Marius Veseth et al (TRYKKEKLAR)


 

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How I found out I had a bipolar disorder: A reflexive-collaborative exploration of the process 

of identifying that one is struggling with a severe mental health problem 

 

Marius Veseth, Per-Einar Binder, Marit Borg & Larry Davidson 

 

 

Abstract. Research indicates that it may take up to 10 years between onset of symptoms of 

bipolar disorder and receiving correct diagnosis and treatment. What is this period like? How 

do individuals experience the process of discovering that they have a bipolar disorder? In this 

study we utilized a hermeneutical-phenomenological approach developed within a reflexive-

collaborative framework to explore these questions. In-depth interviews with 13 participants 

who reported both bipolar I and bipolar II diagnoses were conducted. We analyzed our data in 

collaboration with a group of 12 coresearchers who have experiences of mood disorders, and 

through reflexive dialogue with this group we validated and expanded our results. We describe 

three phases through which participants manoeuvred from (a) “uncertainty and confusion” 

through (b) “grasping the novel and unusual experiential states” to (c) “giving meaning to the 

lived experiences of intense ups and downs.” These results are discussed in relation to theory, 

research and practice. 

 

Keywords: bipolar disorders; recovery; hermeneutics; phenomenology; reflexivity; 

collaboration; service user involvement 

 

Please cite this article as: 

Veseth, M., Binder, P.-E., Borg, M. & Davidson, L. (2013). How I found out I had a bipolar 

disorder: A reflexive-collaborative exploration of the process of identifying that one is 

struggling with a severe mental health problem. Qualitative Studies 4(1): 21-38. 

 

Introduction 

Bipolar disorders are heterogeneous mental illnesses with a lifetime prevalence of about 3.9 % 

of the adult population (Kessler et al., 2005). People who struggle with these mental health 

problems are typically burdened with periods of severe depression, mania or hypomania, as 

well as mixed episodes. According to diagnostic criteria, bipolar I disorder is characterized by 

at least one lifetime manic or mixed episode; bipolar II disorder by at least one lifetime 

hypomanic episode along with at least one episode of major depression; and cyclothymia by 

two or more years of alterations between hypomanic and depressive symptoms that do not 

meet criteria for hypomania or a major depressive episode (American Psychiatric Association, 

2000). The disorders are accordingly often described as a continuum of severity (Cassano et al., 

1999). Bipolar disorders have frequent co-morbidity and hold the highest suicide rates of all 

mental health conditions (Proudfoot, Doran, Manicavasagar & Parker, 2011). As such, the 

disorders are a considerable source of distress and suffering to persons struggling with it. 

 

Studies indicate that it may take up to 10 years from onset of bipolar symptoms to receipt of a 

correct diagnosis (Hirschfeld, Lewis & Vornik, 2003; Suppes et al., 2001). The delays between 

emergence of symptoms, seeking professional help, and acquiring a diagnosis and treatment, 

may be a significant barrier to recovery, as well as contributing to the torment of people affected 

(Skjelstad, Malt & Holte, 2010; Woods, 2000). In the present investigation, we aimed to explore 

how the process of identifying a bipolar disorder is experienced from the first person 

perspective. The article extends findings presented in a previous paper in which we examined 

what persons suffering from a bipolar disorder do to promote their own processes of recovery. 



 

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We found that their efforts toward improvement and growth could be summarized and 

described in the following themes: (a) handling ambivalence about letting go of manic states; (b) 

finding something to hang on to when the world is spinning around; (c) becoming aware of 

signals from self and others; and (d) finding ways of caring for oneself (Veseth, Binder, Borg & 

Davidson, 2012).  

 

Bipolar disorders have been described and explained primarily within a biomedical framework 

for the last few decades (Miklowitz, 2008; Scott, 2006). Little research has been conducted 

outside of this perspective during this period, and, as such, there is a need for developing new 

perspectives and ideas. Because of the hypothesis-generating potentials of qualitative methods, 

these approaches may be particularly important and useful in this context. We draw on in-

depth interviews conducted with 13 participants who reported both bipolar I and bipolar II 

disorders, and offer findings from sections of these data that focus on what it is like finding out 

that one is suffering from a bipolar disorder. The study was designed and conducted with a 

group of 12 coresearchers who all have firsthand experiences of mood disorders. The 

background for collaborating with these service users was to enhance the quality of the research 

project (Faulkner & Thomas, 2002; Trivedi & Wykes, 2002). Most importantly, we aimed to 

strengthen the ecological validity of the study by ensuring that the research questions and 

themes were relevant and meaningful to persons who have lived experiences of mood 

disorders, as well as to have our views and perspectives confronted and challenged throughout 

the study in an ongoing dialogue with this group of coresearchers. As such, we utilize the 

knowledge of two distinct groups of service users in the present investigation: the participants 

who shared their experiences in qualitative interviews and the coresearchers who engaged in 

developing and implementing the study (see also Veseth, Binder, Borg & Davidson, 2012).  

 

The aim of the present study was to explore first person perspectives on identifying a bipolar 

disorder: How do individuals experience the process of discovering that they are struggling 

with a bipolar disorder? What does it mean for the person to find out that their symptoms and 

distress are in line with descriptions commonly seen as a severe mental illness? 

