I have been bouncing back and forth between what is healthy for my future and my present. They are often in conflict. We experience time linearly, but our choices can take us in spontaneous, curved, spiked, and winding direction. All of that contemplation has only landed me here. So, as promised, here is last weekend’s Mental Health Month post. We will continue with Dissociative disorders tomorrow evening. On Thursday, Friday, and Saturday we will talk about Gender Dysphoria, Neurodevelopmental disorders, and Personality disorders.
You know how it goes: we list the different diagnoses, what the manual thinks, and then we dive into the experiences. Today we’re talking about the Bipolar spectrum. If you have experience with Bipolar or any other altered state, including substance use, contact me here, or on my social media (below) to get featured.
Compared to the exhaustive lists of other diagnoses, this section is relatively concise. Most people are familiar with all of the terms listed below:
Bipolar 1, which is characterized by it’s key diagnostic criteria: a manic episode. This includes abnormal levels of euphoria and agitation. It will usually be obvious when someone is not themselves. they may be talking extremely fast, floating enough ideas to make your head spin, and getting a lot of things done–at least until things start not getting done. It’s stated that if you experience this while receiving any type of antidepressant treatment (including ECT) and this state persists, you can be diagnosed Bipolar 1. I’d personally like to see the studies that proved these states weren’t caused by the treatment being received, but of course that will never be possible. Take it with a grain of salt, people. Mania can elevate paranoia and distrust, and present confused, racing thoughts. It takes some time to be able to distinguish this state from an acute psychosis state related to schizophrenia.
After this extreme state, Hypomania (a lesser form characterized by an elevated mood, increased energy, inflated self-esteem and the likes, lasting for most of the day, most days of the week) may or may not occur. Depressive states may occur as well, in which a person cannot function, drowns in hopelessness, and lacks energy. In the same way that people who hear voices can miss their voices if a treatment “takes them away”, those with mania may experience a feeling a loss when stuck in a depressive state, particularly when it’s related to medication treatment.
Bipolar II is the next diagnosis. So, imagine constant, and sometimes severe depression, with a sprinkle of hypomania. You need to meet the criteria for hypomania at least once to be considered Bipolar II. Even if you never experience Hypomania again, or someone misdiagnoses your happiness amid all your darkness, you will have the brand of Bipolar II. Often the Hypomania does not impair the individual.
Cyclothymic Disorder may not be too familiar of a term, unless you’ve been diagnosed with it. This is when your Hypomania doesn’t match the criteria for hypomania, and your depressive symptoms don’t meet the criteria for a major depressive episode, for at least two years. Basically, if you’re more happy than usual, but not too happy, or more sluggish than usually, but not entirely hopeless, you’re also disordered. These symptoms must be present at least half the time, and for that 50% of those two years, if you don’t experience being a little too happy and a little too sluggish for more than two months, you’re just normal I guess.
I do not say with this condescension. I have no idea if Cyclothymic disorder throws people out of their normal routine or how it affects their life; I don’t have this. But if you read the wording in the DSM-5, it’s what I said above, without words like “basically.” It SOUNDS very much like they’re labeling normal states as disordered, particularly when they say “well, if you don’t meet the criteria for any symptoms, you’re still sick.”
While looking up some studies about Cyclothymic, I found that Schizothymia is also a thing–not a diagnosis, but a thing. It essentially embodies the “temperament” required to resemble that of someone with schizophrenia, without actually meeting the diagnostic criteria. So, again, normal but still disordered. Schizothymia has yet to make it in the DSM. It’s only a matter of time.
We can guess what Substance/Medication-induced Bipolar and Related disorder is. What’s highly interesting is that if your “bipolar” is activated by Alcohol, Phencyclidine, other hallucinogens, stimulants, cocaine, or sedatives, then you fall in this category. If it’s caused by an antidepressant or E.C.T., treatment that makes money, you don’t. I don’t suggest taking cocaine in place of your antidepressant, but I also recognize there are overlapping neurochemicals involved when we compare street drugs to legal drugs.
