As World Bipolar Awareness Day is tomorrow (March 30th
2019), I wanted to make a post about Bipolar, to raise awareness and to share
my story in the hopes it might help people in similar circumstance, or educate
others who don’t currently know much—or as much as they’d like to—about
Bipolar. I decided to make two separate posts on the matter, this post will
focus more on facts, and the other post will focus more on my own journey with
the disorder. In this post I’ll outline what
Bipolar is and how it’s classified, mood
episodes like mania and depression, treatments
for Bipolar, common misconceptions,
how to be a great ally to someone
diagnosed with the condition, a Q&A—as
asked on my Instagram page—and finally a list of useful books and websites where
you could learn more or get further support. I am a chronic over-explainer, so
this post is long. If there’s one of those sections that peaks your interest
more than others, just skip down to it!
What is Bipolar Disorder?
In as concise a definition as I can describe, Bipolar
Disorder, once known as Manic Depression, is a life-long, severe mood disorder,
under the clinical classification of psychosis, characterised by extreme states
of mood and energy, referred to as ‘episodes.’
Lots of jargon there, but what does that all mean? Well
someone with Bipolar will experience altered states of mood and energy, across
a whole spectrum, but can come with symptoms—behaviours, feelings and emotions—grouped
into episodes, which I will explain later in this post. The main episodes
talked about and identified are depression and mania. In a nutshell depression
is comprised of low mood, low energy, poor outlook on life, hopelessness,
tiredness, poor sleep and personal hygiene. Mania is almost the opposite of
depression with its key features of high energy, feeling no need for sleep, racing thoughts and rapid speech, however mania
often interferes with a persons functioning—their ability to do day-to-day
tasks like hygiene, eating, drinking, working etc.
The descriptor of ‘life-long’ means that once you’ve ‘got
it’ (experienced established, cycling episodes, or maybe just one or two
manic/depressive episodes), it’s there for life. This isn’t as definite as it
sounds: some people are misdiagnosed with Bipolar and go on to have their
diagnosis changed and so don’t have the label for life; others are able to
achieve ‘remission’, meaning they’ve gone a while without an episode and no
longer need intensive or regular input (some people achieve remission after
their first episode, others may require longer treatment before they remiss),
but the term ‘life-long’ means that they could go on to have another episode,
any time in the future. However, for many people with Bipolar, ‘life-long’
literally means they struggle with symptoms and episodes for life. So far, I’m
in that last category: I’ve had symptoms since I was 13 or 14, was diagnosed
with Cyclothymia (I’ll come onto this soon) aged 17, and diagnosed with Bipolar
and Psychosis aged 20. Since diagnosis and treatment I’ve had several periods
of stable mood, but constant, or baseline, symptoms, and many mood episodes.
The word ‘severe’ is pretty self-explanatory: shit can get
bad. I think the best way I can explain how severe Bipolar can be, especially
left untreated, is through a story. Thomas is in his 50’s and currently in an
inpatient psychiatric unit. He won’t leave his room, spends most of his time
standing on his bed facing the far corner of the room, mutters to himself
constantly, refuses to eat any food (some staff have heard him talking about
poison and assisins) and hasn’t changed clothes or bathed since he arrived.
Thomas smells horrible—this is because he’s lived on the streets for at least
seven years (that’s when people around the town started seeing him often), and
when a nurse finally coaxes him out of the corner, she notices scratches, cuts,
bruises and scars all over his visible skin. What happened to Thomas? Thomas
had untreated, undiagnosed Bipolar and has been living in this state on the
streets for almost a decade. We’ll catch up with Thomas’ story later.
Mood Episodes
As I’ve said, Bipolar is characterised by mood episodes, but
there are more than just Mania and Depression: these are the two extreme states
which usually attract the attention of family members and healthcare professionals,
but within these extremes are Hypomania (literally translated as ‘under mania’),
and dysthymia—a ‘mild’ depression. I’ll try and explain each of these, and then
add some more information and context about how these episodes may present.