 

Method 

We utilized a hermeneutical-phenomenological approach developed within a reflexive-

collaborative framework to explore our research questions. This approach holds a 

phenomenological aim as we seek to generate knowledge about the lived experiences in finding 

out that one has a bipolar disorder. It is directed toward describing and exploring everyday 

experiences on a concrete and jargon-free level (Binder, Holgersen & Nielsen, 2010; Kvale & 

Brinkmann, 2008; van Manen, 1990). We can, however, only progress toward this aim through a 

hermeneutical process of interpretation in which we as researchers actively negotiate the 

meaning of the lived experiences – initially through engaging with the participants in the 

interview situation and later through a dialogue with the transcribed text (Gadamer, 1989; 

Heidegger, 1962). From a hermeneutical-phenomenological perspective, meaning is therein 

conceptualized as co-created by researchers and participants, and as such, the researchers’ 

experiences and subjectivities are acknowledged as an unavoidable part of every study 

(Alvesson & Sköldberg, 2000; Finlay, 2002; 2003; Malterud, 2001a; 2001b). The researchers’ 

preconceptions and intentions are, however, not only sources of errors in this approach – they 

are also seen as providing the researchers’ means to understand the participants’ lived 

experiences (Heidegger, 1962). 

 



 

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In order to enhance the trustworthiness of our study, we have aimed to make our 

preconceptions and intentions explicit in the present article. This is in line with a reflexive 

framework (Alvesson & Sköldberg, 2000; Finlay, 2002; 2003), which has been the guiding 

methodological principle in carrying out the research project. When the researchers’ 

preunderstandings are seen as giving direction to the way in which studies are planned, 

performed, and presented, exploring and reflecting upon these preconceptions are of 

importance to the quality of the research. In the present study, collaboration with our 

coresearchers provided us with an important tool for considering such researcher effects in 

detail. The different positions that we as researchers and the service users as coresearchers 

represent, contributed to an increased focus on this reflexive attitude. Through dialogue with 

our coresearchers we also became increasingly attentive to our own participation in the research 

project. As such, this collaboration held potential for creating a metaperspective, which again is 

an important strategy for continuously articulating questions to the subject matter (Malterud, 

2001b). 

 

Researchers and coresearchers 

The researchers have experience with therapy in the field of mental health care and qualitative 

research on topics within this area. The first, second and last authors as clinical psychologists 

and the third author as an occupational therapist; the first author as a research fellow in clinical 

psychology, the second and last authors as professors in clinical psychology, and the third 

author as a professor in mental health care. The group of 12 coresearchers was selected from the 

largest service user organization in the field of mental health care in Norway and from the local 

health trust in the western part of the country. They all have firsthand knowledge of mood 

disorders and processes of recovery. Many of them have experience as service user 

representatives in the mental health system and most were active within service user 

organizations.  

 

Participants 

Thirteen informants, seven women and six men, participated in the study. Their age ranged 

from 27 to 65 years, with a mean age of 47 years. All were ethnic Norwegians residing in the 

western parts of the country. The participants reported both bipolar I and bipolar II diagnosis; 

and many described co-morbid clinical problems such as anxiety, post-traumatic stress 

disorder, psychosis and attention-deficit/hyperactivity disorder. The participants recounted that 

they had struggled with symptoms of bipolar disorders over the past 2 to 30 years, with a mean 

period of 18 years. Exclusion criteria for participation were alcohol or substance abuse as a 

primary diagnosis and inpatient and/or electro convulsive treatment within the past six months, 

so that none of the participants were in a severe episode of illness at the time of interview. 

 

Data collection 

Ten participants were recruited through their local outpatient clinic and three through 

advertising in the largest local newspaper in the western parts of Norway. All participants self-

identified as having experiences of recovery from bipolar disorders and contacted the first 

author by telephone or e-mail after reading the newspaper ad or receiving initial information 

about the study from their therapists. Individual in-depth interviews were chosen in order to 

facilitate an open exploration of participants’ lived experiences. The first author conducted the 

interviews which ranged from 45 to 110 minutes, with most lasting about 80 minutes. They 

were audio-taped and transcribed verbatim.  

 

 



 

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Data analysis 

In line with our hermeneutical-phenomenological approach, we aimed at generating knowledge 

about the lived experiences in finding out that one is struggling with a bipolar disorder, and to 

attain a reflexive position where we, through collaboration with our service user coresearchers, 

aimed at being aware of our own participation in the research process. Our analysis was 

technically supported by NVivo 8 (QSR International, 2008), and proceeded through the 

following steps inspired by Alvesson and Sköldberg (2000), Finlay (2002; 2003), Kvale and 

Brinkmann (2008), Malterud (1993), and van Manen (1990): 

 

1. The first author noted his initial impressions after conducting and transcribing each 
individual interview, and discussed important topics that arouse with the second 

author.  

2. The first, second, and third author thereafter read all the transcriptions to obtain a basic 
sense of them (Malterud, 1993). 

3. Exploring those parts of the interview that were of relevance to the research questions, 
the first author identified units of meaning that represented different aspects of the 

participants’ experiences and discussed them with the second author (Kvale & 

Brinkmann, 2008). 

4. The first author then developed codes or keywords for those units of meaning. 
5. The meaning within each of the coded groups of text was thereafter interpreted and 

condensed into everyday language by the first author (Kvale & Brinkmann, 2008). 

6. The content of each code was summarized into overall descriptions of themes and 
meaning patterns that reflected the first author’s understanding of what emerged as the 

most important aspects of the participants’ experiences (van Manen, 1990).  

7. For validation and reflexive purposes (Alvesson & Sköldberg, 2000; Finlay, 2002; 2003), 
the first author then presented these themes along with de-identified extracts of the 

transcribed text to the coresearchers in a two-day collaborative meeting in which the 

second and third authors also participated. 

