Moods—everybody has them. We go up, we go down. However, some folk’s highs and lows are a little more extreme than others. But that doesn’t mean these moody people have Bipolar Disorder—even if some doctor said they did. We all have a rhythm to our moods, and my experience over the past decade is that primary care docs, being generally unaware of mood cycles, have become fond of labeling some patients bipolar. And even many psychiatrists, who presumably should know better, are over-using that diagnosis. Having worked in mental health for over 40-years I’ve seen fads come and go, and right now being “bipolar” is having its turn as a diagnostic fad.
In addition to being a licensed psychotherapist I know about being bipolar from personal experience. I’ve written about this extensively in The Unwelcome Blessing. Both of my parents were seriously bipolar. My mother had many hospitalizations over the course of her life. My father, on the other hand, always held it together enough to work and to cope. His illness never got him in any serious trouble, but he had vast mood swings that only made sense when it finally occurred to me that he was diagnosably bipolar as well. This insight occurred to me after I’d worked in mental health for over 20-yrs. I think prior to then the thought that both my parents were diagnosable as mood-disordered was just too threatening to allow into my conscious mind.
During my childhood, teen years and early 20s, I was always perplexed by my father’s behavior—sometimes, quiet and rather sad, but at other times racing thru life with an obnoxious demeanor and energy to burn. When he was down he was a nicer person. He was much easier to be around. He slept a lot in his low times and he spent his waking hours when not at work lying on the couch. He rarely went out except to work or to shop. A cousin of mine said she didn’t see “Uncle Boyd” as depressed because he only came visiting when he was in his manic, too-full-of-himself persona. When he was in his up phase he only slept 2 to 3 hours out of 24 and was always on the go. He cycled over a three-year period with amazing regularity.
The fact is only about 1 to 2% of the general population qualify as having Bipolar Disorder. That means if you have 100 “friends” on Facebook only one, or possibly two, are suffering with this condition. However, up to 20% of the general population will at some point in their life suffer a diagnosable form of depression. In other words clinical depression is a whole lot more common than Bipolar Disorder. Some depressions are the result of life’s circumstances (divorce, losing one’s job, moving, bereavement, etc). That is sometimes referred to as “situational” depression. However, all bipolar disorders are endogenous. Endogenous means they are internal and therefore have a biological origin and likely a genetic basis. All types of depression and Bipolar Disorder are referred to as “mood” disorders, and like I said, we all have moods.
CYCLOTHYMIA and BIPOLAR II
In the official APA diagnostic manual DSM-IV there are criteria for a lesser form of bipolar termed Cyclothymic Disorder (sort of manic-depression lite). For some odd reason this is a diagnosis hardly ever given. Of all of the supposedly “bipolar” mood-disordered clients I’ve had in the past decade I’ve only ever seen one who was previously diagnosed as cyclothymic. Perhaps because cyclothymics are just more or less normal folks who are obviously “moodier.” They cycle up and down on an observable, identifiable basis, but are just though of as being moody or emotional, not ill.
There is also a diagnostic category of Bipolar II. This is a pretty much life-long moderate to severe depression that occasionally erupts with spells of hypomania. “Hypomania” being an unusally high level of “happy” characterized by more energy than usual, but falling well below the level of full-blown mania. Differentiating Bipolar Disorder from Bipolar Type II can be a difficult call.
Many years ago I recall reading an article in which the author was proposing a sub-category of Bipolar II characterized by a life-long hypomania interrupted by spells of clinical depression. I think he may have termed it Bipolar II-A and as I recall he called it “the beneficial illness” or something to that effect. He gave Winston Churchill and Teddy Roosevelt as prime examples. Both men were creative, slept little and had immense energy. They charged thru life in an almost perpetual hypomanic state–but they also had periods of serious depression. Churchill referred to it as his “black dog.” The Bipolar II-Type-A are often high achievers. They do not require normal amounts of sleep and are rarely held back by self-doubt.
MEDICATION and ACCURATE DIAGNOSIS
Being able to accurately distinguish between Bipolar Disorder and the other mood disorders is important. It can be a life or death proposition because true bipolars have a high suicide rate. Up to 15% with that diagnosis will succeed in killing themselves. The psychic pain of extreme and uncontrolled mood swings can make suicide feel like a realistic alternative. Profoundly depressed bipolars and those suffering manias that result in psychosis with the presence of delusions and hallucinations should always be treated with medication.
My own impression is that because of inaccurate diagnoses (e.g., labling cyclothymics as bipolar) that medication is way over-prescribed, and in some instances meds can cause more symptoms than cycling moods. Also, a mind-set of relying on medication to solve all problems prevents many from learning better ways to cope.