Depression and Dysthymia
Depression is one of the most common mental illnesses in the
world, so most people know what it is, but dysthymia isn’t so often heard of,
probably because a lot of people with dysthymia are still functioning relatively
normally (going to school or work, cooking and eating appropriate meals,
washing and changing clothes etc). The most common ‘symptom’ of dysthymia is a
general discontentment with life: someone who is dysthymic may be unhappy with
how their life is, or their work, or relationships, but isn’t necessarily
bothered to the point of doing something about it. They might feel tired and irritable,
but not with big angry outbursts, more like a heavy sigh and a muttered ‘here
we go again’. Apathy is defined as “a lack of interest, enthusiasm or concern”,
someone with dysthymia could be described as apathetic about life: they’re
unhappy, but they can’t be bothered to do anything about it. Depression is
stronger, more noticeable, and usually impacts heavier on a persons’ life and
functioning, depression turns apathy into lethargy. If we see apathy as a lack
of enthusiasm, lethargy is defined as
“a pathological state of sleepiness or deep unresponsiveness and inactivity.” Someone
who is depressed will experience low mood (sadness and crying easily, feeling
hopeless, extremely tired and feeling slowed down), low self-esteem or
self-image (thinking things like “I am useless”, “no body likes me”), and sometimes
thoughts of harming themselves (“everyone would be better off without me” or “my
life isn’t worth living”). Other symptoms of depression can be low appetite, sleeping
too much or too little, withdrawing from daily activities, stomach aches, headaches,
anxiety (worry without cause), speaking of moving slower than usual, constipation,
low sex drive and many others.
Mania and Hypomania
The real differentiator between someone experiencing a
depressive disorder, like Major Depressive Disorder/Dysthymia/Uni-polar
depression, and Bipolar Disorder, is the presence of either Manic or hypomanic
episodes. Mania almost looks like the opposite of depression, with the
exception of extreme anger or rage. Someone who is manic, as I briefly
explained earlier, will generally be of high energy, feeling little or no need
for sleep, seem ‘sped up’, talking very quickly for long chunks, experience ‘flight
of ideas’ (which is exactly what it sounds like—lots of ideas in their head
which fly away as quickly as they come. I like to describe it as my brain driving
at 100mph and wooden hazards popping up, but without the time to steer around
them I end up smashing straight through them). Mania also often brings an
inflated sense of self-importance, which can lead to psychotic features like grandiose
delusions: “I have been chosen by God”, “I’m actually the heir to the throne”,
etc. Unusual talkativeness, unusually high energy, seeming ‘wired’ and ‘jumpy’,
poor decision making (like suddenly spending a lot of money, gambling, drinking
or taking drugs), and increased sex drive also often accompany the heightened energy
and mood of Mania. Mania tends to interfere with functioning quite a bit, some
people even lose their jobs, partners or families because of mania, or the decisions
they make whilst manic. One thing that sets mania aside from ‘the opposite of
depression’ is that someone’s mood when manic will not stay high/hyper/extremely
happy, but often usually turn to disproportionate rage and being ‘on a short
fuse’. If I were to describe my experience of Bipolar rage, it feels like
everything is going wrong, and people are engineering situations to bring you
down/irritate you. When it starts up I sometimes recognise that my reaction is out
of proportion, but it’s like a volcano filled with white-hot fury which is
inevitably about to erupt, at which point I’m powerless to stop it—so I either
go with it and do damage, or fight it and look like the stereotypical ‘crazy
person’ shouting at themselves with their hands over their ears… Regardless of
my choice, I end by feeling completely out of control.