You can also have Bipolar and Related Disorder Due to Another Medical Condition, and Other Specified and Unspecified Bipolar and Related Disorder.
If you feel I’ve been tough on this particular category, I have. Wording matters. Wording is what gets people proper and improper support. Wording is how we start to internalize the views of ourselves. Wording is how others see us. Wording is everything. If you’re a studious kind of person, or already in the world of academia, I’d recommend taking a DSM critique course. They rip this manual apart. If not, give the document a read for yourself; it’s in PDF form across the internet and there are available copies in bookstores. If you are unable to separate your own experiences from the diagnoses though (that is, you can’t read one without going OMG I HAVE THAT), maybe just read some articles on critiques.
To get you started, This article is about how much influence pharmaceutical companies have in the revision and editing process. It’s scary. Again–you have substance-induced Bipolar ONLY if your drug of choice is illegal.
I remember being manic. It’s been categorized as an acute mania, but I remember getting at least a few hours of sleep each night and my functioning wasn’t so impaired, so I’m more inclined to believe I attract the Hypomanic bug. I honestly don’t care, I just know I was managing a 4.0 average across semesters, taking Chemistry, Physics, Calculus, Psychology and Philosophy. I was happy. Very happy. I tackled five classes a semester, spent a lot of time out in the middle of the night, in my car with friends or my boyfriend, and I knew that I was special–beyond special. All of my ideas in science, in philosophy, had never been thought of before and every night I knew the next day brought fame.
My senior year of high school, and my first couple years of college–before I started working at Second Story–I tumbled through a lot of these mood shifts. A lot of my suicidal thoughts and actions, and self-harm, came as a result of these shifts, and so the Mania or Hypomania may not always cause the most damage. Sometimes it’s the aftermath, the picking up the pieces, the coming to a realization that something isn’t going right, that can impede wellness. I did not take care of myself, physically, mentally, every way, nor did I know what that was. I went through medications and doctors and therapy and sometime after one of my more serious depressions, the voices became more prominent and–well, the rest is history.
My experience in many ways pales in comparison to what some people go through. If you haven’t read the book “Mental: Lithium, Love, and Losing My Mind” by Jamie Lowe, I suggest giving it a read. She chronicles her journey fluently, and you get a sense of just how intense and fundamentally altering mania can be.
Many people get a sense of when a manic episode may be near, and this is just one story.
I believe a lot of descriptions of experiences should be thrown away, but Bipolar is not one of them. Mania can slam the breaks on people’s lives. Hospitalizations become traumatizing. People lose their career, their happiness, their stability, their wealth, their trust in themselves, their families, their possessions, their freedom, their understanding of what life is. All of it can be gained back, one way or another, but the act of starting over sometimes feels like an insurmountable obstacle.
Believe it or not, Bipolar 1 and 2 are quite over diagnosed, and ironically the over diagnosis causes stereotypes and expectations in a clinical setting which, in turn, fuels more incorrect diagnoses. For example, the night I was transferred to the psychiatric hospital over the hill, as soon as they learned I hadn’t been sleeping well–I hadn’t been up for days, I just had trouble sleeping more than a few hours, due to anxiety, panic, voices, and the feeling of being hunted–they diagnosed me Bipolar 1.
When I was released to the hands of the county here, I was interrogated with questions I can barely remember answering. I was still kinda gone, pretty sedated, and confused. The social worker acted more like a detective, or a doctor trying to figure out if I was actually in pain or just wanted opiates. Well, what do doctor’s usually assume? That you’re just trying to pop a pill. What did this social worker assume? That my diagnosis has been bogus because “they always throw that diagnosis at people, it’s a throw away diagnosis”.
That’s what he told me. He said I didn’t need any help and through his line of interrogation concluded my state was a result of marijuana. I had told him I’d smoked two weeks prior, but it had been over a year. As I said, I was gone, had no sense of time, and again slipped through the cracks. I also hadn’t been in contact with many people, my parents were still unsure of what was going on, and my boyfriend who came with me wasn’t allowed to say anything. It felt like I had to make a case in front of a judge without a seasoned lawyer, while hoping for my conviction.
