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Useful Notes: Bipolar Disorder
And when you're up you're up
and when you're down you're down
and when you're only halfway up
you're neither up nor down
The Grand Old Duke Of York, Traditional Nursery Rhyme

Most of the time, when a character portrayed as having bipolar disorder, they are usually shown as being uncontrollable, hair trigger Mood Swingers - swinging from affable and pleasant to suicidal or raging in the space of minutes. Or, in constrast, a character will be called bipolar if they are moody, but are never shown actually suffering from their mood swings. Either way, as the disorder is only rarely portrayed in the media beyond these and other unrealistic, simplified forms, most people are unaware that in reality, bipolar disorder is a complex, multifaceted illness.

In the most basic sense of the term, bipolar disorder is defined by the presence of mania. This means that someone who is depressed for the vast majority of the time but has had a single manic episode is as bipolar as the rapid cycler who goes through different moods in months, weeks, or even days. As you can see, this definition still leaves a lot of room for all the forms bipolar disorder can take.

Bipolar disorder is essentially a cycling disorder. Someone with it is assumed to always be in a state of flux, cycling from one mood state to another - technically meaning that someone can never recover from bipolar disorder, but only be 'in remission.' These cycles can speed up and slow down abruptly, ranging anywhere from one episode of mania/depression every few years to one every other minute (this is called Ultradian cycling, and is so rare it is suspected that it may be its own illness altogether.) Moreover, the extent and severity of the moods that a sufferer goes through can vary. The DSM lists three different varieties of bipolar disorder:

  • Bipolar I Disorder, which is defined by the presence of full-blown manic episodes - depression is not required for diagnosis, but almost always occurs;
  • Bipolar II Disorder, where milder hypomanic episodes occur instead, but often with longer and more severe depressions;
  • and Cyclothymia, which has hypomanic episodes and milder episodes of depression called dysthymia.

The Various States of Bipolar Disorders

But what exactly do we mean by mania and depression? In the context of bipolar disorder, these are both abnormal and often disabling mood states, much more severe than anything a healthy person would go through for any prolonged period of time. They do not merely affect mood, but impact every part of how a sufferer thinks, perceives and interacts with the world, and in many cases even biological rhythms like sleep cycles, metabolic rate, blood pressure, and even body temperature. The name "bipolar" is actually somewhat of a misnomer: there are several states commonly experienced by bipolar individuals, with the manic and depressive states only being the two most extreme and recognizable. A bipolar person has no control over when their mood swings occur Swings can be triggered by things like overstimulation, drug use, and positive or negative experiences, but for the most part are governed by semi-regular cycles.

Hypomania

The best comparison of hypomania for those who are not bipolar is an adrenaline rush or extreme stimulant use. If you have ever had any sort of "mountain top experience", had way, way too much caffinene, or chain-smoked cigarettes, you have had an experience similar to a brief bout of hypomania-except that hypomania typically lasts anywhere from several hours to several days.

Hypomania is essentially very similar to The Madness Place trope- it is characterized by intense focus on tasks, Hyper Awareness; high mood and energy; extreme levels of optimism, creativity, productivity, and inner motivation; high mental endurance, and reduced sleep cycles. This, to some, may sound desirable, or even pleasant. Indeed, it is true that many successful artists, inventors, and entrepreneurs have been formally diagnosed as bipolar, and one of the most common motivations for bipolar individuals who stop taking their medication is missing the "rush" of hypomania.

The catch, however, is that humans don't handle being overclocked and run at full capacity for days on end any better than computers do, and that the entire madness place trope applies, including the issues it causes with relationships and neglecting their own health in the name of pursuing their goals. This is particularly true when it spills over from hypomania into full mania.

Mania:

Mania is described by the DSM as at least a week (or any amount of time that requires hospitalization) of "severely elevated mood and energy."

If hypomania is comperable to having had too much caffiene, a full manic state would be comparable to the effects of a high dose of amphetamines or cocaine- but with the effects lasting for days. The manic individual has a very short attention span for anything outside of whatever they are currently fixated on, including things like eating and sleeping. They have little impulse control with regard to their fixations- many find themselves spending everything they have on a whim that they rapidly forget about; compulsively pursuing a task to completion with no regard to whether it is productive, unproductive, or simply inane; or giving in completely to hedonistic behavior. The manic frequently experiences what is known as "Acromegaly"- the feeling that they are invincible and can accomplish any task.

Much of the Hollywood Psych behavior attributed to Paranoid Schizophrenics is actually result of a person with both paranoid schizophrenia (or just simple paranoia) and bipolar disorder- a week of living with racing thoughts and no sleep gives plenty of time to build a Room Full of Crazy, and would make it hard for anyone to tell reality from their own delusions or construct coherent sentences. Its no wonder they have to plot everything out with string to keep track of it all. To make matters stranger, even an diagnosed individual aware of their condition may not be aware that they've transitioned from a hypomanic phase into a full manic phase: the same tunnel vision that gives them focus prevents them from noticing or caring about things like that they haven't slept in three days, so its easy for those with more extreme bipolar disorder to begin with a perfectly reasonable task in mind and end deep in the madness place.

Depression

What goes up, must come down.

When a Bipolar person does crash, the landing is often hard. The depressive state can be thought of as the natural result of the manic state's overclocking of the mind and body- after running for so long at full tilt, it takes time to recover during which time they are Brought Down to Normal. Given the contrast to high of the manic state, its little wonder the bipolar person is left feeling dejected, burnt out, and uninspired, and often regretting impulsive decisions and damaged relationships of the manic phase. This leads many to self-medicate with stimulants and alcohol, to artificially extend or trigger the manic phase and blunt the misery of the depressive phase.

Some bipolar individuals also experience depressive phases prior to their manic phases- this is hypothesized to either be the body and mind "charging up" for the manic phase, or possibly a minor depressive phase triggering a much larger counter-mood swing.

Mixed States.

A mixed state is a bipolar episode in which a person experiences mixed aspects of mania and depression at the same time. It can range from experiencing energy without joy, which leaves them feeling like they're going too fast, to being happy and sad at the same time, to being content to do nothing at all. A good metaphor for the inner life of a bipolar individual is a rollercoaster- at various points in the track the rider can be moving fast or slow, and up and down, in various combinations. Most with Bipolar Disorder actually spend most of their time in something vaguely resembling a neutral, relatively normal, state. Its only when the rollercoaster hits an extreme extreme hill or drop that a series of manic and depressive phases occur.
Asperger SyndromeUseful NotesDepression

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