Hypomania—as I said earlier meaning ‘under mania’—generally encompasses
similar symptoms to mania, but not as extreme. Poor decision making seems ‘down-graded’
from life-destroying decisions, to taking on more projects than someone would
usually cope with, and doing things to excess, like drinking cups and cups of
tea, or listening to the same song very loudly on repeat all day. Someone who
is hypomanic may still be eating and sleeping, albeit interrupted or not sufficient
(maybe getting distracted half way through a meal, or having lots of ideas they
want to act on before bedtime). Hypomania doesn’t always bring the blind rage I
explained about with mania, although someone may still be easily irritated.
There are other states someone with Bipolar may find
themselves in, but they aren’t necessarily defined episodes. Sometimes the same
mixtures of mood and energy can produce different states.
High energy + low mood = agitation
High energy + high mood = euphoria
Low mood + very high energy = paranoia: this area of the
spectrum is most highly associated with psychosis, like the paranoid thoughts
and beliefs that may come with schizophrenia as well as Bipolar with Psychosis.
Let’s look more at Thomas’ story:
When Thomas’ family was finally tracked down several weeks,
almost 2 months, later, across the other side of the country, they explained
that about 10 years ago Thomas suffered a ‘nervous breakdown’. They described
his behaviour: Thomas had been doing well in life, he had 2 young children he
was proud of, a steady job, loving partner. He’d been taking on a lot of
responsibilities at work, at the kids’ school. He was full of ideas and
enthusiasm for life. Very quickly Thomas began to speed up in every area of his
life: he was barely sleeping, would talk a mile a minute, went to work early,
spend his nights writings or painting or goodness knows what. One night,
Thomas’ family woke up to what sounded like a house being knocked down, to find
Thomas knocking down the wall of their kitchen. In the next week Thomas re-mortgaged
the house and purchased a very expensive race car without telling his partner. His
brother and partner sat down with Thomas to try and find out what was
happening. The bank phoned whilst they were talking, asking about unusual
purchases, and when his partner confronted him, Thomas began speaking about
conspiracies, about people who were trying to harm his family, and other things
his brother couldn’t understand. Thomas ran out the house and never came back.
Thomas’ family also said that in the 10 years since Thomas went missing, his
brother and mother had both been diagnosed with Bipolar Disorder. We now know
that Thomas had had a manic episode with psychosis, that went untreated and
undiagnosed to the point of homelessness. He had been extremely vulnerable on
the streets, and it’s impossible to know how long his episode had lasted and if
he’d had other episodes in this time or was still manic from that first
episode.
Treatments
This section is more to inform you of the general treatments
for Bipolar. I am DE-scribing, not PRE-scribing.
The golden standard treatment for Bipolar is a mood
stabiliser called Lithium. Not much is known about how and why Lithium works,
we just know that it does its job very well for most people. It’s basically a
salt—lithium carbonate or lithium citrate— taken orally, however it can do
damage to the body long term, and not everybody is suited to take it. It can
cause Kidney problems, heart problems, thyroid function issues and diabetes
insipidus (where the kidneys don’t filter sugar from the blood correctly). For
this reason, blood tests are required every 6-12 months, along with heart
monitoring. Lithium dosing varies person-to-person, and is dependant on the
level of lithium in your blood—this needs to be tested in a blood test at least
every 3 months. Some other drugs can be used as mood stabilisers, like lamotrigine,
an anti-epileptic drug, however these can also cause depression and anxiety.
CBT and counselling can be used to help Bipolar depression,
and some areas in England have Bipolar Education courses which can advise you
best on how to manage your condition.
Sometimes anti-depressants are used for Bipolar depression,
but should be used with caution as they can sometimes bump someone into a manic
episode. In manic episodes benzodiazepines (tranquilisers) can be used to help a
person relax or sleep: zopiclone, diazepam and lorazepam are commonly used this
way. Some anti-psychotic medication can help in manic episodes, or can be
prescribed for ‘agitation’ in Bipolar mania. Other anti-psychotic medication
can be used as mood stabilisers, or to control hallucinations and delusions for
those who also battle psychosis with their Bipolar.
