Mental Health Month “Unipolar v. Bipolar & the great error”

After a school shooting or shopping mall attack, we nod and say; “Oh the perp was Bipolar (or schizophrenic).”

For those who are Bipolar (or Schizophrenic, discussed in a later post) this is the worst kind of association and thus, stigma imaginable.

Ironically throughout my life, I have been friends with a great number of Bipolar people and can attest that assuming all Bipolar people are gun-toting and ready to blow you away is a little like thinking all feminists want to castrate men.

Sure, mental illness can exacerbate another condition such as anger, and be part of the impetus that leads to an unacceptable outcome. However, this alone doesn’t logically mean all people with certain mental illnesses ARE going to do that. Just as the vast majority of those who are Islam would NEVER be a terrorist, the same is true of those with Bipolar (or other mental disorders)

But try telling that to the media who irresponsibly fuel this stigma.

It’s like the whisper game, you whisper to a friend and by the time you’re at the end of 20 people meaning has changed.

Ask most people and they will say that they think the majority of shooters of that kind are mentally ill and typically Bipolar or Schizophrenic. How could that not impact how they see those people?

As discussed before, stigma is the worst element of any ‘label’ and is carried even when you dismiss it, as a permanent stain in our society so fond of judging others.

Bipolar, previously known as ‘Manic Depression/Manic Depressive’ is a disorder of two parts. Typically you are either Bipolar 1 or ll or mixed-effect meaning not clearly defined by either category. The problem with categorizing is obvious, the benefit is for those trying to establish treatment protocols but like anything else, mental disorders go in swings and roundabouts of popularity, and at times, it’s almost the illness-du-jour to label a higher number of people Bipolar.

I question diagnosis for the simple reason that having seen it implemented I have seen a great many mistakes in those diagnosis. At times it can seem comforting to be ‘told’ what you ‘are’ and ‘treated’ and has saved lives. I don’t dispute that. I do however, worry that the tools by which we diagnose are faulty.

A diagnosis of Bipolar is based upon several criteria, one being that you must have had a manic episode. Bipolar ll requires a manic episode of less severity. A manic episode can be characterized by many behaviors, typically including, insomnia/wakefulness for several days, excessive impulse behavior such as spending money, making rapid and interchangeable big life changes, impulsivity and promiscuity.

Of the MANY bipolar people I know intimately, and have met throughout the years, I have yet to meet two who are alike. What that tells me is labels are usually as counter-productive as over medicating can be and Bipolars are often over-medicated. However unlike Uni-Polar (Depression and/or Dysthymia) Bipolars really respond to medication and are perhaps most likely to benefit from medication of all mental illnesses. As one who doesn’t believe in the ‘magic pill’ I would stand by anyone who has Bipolar taking medication but caution against over-medication and/or not considering other options in tangent, such as diet-change and therapy.

Many people who become Bipolar do so during puberty/late teenage years. It comes on usually as an extreme manic or depressive episode that can lead to hospitalization, suicide attempts or dangerous behavior. In the past Bipolars were characterized from depressives as being ‘delusional’ and thus, ‘clinically insane’ during manic episodes, and thus, their diagnosis was higher up on the ‘illness’ scale of mental illnesses and it was easier to declare them legally unfit.

In this I would agree. Uni-polar depression is basically that, depression. Bi-polar is a mixed cycle (of varying length, degree and frequency) of mania versus depressive symptoms. As such during the manic-period of Bi-polar, individuals can be clinically delusional and suffer delusions of grandeur, extreme expansive thinking and other exaggerated and not literal feelings. One could argue when someone is depressed they are delusional also, but ask a depressed person they will tell you they know it’s depression. Ask someone in a manic episode, they don’t know it until they ‘come down’ and thus, it’s hard to reason with someone during a manic episode. Consequently they can unintentionally do a great deal of harm to others and themselves.

What it takes to push ANYONE to the edge where they choose to shoot people, is more than any mental illness alone. It takes a CHOICE. If you are delusional you don’t have the same kind of choice system as someone sane, so to some extent you can appreciate the diagnosis of clinical insanity when a very ill person shoots other people BUT despite this, Bipolar has more consciousness than say, a full on Schizophrenic delusional episode, and as such, I would argue, most people with Bipolar can choose (not to shoot people) and are more likely to hurt themselves than others (explaining the very high rate of suicide comparatively).

Does that mean they are not capable of making some VERY bad choices? Of course not, they often will, but it is often rooted in self-destruction than destroying others. Some exceptions exist but that is true of everyone. You cannot say someone with Bipolar is more likely to kill than anyone else, because statistically more murders are committed by people without Bipolar than with. As with anything, there is a tendency to push someone over the edge if they are ostracized, shamed, judged, stigmatized and bullied. At that juncture they may act out of their norm because that’s how far they have gone down the rabbit hole.

