Bipolar Disorder

This is Polarized Lens with Jennifer Merchan.
Polarized Lens is a podcast that explores life through the filter of bipolar disorder.
Created and hosted by a person living with bipolar disorder, its aim is to explore the challenges of that mode of life in this neurotypical world,
raise awareness, and help those who want to understand more about bipolar disorder.
Episode 2, Bipolar Disorder
So, what is this bipolar disorder thing that I've been going on about?
Well, it's a mood disorder that you may know by its retired name, manic depression.
This is actually very helpful in that it names the two largest components of the disorder, mania and depression.
There are, in fact, some people who prefer the name manic depression, but the people with the power to do so changed it to bipolar disorder in 1980.
This was done in an effort to curb the stigma and abusive language that are associated with manic depression, words like maniac.
Bipolar disorder is more clinical and precise, but despite the name change, the stigma remains and so does the abusive language.
The word bipolar has become slang for crazy in a world in which people know better than to use the word crazy,
but can't be bothered enough to avoid being denigrating altogether.
While it is sometimes used to mean unpredictably variable, like, this weather is bipolar,
this usage is still wrong and trivializes the disorder and the people living with it.
But enough of that for now. Let's take a look at what bipolar disorder actually is, and more importantly, what it does to people living with it.
It is an illness diagnosed by a doctor, treatable by medications, but not curable.
It is disorder that manifests as alternating elevated and depressed moods.
The elevated mood is called mania or hypomania, depending on its severity.
The severe depression that those with bipolar disorder experience is called a major depressive episode.
As I hinted at in episode one, the heart of bipolar is mood.
Moods are like lenses through which a person experiences the world, and then that person reacts accordingly to what they see.
A psychological mood is a sometimes lasting emotional state that affects a person's views, actions, and reactions.
But what is mania? And have you ever even heard of hypomania? What makes depression major?
Mania isn't just an elevated mood. It's a mood so elevated that it causes the person experiencing the mood to become dysfunctional.
They act in ways they wouldn't normally act and believe and do things they might never consider otherwise.
Mania even sometimes includes psychotic features.
Hypomania, well, hypo is just a prefix that means below.
Hypomania is typically shorter and less severe than mania, and it does not include psychotic features.
A major depressive episode is defined by the length and severity of the symptoms.
The depression itself takes the form of an atypically low mood, loss of interest, changes in sleep, eating too much or too little, slowed movement, difficulty thinking, and thoughts of suicide.
This depression must be present for at least two weeks continuously to be considered a major depressive episode.
Episodes of major depression without mania are sometimes called unipolar depression.
Then there's the mixed episode. This is the mood that you are generally left on your own to discover.
And when you experience it, it leaves enough of an impression that you are determined to find out what happened to you.
To be fair, it's no longer even called a mixed episode, but a blank episode with mixed features, with blank being one of the three main moods, mania, hypomania, or depression.
An episode with mixed features is just what it sounds like.
Your hypomania gets invaded by sadness and despair, and you become a rage monster at the drop of a hat.
Because there are no medical tests for it, bipolar disorder is not an easy diagnosis to make, but doctors seem to be getting better at it.
When I was younger, the average age of diagnosis was about 30, typically after several misdiagnoses.
Current statistics are more promising, with diagnosis coming in the teens or early 20s, often only shortly after a person begins exhibiting the symptoms and behaviors that are hallmark of the disorder.
Early and accurate diagnosis is vital to effective treatment of bipolar.
It is vital to the quality of life of the affected person.
While doctors are getting better at diagnosis, they still make mistakes.
Some common misdiagnoses of bipolar disorder include schizophrenia and borderline personality disorder.
When you look to the older generation of people with bipolar disorder, you often find stories of misspent, wandering, or otherwise marred youth because of misdiagnosis or lack of diagnosis.
No matter how many amusing anecdotes arise from this, they still represent unneeded suffering.
Bipolar disorder is not easy to live with.
There are actually three main types, bipolar I, bipolar II, and cyclothymia.
Bipolar I is considered the most serious form of the disorder because of the severity of full-blown mania and the possibility of psychotic episodes.
Bipolar II typically manifests with hypomania and a prevalence of depression.
Cyclothymia is characterized by variable hypomanic and mild depressive moods for at least two years, with fewer than eight weeks of stable mood.
Episodes with mixed features aren't particular. They can even occur in unipolar major depression.
What does a manic episode feel like?
A clinical psychologist with bipolar disorder described her first manic episode in a book that was first published in the mid-1990s.
She said that everything seemed so easy and that she felt really great.
She felt she could do anything. Everything made perfect sense, but in a cosmic way.
She later falls into delusions and psychosis.
What does mania look like from the outside?
You might witness speech that is too rapid to follow and thoughts that while they make cosmic sense to the speaker are generally incomprehensible to the listener.
A hallmark of mania is insomnia or at least minimal sleep for extended periods.
Someone experiencing a manic episode may appear irritable and agitated.
My experience with hypomania is similar, but without the eventual devolution into delusions and psychosis.
For me, hypomania has been a happy place of unusually productive serial hobbies marred by spending sprees and obsessions that I slowly lose control of.
I had no idea at the time, but I was a senior in high school when I experienced my first hypomanic episode.
I started journaling because everything was important. I took ballet because I could do anything.
I moved out of the room I shared with my best friend because I couldn't stand the crinkling of her food wrappers when she came back from the vending machine.
I wrote terrible poetry I thought was remarkably clever, and I generally felt on top of the world for no good reason.
While time tends to fly during mania and hypomania, with depression, you feel pinned down like a butterfly in a display case.
Life seems unbearable, and suicidal ideation can become a weird coping mechanism.
What does depression look like from the outside?
Loss of interest in things a person once enjoyed, sleeping all the time, and general withdrawal from the world.
But while mania and hypomania tend to present the same way in everyone, depression shows more variety.
Why is it so important to establish the types of bipolar disorder?
Remember how I said in episode 1 that my treatments didn't work until I was labeled correctly?
This is why.
Without the correct diagnosis, treatment can range from pointless to actively harmful.
I was initially diagnosed with major depressive disorder rather than bipolar II and was given antidepressants without mood stabilizers.
This triggered hypomanic and mixed episodes.
This state of affairs is exactly what landed me in the hospital for three weeks, where I was quickly diagnosed and started on lithium.
So, as it happens, hospitalization was one of the best decisions I ever made.
The experience itself was certainly not enjoyable, but having an accurate diagnosis and being properly medicated changed the course of my life.
In one sense, the change was sudden. The lithium immediately quieted my mind for the first time in a very long time.
In another sense, the change was painfully slow. It took nearly 10 years to feel ready to keep a normal full-time work schedule again.
I went from a diagnosis of unipolar major depression with generalized anxiety to bipolar II disorder.
I don't know if the anxiety diagnosis was retained then, but panic disorder with agoraphobia is part of my diagnosis now.
This is called a comorbidity. Some common comorbidities for bipolar disorder are anxiety, ADHD, PTSD, and substance abuse.
Now head on over to the blog on Polarized-Lens.com for a list of resources, because this is an intentionally oversimplified explanation of a very complex illness.
No matter how much you learn about bipolar disorder here or elsewhere, you still need a doctor for diagnosis and treatment.
Thank you for listening. This has been Polarized Lens with Jennifer Merchan.
If you are experiencing a mental health crisis, don't hesitate. Call 988 and connect with someone who can help. Don't go down that road alone.