Occasionally hospitalisations may be required to manage
someone with Bipolar, especially if they are at risk to themselves or others. People
are not always sectioned, but sometimes voluntarily agree to go into a hospital
to manage their mental illness. Electroconvulsive Therapy (ECT) is still
sometimes used for extreme, stubborn, treatment resistant depression, but is
never forced on someone. Even if someone is being held under a section of the
mental health act, they can dispute decisions on ECT treatment, either through
a family member or a patient advocate.
Are there different types of Bipolar?
Yes and no. There are different classifications which vary
country-to-country. In the USA there are something like 14 types of Bipolar.
Internationally and in the UK, the most commonly recognised types are: Bipolar
I (with or without psychosis), Bipolar II, and Cyclothymia. The general
criteria for these are the severity of episodes. Bipolar I is made up of manic
to depressive episodes and anything in-between, but at least one full manic
episode is required for diagnosis, which has to either last 5 or more days, or
require a hospital admission. Bipolar II is made up of hypomanic to depressive
episodes. Cyclothymia is sort of a ‘subthreshold’ Bipolar condition, sometimes
called Cyclothymic Bipolar Disorder, and is made up of hypomanic and dysthymic
episodes. 50% of people diagnosed with Cyclothymia go on to be diagnosed with
Bipolar type 1 or 2 later in life (I am one of those 50%).
Common Misconceptions
Misconception: people with Bipolar are dangerous to me or
my children.
Reality: people with Bipolar are more likely to pose a risk
to themselves than others, usually due to self-harm, abnormal thinking, poor
medication management, psychosis, or depression leading to suicide attempts.
Misconception: someone with Bipolar cannot lead a
meaningful life, they will be unwell until the day they die
Reality: whilst some people with Bipolar struggle to maintain
a stable mood, most people are able to manage the condition with periods of
stability, are able to work, date, have a family and a relatively normal life. Early
diagnosis and intervention are key, along with proper access to mental health
care and the right treatments.
Misconception: Mania is a really happy, hyper mood.
Reality: mania is often a lot scarier and unpredictable than
depression, and can bring irritable mood, anger, rage, and can destroy peoples’
livelihoods, families and careers.
Misconception: People with Bipolar are psychos.
Reality: ‘psycho’ is short for ‘psychopath’. Psychopathic
personality disorder is in a completely different category to Bipolar. If you’re
using the term ‘psycho’ to describe hallucinations and delusions, you’re wrong.
That’s called psychosis, not psychopathy. Psychopathy is a personality disorder
in which a person manipulates and ruins others for personal gain, they have
little or no respect and empathy.
Misconception: If someone with Bipolar is stable, they
must be mentally healthy.
Reality: Baseline symptoms are symptoms of Bipolar that don’t
go away with treatment, or stubbornly hang around even if you’re not in a
Bipolar episode. These look different for everyone, but I personally struggle with
social anxiety, poor sleep, poor appetite, irritability, and PMDD. I also take
a lot longer to calm down after an exciting or stressful event.
Misconception: Bipolar is mood swings; my cousin said I could
borrow her car yesterday but today won’t even give me the keys, she’s so Bipolar;
ten minutes ago it was raining and now it’s sunny and warm out, the weather is
so Bipolar.
Reality: Bipolar is so much more than ‘mood swings’. If
someone is having severe mood swings and over-reactions which leave them
mentally distressed, I’d advise you speak to a doctor about Borderline Personality
Disorder. Janet not lending you the keys to her car after saying you could
borrow them doesn’t make her Bipolar, it makes her flakey, or maybe she’s just a
bitch. And the sky cannot have a severe, lifelong, psychotic, mental illness,
so no matter how often those rainy clouds come out and go back in again in a
day, the weather is not Bipolar.
Misconception: Bipolar is not a disability.
