“There is a time for everything, and a season for every activity under heaven. . .a time to weep and a time to laugh, a time to mourn and a time to dance.” Ecclesiastes 3:1, 4
Rapid cycling isn’t about peddling a bike extremely fast—though some manias may feel that way.
Having just experienced an up and down emotionally challenging couple weeks with a very labile mood, I’ve been doing some online research–and giving some thought to the experience of being bipolar. I even consulted my biorhythm chart for the first time in a few years. Biorhythms were a hot topic back in the late-1970s, but have fallen out of vogue.
Biorhythms are likely a pseudoscience–(but I’m not completely convinced of that). Back in the 70s I charted mine for several years and seemed to discern some patterns in my life. They posit three rhythms: Physical (23-days), Emotional (28-days) and Intellectual (33-days). The three rhythms start on the day you are born and continue unswerving for the rest of your life. I thought I saw things in my personal cycles that gave some credence to the theory–but maybe it was just confirmation bias and wishful thinking. Anyway, today one can simply go online and find sites where they’re all charted for you.
When I checked recently my chart showed that I was at bottom on two of the rhythms and near the top on the other—looking for all the world like an unstable, crazy-making scenario. It tended to confirm how I was feeling.
A few years before I read the biorhythm book I read Cycles by Edward Dewey and my mind was permanently expanded. Dewey was an economist and scientist and founded the Society for the Study of Cycles back in the 1930s. He stated that every natural phenomenon that could be measured recurred in rhythmic patterns. His organization charted dozens of cycles found in both business and nature, including human behavior. His theories are controversial and disputed but my own belief is that he was on the right track. I believe that patterns reoccur in nature over and over. The question is how consistent are they and what underlies them. Many natural cycles appear to follow the 11.1-year solar activity cycle–and its multiple 22.2. Sunspot activity follows a very consistent 11-year pattern from high to high and low to low.
The American Psychiatric Association’s diagnostic manual’s (DSM-V) conventional diagnosis for rapid cycling is defined as four or more periods of mood disturbance (manic, hypomanic or depressive episodes) within a 12-month period. A fairly typical pattern is two episodes per year with the switch occurring in autumn or spring.
THE TWO DOCS RAPID CYCLING THEORY
One of the articles I read in my online research was written by two psychiatrists, Drs. Mackinnon and Pies. They write about “affective instability.” They hypothesize that there are three cycles that bipolars (and normals) have that overlap each other and combine to shape the parameters of mood. Their three rhythms were Emotional, Intellectual and Energy. That sounded to me suspiciously like the three cycles of biorhythm theory. However, the two docs were saying that each person had their own specific individual wavelengths on those rhythms and not the rigid 23, 28 and 33 day cycles of biorhythm theory.
What the two docs wrote made perfect sense to me. The intellectual rhythm would be correlated with creativity and facility in problem solving. We all know that for whatever reasons there are days when our minds are sharper–and conversely days when our thinking seems sluggish and we worry about the onset of early dementia.
The emotional rhythm would perhaps be characterized by how tearful vs how cheerful we happen to be feeling. Some days we smile perpetually and feel optimistic—other days not so much.
As for energy, there are clearly days there’s bounce in our step and we have the capacity to work longer and harder—other day we just feel tired and listless for no really apparent reason. We slept well, we ate smart and yet we felt tired.
Manic episodes would likely be the result of all three cycles peaking at about the same time. And the interaction of these three cycles bounding up and down like out of control yoyos—sometimes in tandem and sometimes in opposition—could account for all sorts of anomalous states of mood including rapid cycling. Their theory had the ring of truth for me.
The American Psychiatric Association’s diagnostic manual, DSM-V, doesn’t recognize cycles shorter than four days. They attribute serious mood fluctuations of shorter duration to another diagnostic category: Borderline Personality Disorder. Borderlines can love you and hate you within the same hour. Their moods can appear very unstable. Borderlines typically have been traumatized early in life by abandonment, abuse or other attachment issues. But an unstable mood is just part of the borderline scenario. Borderlines appear to have been shaped by life experiences whereas mood disorders such as bipolar are underpinned by biology.