8. The second author led a process in which the group of coresearchers critically audited 
the themes and negotiated a common orientation to the phenomenon of study (van 

Manen, 1990). This process was recorded by the first author in notes in which he aimed 

to pay attention to both the homogeneity and heterogeneity of the group’s 

interpretations. 

9. The first author thereafter reorganized the themes and discussed the research process 
and resulting meaning patterns with the last author. 

10. Finally, the themes were formulated and agreed upon by all authors, and presented for 
a concluding validation at another collaborative meeting with the coresearchers. 

 

Ethics 

The study was approved by the Regional Committee for Medical and Health Research Ethics 

Western Region and the Norwegian Social Sciences Data Services. Informed consent was a 

requirement for participation. Before the service user coresearchers were presented extracts of 

the transcript material, they signed a declaration of confidentiality and all identifiers were 

removed. The participants were informed of the coresearchers roles and participation in the 

project.  

 

Findings 

In the individual interviews, the participants described how they first experienced various 

symptoms and problems that they later identified as a bipolar disorder. This process of learning 



 

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and recognizing their distress was experienced as a challenging and enduring enterprise. For 

some it was a sudden shattering of their worlds, for others a lurking feeling that something was 

wrong. All of them, however, described this process as hard and demanding, as it required that 

they began to give meaning to the intense experiences of not knowing what was happening to 

them. In their efforts, the participants gradually started to acknowledge that their emotional 

and psychological distress was in line with descriptions commonly seen as a severe mental 

disorder. This was a strenuous and painful task for many, but it also created an important 

momentum to discover what they actually could do to overcome their symptoms and distress. 

In our presentation, we have organized the participants’ descriptions of how they found out 

they were struggling with their mental health into three phases through which they manoeuvre 

from (a) “uncertainty and confusion” through (b) “grasping the novel and unusual experiential 

states” to (c) “giving meaning to the lived experiences of intense ups and downs.”  

 

“I didn’t recognize myself anymore” – Uncertainty and confusion 

An initial state of not knowing what was happening to them was a common description among 

participants in the present study. All of them highlighted a phase of uncertainty and confusion 

in their lived experiences of finding out they were battling a mental health problem. For some 

of the participants, this phase was characterized by a growing feeling that something was 

wrong. They had for some time noticed experiences that were difficult to comprehend and 

relate to. Others described the onset and unveiling of their symptoms as an acute breakdown. 

Suddenly they were hammered by intense experiences they could not understand. In both 

cases, participants experienced various symptoms and problems as both extremes of moods – 

high and low – started to affect their lives in new and different ways. These evolving bodily, 

emotional, and psychological phenomena puzzled and confused them. A description of how a 

blurring and novel feeling of sadness developed as a boyfriend left one of the participants can 

illustrate this: 

 

When this man left me, I gradually became more depressed. And that was kind of a 

new experience to me. I had been sad earlier, but this time my thinking started to 

become… I didn’t manage to do things, organize things the way I had been able to 

earlier. And it was very chaotic. Very chaotic. It was an unfamiliar feeling to me, but I 

didn’t think of it like a depression, I wasn’t able to see it from the outside. 

 

In another interview, a young woman reflected on how she experienced the unveiling of her 

first episode of elevated mood. As in the description above, this participant highlighted the 

sense that something was going on, and at the same time she felt that she was not able to 

understand what it was. For her, the “something” was experienced as originating in her body. It 

was a kind of tingling or distress that she was struggling to figure out and comprehend. In the 

following account she described how she suddenly found herself shaky and distressed at a 

holiday trip with a friend: 

 

When I had been there for about three days, I felt there was something happening to my 

body, and my friend felt like she didn’t know me at all. She was wondering if I had 

been doing drugs or something, and was very upset with me. Actually, I had only been 

drinking water and eating some fruit, I hadn’t been liquoring up at all, so I didn’t 

understand what was going on. That’s when we found out we had to go look for a hotel 

so that we could get some peace and quiet as an alternative to the motel we were living 

in. . . . And as we were out looking, I felt a tingling in my body. I thought I was having 

some kind of sun stroke or something. I was really off. 



 

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For many of our participants, not being able to make sense of these experiences was 

challenging. A growing awareness that something is happening to oneself and at the same time 

not getting hold of what it is, can be scary – particularly so when the experiences are as colorful 

and intense as they can be in periods of elevated mood. A female participant described her first 

experiences of these vivid and altered psychological states as a frightening feeling of her mind 

being like a high speed rail that was running continuously. However, she did not realize what 

was going on as she just thought she was “all stressed out.” This uncertainty and confusion 

created an increasing need to respond to the psychological and emotional state that developed. 

In the interview she described how she eventually stepped in and started the process of 

addressing what was going on in her life:  

 

Then I thought this isn’t working out, I had only a few hours of sleep night after night. I 

got up in the morning, started at about five a.m. and was full of energy. I had only slept 

an hour or two, three, four hours. That was when I thought – this isn’t normal, this isn’t 

who I am. I have been all stressed out before, but I have never been like this. 

 

The participants’ need for awareness and understanding was met by engaging others who 

could help them in this process. As such, the uncertainty and distress seemed to drive many to 

make connections that could enable them to understand more of what was going on. A male 

participant, for example, described that even though he had no prior experiences with 

psychiatric treatment or services, he intuitively felt the need for mental health care when he 

experienced a new and different kind of pressure: 

 

Interviewer (I): Can you tell me about how you first found out you had a bipolar 

disorder? 

