- Psychological Issues
Or, “I once spent my mortgage money on African violets. Yep, $1,500 on African violets. Then I got depressed and let them all die.”
Among mental illnesses, bipolar disorder isn’t terribly uncommon – it directly affects 2.6 percent of the American population. (In comparison, borderline personality disorder affects 1.6 percent, schizophrenia 1 percent, and agoraphobia 0.8 percent. Statistics from the National Institute of mental health.) Its prevalence, combined with our growing acceptance of mental health discussion, means most people have at least a vague idea of what it is. For better or worse, some of us drop the word “bipolar” into casual conversation, which makes it abundantly clear that knowing something exists doesn’t automatically mean we know what we’re talking about. (For the record, “PMS makes me feel so bipolar!” is about as accurate a statement as “I love The Container Store! I’m so OCD!”)
Stripped to its most basic explanation, bipolar disorder causes unusual, severe, and often unpredictable fluctuations of extreme moods and behaviors. A depressive episode causes depression. A manic episode causes mania. Until recently, the official title of this manic/depressive disorder was “manic depressive disorder.” (The literal-minded fellow who named it may also be responsible for “alien hand disorder”, “foreign accent syndrome” and other real afflictions that will seriously confuse your insurance company.) Thanks in part to a flood of mid-90s memoirs, this Prozac-ed nation mostly grasps depression in theory (if not always in reality), but we’re not entirely clear on the manic part. A completely unscientific but well-intentioned survey (“what does ‘manic’ mean to you?”) resulted in many conflicting answers, including:
“A WAY WORSE version of depression.”
“It’s like being drunk sort of?”
“Your head is doing cocaine but you’re not awake.”
“I think it’s a type of hair dye.”
Well. We get points for trying, right?
“Suddenly I wanted to get better. Mania wasn’t fun anymore. It wasn’t creative or visionary. It was a mean parody at best, a cheap chemical trick.” –David Lovelace
What is mania? How to explain such an individual experience? Perhaps a better question is “what isn’t it?”
Mania is NOT…
True, some people with bipolar disorder find the manic episodes enjoyable at times, especially when compared to crushing depression. Simply put, mania can make people happy, just like depression can make people sad. But clinical depression isn’t just about sadness; it affects motivation and appetite and weight and sleep and thoughts and attention and relationships. Similarly, mania isn’t happiness; it’s an equally complex state that affects… motivation and appetite and weight and sleep and thoughts and attention and relationships.
And remember, bipolar mania by definition can’t exist without depression. Not only do impulsive decisions backfire, they can backfire while someone is in a depressive episode – and make the episode that much worse.
“But then back on lithium and rotating on the planet at the same pace as everyone else, you find your credit is decimated, your mortification complete: mania is not a luxury one can easily afford… so after mania, when most depressed, you’re given an excellent reason to be even more so.” –Kay Redfield Jamison
There are two main types of bipolar disorder: bipolar I and bipolar II. (Again, very creative.) When you picture full-blown stereotypical B-movie mania, you’re thinking of bipolar I. The episodes are severe, pronounced, and sustained. Someone with bipolar II disorder is more likely to experience a milder form of mania, or “hypomania.”
Let’s say that you’re staying with your friend George, who has bipolar II, and his wife Gertrude, who has bipolar I. You’ve had a great day with George. He’s usually pretty bummed out, but today he was so chatty and energetic that you could barely keep up with him. You didn’t even know he liked sailboats.
Now you’re exhausted and ready for bed. They’ve put you on their finest air mattress, but you can’t get any sleep because it’s 3 AM, the lights are blazing and Gertrude is composing “Beowulf: The Musical!”, which is already seven hours long. Complaining does nothing except agitate Gertrude; after all, she’s an artistic genius. And she’s not nude, by the way; who are you to say a parakeet-feather boa isn’t eveningwear? And okay, the neighbor called the police on Gertrude yesterday (noise complaint… again), but that doesn’t necessarily explain why his birds are missing. God. You’re so paranoid.
“Mania is the worst kind of pyramid scheme, one that the bipolar individual doesn’t even know they’re building, only to find out, too late, that they’re also its biggest casualty.” –Diriye Osman
Okay, our friend Gertrude seems pretty unstable, but it’s hard to blame her. Imagine the exhaustion of jumping without warning from crushing lows to breathtaking highs. Imagine the fear of not knowing who you’ll be next Wednesday, or next month, or next year. Unipolar depression is singularly awful, but it’s predictable.
How does unipolar depression make you feel next Wednesday?
How does bipolar disorder make you feel next Wednesday?
Flip a coin.
Does a manic person endanger the public? Statistically it’s the other way around. People “with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime (Appleby, et al., The Lancet, 2001). People “with severe mental illnesses… [including] bipolar disorder…, are 2 ½ times more likely to be attacked, raped or mugged than the general population (Hiday, et al., International Journal of Law and Psychiatry, 1999).”
Mania does not turn people into psychopaths or wild animals. It does not eclipse who they were while not manic, and neither mania nor depression defines who someone is.
Perhaps that’s why we’re confused. That’s why we’re lost. It’s comforting to look at a road map and think, “ah, so that’s where we are now, and that’s where we’re going, and here’s how we’re going to get there.” But there isn’t one direct, foreseeable route from depression to mania or mania to melancholy. The disorder’s clearest element is its very capriciousness, and mania, by definition, is “of an extreme and transient nature.” It is essential both to bipolar pathology and the human condition.
A manic episode no more erases a person than a curtain erases a window. The curtain is visible, yes, but you can still see how the light gets in.