In short, Bipolar is not a throw away diagnosis. People’s experiences are real, they are intense, scary, and incapacitating.
Because they present similarly, and the wording to diagnosis either of these states is vague compared to the amount of variety in symptoms. For a proper separation of diagnoses, the key is to wait. Watch how the state presents itself, how it reacts to what medications, what kind of services, and how is the person after they are more lucid. Are the paranoia and hallucinations persistent without the lack of sleep? What level of insight does the person have to their experiences?
Although not much is known about psychiatric medication, I cannot deny the fact that there are people who are helped a great deal by it, including myself at one point. Sometimes we have data on medications that work better with some diagnoses compared to others. Mood stabilizers may not affect someone with persistent psychosis, and that can help rule out Bipolar 1.
This process is similar to when someone is on a substance, like amphetamines. Once the drugs are out of the person’s system, you observe their behavior and see if the temperament and experiences persist.
Two things are very important if you deal with any kind of mood fluctuations, but particularly if you have a bipolar-type condition: sleep and routine.
One thing that made doctors notice I had a mood issue was the fact that I wasn’t consistent in anything that I did, especially taking medication. I’d go on it for a few months, feel well, balanced, and annoyed by the medication side effects, and I’d stop cold turkey. I’d feel okay for a couple days, and then spiral, usually into a depression or severe agitation.
Having a routine includes being consistent with medication: this is true even if you decide to stay off of medication. Forcing your body through the process of adapting to medication, juggling brain chemicals, and then having to re-adapt when you stop isn’t good for your mind or your biological systems. If you choose to stay off medication, what are your limits? It may sound crazy, but mine is hospitalization; if I get hospitalized or feel myself moving toward the idea of voluntarily committing myself, I need to get back on medication. Neither has happened yet. If you choose to stay on medication, what are your limits? Do you believe you will have to stay on them forever or are you open to the idea of working toward getting off of them?
Having a bedtime and morning routine can help develop that stability. Having a set time to sleep and wake up, having rituals even (shower, teeth, pjs, a good book) can aide in that process. It’s important to note that this is not to make you feel “normal”. This is part of self-care. It’s not about being like everyone else, or wanting to feel like a “normal person”, it’s about being healthy and learning what you need to stay well.
And that takes us to sleep.
Get it. It’s important.
Medication is helpful for this in many respects. One thing I miss being on medication is how I got 8 hours of sleep every night, to the second. My body just instinctively took on this role of: wow, my brain has slowed down, I don’t have as many distractions and the sun is going down, you should probably start winding down. Melatonin and chamomile tea can help accentuate this if your normal medication doesn’t quite do the trick. Be wary of sleeping aides like Ambien.
Staying active and nutritious will also help your body get back into the natural sleep-wake cycle. No one will kill you if you have one of those chocolate pies or a doughnut, but if your diet is perpetuated with processed sugars, heavy carbs, and un-nutritious fats, sleep will be hard to come by. Exercise stimulates many different hormones and chemicals in our body, the same ones some psychiatric medications attempt to promote, so adding in a routine if you don’t already have one can dramatically affect how you feel in yourself and about yourself.
These are important for everyone, diagnosis or not, but especially important with a diagnosis. Wellness does not come from one branch on a tree. Wellness is the tree, and its branches are things like exercise, nutrition, attitude, outlook, worldview, medication, physical health, productivity, e.t.c. The more branches, the bigger the tree.
Thank you all for the Instagram messages and for reading this blog. I’ve been so incredibly happy to see that so many viewers are enjoying this content. Tomorrow we will talk about Dissociative Disorders. If you have a story to share with me, or you want to put it on this blog, please reach out to me via my contact page ( linked above) or my social media:
If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue reporting poorly executed science.