Reality: In England, a disability is a condition or illness
which impairs one of more aspect of daily living, expected to last 12 months of
longer. It’s case-by-case, but if Bipolar impairs (stops, hinders or interferes
with) a persons’ daily functioning (working, walking, driving, feeding
themselves etc) for 12 months of more (remember Bipolar is life-long), then they may indeed be disabled.
Misconception: Bipolar is like waking up and not knowing
if Tigger or Eeyore is in the driving seat.
Reality: Bipolar is like having a life-long, severe, mental
illness, which causes periods of elevated mood and energy which can literally
destroy your life, and periods of severely low mood and energy which can also
literally destroy your life, facing an onslaught of physical an psychological
symptoms, often having doctors dismiss physical health concerns with “it’s
cause by your Bipolar/medication”, workplace bullying (if you’re even well
enough to work), and discrimination in many forms. So no, it’s not really like your
brain is driven by a child’s story book character, but nice attempt at romanticising
and normalising a severe mood disorder, Janet.
Q&A as asked on my Instagram
Q: Are you on medication for Bipolar?
A: Yes, I’m on Lithium, Quetiapine (and Procyclidine for
extra-pyramidal side effects of Quetiapine).
Q: How did you end up being diagnosed?
A: I started having very slow, mild mood swings when I was
about 12 or 13, and at 15 started hearing voices and seeing things other people
couldn’t. I ended up depressed and self harming as a 14/15 year old and was
diagnosed by Child and Adolescent Mental Health Services (CAMHS) with Cyclothymia.
I was never put on mood stabilising medication, and my first adult psychiatrist
said she thought I had traits of BPD, not Bipolar. In July 2016 I was admitted
to a mental health unit (psych ward) in extreme mania and actively psychotic,
and diagnosed with Bipolar and Psychosis almost immediately.
Q: Do the stereotypes annoy you?
A: I hope my sass came across in the ‘common misconceptions’,
but yes! The worst one honestly is the Tigger-Eeyore thing.
Q: What is Bipolar Disorder? My friend has it and I’d like
to understand it.
A: I hope this post has enlightened you, but scroll down to
the section How To Be A Good Ally.
Q: Does Bipolar Run in families?
A: Yes it can do, but not exclusively. I’m the first in my
family to have been diagnosed, but my mum and I sometimes ponder about other
family members. It can be caused/triggered by traumatic events, but there is a genetic
element (currently unidentified but generally agreed in the medical world).
Q: How does it classify as a mood disorder in comparison to
a personality disorder?
A: Well simply put, Bipolar is a mood disorder, which is a
completely different category to a personality disorder. Whilst it shares some
similarities with BPD, the big differences are the cause of the symptoms: Bipolar
is chemical, known as ‘organic’, hence it being treated with certain drugs.
Various levels of hormones and chemicals can be imbalanced in people with
Bipolar Disorder. Personality disorders are more to do with thought processes
and cognition, hence treatment for BPD mainly being intensive therapy, DBT and
partial hospitalisation programs to help someone cope with feelings and
challenge their thought patterns.
Q: How does it make you feel on good days? How does it make
you feel on bad days?
A: As I talked about baseline symptoms earlier, on good days
I can feel relatively stable in mood, but still have crap quality of sleep, be
anxious about talking on the phone or to strangers (sometimes even friends and family),
and I’m kind of on edge and on the lookout for early warning signs. I also have
to take medication which have some crappy side effects. On a bad day with mania
I’ll be out of it and dissociated but on a crazy high, usually end up in
hospital with mania. Bad day with depression looks bleak, black, lonely, filled
with tears and possibly self-harm, not eating, staying in bed.
