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Bipolar II Rant from a Bipolar I

Ranting on Bipolar II

For starters – this is a pure opinion piece.  I am going to rant a bit about Bipolar II.

I read a lot of bipolar “stuff” – articles, study results, chat boards, Facebook pages – a lot.  Recently, once again, I have become irritated by the use of “Bipolar II”.

I recognize that Bipolar II is a DSM diagnosis that indicates that a person has cyclical periods of depression alternating with Bipolarity in Hellhypomania.  I know that is true – and that the diagnosis must fit some people. Bipolar I, on the other hand, is defined as cyclical periods of depression, alternating with manic episodes.  If you are a rapid cycler or have mixed state disorder – you are usually classified as Bipolar I.

My current irritation is with a story – not a celebrity this time – but an apparently real person from a news story.  The article reports that this particular woman had been diagnosed with Bipolar II when she was 20 and now 38, she is stable on a myriad of pharmaceuticals.  Fine.

The article goes on to say that she “experiences the manic phase” but mostly struggles with the severe depression, adding that she also has PTSD, anxiety and has been unemployed most of her life.  Let me repeat, she has manic phases, PTSD, and anxiety. She has always been unemployed (due to her psychiatric condition).  Doesn’t sound very stable to me…and doesn’t sound much like Bipolar II.

I have a problem with the fact that so many stories I read are about people who claim to have Bipolar II, and are careful to clarify that they don’t have Bipolar I.  Naturally, this would be a kinder, gentler form of Bipolar disorder.  A Bipolar disorder where we never bother anyone, get lots of stuff done in an organized fashion but sometimes get depressed.  A Bipolar disorder that makes us “better”.  Better than Bipolar I’s craziness – and even better than regular people.

I don’t live in that world, and I am not truly convinced that it exists.  I have known lots of people with Bipolar disorder – in fact, I used to go to a group just for people with Bipolar disorder.  Every single person there was initially told they were Bipolar II – and then once they got used to that… the real news came out.

Many of us were “high functioning”, many of us had “good jobs”, many of us were “organized”… except when we weren’t.  We didn’t come to the bipolar group because things were going great.  We had all had periods of depression, periods of extreme productivity and periods of crazy when we told the truth.

Bipolar RantIn my experience, people with Bipolar disorder don’t seek help.  They are driven to it – or dragged.  People are driven to help when they are depressed, and they are dragged to help when they are manic.  If they arrive when depressed, they don’t report the mania that gets them a Bipolar II diagnosis.  If they arrive when they are manic – they won’t listen to anything about “crazy manic depression” so they are told about how much better Bipolar II is.  They will take the diagnosis and take the meds.  Either way, the first diagnosis is probably going to be Bipolar II.

I could claim to be Bipolar II.  I could even get a couple of doctors to agree with me.  Most of the time, I am “high functioning” – except when I am not.  Bipolar I won’t ever lose the stigma if Bipolar II continues to be presented as “better” and people continue to be dishonest.

Take your meds!

Melissa Lind

Mental Illnesses on Movies

Movie attractions about mental illnesses

Recently I wrote about the premiere of a new movie, Mania Days, which stars Katie Holmes and is based on the life of the author who has Bipolar disorder.  One of our Facebook friends asked where it could be seen.

Well, the answer, in short, is “not yet”.  It is an independent film and caught my eye because it premiered in Austin TX, near where Old Fox MovietoneI live. Unfortunately, no matter how good it is, it won’t be released on the “big screen” until the writer/director/producer has an offer from a large movie production company – for a lot of money.

He may get one of those offers at upcoming independent film festivals, and the prospects look good as the film has received positive reviews.  It is likely that no matter how good the film is, we won’t see it in theaters for several months, if not longer. (It will probably be available on DVD though)

Sorry if it was a big tease.  In any case, it got me thinking that there are some well-known and available movies that you can see.  Maybe you have seen them, but you probably haven’t seen all or even most of them.

The good news is that since mental disorders tend to produce notable or even outrageous and shocking behaviors, they do make good subjects for movies.  This list is only a few of the movies that I have seen – and in many of them, there is no clear “diagnosis” for the characters but the symptoms are there.

Borderline Personality Disorder

Most of the films that feature characters that may have borderline personality disorder focus on murderous women.  Certainly BPD doesn’t only affect females but it does make good movie fodder.

