If people were going to say it about me, then I was going to say it first and I was going to say it better. It’s my way of trying to own the situation.
— Carrie Fisher
If you know me well enough to be reading this, there’s a good chance you already know this about me: I have bipolar disorder. More specifically, Atypical Bipolar II.
I’m an open-book when it comes my mental illness. I’ve found that when I’m upfront about my own mental health struggles, other people feel comfortable letting their guard down. When I’ve fought my toughest battles with mental health, the most consistent strength I relied on was the support of people who I know could relate to what what I was going through. I share my experiences to let others know that I can be that person for them if they need. I’m proud to say that on a few occasions, I have been.
I also believe that every time someone is shamelessly honest about the reality of their mental struggles, it chips away at the wall of stigma surrounding mental health.
In the past, I primarily referred to my mental health in terms of symptoms (like, “I was going through a period of paralyzing anxiety”) or day-to-day experiences (“I couldn’t get out of bed most days”) rather than diagnosis. Given the relative rarity of Bipolar Disorder compared to other mental illnesses like Major Depressive Disorder and Generalized Anxiety Disorder, I felt it made more sense to speak to the most common struggles.
However, I’ve recently become increasingly vocal about my Bipolar diagnosis. After noticing how frequently bipolar is used as a pejorative, I realized that most people probably have no idea what the disorder actually entails. In researching this article, NAMI confirmed my suspicions: while most US adults claim to know the symptoms of Bipolar Disorder, less than half are able to actually identify them (source).
It’s not their fault. Accurate information about Bipolar Disorder can be hard to come by, while misrepresentations run rampant. So my friends, I’ve come to explain just what Bipolar Disorder is and isn’t, and to share a little about what it’s like to live with it.
What Bipolar Isn’t
Media and Societal Depictions
Colloquially, the term bipolar is used in numerous ways, all misrepresentations of what the word actually means.
It’s often used (innocuously but still inaccurately) to describe someone who vacillates between seemingly contradictory choices. This is referenced in Inside the Rain, a semi-autobiographical movie written by, directed by, and starring a college-aged man with bipolar disorder:
“I’m Brian. I haven’t declared my major yet. I guess I’m bipolar in terms of my interests.”
“I’m Ben, and unlike Brian, I’m actually, literally, bipolar.”
More maliciously, it’s used in place of words like temperamental, volatile, or capricious: given to sudden and unreasonable changes of mood or behavior. The person who, at the slightest provocation, flips out and starts smashing things. People who are erratic, unpredictable. Like your ‘psycho’ ex-girlfriend who you call bipolar just because she used to get upset when you treated her badly. Dramatic. Over-emotional. People with Bipolar are perceived as unstable. The worst is the C word — crazy.
We’re feared to be explosively violent. While there is truth to the notion that individuals with Bipolar Disorder are more likely to have, at some point in their life, acted out with aggression or violence, these behaviors are usually isolated within severe episodes, and tend to be associated with other factors, including past trauma, substance abuse, and co-morbidities (source).
Being bipolar doesn’t make a person just fly off the handle at the first sign of something that upsets them. That’s an anger management issue.
Part of the problem may be that that Bipolar is often falsely conflated with Borderline, a condition that is characterized by extreme, rapidly-shifting mood swings (in Borderline, individuals may experience numerous mood swings in a single day, whereas in Bipolar, moods typically last days to weeks). It doesn’t help that Bipolar Disorder is frequently mis-abbreviated as BPD, the medical abbreviation for Borderline Personality Disorder.
The other part is that mental illnesses as a whole are grossly misrepresented in the media, depicted in only extremes. On one extreme, you have the violent psychotic. One analysis found that in televisions, characters with any mental illness were significantly more likely than non-mentally ill characters (or mentally ill people IRL) to commit violent crimes (source). Then there’s the stereotype of the helpless and pitiful victim. The one who’s portrayed as a constant burden on their loved ones. Most egregious are the programs that romanticize mental illness. They pretend that they’re progressive for portraying mentally ill characters in a ‘positive’ light by making mental illness out to be a quirky personality trait. There is no depiction of their actual struggle; the label only serves to make the cute ingenue even more ~unique.~ Most disappointing are the shows who start off as a strong reflection of mental illness, only to become lazy and use the character’s disorder as a plot crutch to lean on when they run out of fresh ideas, like what crazy thing will she do this week?!
I understand that, in all things, extremes make for better entertainment. The the problem is, the media is a primary source of education for many Americans. When they have nothing else to compare it to, they’re going to assume that’s the truth.
The Consequences of Mischaracterization
Anyone who has frequented Reddit knows that it’s full of people who, if they disagree with you about anything, will search your profile for something they can hold against you. In my former Reddit days, I was active on a few Bipolar-related forums. I lost track of how often that fact was used to automatically discredit anything I had to say.
“What do you know? You’re crazy anyway.”
