Bipolar Disorder, a psychological condition, can be overt, or it can be insidious. When overt, Bipolar Disorder can be frightening, destructive, and unpredictable in its highs, only to be followed by devastating lows. Bipolar Disorder in its insidious form can be alluring, bright, and expansive, but like above, it can be followed by emotional drops that have the ability to be wholly incapacitating.
My intent with this piece is to bring this topic into the light from the darkness of stigma. I am in the unique position to experience Bipolar Disorder both as a clinician and as one with the condition. Therefore, I am able to offer a well rounded view to you, the reader, about how it manifests, and its impact on my life. I am not alone, however. Dr. Kay Redfield Jamison is one of the preeminent researchers on Bipolar Disorder. She also lives with a particularly virulent form of the condition. Her brilliant and literary book An Unquiet Mind documents her journey through Bipolar Disorder as she strives to maintain a demanding life with ever-shifting moods.
Dr. Jamison defines Bipolar Disorder as a biological illness that is psychologically manifested [she prefers the term manic depressive illness, as in her mind it better captures the nature of moods, the hallmark of the condition] and indeed it is an illness of moods, ones with potentially tremendous highs and devastating lows. Ideally, I’d liken Bipolar Disorder to an emotional wave, one the crests then breaks but the timing of highs and lows are not always the same. In addition, there are various forms of Bipolar Disorder based on types of symptoms and the temporality of mood shifts, as well as specifiers further defining the condition.
The primary symptom of Bipolar Disorder (or more specifically, Bipolar I Disorder) is the manic episode. In order for Bipolar I Disorder to be formally diagnosed, a manic episode must be present. What constitutes a manic episode? According to the DSM 5 (the Diagnostic and Statistical Manual), the first symptom is “a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day.” To paraphrase, one has to have a mood that is in turn mercurial and heightened, with increased energy toward a particular goal. This is a defining feature of Bipolar Disorder. During this period of increased energy and mood, other symptoms (one does not need all of the following, but three to be exact) are required to make a diagnosis, namely grandiosity, decreased need for sleep, talkativeness or pressured speech, racing thoughts, distractibility, increase in socializing, whether at work or school or sexually; and much involvement in risky behaivor. The above symptoms need to severely and negatively impact social and work interactions, or to require hospitalisation to protect from harm to self and others, or to have psychotic features.
Following a manic episode is the seemingly inevitable depressive episode. Symptoms for this episode (five required) include depressed mood, inability to find pleasure in most or all activities, significant weight loss or weight gain, too little sleep or too much sleep, being significantly fidgety or sluggish, fatigue or loss of energy, feelings of worthlessness or inappropriate guilt, problems with concentration or decisiveness, recurrent thoughts of death, thoughts about suicide without a plan, speific plan for suicide, or a suicide attempt.
However, there are symptoms that constitute the hypomanic episode, and these episodes can be included with manic and depressive episodes to fulfil criteria for Bipolar I Disorder. Similar to mania, hypomania has a few distinct differences that are important to note. WIth hypomanic symptoms, they are the same as manic symptoms, except for the fact that the episode is not severe enough to cause marked impairment in social or work environments, not severe enough to cause hospitalisation, not severe enough to engender psychosis. The aforesaid separates a manic from a hypomanic episode. Bipolar I Disorder must include a manic episode and may include depressive and/or hypomanic episodes. Bipolar II Disorder includes hypomanic and depressive episodes.
The above symptoms may be read as immense and dizzying, but most people do not possess every one. Still, having Bipolar Disorder is frequently experienced as intense and disconcerting, owing to its seemingly overwhelming mood shifts. Dr. Jamison explained her moods manifest as
“Compelled with an immediate and inflaming sense of urgency, I ran off to the bookstore…I was weighed down with at least twenty other books…they seemed together to contain some essential key to the grandiosity tizzied view of the universe that my mind was beginning to spin…my mood would crash, and my mind again would grind to a halt…and I would wake up in the morning with a profound sense of dread…on occasion these periods of total despair would be made even worse by terrible agitation.”
Notice the cycling of moods seen in this short description. Throughout her book, Dr. Jamison takes the time to illuminate in detail the nature and the deeply internal experience of her moods, from a racing mind as well as behaviours to a kind of emotional flatness that could even be seen as a vast and deadening space.
My experience with Bipolar II Disorder does not necessarily mirror that of Dr. Jamison. I did not experience her manic psychosis and wild, out of control behaviour. Rather, my “up” phases consisted of less sleep, (waking up at two or three in the morning, wide awake) being quite talkative and social to an extreme, exhibiting elevated moods, and having racing thoughts. My “low” phases included depressed mood, excessive sleeping, significant weight and appetite fluctuation, feeling slow and with little energy, trouble with concentration, as well as dark and morbid thoughts. Although I am a psychologist, there was a time lapse first having these symptoms and getting a diagnosis. I was too mired in the mood shifts to recognize what this could be: mental illness. Frankly, I was profoundly relieved to have a name on for my jumbled symptom profile. (Of course, as a psychologist, I smacked my head, thinking “I cannot believe I did not see this”.) But again, I now recognize my blindness to my mental illness, as it were. Like Dr. Jamison, properly prescribed medication and an excellent therapist have slowed down my Bipolar II Disorder significantly – but I also know, both as a psychologist and one who has the disorder, that this condition has not permanently vanished. I have to be vigilant. I have to pay strict attention to my moods and watch for sudden shifts. I have to do so for my family, clients, and myself.
Because therapy is part and parcel to effective treatment for Bipolar Disorder, it is important to reach out and call for an initial consultation to best determine how to get your mental health needs met. There is nothing to fear when you speak to someone who is an empathic and skilled clinician. Think about it: call for your friends, your family, but perhaps most importantly, yourself.
Written by An Elegant Mind Clinician Dr Dana Wasserman, Psy.D., R. Psych.