•    Fatal Attraction
•    Single White Female
•    Casino
•    The Cable Guy
•    Margot at the Wedding
•    The Crush

Anxiety Disorders –

Anxiety disorders are harder to see in a movie as a single issue as they often occur with other disorders – as they do in real life.

•    Ordinary People
•    Parenthood

Social Anxiety Disorder

Can result in avoiding being in public, speech disorders and fears of other social situations.

•    The Kings Speech

Obsessive Compulsive Disorder

OCD is a real problem, but many people don’t realize how debilitating it can be.  In addition, it is also an anxiety disorder but doesn’t show as well on the screen.

•    The Aviator
•    As good as it gets

Post-Traumatic Stress Disorder

PTSD often follows a “war” event – but can follow other traumatic events. In most cases, these events are “acute” but in some cases they are chronic, occurring over a period of many years.

•    Prince of Tides
•    Forrest Gump
•    Born on the Fourth of July
•    First Blood
•    Sudden Impact
•    Reign Over Me
•    The Hunger Games: Catching Fire

Autism

There is really only one good example that I know of – and it is a classic.  That said, it is not an exact example as Autism is a “spectrum disorder” that ranges from high-functioning to non-functioning.

•    Rain Man
•    The Boy Who Could Fly

Bipolar Disorder

There are actually a lot of movies that can be seen showing bipolar disorder though. Rarely do they discuss the actual diagnosis but here are a few good ones.

•    Mad Love
•    Blind Date
•    Michael Clayton
•    Manic
•    Of Two Minds

Clinical depression

In most cases, clinical depression doesn’t look good on a screen.  Unless the character has some other event going on, watching someone not do anything doesn’t attract movie attention.  In these cases, there were other things going on in the movie that made them interesting.

•    The Fire Within
•    Leaving Las Vegas
•    Rushmore

Silver Linings PlaybookAnd the winner for “Most Psychiatric Disorders Featured in One Movie” goes to:

•    Silver Linings Playbook
•    Girl Interrupted

Both movies show a number of intertwining psychiatric disorders including anxiety, depression, borderline personality disorder, bipolar disorder, and eating disorder, are great films and two you really shouldn’t miss.

Most of these movies should be available on DVD.

Melissa Lind

List of films featuring mental disorders

Bipolar II – Really?

Is it Bipolar II – or just plain Bipolar Disorder not yet recognized?

Google “Bipolar” on the “news” tab and see what you find.  It is astounding how many semi-celebrities have come out and said “I have Bipolar Disorder”.  Unfortunately, the story is often about Bipolar II, which somehow makes it “better”.

Bipolar Disorder is still a serious stigma – prevents people from getting jobs and such.  Technically, as Bipolar Disorder is considered a disability, an employer who did not hire or fired an admitted bipolar patient based only on that fact would be in violation of the American Disabilities Act, but few people are willing to go to the carpet on that.  Plus there is the little issue of being “able” to perform one’s job.  I can perform a job if I am taking meds.  If I am off of meds, I become highly unreliable with a lot of other liabilities – risky behavior that I have decided not to discuss.

Only a couple of years ago, I was warned by a well-meaning family member against posting too much on social media about Bipolar Disorder – and this in his mind included “liking” too many Bipolar pages.  He was concerned about my ability to obtain a decent job.  I don’t know if I have a “decent “job today – I have made my own way which works out better for me – no boss to annoy, no dress code, nobody else’s time clock.  For the most part, I don’t worry about social media – I don’t think I will ever have a “real” job again – no more frequent flyer miles for me.

Bipolar 2I was once diagnosed as Bipolar II – but really, both the doctor and the therapist thought differently – they both knew that I had regular Bipolar Disorder but wasn’t ready to accept it.  Actually, I am pretty sure my doctor tricked me into taking Lithium for the first time by telling me that it would help boost my antidepressant activity.

In retrospect, I am astounded that I believed him since I know so much about medication – but I took the medication.  How many of these people really have Bipolar I Disorder and just don’t say so.

It is much easier for people to say and accept that they have Bipolar II.  In my opinion (which is obviously vast and knowledgeable – just kidding, no really), Bipolar II is a way of sliding by the real diagnosis.  As in “I have Bipolar Disorder but not really”.  “I have Bipolar Disorder but I am not crazy”.  “I have Bipolar Disorder but I am not dangerous”.  “I have Bipolar Disorder but I won’t embarrass you”.
When it gets down to it…wasn’t that true for all of us at one time?  Or at least didn’t we believe it at one time?  I still fit some of the criteria – I am “functional”, “productive”, “hypomanic” – except when I am not.

