I thought I’d share with you a case study from my work with clients to raise awareness that sometimes in our need to understand what’s happening with us we rush into drawing conclusions and put labels on our thinking and behaviour that can be very detrimental to our wellbeing, especially when we get diagnosed by Dr Google.
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She wanted to see me “as soon as possible”. When I hear that request I am tempted to imagine an emergency situation so I created urgent space and prepared for the worse scenario.
At the time of the appointment I open the door and I see a beautiful young woman, slightly shy (or perhaps embarrassed to reach out for help). She is articulate and has a very warm and engaging voice. I’m thinking that she would make a great radio host if she would speak with a bit more confidence, and then I listen.
She has nothing to do with media though. She is an entrepreneur in the fashion industry, quite successful in what she’s doing, single in her private life and maintaining a quiet social life. I am not surprised to hear she is a workaholic, spending most of her time in the office, travelling between factories and shops and talking for hours on the phone each day to manage her business.
“I am bipolar”, she eventually shares. I remain quiet. The silence is uncomfortable for her. Yet she finds it hard to continue. She looks down and sights. “Today I am low, but this is not me” she adds. “Who is you”, I ask?. “I am a bipolar woman with a changing mood and this is killing me. Most days I am high to the point where I drive everybody crazy with my demands and then I suddenly become like this quiet, low person in the evening”.
“This must be hard for you to handle”, I think out loud. “It’s making my life horrible and I can’t tell anyone that I’m ill. I know that my reputation can be affected and my business will suffer”. “How long have you been struggling with this for?” I ask, hoping to get some understanding of how her issues have started and evolved in time.
“I’ve been like this since I started the business. I was a completely different person before, but this work has changed everything. I need to stay focused every single second, there is so much going on and I cannot trust others do their job properly so I have to do most of the work myself”. “How tiring must that feel…” I say.
“It is very tiring. This is why I developed the illness I think. I read on the internet that bipolar can develop because of high levels of stress”. “It can indeed. Can you tell me a bit more about its start?”. “Well, I had quite a balanced in life. I traveled a lot with my parents who are diplomats… loved the countries we lived in… I had quite a nice and peaceful childhood I’d say and a happy one as a single child. Quite spoiled by my father, loved by my mother too… Then during the uni I started thinking to open a lingerie business as I spotted a niche in the market, but I knew my father would not approve that, he wanted me to do the MBA first. So, I waited and I told him towards the end of the course. He got really mad. He did not want me associated with the image of bras and knickers, he had other plans for me. I started anyway with the money from my grandfather and he eventually gave up fighting, but that put a strain on our relationship and it’s never been the same”.
A much clearer picture was starting to emerge at that point, but it was still too early to jump to conclusions. “I started the business and it was hard right from the beginning. There was so much to do and I felt under so much pressure as I knew my father waited for any opportunity to see me failing and giving up the fashion world which he thought “was not for a serious young woman”.
“Your father seems a bit conservative” I say. “Very. And this makes my life a hell… It’s been a few years now and the business is building up, but the pressure is increasing and I find myself agitated every morning checking that everything is in order, from production to distribution and marketing and then in the evening I get tired and depressed and I ‘m alone in London and my parents are in the middle East so we don’t see each other that much although we speak on video chat…but yeah…my illness showed up when I started the business”.
“Many things have changed when you started the business I say: you became an adult, a responsible person, not just for your life but also for the business, for the life of your employees, and potentially for the pleasure of your customers buying your products. You started to live on your own, far away from your parents, with a small circle of friends I would think, in a large and lonely metropolis like London. And on top of this, your relationship with your father is distant and cold and you miss his encouragement, his reassurance and ultimately his approval. It’s a completely foreign life to you”, I summarise my interpretation of her story.
“Yes, exactly and this is why I got ill”. “Would you like to tell me a bit more about your struggles? How does it feel to be you on a daily basis?”. “I get agitated and tense in the morning and that carries on throughout the day as I make sure everything happens as they should, then at night I tend to be highly depressed, I feel that my life is horrible”.
“What you describe seems to be a natural response to the demanding work environment you created around you which I see often in entrepreneurs, and you seem to experience also a sense of loneliness at evenings when not much happens in your life”. “Yes, that’s true”, she agreed.
“I wonder what was your worse high and low throughout this time. Can you remember that?”. “The highest ever I’ve been on the day when I launched the new line, I thought I will not make it to the end, that agitated I was. And the lowest happened one night when I cried alone in my house which felt so big and cold, and insanely quiet as well”.
“So far I only hear about natural human manifestations in what you describe. Where have you been diagnosed and when, also do you take any medication?”. “I have not seen a doctor yet, I wanted to talk to you first. But I am sure I have bipolar as I googled intensively about my symptoms and I even took a test to get a quick diagnosis and the result was clear: I am bipolar”.
This is a junction where I arrive often with my clients and the greatest part is that I look beyond the medical model. They need to understand what is going on with them and they want clarity and they want it NOW. Nowadays people rush to attribute their behaviours, thoughts and feelings to a cause and in their search for answers they reach out to the most convenient places like the internet.
