 narratives from people in the author's practice who have successfully managed and thrived without pharmacological treatment. For comparison purposes, 24 patients who could not manage without medication (even though some tried) were selected from the author's practice and matched for age, sex, socioeconomic status, and years of illness. Comparisons between the stories reveal that recovery without medication requires more substantial life change than does management with medication. Such non-medicated recovery becomes an all-encompassing life project. The patients who follow this path make major life changes and maintain them. The worldview of non-medicated bipolar patients differs, in that their struggle for recovery provides them with meaning and purpose, which is, in itself, healing. These patients avoid health practitioners who would criticize their alternative approach. They are compared to patients who do not manage well without medication who nevertheless try to manage their condition with herbs or vitamins or other alternative therapies and are unable to do so. Accurate appraisal of illness versus denial of illness emerges as the guiding theme. It may be important to recognize a successful strategy for living without medication compared with strategies of denial or flights into herbs and/or vitamins that will ultimately not succeed. Indigenous (or aboriginal) people, in particular, may reject the conventional psychiatric model in favor of a more holistic approach more congruent with their cultural healing paradigms.