I often confuse my doctor when he asks how it is going by saying “good enough”.  What I mean is that I am not manic exactly, I am not depressed.  Actually it works better for me if I am teetering on the edge of mania.  If I am just crazy enough that I know that I am crazy – then I will keep taking my meds.  Because I forget.

I originally sought treatment for severe depressiondepression bad enough that I had to decide whether to kill myself or study (I had a big exam the next day).  In retrospect, I was actually in a mixed episode with plenty of energy but in a really bad mood.  Oh, and then there was the slight issue of the hypnogogic hallucinations which I denied at the time.  See, even if I know that I have Bipolar DisorderManic Depression – I still forget.

It would be easier for me to say that I have Bipolar Disorder but it is “just” Bipolar II.  I thought that too.

Melissa

What Type of Bipolar Disorder Is It?

Each bipolar disorder illness is unique!

Uniqueness of Bipolar DisorderWhen nearly anyone thinks about bipolar disorder, they think of the symptoms of “regular” bipolar disorder.  Not that any person with bipolar disorder is “regular” (and most would not want to be), but there are several different subtypes of bipolar disorder.

One big problem with bipolar disorder is that each illness is unique.  Psychiatrists may classify them into categories – but they don’t always fit.  Here are some case scenarios: (bipolar episodesbipolar groups)

•    Jennifer has episodes where she is extremely agitated and unhappy and never seems to sleep very much.  These periods seem to last for a long period of time – but can alternate with months where she is simply unhappy and doesn’t feel like doing anything.
•    Max has had periods of depression before.  A lot of times, they go away after a couple of months and then he seems normal but recently he “disappeared” for a couple of weeks after some really bizarre behavior.  His friends never knew that he was any kind of bipolar until he told them he had been at the hospital.
•    Ben has periods of depression that can last for several months but when he is not depressed, he is productive and seems quite outgoing.
•    Sandra’s mood state can switch erratically.  One day she is all about shopping and the next time you call her, she is still in bed at noon.   This is a constant issue – and you never know what you are going to get.

These are three examples of bipolar disorder that don’t seem to fit the “normal” pattern.  None of these patients seems to be “regular” bipolar.

Bipolar disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as:

Bipolar Disorder TypeBipolar I Disorder: manic or mixed episodes that last at least 7 days – or if manic symptoms are severe enough to need hospitalization.  This, usually, includes periods of depression that last at least two weeks.
Jennifer and Max both fit into this category.  Even though Max never had a severe manic episode, having a bipolar episode that warrants medical attention, he qualifies for the Bipolar I category.  Jennifer has mixed episodes – rather than euphoria or traditional mania – she has periods of “dysphoria” where she is agitated, irritable and irrational but with an excess of energy.

Bipolar II Disorder: depressive and hypomanic episodes in a pattern – but manic episodes are not severe.
Ben has Bipolar II disorder.  He has periods of depression that are debilitating, but his non-depressed periods are quite productive, and he doesn’t exhibit manic behavior.

Bipolar Disorder Not Otherwise Specified: (Bipolar Disorder NOS) symptoms of illness don’t meet any other group, but the symptoms are clearly not within the standard range.
Sandra has BP-NOS.  She is what is commonly called a “rapid cycler,” meaning that she switches back and forth from mania to depression much faster than other people with bipolar disorder.

There is also a very mild form of bipolar disorder known as cyclothymia.  It is a cyclical pattern of hypomania alternating with periods of mild depression.  Many people would not even realize this is a problem.

Bipolar disorder is hard to classify.  It may be easy to determine that someone has a problem – but the uniqueness of each bipolar case makes it more difficult for even a patient to identify with the diagnosis.  Each type of bipolar disorder is, usually, treated the same medically. With an anti-manic agent (Lithium), anti-epileptic (Lamictal, Depakote) or atypical antipsychotic (Abilify, Zyprexa) – and sometimes with an antidepressant.

Melissa Lind

Bipolar Disorder Research Funding – Poorly Directed

Prepare yourself for a bit of a bipolar rant!

An article entitled “Bipolar Disorder in Youth Not as Chronic as Thought” in Medscape Pharmacists e-newsletter came across my email and while I was initially quite interested, I soon became annoyed.
Bipolar and Borderline (BPD)A recent study done at the University of Pittsburgh School of Medicine shows that bipolar disorder may not always be a chronic condition. While this may look like good news and you might see it pop up in the media as a big positive – cheerleader kind of thing, it really isn’t.