Participant (P): Then we’ll have to go back several years. . . I was working full time, and 

got a lot of work from my employer. That is, it was a lot of pressure [at the time], and 

suddenly, in only a few weeks, it all built up. And I had never heard about psychiatry 

or anything, but I understood that something was wrong and got to see my company’s 

on-site doctor. Instinctively I understood that I was in need of psychiatric assistance, I 

didn’t know what it was, but I knew I needed psychiatric help. 

 

Participants’ first step toward awareness and understanding was in this way an active one. By 

deciding to communicate their uncertainty and confusion to others, the participants initiated a 

movement toward the next phase in finding out what their unusual experiences were about. 

The interview with the young woman, who was on vacation when a novel and intense state of 

elevated mood developed, can help to shed light on this. She described how she started to talk 

to her friend about her experiences. Together they then agreed upon making contact with the 

local health authorities: 

 

That’s when we talked about that something was not right. I was in despair, I didn’t 

recognize myself anymore. I was very stressed and very shaky. . . . And that’s when we 

found a small local hospital where we got help immediately. 

 

“Now you’re either manic, mum, or you’ve won the lottery” – Grasping the novel and unusual 

experiential states 

We have interpreted our participants’ commencing efforts to grasp and understand their 

experiences as the second phase in the process of finding out they were battling a mental health 



 

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problem. In order to move beyond their feelings of uncertainty and confusion, the participants 

approached their experiences through discussing them with others. Some of them initially 

talked to their family or friends, but eventually all made contact with health care professionals. 

For some, these relationships were established quite quickly, but most had suffered symptoms 

and pain for many years before they got in touch with the health care system. As a first step 

toward grasping their distress and relieving their despair, the participants in this phase 

disclosed their experiences and feelings. One of them described how she explicitly had thought 

about the possibility that her symptoms and distress could be coined a bipolar disorder. 

However, despite her suggestions and proposals, she still did not receive health care that could 

meet her needs:  

 

I’ve had problems with mental fluctuations and depressions since I was young, and I’ve 

had many turns with the health care system, to medical doctors, referrals to clinical 

psychologists. That is, I approached many people and said that there is something I 

need help with. . . . I don’t think I ever got a thorough screening, but what I knew was 

that my grandfather was manic-depressive and that some of his brothers and sisters 

were ill too. And that there was something… I knew my mother had struggled with 

depressions and that there was something with my own experiences of… I didn’t think 

in terms of mood, I didn’t use that vocabulary at the time. But there still was something 

that made me think – is there something to it? At one point I asked a psychologist I was 

in treatment with openly. . . . But I didn’t get any answers. It was on the one hand like 

this, and, on the other, like that. 

 

Most of our participants, however, did not have as concrete ideas or straightforward 

approaches as this woman. As such, many of them described spending years battling the 

system as well as their symptoms in this process. Their initial feelings of uncertainty and 

confusion made them anxious and insecure, and for many this anxiety was enlarged and 

prolonged as they experienced that others were also unable to understand what was going on. 

This was particularly pertinent in relationships with professional health care workers – the kind 

of others the participants expected and counted on to be capable of offering them some help in 

relation to their distress. Many of the participants in this study highlighted negative experiences 

related to this. One of them described, for example, being given medication for gastroenteritis 

while presenting a major depression, another how a nurse at an intensive care unit tried to talk 

her out of transferring to a mental hospital because she could be in danger of disappointing her 

family and friends. A third participant elaborated this point further. She had initially thought 

her mood fluctuations were the effect of premenstrual syndrome or possibly the aftermath of an 

infertility treatment. Gradually she then started to develop a feeling that there had to be 

something more to it: 

 

P: I summoned my courage, I realized that it was mental, and went to a medical doctor 

who stood with her back onto me, arranging her hair, and… I spilled my guts, I 

divulged my soul and secrets, for the first time I talked about it. And when I was all set, 

at first I was there to do some samples, and when I was all set I received a letter that I 

might be anemic. At that moment I fell apart. Because the prize of making my problems 

known was very high at that time, and she didn’t see the issue at all. 

I: What did you say to her? 

P: I told her that I had the most gorgeous child, I had a sweet and supporting husband, I 

had a nice house and all. But nevertheless, I was in the dumps. I cried from the time I 

left work on Friday until Sunday afternoon, I was desperate and everything was off. 



 

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And when I went to work I just stood in the resting facilities shedding my tears, hoping 

that no one could see me, because then I would have broken down. And then she says 

that I might be a little anemic. 

 

One of the male participants had until recently very similar experiences with the health care 

system. He had received little or no help from his doctors besides symptomatic medication, and 

described how he over a long period of years had moved from one episode of illness to another. 

Eventually he was not able to put up with his demanding position as a leader and had to take 

sick leave. At the time he had massive digestive problems and struggled to catch on to how 

these complaints were related to his mental health. This time, however, he met a general 

practitioner who was able to help him start to grasp these experiences. In the interview, he 

described how he felt the relationship between his stomach-related problems and his mental 

health issues got uncovered by his doctor:  

  

How I first found out I had a bipolar disorder? Let me put it in a different way – how I 

got unmasked by my medical doctor who then intervened and helped me. And in that 

process, I was diagnosed with bipolar disorder as well as generalized anxiety, social 

phobia and post-traumatic stress disorder. . . . But I had my first downers when I was 

about 18 or 19 years old, maybe even earlier. What happened then was that I saw our 

family practitioner who gave me a box of pills, antidepressants I think, which I ate and 

perhaps got a little better. Thereafter I had new setbacks and got new boxes of pills. But 

I never knew that I had a disorder in any way, it was just that I had a hard time and 

needed help to get back on my feet again. . . . And when my doctor looked at me and 

said: Are you depressed? - at that point she unmasked me, she brought light to what the 

problem was. 