Bipolar is a very painful disease to live with because on the one hand it can produce the highest elation and feelings of wellness, ability, skill, intellect, foresight, emotion and productivity, followed by a massive crash and the exact reverse. It is the rollercoaster of emotions that cause the higher risk of suicide, imagine feeling on top of the world followed by feeling like you want to die? How is anyone supposed to live with that? This is why medication does work because it can suppress the extent of mania and the extent of depression and level off that individual to a safer plato. But of course ask any Bipolar they will tell you it also curbs the intensity and feels a lot like castration of the mind and emotional pallet which is why periodically Bipolars will ‘go off’ their medication in an attempt to ‘feel’ authentic.

In my own experience, the vast majority of people with Bipolar are considerably above-average in intelligence, and can produce in short periods of time literally incredible outcomes be it artistic or another form. They often have an addictive intensity and are highly likable in those moods, and then quite a different person when crashed. It can be challenging being friends because even when medicated there are up and downs and these medicated shifts, are often characterized by irritability, argumentive(ness) and ‘bitchiness’ which can be difficult.

But all in all Bipolars are given an unfair ‘rap’ by society and struggle every day to achieve an equilibrium that is false to their very natures. In some ways their lives are more interesting than a uni-polar depressive who fights to ever feel that euphoria or happiness, but on the other hand, the swing and mercurial dive into darkness can be more life-threatening. Stupidly I used to envy my more manic friends who seemed to have endless energy and enthusiasm, but there is definitely a high price for this.

Diagnosis is an imperfect science and it is worth noting that more and more people are being diagnosed as suffering from Bipolar 1 or ll and I find this highly suspect. If you are diagnosed you may want to double-check by getting a second-opinion. If you asked anyone if they had a manic episode, chances are they have, be it in a fever-dream or otherwise. People can be promiscuous or manic for other reasons than Bipolar and given that the medication is often strong and has serious side-effects it’s dangerous to accept a diagnosis without being absolutely sure.

Additionally, Bipolars are often diagnosed in their 60’s and beyond which I believe is a misnomer and incorrect. Bipolar disease is a manifestation of the young, and it can worsen as you age, but rarely if ever occurs in older age. If it does this could be the result of something else and that should be treated before the symptoms of Bipolar. Bipolar without a co-morbid primary causality does not just ‘suddenly’ strike a 60-year-old or I would argue, even a 40-year-old. Yes you can go many years ‘un-diagnosed’ but to suddenly start exhibiting symptoms? That’s something else and you should not accept a doctor fobbing you off.

Some Bipolars can function without medication and if you are in that category that may save you the long-term side-effects of medication and the tendency of over-medication by medical professionals, but there is no shame if you are not able to function without some medication and many Bipolars find it helps so much to get on a regiment of medication that works for them, like anything, Bipolar is a disease of extremes and can be ‘mild’ or ‘severe’ just like depression can.

I cannot tell you the number of people I have known who were let-go, fired or forced to leave their jobs when their diagnosis was found out. Equally there are examples that concern me, of Bipolar Psychotherapists hiding their diagnosis and treating patients. I have a lot of compassion for this but from my own experience I think it’s best not to hide a diagnosis even if it means not being able to be a therapist. The same is not true of other jobs, we cannot expect most bosses to understand and we’re only increasing the likelihood of stigmatization to reveal it to them. That said, in some instances with healthcare insurance tied to employment it’s impossible not to.

Contrary to Bipolar stereotypes most with Bipolar are functioning pretty well all things considered and can be supportive to others, and often leaders in innovative, creative expression. But for every success story there are many who suffer so extremely and do not respond to medication and those people are often left feeling they have ‘failed’ where others have succeeded which only makes them feel worse. This is not the case. There is no failure there are degrees of illness. For some, Bipolar can be managed, for others, it cannot just as with varying degrees of depression. If you are not able to function ‘normally’ (whatever that is!) that’s not a personal weakness or indictment of YOU.

Try convincing someone of that … not easy especially when they are bombarded with stories of over-coming Bipolar. Bipolar cannot be eliminated but it can be dealt with. The extent to how much it can be dealt with depends entirely upon the severity of Bipolar and NOT the personal weakness/strength of the individual. It’s imperative never to compare those suffering from Bipolar unfavorably and make someone feel they are failing or not trying.

Typically Bipolars are more at risk for co-morbid diseases such as Borderline Personality Disorder (BPD) Anxiety, Attention-Deficit-Hyperactivity-Disorder (ADHD), alcohol and substance abuse. Again, this is not because they are ‘choosing’ these co-morbidities but because of the interrelationship between some mental diseases. Consequently Bipolars also report higher rates of sexual assault, and injury.

Our understanding of the facets of any mental illness is our way of being an inclusive and supportive society for those among us who suffer. What does it take to read this and learn more about a disorder that affects so many people in our society today? What does it take to become more aware of the pitfalls in hope that you could help someone in crisis in the future?

Finally, it is worthwhile considering holding off on a diagnosis of Bipolar in children unless ABSOLUTELY certain because many manifestations that ‘look like’ Bipolar are in fact not, and medication has a deleterious effect on growing-brains that is little understood. Therapy and treatment for the effects is a less dangerous way of dealing with symptoms that resemble Bipolar in children. It is uncommon to manifest as Bipolar before puberty and I personally though not a Psychiatrist, caution against diagnosis until late teen age years (17+).