Bipolar: Correcting the Diagnostic Misunderstandings, Head Butting the Stigma, and How to Cope

In my clinical practice nothing bothers me more than seeing someone misunderstand, be misunderstood, or, even worse, be misdiagnosed themselves with a mental illness, specifically, Bipolar Disorder. The inaccurate clinical picture society and even our own mental health system and it’s providers has about the diagnosis and thus proceeding psychopharmacological treatment is harmful and perpetuates the social stigma of what Bipolar Disorder truly means for an individual. So, let’s get some things cleared up, shall we?

First and foremost, let me be clear: Having mood swings throughout the day or even throughout the week, IS NOT BIPOLAR DISORDER. The popular social description, “he’s happy one minute and then the next minute he’s totally OMG going off the deep end!”, IS NOT BIPOLAR DISORDER. Being nice and friendly and then the next day being angry and mean IS NOT BIPOLAR DISORDER. You hear me, yo’? None of this is Bipolar Disorder. Rather, it suggests a difficulty regulating one’s emotions. And emotional dysregulation is not being Bipolar. Emotion dysregulation can derive from multiple etiologies; indicative of being overly stressed due to life, having depression, an anxiety disorder, sleep deprivation, Borderline Personality Disorder, Menopause, an organic cause, etc. You get my point. It could be a lot of stuff, one that is not, my friends, Bipolar.

Here is what Bipolar Disorder IS: Have you or someone you know experienced for AT LEAST 5 DAYS IN A ROW, a ton of energy? I mean, like a ton of energy. Like you felt so good that you could be Superman. And during that 5 consecutive days of feeling super amazing, you weren’t sleeping. Because you didn’t need it. You had so much energy and had so many thoughts racing in your head. Some of these thoughts being amazing ideas of what you want to do with yourself and maybe for the world, but also some ideas that are a bit paranoid in nature, like your kitchen floor is on fire, or that the water you’re drinking is poisoned, these thoughts making you act in certain ways that you normally wouldn’t. Maybe you’re a bit more irritable and distracted (oh look, a squirrel!) than you normally are. So, in your at least five day in a row of no sleep state because you're feeling energized, and having racing thoughts, you also have a bunch to say. So much to say in fact, that it almost feels as though your mouth can’t keep up with your brain. You’re also acting differently in general - maybe a bit more impulsive (you just bought a bunch of stuff, just hooked up with that dude you just met, getting creative with your wardrobe expression, just took that train downtown because why not, you’re feeling great.) People are starting to express concern, they don’t understand. But now you’re in the hospital. Against your will. You swore that what you saw in the rafters in your garage was real, that if you truly drank the water you were going to be poisoned. Now the doctors are forcing you to take medication against your will and you’re in this hospital around people that you don’t know, you feel like you’re being categorized by staff, and you’re terrified. You’ve also just lost some of your civil rights. You’re angry, confused, and let me emphasize again, scared. A few days go by after having to take these medications that make you gain weight and require regular blood tests, and you feel a bit more calm, sleepy, and remember some stuff of what happened. You don’t remember all of what happened, but from what you do remember, you’re absolutely terrified and embarrassed. Shame. Guilt. Now needing to make amends or fix what you did in your manic state. You are a loving, kind individual that struggles with episodes that take your reality and control away from you, that hijack your judgment, in a way that can turn your world upside down as a result. You are loved. Difficult conversations with others, making amends, fixing financial and even legal matters can all be a part of the game here. In order to try to never go there again, you have to stay on these meds and learn a lot about what Bipolar is. This is your new life. This is a true manic state of Bipolar Disorder. Bipolar Disorder, Type 1, is characterized by going into manic states (as described above) and into depressive states. Most often this depressive state will occur after a manic state (no surprise, right?!). These states will usually last weeks at a time. It takes even longer to recover from these states once you are out of them. You are not your diagnosis.

For those (accurately) diagnosed with Bipolar, I’ll say it again - You. Are. Not. Your. Diagnosis. If anybody makes you feel that way, you need to educate them or may even need to kick them to the curb. You are everything else that you make your life; a friend, a mother, a spouse, an athlete, a reader, a video game player, a gardener, a veterinarian, an actor, a singer. Make your life about THESE identities and maintain your state of being.

A word on how to manage your symptoms - Yes. You are going to have to have a very loyal relationship with medications likely for the rest of your life. These medications can be brutal because of the side effects at times. But, this allows you to live your life the way you want. There will be times when that won’t be enough, however. You may get triggered, may develop insomnia, and will need to make temporary adjustments to keep you where you need to be emotionally. So, have an open relationship with your prescribing physician and those you trust. Know your triggers. Know what works for you regarding self care, sleep amount, foods, alcohol and caffeine maxes, other meds you may be on. SSRI’s, a common type of antidepressant, can actually cause someone to go into a manic state if they are truly Bipolar. There is a great acronym that should be part of your ideal treatment plan: WRAP (Wellness, Recover, Action, Plan). Originally developed by Mary Ellen Copeland, Ph.D., it can be applied to virtually any diagnosis, but can be especially pertintent for Bipolar symptoms. It involves a daily wellness plan of self care and doing things you know keep you centered. It also involves identifying your triggers of what can “set you off” in terms of experiencing too much stress or engaging in certain behaviors (which could lead to a manic or depressive episode). Some examples are specific hour of sleep deprivation (i.e. you know you need to have 6 hours minimum) for an identified amount of days, certain foods and substances that affect your mood, certain seasons (Spring can be triggering), certain people or situations that can stress you out to the point of triggering you, etc. It also involves identifying certain symptoms, behaviors or signs that may indicate your are beginning to escalate. It involves having an already specific team of people that are a part of this plan - your best friend, spouse, or parent that knows you well enough to tell you if they are starting to notice you slowly escalating into mania. It also involves having a plan of what to do at this point if you are beginning to escalate (i.e. contact your prescriber for a med adjustment, sometimes this can include sleep meds to override insomnia induced mania, attend your Bipolar Support group, and other specific coping skills that you know are your “go-to’s”). Communicate, trust your plan and thus the process.

One of my patients living with Bipolar once told me that if it wasn’t for her diagnosis, she would never have been so in tune with her body because as she explained, while Bipolar at times has been a curse for her, it has also served to be a blessing in being able to develop an uncanny ability to listen to her body and care for her physical and mental health needs arguably better than more so than the “non-Bipolar” folks. She is a well oiled machine regarding her sleep needs, her diet, knows how to identify who genuinely wants to be in her life, she knows every trigger for herself, her self-care plan when she is beginning to become overwhelmed, what makes her happy and strong, how to have difficult conversations with people, how to kick toxic people out of her life, how to enjoy her life. A disorder provided her with all of these gems of knowledge. How many of us can say the same? Pretty cool, right?

I do hope that for anybody reading this now has a better understanding of what a true Bipolar diagnosis is and what is involved with episodes. I hope education, understanding, empathy, self-compassion, respect, and empowerment has also been gained. Further, I do ask that you are mindful of yourself and others around you when the term “Bipolar” or “being manic” is being casually used in attempting to describe or even diagnose someone’s emotional state of being. It’s unfair not only to that person but also for the folks who truly live with this diagnosis and are being put into an inaccurate and rather insulting category of what Bipolar certainly is not.

~ You’ve got this!