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"Bipolar Disorder"
What Is It?
By Anitra L. Freeman

      Moods, for most people, swing according to a reason, a stimulus from the environment outside of us or the environment inside. You lose your job, you're depressed—you feel saddened, you lie around the house listlessly, you aren't interested in food, sex or much of anything else. You get a new job—you're on top of the world, you hug everyone you know and a few people you don't, you're a whirl of activity. Or you and your friends are having a picnic by the lake. Everyone else is laughing and playing. You start remembering happy times with your grandmother in her house by the lake—the grandmother who died last week—and you become quiet and sad.

   Energy levels also change according to circumstances. In an emergency, your adrenaline shoots up and you accomplish many times more than you thought you could. After the emergency is over, you may crash into grief, anxiety, and fourteen hours of bedtime.

   But imagine your moods and energy levels swinging wildly on their own, with no relevance to anything going on or to any of your intentions. You initiated a major project at work, you've been put in charge of it, you are happy and excited—until you wake up one morning totally disinterested in even getting out of bed. If you are able to drag yourself in to work, you have to fake interest solely because you know mentally that you care. You can't feel it. Keeping your eyes open is a major effort.

   Or you are with a friend you care about very much, who has just lost his father. You keep breaking into giggles. You hate it, you hate yourself, but you can't help it. You are distracted by things like the headlights of a passing car swinging over the ceiling and making the tiles sparkle. You remember plots of old "Father Knows Best" episodes. You remember every bad joke you ever heard or made up about fathers. You can't stop your mouth from running.

   These are mild versions of bipolar disorder. You may hear your name spoken everywhere in a crowd, be certain that strangers are coming at your back with knives, attack the clerk in the grocery store because her tone of voice was hateful to you—or be unable to stop crying, unable to stop gouging the pain out of your flesh with a razor, unable to keep yourself from the edge of the bridge.

   So we have numerous scientific studies, support groups, and medications. But there are still many people who go undiagnosed or wrongly diagnosed for years; there are people who, forty years after their original diagnosis, have still not found effective medication; there are people who have lost jobs, families and friends as a result of their illness. Or lost their lives—cutting their wrists in a deep depression, or leaping off the Empire State Building with a bright green umbrella in a fit of mania.

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   Treatment is easier and more promising for people whose disease is identified early—for bipolar disorder or any other condition. Health statistics are better, regardless of specific conditions, for people who take an active part in their own care, and become knowledgeable about their own health. Anything that affects us is easier to handle when we understand it better—and that includes bipolar disorder.

   So, how can we learn to spot bipolar disorder earlier—without dragging our children or coworkers in to the psychiatrist every day? How can we take more responsibility in our own treatment? What can we do to make it easier to live with a bipolar friend or family member?

   Bipolar disorder is easier to identify when it's extreme. One friend of mine has a husband who cycles between black depression and explosive anger. At other stages he seems to have 10,001 physical ailments and is obsessed with them all—but visitors will trigger him to become "an Irish setter puppy." His entire outlook/world view changes drastically every few days. He has very different eating patterns when he is in one mood than in another. He has "about 100 times the reaction to coffee that most people have." He doesn't notice major things, doesn't remember them, and this not noticing, not knowing, not remembering seems to run in cycles.

   My mother was "unipolar"—she cycled between "normal" and extreme mania. (There are also unipolar depressive disorders.) I remember her standing naked in the living-room at three-o-clock in the morning screaming about the demons coming in through the walls. But even with this extreme behavior, she was only diagnosed when she began doing it in front of strangers.

   Human beings are reluctant to recognize a problem unless they know that something can be done about it. Many generations have lived with "difficult" or "moody" spouses, parents or children because "that's just the way they are"—and nobody knows how to change it. Among the reasons for the rise in the reported statistics of bipolar disorder is that more people have heard of it, recognize the signs, and know that there is treatment for it.

   Even so, people whose bipolar cycles are less extreme and dramatic usually go much longer before diagnosis and treatment. There are family accounts of my behavior from as early as three years old indicating cycles of being the outdoing, active commander of the block alternating with cycles of being slow, dreamy and withdrawn. My friend's account of her husband "not noticing, not knowing, not remembering" hit home with me, because I was constantly called "The Absent-Minded Professor." My absent-mindedness ran in cycles, also, which made it especially frustrating for myself and others. My mother used to shout, "You can remember when you try!" and I would try, and try, and try ... but sometimes it worked, and sometimes it didn't.

   For a number of years my sister and I were separated geographically. During that time she got a masters degree in psychology and also made an extensive study of our family history. When I visited her again, we had a long, wonderful, intimate talk—and I woke up the next morning distant and disconnected, "wandering around like a zombie" as she put it. She told me "not all manic depressives are like Mom" and persuaded me to go to a doctor. I was lucky to connect with one who was acquainted with "Bipolar II", the form of mild and sometimes anomalous mood-swings I experienced. (I can for instance, go to the doctor in a deep depression, describe it to him lucidly, and joke and laugh about it.)

   In The Bipolar Disorder FAQ, there are some questions you can ask yourself to help you decide whether to consult with a doctor. Another place to get good information on the varieties of mood disorder is Dr. Ivan Goldberg's Depression Central. The National Alliance for the Mentally Ill, NAMI, has information about the Stanley Foundation Bipolar Network, which may be helpful. If you can tolerate medical terminology, there is a good interview posted by with Dr. Akiskal.

   Identification seems even more difficult with children. Children who have extremes of behavior, going into wild rages one day, and acting sleepy, uninterested in food or play the next, are easier to identify as possibly bipolar. There are also other possible explanations for such behavior, from medical allergies to family stress. Erratic school performance—excelling in all subjects, then losing interest in everything, then jumping into action again—is also a signal. However, children's interests can swerve all over the map and still be healthy. cont.