The APA’s four day criteria struck me as rather arbitrary. My own personal experience of mood–and in observing hundreds of clients I’ve treated, suggests that there are rapid cycling bipolars who experience much shorter cycles than four days—perhaps, even a few hours duration. Clearly, they have a mood disorder and not borderline personality disorder. Sometimes these states are categorized as “mixed manias.” Also, there is a state termed an “agitated depression” in which one could be very active, appear cheerful at times, and yet exhibit extreme irritation and weeping from minute to minute.
As for me, I can feel joyfully blessed and yet full of sadness and despair in almost the same moment. And what I have noticed is that this mixed state is becoming a more prominent feature of my mood as I get older. I think of the famous W.H Auden quote of “stagger onward rejoicing.” That’s what I seem to be doing as I get older—limping onward and at times joyfully so. And I also think of St Paul writing: “…dying and yet we live on; beaten and yet not killed; sorrowful, yet always rejoicing. . .having nothing, and yet possessing everything.” (2 Cor. 5:9-10)
It seems reasonable to me to feel both blessed and sad at the same time. To anyone living with their eyes wide open life on this planet is a sad spectacle full of tragedy, angst and loss, and yet for the maturing Jesus-follower it should be one of ever increasing joy. I think that’s what St. Paul was noting in the above scripture.
DYSTHYMIA V. BIPOLAR II
Most of my adult life I’ve thought of myself as having Dysthymic Disorder. This is a mild to moderate depression of long duration—probably life-long. Dysthymics are perpetually sad and worried. Many self-medicate their sadness and anxiety via an addiction. They are sometimes seen as addictive personalities, but really they’re dysthymics just trying to give their brains a shot of the neurotransmitters serotonin, dopamine, GABA or norepinephrine via their addictive substance or behavior.
I write about cycles and mood swings in my 2005 book The Unwelcome Blessing. This book is about how one copes with depression, anxiety, and mood within a Christian context. And a decade ago when the book was published I saw myself as solidly dysthymic. Now I’m not so sure.
About four years ago I experienced several months of what I came to realize was an episode of hypomania. During this time I only slept 3-4 hrs per night and I had an ongoing sense of anticipatory excitement. I was unusually cheerful. I was more energetic, focused and productive than usual. I changed some of my daily habits. I lost about 15-lbs. Overall, a generally pleasant experience. However, waking at 4-a.m day after day with your brain going like an out of control locomotive does get old after a while.
Anyway, after a couple months I gradually settled back into my chronic mild funk. In reflecting on the experience I realized that I’d had a similar episode ten years earlier in 2002–and I also came to the conclusion that I was more likely Bipolar II as opposed to Dysthymic Disorder. Bipolar II is a subcategory of Bipolar Disorder characterized by long periods of a depressed mood punctuated by occasional sub-manic highs of a few weeks duration.
A GENETIC HERITAGE
Well congratulations, I’d inherited a form of the family illness. Both of my parents were certifiably bipolar. My mother had many hospitalizations for manic episodes of psychotic proportions. My father always held it together enough to work a responsible job–and function without treatment or hospitalization, but he had vast three year mood swings over the entire course of his adult life. He was aware that he “had three good years and three bad years” that alternated. I did not recognize his disorder for what it was until I had worked in mental health for over a decade myself. I think seeing my father as having a form of mental illness as well was just too threatening a thought to allow into my conscious mind. In addition to my parents, both sides of my family tree are loaded with alcoholics, depressives and over-eaters. And I have a cousin who has battled bipolar disorder all of her life.
Research with identical twins strongly suggests that there is a genetic link underlying bipolar illness. An identical twin diagnosed as bipolar has a 67% chance of their twin sibling having the same illness. These are twins reared in separate homes. Twin studies also show the concordance rates for various mood disorders at 76% for identical twins versus 19% for fraternal twins. It also appears that it’s not one particular gene but rather a constellation of several that accounts for bipolar illness.