The study followed 413 children and adolescents who were 7 to 17 years of age and diagnosed with bipolar disorder at the time of study enrollment.  The patients and family members were interviewed about every eight months, for eight years.  What they found was that some of the patients were “ill” most of the time, some were “well” most of the time, and some were both ill and well.  Sorry, but that result isn’t astounding.

I find a couple of things wrong with the published results.

  1. They didn’t say whether the patients were stabilized on medication during the study – what medication, whether the medication was changed, whether the patients took the medication – in fact the publication doesn’t mention medication at all.
  2. The data collected was based on “interviews.”  Sorry, but being bipolar inherently predisposes you to lack of complete transparency.  Bipolar patients are likely to hide and lie – whether it is purposefully or subconscious behavior, it is a known problem.
  3. The patients were ages 7 to 17 when entering the study, meaning they were 15 to 25 at the end.  Many of the patients went through puberty during the study and what pubescent child or the post-pubescent adolescent is truly stable…or honest for that matter.  Interviews with the family may have partly balanced this but we also know how “well” our families may know us…some, not at all.

What I did find a little more relevant was that the patients tended to be “well” more of the time if they:

Though true, this is not astounding either.  It is easily recognized that if your family has a history of mental disorder, you are more likely to have a mental disorderBipolar disorder and substance abuse go hand in hand, and sexual abuse makes nothing more manageable.

Incidentally they also showed that patients would be more stable if they:

•    Had less history of severe depression, manic or hypomanic symptoms
•    Had fewer subsyndromal episodes

So basically, if the patients had a history of fewer episodes, they would have fewer episodes……really?
Not discounting the fact that any academic attention given to bipolar disorder, especially in juveniles should be welcome, I am disappointed because the study results didn’t show anything.  This is all information that anyone could guess – and the funding for mediocre “non-results” could have gone elsewhere.

This sort of news can easily lead to an “it will go away” thought process, lack of medication and lack of attention to and acknowledgment of the real and long-term challenges that a bipolar patient can face.  Yes, let’s all believe that bipolar disorder is not a chronic medical condition… let’s undo all the progress that has been made.

Melissa Lind

Academic attention given to bipolar disorder should be welcome!

Bipolar Disorder – Euphoria vs. Dysphoria or Mixed Episode

Most symptoms of Manic Episodes appear to be positive

Manic-depression or Bipolar disorder is usually perceived on of two ways – a person who alternates between depression and euphoria – or a person who alternates between depression and craziness.

Often a person who is told that they are bipolar will identify one of those two states – and will object based on the fact that they have never been “euphoric“, and they have never been actually psychotic or “crazy”.

Bipolar disorder or Manic-Depression is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) – “the Bible” of psychiatric disorders – as “…clinical course that is characterized by the occurrence of one or more Manic Episodes…”

7 “points” retrieved from: DSM IV Criteria for Manic Episode – Food and Drug Administration

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week. With three or more of:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only three hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas, or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school or sexually) or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

There is another specifier – “The symptoms do not meet criteria for a Mixed Episode” which is left out in a lot of thought processes.

Bipolar - EuphoricOne problem that is often encountered when diagnosing Bipolar disorder – or when trying to convince someone who has Bipolar disorder that they do, indeed have the illness – is that most of the “symptoms” of a Manic Episode appear to be “positive” or “happy.”  If you examine the wording – it looks on the surface and is often described as periods of “Euphoria” or extreme happiness.

In truth, many people with Bipolar disorder don’t have periods of “euphoria,” they don’t have what is perceived as “inflated self-esteem or grandiosity“, and they don’t seek out “excessive involvement in pleasurable activities.”  They may have “dysphoria,” they may believe that they have to do everything themselves, they may experience psychomotor agitation…they may be in a really active bad mood.

This is a state of “dysphoria.”  It is also called a “mixed state” where the Manic Episode and the Depressive Episode occur at the same time.  Features may include the racing thoughts, irritability, lack of sleep, psychomotor agitation of a Manic Episode but also include anhedonia or lack of enjoyment, inappropriate guilt, or suicidal thoughts which are symptoms of depression.

Unfortunately, this disconnects in presentation, and lack of awareness of mixed states (in both the patient and some professionals) often gives the bipolar patient an “easy out” in acceptance of the diagnosis.

Melissa Lind

Mixed Episode or Manic Episode with Mixed Features is given too little attention!