How To Be A Good Ally
I feel like I want to split this into ‘good’ and ‘great’ allies
really. There’s only so much a friend can do without becoming really intensely
involved. I guess some do’s and don’ts are a good starting point. The biggest
thing I’d advise is to just be their friend: make sure they’re having a good
time when you’re out and about, respect their boundaries (whether that be practical
things like if they need to go home at a certain time, or take meds, or if you’re
going to a pub and they don’t drink etc), and don’t act all weird around them
once you find out their diagnosis—they’re still the friend you knew before,
just with a few more pills in their pocket. If they’re unwell some basic ways
of helping are phoning them in the morning or evening to make sure they’re
taking meds/going to bed if manic, or making sure they wake up for work or
school is they’re depressed; ensure they’ve eaten, maybe by cooking them some
food or taking them out somewhere, or ordering food in together; if you’re
really concerned about them, find the local crisis team number or phone their
GP to make them aware. In terms of being a really great ally or advocate, you
need to make sure you don’t take on more than you can handle, set out those
boundaries when your friend is relatively stable. You could keep a copy of
their advanced statement, offer to feed the cat/water plants if they have to go
into hospital, have a copy of their relapse drill or early warning signs etc.
Learning about Bipolar, myth busting and spreading awareness are also all great
things you can do. If your friend asks you to come to a Bipolar UK support group,
go for it! If they don’t know what Bipolar UK support groups are, tell them!
Knowledge is power. Also you as a friend/family member/carer are welcome to go
along to Bipolar UK support groups to get support for yourself. You might find
yourself learning more, and able to share the difficulties of looking after
someone with Bipolar.
What not to do: do not ask “have you taken your meds?”
unless this is an agreed task. It gets irritating, tedious and can also be used
as psychological warfare: I’ve had people try and gaslight me when they’ve
upset by saying I look tired and asking if I’ve taken my meds. It’s horrible.
Don’t do it. Don’t try and be a superhero; if you have agreed tasks in a
relapse drill that’s fine, but if you end up going to their house every day and
cooking them food, or scooping them up and taking them to A&E 3 nights a
week, it’s going to get to a point where you don’t even want to be their friend
any more, and it creates a dependency for them on you which can get unhealthy, quickly.
Also if mental health/crisis services know there’s someone taking
responsibility for your friend, they’re less motivated to provide support and
do their job. So being a super-hero best mate can be far more damaging to all involved.
That basically wraps up this post. I really hope you’ve
found even a little bit helpful, educational or enlightening, feel free to ask
me any more questions about the topic, general or personal, I’ll do all I can
to answer you. Best way to contact me is on my Instagram @frankiegrace_ or to
leave a comment on this post so I see it on my Google+ account. I will be
making another post soon, about my own journey/battle/story with Bipolar, so be
sure to check back here soon, especially if you want to learn more about my
personal Bipolar Disorder. I also do some pretty good advocacy on my Instagram
every now and then so go check out my story highlights (especially the one called
Bipolar Explained which goes through mania in more detail and why I think the
way we score Bipolar mood needs revamping!)
Extra reading:
Books
Bipolar Disorder The
Ultimate Guide – Amanda Saunders, Sarah Owen
Postcards From The
Edge – Carrie Fisher, famous actress and Bipolar advocate
Bipolar Disorder For
Dummies – Candida Fink, Joe Kraynak
When Someone You Love
Is Bipolar: Help and Support for You and Your Partner – Cynthia Last
Websites/Organisations
Bipolar UK – Charity for people with Bipolar and their loved
ones living in the UK. Find mood monitoring help and support groups/phonelines
here
Mind – UK charity for all things mental health, provides
general overview of the condition and signposts to where you can get help
World Health Organisation – WHO provide information,
statistics and condition overview (including symptoms and recommended treatments)
of almost every disease, worldwide
NHS – National Health Service in the UK, provides overview
of Bipolar Disorder, signposting to other helpful organisations, and how to get
help through NHS England, NHS Scotland or NHS Wales
Samaritans – UK suicide helpline, also provide telephone support
for friends a family, and anyone in emotional crisis “You don’t have to be suicidal to phone.” Dial 116 123 from any mobile,
phonebooth or landline in the UK