As many as 18% of all people might at some point in their life have enough symptoms to be diagnosed as “clinically depressed” but true bipolar illness only occurs in 1 to 2% of the general population. And yet the term “bipolar” is thrown around a lot these days to explain the behavior of those with more or less normal mood swings.
But real bipolar illness is a very serious and often lethal illness. About 15% of bipolars succeed in committing suicide. My suspicion is that short cycling, agitated depression or mixed mania bipolars account for most of that 15%. Living thru extreme ups and downs that fluctuate moment to moment, that feel completely beyond one’s control, is an excruciating experience and one where simply ending the pain would sometimes seem an attractive solution. My mother in the most acute phase of her breakdowns could go from laughing to crying to frenzied agitation in a matter of minutes. Having experienced a smidgen of that labile moodiness myself I can attest to it being an excruciating condition.
JOB, DAVID AND PAUL
However, my answer to the affliction of tormenting moods is Job’s solution—praising God thru the misery and focusing on His goodness: “Though He slay me, yet will I hope in Him. . .”
Job lost everything: family, possessions, health–and then to add insult to injury he had to endure three well meaning friend’s copious “advice”—men tying to explain God’s will as to why Job’s happy life took a sudden tragic turn.
My own ability to handle dark moods was permanently altered over 20-yrs ago by a sermon on First Thessalonians 5:16-18: “Rejoice always; Pray without ceasing; In everything give thanks, for this is the will of Christ Jesus concerning you.” The Holy Spirit illuminated my despair one Sunday evening in April, 1995, with this thunderclap of scripture. Dr. Hunter added, “Oh by the way, that’s not a suggestion, that is a command. The God of the Universe is communicating His will for us thru the church’s greatest theologian, Paul.”
Praise, thanksgiving and constant prayer is essential. David, the man after God’s own heart, and a man of mercurial moods wrote in Psalm 9: “I will praise you, O Lord, with all my heart; I will tell of your wonders. I will be glad and rejoice in you; I will sing praise to your name, O Most High.” and again in Psalm 34: “I will bless the Lord at all times: His praise shall continually be on my lips.”
Rejoicing and giving thanks to God in every and all circumstances is praying in lavish praise and complete humility. Doing this changes our focus from our pain to God’s greatness and goodness. It is for me far and away the single best exercise in coping and overcoming. This was something Job understood, that David understood and that Paul understood.
In reading David McCulloch’s biography of John Adams I found a confirmation for this spiritual discipline. In a letter written by the former president to Dr. Benjamin Rush at age 77, he states that the admonition “rejoice evermore” would “never be out of my heart, memory or mouth again as long as I live. . .” Benjamin Rush is sometimes credited as being the father of American psychiatry. And in a letter to his son John Quincy Adams he wrote, “Rejoice always in all events, be thankful always for all things is a hard precept for human nature, though in my philosophy and in my religion a perfect duty.”
FOR THE SECULAR & BELIEVERS AS WELL
(1) Mood stabilizers like Depakote, Lithium Carbonate or Seroquel are sometimes what’s needed to get thru an episode of acute mania. And a few should probably remain medicated for the rest of their life.
(2) Mindfulness and focusing exercises like yoga, autogenic training, progressive relaxation, meditation or guided visualization can be helpful. Disciplines such as these that slow down and focus the mind are useful both during and between episodes of extreme cycling.
(3) Also, knowledge is essential. Read up on bipolar disorder and short cycling for your own edification and then inform loved ones about what you’re experiencing. Support and education groups such as NAMI or Celebrate Recovery can be helpful.
(4) Simply understanding that it’s a cycle and that eventually it will attenuate on its own is good to keep in mind. It gives one some sense of control over the extreme ups and downs of short-cycling.
Hang on, though it may not seem so, it will pass.