 

To approach and grasp such confusing periods of bodily symptoms and extended sadness was, 

however, not sufficient to find the appropriate treatment and care for the participants in the 

present study. For some of them, identifying these episodes of depression only led to a 

temporary feeling of being understood, as treatment with antidepressants was of little help for 

their problems and distressing life situation. Instead, this seemed to worsen the course of their 

symptoms, as it triggered for many participants an intense period of elevated mood. They were 

once more left feeling uncertain, confused and not being listened to as their symptoms and 

distress escalated and intensified. The following account describes how a female participant 

experienced the onset of a manic episode. She was at the time trying to communicate her 

growing feelings of anxiety and despair as psychotic symptoms emerged. Paradoxically, it was 

ultimately her son who identified her unbearable complaints as a manic episode: 

 

P: I started on [antidepressants] and was supposed to talk to my general practitioner 

again. . . . I made contact with my doctor, I don’t remember how many days I used the 

medication, but I responded extremely from day one. I made contact with my doctor 

and said that I’m not sure that I have nerve to use the medication any more because I’m 

going crazy, I’m afraid of becoming psychotic. . . . Because there is something strange 

going on that has never happened to me before. But no, I shouldn’t stop taking my 

medication, I shouldn’t stop. . . . I observed by myself that there was a change and 

that… And then, then I became very ill. 

I: What was it that changed? 

P: Well, I became psychotic. Everything was… I went to my doctor and said that 

everything was fantastic, all my problems were going away. . . . And at the same time as 



 

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I felt that all my problems were going away, I had a panic attack. When I tried to 

communicate to her how I was doing, I used two images, because there was something 

going on that I had never experienced before. The first was that I was running on ice 

and I had to run faster and faster to keep me from falling. The second was that I felt like 

a runaway horse. At that time I was psychotic. And before I got hospitalized, I sat in my 

kitchen, and my son said, he suspected it, that now you’re either manic, mum, or you’ve 

won the lottery. 

 

Communicating these confusing states associated with the extremes of moods in mania and 

depression can be hard. The experiences that the participants had not yet developed the words 

to describe, can for many of them have triggered a need to simplify and concretize their 

complex experiential world. This, in turn, may have created challenges in their communication 

with the health care professionals. As such, the participants were clearly in need of an especially 

attentive and caring health professional at this point in the process of discovering their mental 

health problems.  

 

“I’ve been wondering if that’s enough, am I thereby manic-depressive?” – Giving meaning to the lived 

experiences of intense ups and downs 

As our participants moved from their initial feelings of uncertainty and confusion, through a 

phase of seeking help from others in starting to grasp their novel and unusual experiences, they 

eventually arrived at a place where they began developing ways of giving meaning to these 

extreme bodily, emotional and psychological states. One example of reflections that characterize 

this phase can be drawn from an interview with a female participant who retrospectively tried 

to relate her lived experiences of intense ups and downs to the diagnostic terminology of a 

bipolar disorder: 

 

I: What’s it like to think back on this period now? 

P: No, it’s… It’s emotional, of course, because it’s not something I reflect much upon 

today. . . But I’ve thought about it like… Okay, the first thing that happened, that was a 

depression. But then what… And then a manic period followed, that’s true. But I’ve 

been wondering if that’s enough, am I thereby manic-depressive? Because it’s kind of… 

At least it felt very natural. After being in a state of void and meaninglessness, when I 

once again felt meaning and worth… It seems to me more of a normal reaction. 

I: For you it felt like… You think of it as natural. 

P: Yes. And also the thing that happened afterwards, the [childbirth] . . . They say it is 

normal to have special reactions . . . because of the hormonal changes.  

 

People make sense of their experiences in different ways. As such, the phase of giving meaning 

to the states in both extremes of mood was built up by a multitude of views and reactions. Some 

of the participants weighted their responses to the diagnosis in this process. It could be 

experienced as carrying stigma and sometimes like a prophecy of doom. Others, again, focused 

on how their growing understanding of what was going on could be a comfort and relief. For 

many of them, recognition and acceptance enabled them to work on their problems and 

distress. In the interviews, most of our participants described nuances of both these polarities. 

We have termed the subthemes “challenges in defining one’s symptoms” and “recognition as a 

step toward recovery.” 

 

Challenges in defining one’s symptoms. Being diagnosed with a mental illness can be a demanding 

and challenging exercise. Some of the participants in our interviews put weight on this aspect in 



 

30 
 

 

the process of giving meaning to their experiences. For them, understanding and labelling their 

symptoms and distress as consequences of a bipolar disorder was not necessarily helpful. One 

participant elaborates on this point in the following words: 

 

P: The only thing is that I don’t feel I have gained something when trying to understand 

myself. Being given that diagnosis with… That it… It is, you know, categorized as 

serious, isn’t it? 

I: Well… 

P: Serious or severe or something like that. And that… Being given that label without 

anyone trying to make me more comfortable with it or help me increase my 

understanding of it… What kind of consequences this may have… It’s just that I’m left 

with too many questions in relation to this. 

