How Do We Know What Is Real?

QUESTION: I believe my husband is bipolar. We have been married for over ten years. He thinks he is just depressed, but he has had major mood swings over the years ranging from very depressed and suicidal to angry rage. He is bothered by life in general,most things are negative as he sees them. He's also very paranoid and thinks of things happening that are unrealistic. when we met he complained a lot, no matter what was happening. These are just some examples, but does this sound like depression, bipolar, or something entirely different?

ANSWER: Sometimes, people have trouble with what we call, "reality testing."  What this means is that some people can not always distinguish between what is real and what may be simply a thought or an assumption.  It sounds like his symptoms of rage, paranoia, and mood swings, are interfering with his life and your life together.  When a person can not distinguish inner thoughts and feelings from the external world, therapy and possibly medications can help reframe a person's understanding of what's real or not real.  I would recommend cognitive behavioral therapy as the technique will help your husband self-assess his internal thoughts and assess their influence on his mood and behavior.  He may need medication too.  There are a variety of medications that may help with his thoughts.  Now the hard part, trying to encourage him to seek counseling!  If he does not think he has a problem, then he will not go for therapy.  It may help you convince him if you take the time to help him assess his thoughts in the moment he verbalizes the thought. For example,  saying something like, "Let's see what evidence might exist to support that thought."  Of course if he has rage issues, please consider your own safety before challenging his thoughts.  There is also the philosophical debate about what is real.  Reality in Buddhism is called Dharma. Buddha says, "We are what we think. All that we are arises with our thoughts. With our thoughts, we make the world."  This means that our thinking pattern determines the ways in which we view all things that happen.  So one could argue that an individual's perception is reality, no matter how skewed others think it appears.  So your husband has a choice to continue thinking his negative thoughts, thus creating his "reality of paranoia and rage," or he can learn new ways of thinking that may, in turn, improve his mood and behavior. There may be several different diagnoses that would fit with his symptoms. Try your best to get him to see a mental health clinician.