Bipolar Disorder - It's Really All About Cycling

John McManamy Health Guide
  • Is bipolar the wrong term for our condition? Tabby writes:


    I've had the high manias that landed me in IP a few times.  This qualifies me for the bipolar I diagnosis and often times I have psychotic symptoms. Yet, I struggle more and are more in danger of harming myself during the depressions. The depressions last longer than the manias and because of that I've often received the bipolar II diagnosis.


    What is going on? Tabby was responding to my recent post - Can Bipolar Include Ups That Seem Normal? - where I noted:


    Why this is important is that bipolar needs to be conceptualized as a “cycling” illness, a notion which dates back to 1854 when Jean-Pierre Falret came up with the term, "la folie circulaire" (circular insanity). Everything is moving, nothing is standing still.

    Add This Infographic to Your Website or Blog With This Code:


    Indeed, Tabby validated this view:


    Bipolar is a cyclic illness, at its most basic form.


    So how come our doctors don’t know this? In her comment, Tabby points out that the people who treat her tend to be locked into a symptom-of-the-day mindset, with no regard for the cycle that is driving either her current condition, her past ones, or her future ones. Thus, when she winds up in Inpatient, either due to mania or severe depression, she will get a diagnosis-of-the-day to match her symptom-of-the-day.


    Wait - it gets even more ridiculous. During other phases of her cycle, Tabby tells us that she has been variously labeled with bipolar NOS, mood disorder NOS, and recurring major depression. These tend to occur, she goes on to say, when she is cycling (Tabby’s terminology) within her less extreme ranges, often stable and perfectly normal, when a new and ever-interchanging psychiatrist or therapist happens to see her for the first time.


    Is this crazy or what? Donna, who has been variously labeled as bipolar II, schizoaffective, and schizophrenia, adds this twist:


    The thing is, the labels tend to change according to the effectiveness of my meds.

    Donna relates that when her moods were raging from one extreme to the other, bipolar was the diagnosis-of-the-day. Her meds got her moods under control, but then there were her psychotic symptoms to contend with. which led to an inevitable relabeling. Asks Donna:


    Why do doctors change the "label" when, to me, it just looks like medications are responsible for the changes in symptoms?  The underlying symptoms are doubtless still all there beneath the meds.


    In the 1921 "Manic-Depressive Insanity," the pioneering diagnostician Emil Kraepelin described the illness as including "the whole domain of so-called periodic and circular insanity."


    Simply knowing that we have ups and downs is not sufficient. What we need to know is how these ups and downs relate, what is driving them, and what else is interacting with the dynamic. Kraepelin saw a lot more to cycling than just mood. Also feeding the cycling dynamic were “intellect” and “volition” - ie thoughts and motivation and energy - in constant movement and not necessarily in sync. Thus “excited depression” and “inhibited mania” and other states.


    Add This Infographic to Your Website or Blog With This Code:

    As I describe it on my lead bipolar article on mcmanweb:


    Day slips into night, the moon waxes and wanes - my brain is a veritable I Ching. I may head out into the world cool, calm, and collected, but will my brain be working for me two hours from now when it really matters?


    Throw in out-of-whack circadian rhythms - which is a trademark feature of bipolar - and maybe we can come up with the new omnibus diagnosis of "la folie circulaire deluxe." Indeed, there is very strong genetic evidence that suggests bipolar - it least in some cases - may be the result of a failure in the brain’s “master clock,” the suprachiasmatic nuclei, a tiny region in the mid-brain that receives signals from the optic nerve.


    We must never forget that our brains are virtual perpetual motion machines, always on the go, never at rest. Always, we need to be looking ahead - at the same time learning from the past - vigilant, anticipating, ready to act. Doctors love throwing labels at us, which may be fine, so long as they fully comprehend what is really going on. Let’s give the last word to Cretin:


    I don't like the term "bipolar disorder". The two "poles" are on opposite sides of, say, a sphere. It implies your are at one or the other. But as you have pointed out, things get all mixed up. My psychiatrist doesn't like the DSM. Instead of the "bipolar" label, he prefers to call my illness a cycling mood disorder with psychotic symptoms. I prefer that. It fits me.

Published On: July 03, 2011