 

Other participants went even further with regards to this. For them, the diagnosis became 

another painful problem they had to deal with. A male participant described it initially as 

doubling his burden, as he already had an anxiety condition he had spent years battling, and a 

female participant highlighted how difficult it was to integrate and relate the diagnosis to her 

sense of self: 

 

That’s part of my suffering right now, the pain related to the diagnosis. I know that this 

is different from person to person, but to me it wasn’t a relief being given the diagnosis. 

I thought it was totally awful because it carries so many conceptions in me and in the 

society too. . . . Totally awful that my children must have a mother with this diagnosis, 

that’s the worst part of it. But I acknowledge that there has been too much drama in my 

life. I do see that there are things that support the diagnosis. . . . It’s not that I’m of the 

opinion that the diagnosis is wrong, but it’s been extremely difficult for me to relate to. 

They introduced it as, I’m not sure whether they called it bipolar or if they used the 

term manic-depressive. It’s possible that they called it bipolar, but anyway, manic-

depressive, severe mental disturbance. No, that was… To integrate that as part of self… 

That is – I am severely mentally disturbed? Dear God, I am… And then I thought – no, 

that means that everything is over, I have nothing to look forward to. 

 

At the same time, this woman acknowledged that her diagnosis was important as something 

she could relate her experiences to, as well as to provide information on how she could navigate 

in her daily life to keep well. But still, identifying with the diagnosis and integrating it as part of 

her sense of self was a difficult and utterly distressing task. Another female participant 

responded similarly when the interviewer posed a question about what the process of 

assessment and being diagnosed was like. She found acceptance particularly challenging as a 

family member she was displeased and sickened with had had the same diagnosis of bipolar 

disorder: 

 

I didn’t like it. I didn’t like it at all. And that was probably because of the knowledge I 

have about it through my brother. I don’t look at myself like that at all. But I do 

appreciate that professionals have assessed me, and in my experience no one wants this, 

most people deny it, and I guess I think it’s better to accept that I have this and work 

from that position rather than battling the diagnosis. 

 

Recognition as a step toward recovery. An important part of giving meaning to the experiences of 

mania and depression was to find ways of relating to the multifaceted aspects of these 



 

31 
 

 

phenomena. Many of the participants had experienced loneliness and alienation in the process 

of finding out that they were battling a bipolar disorder, and these difficult feeling states were 

enlarged and prolonged as they recognized that others were unable to help them understand 

what they were going through. With regards to this, discovering that they had a bipolar 

disorder could be a relief, as the participants finally experienced that they were not alone and 

detached anymore. One of the participants highlighted this process of identification as she 

described the value of a group-based intervention she attended at her local outpatient clinic:  

 

Even though they didn’t have the same diagnosis as me, they had other problems and 

other diagnoses. And… to put a face on mental illnesses and meet other people who 

were like me. Normal… All kinds of ages and life situations and… A lot of young 

ladies… To be able to talk together and be together, that was very important. Yes, it 

was. Previously I felt like I was the only one being ill, and then I arrive and meet so 

many others who live well organized lives, just like everybody else. That gave me 

courage to keep fighting. 

 

Figuring out and being able to give meaning to their experiences was also comforting and 

reassuring to many of the participants. They contrasted their present symptoms and distress 

with the uncertainty and confusion that coloured their first experiences of the emotional and 

psychological shifts of intense ups and downs. Said one participant: 

 

Had I, when I first became ill, known that I was ill, I would probably not have tried to 

commit suicide. Do you get it? I didn’t know that I was ill, I was just not worth 

anything. That’s what’s helped me later – that when I’m ill, I know I’m ill, that there is 

help out there. 

 

As such, for many of the participants, discovering their symptoms and distress created an 

important momentum in their recovery. One of the participants underscored this period as a 

turning point in her processes of healing and growth: 

 

I: Thinking back on this process, when was it that you first felt you were improving or 

that you were in recovery?  

P: I think it was when I received the diagnosis. I think it was then, when I was given 

proper medication. I think that’s when I felt that I was able to see the light in the tunnel 

and start to work my way back to life. . . . 

I: So it was in the beginning, when you received the diagnosis and started on the 

medication. That was an important period. 

P: That was a hard period. To kind of accept that one is ill. But it was also… It sort of lit 

a fire at that point. Now I have received a diagnosis, now I have got my medication, and 

now I can start. 

 

Discussion 

What do our findings tell us about the experience of finding out that one’s problems and 

symptoms can be understood as a bipolar disorder? How is this exercise of giving meaning to 

one’s distress related to the processes of recovery? And what are the implications of our 

findings for practice? In this study, we have presented the process of discovering a bipolar 

disorder from a first person perspective. We have identified three phases as our participants 

move from (a) “uncertainty and confusion” through (b) “grasping the novel and unusual 

experiential states” to (c) “giving meaning to the lived experiences of intense ups and downs.” 



 

32 
 

 

These phases are seen as themes that describe an epistemological movement through which 

participants start to create a new understanding of who they are and what they can become. We 

interpret this progression towards recognition as both a challenge as well as a drive in the 

participants’ processes of recovery. 

 

From feeling lost to the ambiguity and diversity of finding out 

What is happening to me? Why does everything seem so grey and dull? What is going on? Why 

are my thoughts and feelings racing away? These are questions the participants asked 

themselves in the initial phase of “uncertainty and confusion.” A sense of being lost arouse for 

many as their lives and experiences were suddenly unknown and incomprehensible. In order to 

approach and understand this phenomenon, we may turn to Heidegger’s (1962) notion of 

Unheimlichkeit in which he describes and explores experiences of uncanniness and 

unhomelikeness. This concept has been seen as important to understand the phenomenology of 

illness (Svenaeus, 2000a; 2000b) and as notable in the process leading up to an existential 

breakdown in exhaustion disorder (Jingrot & Rosberg, 2008). Finlay and Molano-Fisher (2008) 

have moreover demonstrated how it also can be of significance in comprehending other 

phenomena, as they argue that the concept is helpful in approaching the existential anxiety that 

can follow the transformed lifeworld after a cochlear implant. 