In spite of my parent’s problems with mood, and the genetic linkage of manic-depression, I had never thought of myself as bipolar. My self diagnosis was that of Dysthymic Disorder. Dysthymia is Greek for “bad mood.” It is a life-long depression of mild to moderate intensity. It is often not recognized for what it is and therefore never diagnosed. Dysthymics are people who are a bit sad, quiet, shy, grumpy and have low energy levels. It seems a kind of a life-style but really it’s a subtle illness. Often these people are labled “introverts.” Grumpiness, or on some cases flat out anger, are sometimes part of the picture, especially in men. Also, my own observation is that most addicts are really dysthymics “medicating” their illness with an addiction. They are engaging in behaviors that will momentarily brighten their mood. Most drunks and bar-flies are really dysthymics looking for the brief euphoria they get from alcohol. Ditto for drug abusers and slso the 300-pounders navigating their way thru the all-you-can-eat buffet.
What I’m proposing now is a new sub-category of Cyclothymic Disorder based on my personal experience. What I’ve experienced I’m sure others have as well. A couple of years ago I had a 2 to 3 month spell of hypomania. My optimism and energy level were both much higher than my normally dysthymic state. I was sleeping only 4-hrs per night, getting to the gym five times a week and losing weight. I was productive, creative and often noticed my thoughts racing. The racing thoughts and insomnia was a bit disconcerting but I rode the rollercoaster high because it felt so good. Not wanting to stop is the M.O. of folks in the midst of a manic high.
When I came down and reflected back I could see it for what it was (hypomania), and I was able to identify three other times in my adult life when this had occurred. In each case it lasted about three months and it was characterized by a change in my daily routine and an accompanying weight loss. Fortunately, I didn’t over-spend or do anything really crazy. I didn’t think I was going to save the world or write a best-seller. I didn’t turn into a Day Trader and gamble my money away in the Stock Market. The riskiest thing I did was confess to a couple of ladies that I’d fallen in love with them. In the midst of it I was still able to discern what was happening and to some degree put the brakes on. Fortunately, 40-years as a psychotherapist had taught me something.
FINALLY ~ HOW TO COPE
Well, if you are seriously, diagnosably Bipolar, or like me, merely Cyclothymic Lite, I have a few suggestions for coping with the rollercoaster.
(1) Don’t ride that bad boy: See it coming by daily tracking your moods. Keep a chart and each day rate your predominant mood on a scale of 1 to 10. Also, note your hours of sleep. Have a trusted friend or two to give you at least weekly feedback on how they see you doing. If they really know you well and really care about you then they will tell you when you’re seeming a little too cheerful for a little too long.
(2) Live on a budget: One of the big problems bipolars get themselves into is over-spending and allowing a few weeks high to put them into dire straights financially for years. Therefore, have a budget and stick to it. Also, only keep credit cards with very low limits and keep them at home to limit impulse buying.
(3) Engage your creativity: Many bipolars are very creative and this comes out particularly when they are in the manic, up-phase of their cycle. So use that extra energy to write (keep a journal), draw, paint or play a musical instrument. We may not be budding Hemingway’s or Van Gogh’s but even acts as simple as gardening or rearranging the furniture are creative. Dr. Kay Redfield Jamison has written extensively about the strong link of creative genius and bipolar illness in the book “Touched With Fire”.
(4) Exercise: Working out is the best way to cope with depression, and so exercising may seem counter-intuitive when it come to mania. However, it is a way to work off that excess energy. Also, folks who exercise vigorously sleep better and poor sleep is characteristic of mania. Also, meditative exercise such as Yoga or Tai Chi can help focus a racing mind.
(5) Use your energy to learn a new skill: Study a foreign language on your own, or sign up for a class in some skill you’ve been wanting to acquire (computers, cooking, painting, etc.).
(6) Clean, fix and repair: Use your extra energy to do projects around the house that you’ve been putting off.
(7) Self-talk: If you’ve ridden that rollercoaster before you know that the high will not last (and tell yourself that’s okay). You’ve been there before, will be again, and that what you are experiencing is just part of your cycle. Tell yourself that things are never really as good as they seem during a manic high and conversely, never as bad or hopeless as they seem during a depression. Plenty of self-talk can keep one from panicking.
(8) If you are a Christian: Pray and rejoice! God made you how you are for a reason. The Bible is full of characters like Elijah, Solomon and David who had vast mood swings. Do a little biblical study on them. Recall that David was referred to as a “man after God’s own heart.” Read Ecclesiastes 3:1-15, also read Psalms: especially, 13, 23, 27, 34, 42, 91, 103 and 121. These are typically psalms of reassurance in times of trouble and emotional turmoil and most were composed by David.