If I expressed offense at anything, the response was predictably “you’re Bipolar so you’re just dramatic.” If you have a condition that predisposes you to periods of intense feelings or reactions, it must mean that any and all feelings or reactions you experience must be attributed to pathology, no matter how rational they are. It’s an extension of the phenomena every woman has experienced at some point — men dismissing your entirely valid anger by asking if it was that time of the month.
Even in the health field, Bipolar Disorder is largely misunderstood. I once had a patient who was notoriously ‘difficult’ — constantly angry, irrationally demanding, and intentionally insulting. Her medical history also happened to include Bipolar Disorder. It had nothing to do with why she was in the hospital, but yet in every single discussion I heard about this patient, it was mentioned. At change-of-shift, it was said as a warning to the oncoming staff: good luck with that one today, she’s Bipolar. Judging from my many nights of working with this particular patient, along with my many years of battling this disorder, I can assure you her bad attitude had nothing to do with her diagnosis. And yet, the implication lingered.
Yes, people with Bipolar can be emotionally labile (I’d be lying to pretend I’ve never gone from laughing to crying in the same conversation). We can be impulsive (like the Wednesday that I spontaneously called out of work and booked train tickets to DC for less than 24 hours so I could attend a random speaking event at my alma mater, the topic of which inspired me to research new career opportunities on my 4AM train ride back, and then quit my job the very next day). We can be erratic and unpredictable. But these are symptoms of acute episodes (which in my case, I might add, occurred prior to initiating treatment), not inherent characteristics of our personalities.
What Bipolar Is
The Basics
The term “Bipolar Disorder” doesn’t actually refer to one disorder, but a spectrum of mood disorders formally divided into Bipolar I, Bipolar II, and cyclothymia (sometimes called Bipolar III). They are characterized by cycling between manic states and depressed states, hence the former term “Manic Depressive Disorder.”
Mania (and its little sibling, hypomania) is a state of euphoria involving elevated mood and at least a few of the following:
- Flight of ideas: thoughts jump between unrelated topics very rapidly. Their speech is a reflection if this, rapid and disorganized.
- Grandiosity: feeling invincible
- Excessive energy: can go for up to days at a time without sleeping or eating
- Surges in creativity and inventiveness
- Impulsivity: this can manifest in many ways, but often involves reckless spending including exorbitant shopping sprees, excessive gambling, and risky business investments
- Hypersexuality
- Paranoia and irritability
Mania can become so severe that patients reach the point of psychosis, a state of disconnect from reality characterized by delusions and/or hallucinations, similar to what’s experienced in schizophrenia.
Hypomania is just a less severe form. While there is a bit of grey area between what might be considered hypomania vs. full blown mania, the one clear delineating factor is that hypomania never progresses to the point of psychosis. Hypomania is often poorly characterized as a positive trait — what’s bad about having some extra energy and creativity to make me more productive at work? Even without psychosis, the impulsive behavior that accompanies mania and hypomania can still be incredibly detrimental.
Individuals with type I cycle between episodes of mania and episodes of mild depression. In Bipolar II, individuals ‘only’ experience hypomania, but tend to have more severe depressive episodes. Cyclothymia, essentially a mild version of Bipolar, involves episodes of hypomania and mild depression.
Personally, I’ve never experienced full blown mania, only hypomania. For ease of communication, I’m going to refer to both mania and hypomania as just mania going forward. For me, mania most commonly presents with disorganized speech, inspiration to start new projects, and impulsive spending. The latter is usually the first sign. My family have come to recognize this. Any time I have a couple of Amazon packages delivered within a short timespan, my mom confronts me about my mental state.
Finally, all forms of Bipolar can be further categorized as either Classic or Atypical. In Classic Bipolar, stretches of stability are punctuated by clearly differentiated episodes of mania and depression. Atypical Bipolar involves either mixed episodes, in which individuals can experience symptoms of both mania and depression at the same time, or rapid cycling, in which episodes switch back and forth rapidly. While an individual with Classic presentation is more likely to experience severe extremes like psychosis, this form is more easily managed. It’s the overlap between states in Atypical that makes treatment more difficult. What’s more, when the low mood of depression overlaps the high energy of mania, suicide attempts jump (source).
The Onset
Bipolar Disorder is estimated to affect about 3% of the US population (source). Unlike most other mental illnesses, it affects men and women at equal rates (though the proportions of presentation differ). Most people begin experiencing symptoms in their late teens to mid-twenties, though onset ranges from early teens through forties.
Like most disorders and diseases, it’s causes are multi-modal, influenced by both genes and the environment — though genetics is believed to play a significantly greater role, accounting for the majority of phenotypic expression. If you have a first degree relative with Bipolar, you are at least 10x more likely than the average American to have it as well (source). It’s believed to be more hereditable than breast cancer.