 

According to Heidegger (1962), we have a fundamental familiarity with our lifeworld, a 

homelikeness, that co-exists with uncanniness and unhomelikeness, feelings of being alienated 

or not at home: “This is my world, but it is also at the same time not mine, I do not fully know it 

or control it” (Svenaeus, 2000b, p. 215). Heidegger (1962) argues that this basic Unheimlichkeit 

may lead to existential anxiety, moments in which the world looses its meaning. In his 

presentation and interpretation of Heidegger’s philosophy, Svenaeus (2000a; 2000b) makes use 

of this concept in understanding health and illness. Illness is here seen as a rupture in the 

familiarity, balance, and rhythm that characterize good health. Feelings of being unhomelike 

and out of tune will gradually emerge as illness sets in: “Where there was earlier a homelike 

attunement, there is now the growing despair of uncanniness” (Svenaeus, 2000a, p. 12). 

 

In our participants’ process of finding out they were battling a bipolar disorder, many described 

how they were not able to recognize themselves anymore. They highlighted frightening 

sensations of something happening to their bodies and unfamiliar feeling states that suddenly 

seemed to arise. As such, our participants described a growing anxiety and alienation – what 

may be described as an evolving state of Unheimlichkeit. These experiences of being lost, strange 

or out of control were in our material further amplified as people around the participants were 

also unable to understand and give meaning to their experiential world. Why do not my family 

and friends recognize me either? And what does it mean than not even my doctor or therapist 

seems to know what is going on?  

 

The participants’ lived experiences of not being able to understand and control what was going 

on in their daily lives were in some ways validated and confirmed through their initial meetings 

with others. Many described how no one seemed to be able to help them make sense of their 

symptoms and distress. As such, the described phase of “grasping the novel and unusual 

experiential states” that emerged in the participants’ lives prolonged and enhanced their 

feelings of uncanniness and unhomelikeness, their experiences of not knowing and not 

controlling their own lives. According to Lam and Wong (2006), it is often observed in clinical 

work with persons with bipolar disorders that depression can spiral down and mania can fuel 

itself. As such, this kind of existential anxiety can be an important aspect in the first person 



 

33 
 

 

perspective of battling such mental health problems. A particularly crucial challenge when 

facing bipolar disorder may therefore be to find ways of taking charge in one’s own life. But 

how can individuals wrestling a bipolar disorder go about resuming control and promoting 

their personal recovery? How can the person regain his or her feeling of homelikeness? 

 

In the present study, we find that two different roads characterize participants’ experiences in 

the phase of “giving meaning to the lived experiences of intense ups and downs.” While the 

participants were similar in their descriptions of the first two phases, their experiences of 

developing ways of understanding their symptoms and distress were more varied and 

divergent. As such, we may say that a heterogeneity characterized their experiences of this 

phase. Many of the participants felt comfort and relief as they eventually were able to recognize 

and understand that they were battling a bipolar disorder. Others emphasized that they 

struggled to find themselves at home in the diagnosis and descriptions of a severe mental 

disorder. Thus, knowledge and recognition seemed to be important to, as well as a challenge in, 

the participants commencing processes of recovery. The security of knowing what is going on 

in one’s life can in many ways be seen as principal to initiating one’s personal recovery. Several 

studies have shown that accepting that one is struggling, being able to manage one’s symptoms 

and resuming control in one’s daily life are important to processes of improvement and growth 

(Davidson, 2003). Acceptance, management and control presupposes, however, that one is able 

to recognize what is happening in one’s life. For some of the participants in our study, 

recognition also indicated that they were not alone as they found an implicit ‘we’ in the 

diagnosis. To them, the phase of giving meaning to symptoms and distress may therefore have 

been an important answer to the loneliness, alienation, and anxiety they had experienced.  

 

At the same time as the participants weighed these favourable sides of recognition and 

understanding, they had clear experiences of not wanting the label that the diagnosis 

constituted. Deegan (1993) describes similarly how she experienced that others suddenly got 

blind to the person she was and tended to see her only as an illness when she was diagnosed 

with a major mental illness. This was particularly challenging with regards to initiating her 

processes of recovery:  

 

Once a person comes to believe that he or she is an illness, there is no one left to take a 

stand toward the illness. Once you and the illness becomes one, then there is no one left 

inside of you to take on the work of recovering, of healing, of rebuilding the life that 

you want to live (Deegan, 1993, p. 9). 

 

From this perspective, recovery is not necessarily about finding a homelike feeling in one’s 

symptoms and distress, but may as well be about building a new house that one can call home. 

Following this line of thinking, Davidson et al. (2007) have defined recovery as “a process of 

restoring a meaningful sense of belonging to one’s community and positive sense of identity 

apart from one’s condition while rebuilding a life despite or within the limitations imposed by 

that condition” (p. 25).   