“Have you ever felt in a highly alert state for a long time, unable to sleep, feeling restless and distracted, then have massive mood swings and feeling very sad, empty inside and hopeless, insomniac, fatigued and lacking energy, unable to concentrate and wanting to end your life?”, I thought I’d clarify. “Not really, I always had this focus on work and I would never jeopardize my business… I felt more under pressure and kind of anxious that things might not go well, and sad sometimes, yes, but never empty and unable to sleep or thinking to end my life, no”.
“I have the feeling that you have self-diagnosed relying on Dr. Google and I doubt that this is an accurate diagnosis. In fact, I do not see any set of symptoms to justify a bipolar diagnosis, you seem to struggle in all 4 relationship circles and your experiences are natural responses and not symptoms of an illness. I am thinking that the trigger of what you call “illness” is the change that occurred when you moved into the adult life. You separated from your family, found yourself in a less familiar environment and at the same time you started a business alone, one that your father, a very important figure in your life does not approve and as a consequence has left you unsupported, most likely hoping you’ll give up and move into another field more appropriate for the “serious woman” he was hoping you’ll become. You’ve been very brave to go through all of that journey and succeeded on your own, yet I have not heard any sign of celebration and appreciation for your efforts”.
The client seemed somehow shocked and looked at me struggling to find her words. “You could be right, she eventually muttered. “I could”, I say, “and I wonder what would that mean for you if this was the case”. “That would mean that I beat myself up all of these years for nothing, that I never enjoyed what I achieved…
That would mean that I harmed myself, keeping myself under pressure every day, making sure everything is perfect… that would mean I wasted a few years of my life… this is now going into a direction that makes me sad…”. “I am sorry you are realizing there is a new perspective to your story and that it is making you sad, but again, you have this tendency to be harsh with yourself and think in terms of control or black and white sometimes… I would say that you have not wasted these years, but on the contrary, you invested in yourself, in your future, you accomplished a lot and probably, part of that accomplishment took place exactly because you have been focused, committed, hard-working (which you might call “agitated”, a symptom of hypomania that maybe made you think you are bipolar). In a way this has been a journey that taught you a lot, but you are only at the beginning of becoming aware of the learnings you accumulated which will take some time to unveil. And now, that the business is established, I wonder if you would be ready to let go a little of that control and delegate some of your work so you can create time and space in your life for enjoyment and happiness, for fun and adventure and whatever you were dreaming about when you were little?”.
She stayed quiet there on the sofa and started to cry softly. I did not disturb her, how could I? She waited to find this safe space to reconnect with herself for a very long time. She cried and spoke quietly close to the end of the session and shared the insights she just had about the losses in her life, the unspoken pain and all the challenges she’s been through, how much she missed her parents and the close relationship she used to have with her father. “All of these can be changed. You can transform your life that way you want. I am here for you and I can guide you within yourself to find out what you want from life, what does it mean to live a good life for you, and I’ll show you the way to make that happen”.
“I would very much like that”, she replied. “Then let’s take a bit of time to reflect on all these experiences and next time will resume with a plan of action to make your desired life a reality”. She smiled and her face lightened up for the first time. She looked like she was a completely different person now. “But no more browsing on the internet”, I say smiling myself. “No more”, she agreed and we parted.
The following 2 sessions we worked intensively on her “Big Plan” as she called it. She drafted what she wanted to change in her life and I was absolutely amazed by her ability to implement action and change in a short period of time, as well as of her creativity and discipline in life. It was clear to me that her qualities have played an important role in the success of her business and I was reminded again that sometimes we sacrifice some aspects of our lives for a while to make it easier for the remaining of our lives. I witnessed that happening in her case and it was an amazing story.
She reorganized her work environment and created a much pleasant life style, coordinating a lot from distance and appointing a managing director to oversee the operations. She started going out more and dating men, and most importantly she started visiting her parents more often. She told her father that she missed him and how much she would have liked to have his support. The father was moved by her disclosure and reconnected with her. In the space of a couple of months this client’s life transformed profoundly. She felt more balanced and joyful, she reconnected with herself and the others and she developed into a more mature young woman able to learn from her life journey and willing to inspire others as well. She even took part in a coupe of speaking events for young women entrepreneurs and this way conquered her anxiety of speaking in public.
We ended our work on a very high note. What a marvelous success story, how easy to achieve it and how massive the loss if she wouldn’t have reached out for support. Dr. Google might be helpful in offering us information, but should not be used as a diagnosis tool, especially for our mental health. Sometimes, even when the described symptoms look very similar to our experiences there can be a huge difference between them. An alternation of high and low mood is not in itself sufficient for a bipolar diagnosis. A much complex set of diagnosis criteria needs to be met to lead to that diagnosis and when used carelessly labels get integrated into our identity and end up defining who we are, what we think and how we behave. We sometimes forget that our life experiences are natural manifestations and our inner lives oscillate naturally on a continuum of experience between well and unwell in all of us, all the time.
We are humans and we should take time to understand our drives, our actions and non-actions in the large picture of our life experience and circumstances and do our best to repair and improve our relationships with our self, our family, other people and the world. Only this way we can get a deeper understanding of what is really happening, why it happens and most importantly how can we change what is not longer needed in our lives to create that space for what is wanted and desired. Because every single one of us deserves a good life and every single human being can create a life in their own terms, based on their understanding of success, meaning and purpose in life. Including you! So trust yourself and do it, because you are worthy!