I’m not sure exactly when my symptoms first appeared, but I became aware of them sometime around the age of 15. On nights I couldn’t fall asleep, I would stay up painting until it was time to get ready for school. Shortly before my 16th birthday, I experienced my first major depressive episode. I gained over twenty pounds in two months, slept all the time, and, for the first time in my life, stopped caring about school.
I also don’t remember when exactly I learned what Bipolar Disorder was, or that it ran in my family, but I do remember the first time I realized that it might explain how I had been feeling. My Mom had interrupted one of my many rambling diatribes, forcing me to pause for a breath.
“Slow down, you’re talking a little manic right now.”
A phrase she has since repeated countless times. That night I Googled “manic depression.” In previous attempts to understand my moods, I had researched Seasonal Affective Disorder and related terms, but reading about Bipolar, everything clicked.
The Outcomes
Across all forms of the disorder, individuals with Bipolar are at least 20 to 30x more likely to die by suicide than the general US population (source). We are 6x more likely to abuse alcohol and 14x more likely to abuse illegal substances (source). Worldwide, it’s one of the leading causes of disability amongst people ages 15 to 44 (source).
That’s why getting help is so vital. Unfortunately, just attempting to do so can be exhausting. It takes an average of six years from symptom onset for adults with Bipolar to receive a diagnosis (source). It’s common across mental illnesses that individuals wait years before seeking help. However, when an individual with Bipolar does finally seek help, appropriate treatment is often further delayed by misdiagnoses. For those who present during a depressive episode, they may be simply treated for depression. For those who present during an episode of acute manic psychosis, they may be misdiagnosed as schizophrenic. These misdiagnoses can have dire consequences: not only does the wrong medication not help, but it can actually worsen symptoms. SSRIs, the first-line medications for depression, can trigger mania. Even once you finally receive an accurate diagnosis, the process of finding a medication regime that works for you can be long, emotionally taxing, and expensive.
I know all of this too well. When I first sought treatment during my sophomore year in college, I was told that I was just experiencing the normal highs and lows of #collegelyfe. It took four more years to finally start treatment. The first time I was prescribed medications, a high dose of Prozac in the absence of a mood stabilizer set off my worst manic episode to date. Seroquel made me sleep half the day. Abilify gave me acute dystonia, one of those rare but serious side effects you hear rattled off on TV ads in which the muscles in my jaw and throat became partially paralyzed in the hours after taking the med.
Don’t even get me started on the process of finding a decent therapist.
Even with an accurate diagnosis AND the proper treatment protocol, the nature of the disease can make managing it extremely difficult. Individuals who struggle with impulsivity may not be able to hold down a job; multiple studies have demonstrated that the unemployment rate amongst individuals with Bipolar disorder is 10 to 15x higher than that of the general US population (source). Here in the US, where health insurance is usually tied to employment, that can mean patients are unable to access the mental health resources they so desperately need.
As with all chronic conditions, but especially mental health disorders, there is nothing more valuable to a patient’s success than a strong support system. Unfortunately, mental disorders can strain even the strongest interpersonal relationships. Individuals with Bipolar Disorder are less likely to get married, and when they do, more likely to get divorced (source). It’s not hard to imagine why: emotional lability and excessive spending are not exactly characteristics people search for in a partner.
A Positive Ending
Still, it’s not all bad. There’s a reason Bipolar Disorder is called the artists’ disease. Thought to be attributed to the common characteristics of mania, people with Bipolar Disorder tend to exhibit higher levels of creativity. We are vastly over-represented in the creative arts fields. Countless famous creatives — from artist Vincent Van Gogh† to actress Carrie Fisher, the queen of Bipolar Disorder — have been treated for Bipolar. They’ve even found that those that work in the creative fields that do not exhibit symptoms of mania or depression are still more likely to carry some of the genes associated with Bipolar Disorder, implying that the genes known to code for Bipolar may also code for enhanced creativity (source).
In addition to being more creative, people with Bipolar Disorder tend to exhibit higher levels of empathy, realism, and resilience (source). We are better at connecting and relating to others. We are more aware of our strengths and shortcomings. We don’t give up. In the words of Tom Wootton, a Bipolar advocate, “through proper treatment and coaching, bipolar can be an asset instead of a curse.”
Or, as Kanye West† put it:
“it’s not a disability, it’s a superpower.”
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This story is the first in a series I’ll be posting about my experiences living with mental illness in a world that doesn’t always understand or accept it.
If you’re interested in watching something that more accurately portrays Bipolar Disorder, here’s a good list. If you want to read someone else say pretty much all the same stuff I did in this article, but in a way more succinct and professional way, here’s a better article.
† I’m aware these might not be the most endearing examples of success with Bipolar. Van Gogh cut off his ear in a state of psychosis, and West has had his fair share of very public mental health struggles in recent years. Still, they are realistic examples. I’ll explore this more in another article.