 

Methodological limitations and strengths  

In order to ensure the integrity and increase the validity in qualitative research projects, 

monitoring and evaluating one’s own presence in carrying out a study is of importance to the 

quality of the research (Finlay, 2002). In many ways, this is an exercise of sidestepping in which 

the aim is to make one’s position and preconceptions explicit and transparent to both oneself as 

well as the audience. This may provide what Malterud (2001b) metaphorically calls “the 



 

34 
 

 

knower’s mirror” – a frame in which researcher and readers are offered the context of the study 

so as to be able to evaluate and understand the whole process of carrying it through. In the 

present study, we have given relatively many quotations to enable the reader to see the ways in 

which we have reached and understood our findings.  

 

Collaboration with our service user coresearchers provided us with an important tool for 

working with a reflexive attitude throughout the research process. The approach also holds, in 

our opinion, the potential of both validating our results as well as expanding our understanding 

of them. As the coresearchers and participants were two distinct groups of persons, we were 

able to keep close to the phenomena of study by maintaining the context and references that 

firsthand knowledge may represent, and at the same time the approach made possible the 

necessary distance for approaching and understanding differences in such experiences. When 

analyzing one’s own experiences, for example, this may be particularly challenging. One 

example of contributions from our coresearchers can be drawn from the meetings focusing on 

data analysis. In the initial interpretation and condensation of the first phase of “uncertainty 

and confusion,” the first author weighted anxiety as a central aspect of the participants’ 

experiences in the process of finding out that they were battling a bipolar disorder. In their 

auditing of the data, however, the coresearchers put equal weight on solitude and alienation at 

this point in the process. Where we as researchers saw illness in our interpretations, the service 

user coresearchers then saw existential themes – where we emphasised anxiety, the 

coresearchers also made us aware of the loneliness in this phase. Through this process, then, the 

coresearchers both endorsed our interpretation of the data and elaborated on our 

understanding of the phenomena (see also Veseth, Binder, Borg, and Davidson (2012) for an 

additional discussion on our experiences of collaboration in this research project, and Moltu, 

Stefansen, Svisdahl, and Veseth (2012; 2013) for a study of the coresearchers experiences of 

doing collaborative research).  

 

In the present study, the participants highlighted the health care system as important in their 

efforts to give meaning to their intense experiences – both for good and for bad. It is possible 

that for some persons battling a bipolar disorder, other institutions could have played an 

equally important role in these processes. Spirituality or faith may, for example, hold potential 

for contributing to the development of meaning in many people’s lives. However, because most 

of our participants were recruited from within the health care system, we were not able to reach 

persons who could have described and elaborated more on these experiences. Furthermore, it is 

also possible that the interviewer’s background as a clinical psychologist may have influenced 

the dialogue in direction of focusing on experiences within the health care system. If the study 

had been conducted by a social anthropologist or a religious leader, it may be likely that we 

could have found other ways of giving meaning to one’s symptoms and distress that were 

equally important.  

 

Another possible limitation in the present study is the relatively small and homogenous group 

that our participants constitute. They were all adult ethnic Norwegians who lived under the 

same cultural horizon. The participants had battled their symptoms and distress during the 

same period of time and had dealt with a more or less identical health care system. However, as 

we have aimed at being transparent in our methods, as well as in our presentation of our 

findings, the reader can independently evaluate if our findings and interpretations can be 

translated to his or her particular cultural context.  

 

 



 

35 
 

 

 

Implications for practice 

A key finding in our presentation is that the experience of discovering that one’s symptoms and 

distress disclose a bipolar disorder is a diverse and multifaceted process. We believe that one 

important consequence of the present study is that it underscores the need for a multitude of 

treatments and ways of supporting individuals in their own personal recovery. This may be 

particularly pertinent in bipolar disorder as the diverse and multifaceted process traditionally 

has been met by a uniform approach to therapy in which medication has been described as the 

only real treatment option.  

 

Another important finding in our study is the significance of giving meaning to the lived 

experiences of symptoms and distress. We are of the opinion that professional helpers should 

put more weight on this process when conducting treatment. Our findings indicate that it may 

be of importance that therapists give the person battling a bipolar disorder time and space to 

initiate his or her own process of creating meaning. In this way, professionals can become a 

complementary part of the joint creation of new understandings of the person’s problems and 

processes of recovery, instead of being in danger of imposing their own therapeutic 

perspectives onto the individuals. 

 

Conclusion 

In the present study, we have explored the lived experiences of finding out that one’s 

symptoms and distress are in line with what is commonly described as a bipolar disorder. We 

have interpreted this process as three phases through which the participants move from (a) 

“uncertainty and confusion” through (b) “grasping the novel and unusual experiential states” 

to (c) “giving meaning to the lived experiences of intense ups and downs.” We have discussed 

our results in relation to theory and research, considered the process of conducting the present 

study, explored possible strengths and limitations, and finally outlined some implications for 

clinical practice. 

 

Acknowledgements 

We are indebted to the participants in the study for sharing their views and experiences. In 

addition, we thank our coresearchers for their valuable contributions. 

 

Funding 

The project was financed with the aid of EXTRA funds from the Norwegian Foundation for 

Health and Rehabilitation. 

 

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Authors 

Marius Veseth (Department of Clinical Psychology, University of Bergen, Norway and 

MoodNet Research Group, Haukeland University Hospital, Bergen, Norway), Per-Einar Binder 

(Department of Clinical Psychology, University of Bergen, Norway), Marit Borg (MoodNet 

Research Group, Haukeland University Hospital, Bergen, Norway and Department of Health 

Sciences, Buskerud University College, Drammen, Norway) and Larry Davidson (Program for 

Recovery and Community Health, Yale University, New Haven, USA). Corresponding author: 

Marius Veseth. Email: marius.veseth@gmail.com