Beyond the Bipolar Label: Dr. Andrea Vassilev on Self-Stigma, Shame, and Identity
Dr. Andrea Vassilev was diagnosed with a mood disorder at 14. Today she's a psychotherapist in Southern California who specializes in treating bipolar, a member of the Depression and Bipolar Support Alliance's scientific advisory board, and the author of Beyond the Bipolar Label: A Workbook to Overcome Self-Stigma, Break Free from Shame, and Live Authentically. In this episode of Success, Rewritten, she and host Emily LoMenzo Washcovick, who also lives with bipolar disorder, talk about the years bipolar took from her, what self-stigma is, and why healing never moves in a straight line.
In this episode:
What bipolar self-stigma is, and the two ways it develops
Why nearly 60% of people with bipolar don't fit the textbook bipolar I or bipolar II criteria
The difference between "I have bipolar" and "I am bipolar"
Dr. Andrea's non-negotiables for managing bipolar
How to support someone living with bipolar
Who is Dr. Andrea Vassilev?
Dr. Andrea Vassilev is a psychotherapist, author, and award-winning mental health advocate who treats bipolar through an idea she calls "making your mess your message." Before grad school she led a local peer support group for the Depression and Bipolar Support Alliance (DBSA). For her doctoral dissertation, she created a group program for self-stigma in bipolar that is now running at hospitals across the US, with translations into Japanese and Greek. Beyond the Bipolar Label, published by New Harbinger Publications, is that program streamlined into a workbook anyone can use.
She's quick to say her story didn't unfold neatly. "I don't want anybody to hear this and think, 'Oh, gee, things just worked out perfect for her,'" she says. "I'm very grateful, but I also want to acknowledge people who are really struggling, because I have been at all of those places."
What is bipolar self-stigma?
Dr. Andrea defines stigma as "the negative beliefs held about a group of people due to a difference in them." Self-stigma, by extension, is "the negative beliefs you hold about yourself due to a difference in you."
She sees self-stigma forming in two ways. The first is internalizing what society says about people with bipolar. The second is what she calls the cognitive distortion model, where a person takes something that really happened during an episode and makes it global, personal, or permanent. In the peer groups she ran, people would tell her they actually had been dangerous during an episode. Her response separates the moment from the person: "I did this one thing that was violent because I was having an episode. Well, now I'm a violent person. No, those are not the same thing."
Why does it matter when you're diagnosed?
Because Dr. Andrea was diagnosed so young, bipolar didn't carry much weight for her at first. "I had bipolar, I had red hair. Like, what is the difference, right?" she says. People diagnosed as adults often have a harder time, because they already have a full sense of who they are and have absorbed years of public stigma before the label arrives.
Emily was diagnosed as an adult, after a manic episode and hospitalization in 2018. She took to the diagnosis as information that explained a lot, but she has also wondered whether she would have believed as much was possible for herself if she'd been diagnosed younger.
What does recovery from bipolar look like?
For Dr. Andrea, recovery was anything but a straight line. She describes losing about 10 years of her life to being unable to work or move through the milestones her peers were reaching. "People spend their 30th birthday going out and partying and thinking about having babies and this and that," she says. "And I was having ECT treatments."
Her path included good years on lithium that eventually fell apart, followed by ECT and IV ketamine. She has been on her current medication for almost five years. After a hospitalization in 2010, she also moved from the Northeast, first south and then to California, because her seasonal mood patterns were so severe. She explains that receptors in the eyes connect to the part of the brain that controls circadian rhythm, which is linked to mood, so changes in daylight can push some people with bipolar toward depression in winter and elevation in spring and summer.
Why is bipolar so hard to diagnose?
Most people go 8 to 10 years between the onset of symptoms and a bipolar diagnosis. One reason, Dr. Andrea explains, is that about 75% of the time people with bipolar are unwell, they're experiencing depression. If someone shows up to a doctor while depressed, they may be treated with an antidepressant alone, which can trigger mania or simply stop working.
The diagnostic criteria are also narrow. According to Dr. Andrea, almost 60% of people in a recent global survey didn't qualify for bipolar I or bipolar II, which is why clinicians increasingly talk about a bipolar spectrum. Dr. Andrea herself falls outside both categories, because her manic episode didn't last the seven days the criteria require.
"I have bipolar" vs. "I am bipolar": does the language matter?
The identity section of Beyond the Bipolar Label looks at how the words you use shape the way you see yourself. "I'm not the language police, it's just research shows that that could be really helpful for some people," Dr. Andrea says.
Part of that work is learning to tell a symptom from a personality trait. If irritability is showing up, she encourages people to say, "That's not me. I'm unwell right now. That's a symptom. What can I do about it?" She's clear that it's not a free pass. It's a way to understand your own experience more accurately.
What's inside Beyond the Bipolar Label?
The workbook moves from understanding stigma and myth-busting about bipolar, into identity work and telling your own story, and then to its core in chapters four and five: identifying self-stigmatizing thoughts and reframing them to be more true and more helpful. Chapter six covers disclosure, including who to tell, what to say, and how to handle pushback. New Harbinger offers a free companion tool called the Disclosure Decision Cheat Sheet. Later chapters cover family, culture, and relationships, and close with wellness. The workbook also includes free book club activities for readers who want to work through it with others.
What are Dr. Andrea's non-negotiables for managing bipolar?
"My non-negotiables are meds and sleep," she says. She keeps a structured routine built on social rhythm therapy principles, sleeping at the same time for the same amount of time and doing the same things at the same time each day. Emily orients her whole day around her medication time too, because it sets her bedtime. As always, talk with your own care team about what works for you.
How can you support someone living with bipolar?
"Listen more and assume less," Dr. Andrea says. Every presentation of bipolar is different, so even if you know a lot about the condition, you can't presume to know a lot about one person's experience of it.
Is healing from self-stigma linear?
No, and Dr. Andrea doesn't want anyone adding judgment, on top of self-stigma, on top of bipolar. If you're not ready to talk about your diagnosis openly, that's where you are right now, and that's okay. "So don't judge your own level of self-stigma," she says. As she puts it near the end of the conversation, "Nothing about healing or nothing about life is linear."
Frequently asked questions
What is the difference between stigma and self-stigma? Stigma is the negative beliefs held about a group of people due to a difference in them. Self-stigma is when you hold those negative beliefs about yourself.
What’s the difference between bipolar I and bipolar II? Bipolar I is diagnosed when someone has had at least one manic episode, and depression isn't required for the diagnosis. Bipolar II requires at least one major depressive episode and at least one hypomanic episode, with no history of full mania. As Dr. Andrea explains, the difference between mania and hypomania comes down to impairment, psychosis, and duration. Mania lasts at least a week (or any length of time if hospitalization is needed) and can include psychosis, while hypomania lasts at least four days and is less severe. She also notes that the criteria are narrow and almost 60% of people don't fit either category, which is why many clinicians talk about a bipolar spectrum.
Where can people with bipolar find peer support? The Depression and Bipolar Support Alliance (dbsalliance.org) runs free peer support groups, including online groups. Registration is required.
Resources mentioned
Dr. Andrea Vassilev: andreavassilev.com and @best.life.bipolar on Instagram
Beyond the Bipolar Label (New Harbinger Publications)
Depression and Bipolar Support Alliance: dbsalliance.org
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