The very first piece I wrote for HealthCentral, back in 2005, was The Top Ten Myths of Bipolar Disorder. Two years ago, I revisited that list and expanded it to a Top 13 list. In a response to that piece, Lori served up the mother of all myths, namely:
When I hear others talk about bipolar, it is that we all have a certain way that we act, [as if] we all have the same symptoms. ... We are not all the same.
Bingo! Lori. Spot on. Let’s see if we can take this step-by-step, beginning with the one element we all share in common:
Bipolar is a cycling illness, not an episodic illness.
If we strip bipolar to one universal trait, it is that our moods cycle up and down, and not necessarily in sync. Back in the 1850s, the French psychiatrist Jean-Pierre Falret came up with "la folie circulaire" (circular insanity). Viewing our brains in a constant state of flux rather than flipping from one episode to another encourages us to anticipate the next turn of the wheel rather than merely react to events.
But our cycles are not the same.
For most of us, manias (where we are demonstrably out-of-control) are rare occurrences, and a good many of us cannot even recall our hypomanias (mania lite). But cycle we do, even if “up” is only noticeably higher than “down.” That’s not all. Some of us get whiplashed from one extreme to the other while others move at the pace of continental drift. A good many of us also experience down and up at the same time. On and on it goes.
Moreover, our cycles are linked to other stuff going on.
Back in the early twentieth century, the pioneering diagnostician Emil Kraepelin noted that as well as mood, our cycles were linked to intellect and volition, which loosely translates to thought and energy. One minute, our brains are on rocket fuel, the next stuck in molasses - and often rocket fuel mixed with molasses. Kraepelin, for instance, described “excited depression,” “manic stupor,” and other exotic states.
More recently, researchers are turning up evidence of irregularities in the suprachiasmatic nuclei, the brain’s “master clock” that regulates circadian rhythms, including sleep.
On top of that, our cycles are superimposed on our personalities.
Kraepelin also touched on this, and current experts, such as Hagop Akiskal of UCSD, are further exploring the issue. Personalities are based on heritable traits that remain fairly stable over a lifetime. What, for instance, is mania supposed to look like in someone born with a depressive temperament? Probably a lot different than in someone who is usually upbeat.
Add to that the zillions of ways of slicing and dicing personality (such as introvert vs extravert, avoidant vs novelty-seeking, selfish vs cooperative, and so on) and you will see very different behaviors in people nominally experiencing the same mythical phase of the same mythical cycle.
Not only that, we have stress to think about.
A combination of genes and environment (including past trauma) renders certain brains more vulnerable than others to whatever life happens to throw our way. This often translates into exaggerated perceptions of feeling threatened and overwhelmed, combined with a lack of ability to control the situation. One guess - which brain is more likely to experience runaway depression or mania?
And just to confuse matters, we need to take the situation into account.
Do you blend in or stand out like a sore thumb? Personally shouting insults at someone is okay if you’re a football coach raging against the guy in the striped shirt. Doing the same thing to a flight attendant at 40,000 feet will get you arrested. The behavior may be the same, but it is viewed very differently.
As if all of that is not enough, very few of us have just one diagnosis.
Imagine an anxious depression or an anxious mania and you can see why mood is colored so differently, from individual to individual. Throw in substance abuse, alcoholism, ADD, psychosis, PTSD, sleep disorders, eating disorders, various phobias, assorted personality disorders, not to mention physical conditions, and on and on - perhaps just a hint, perhaps full-strength - and it’s clear that bipolar is not just bipolar.
As I am wont to say - if only a mood disorder were just about mood.
How many variables do you count?
If you came up with 12, that is the number of notes in the chromatic scale, yielding everything from Beethoven to Elvis. If you came up with 24, that is the number of letters in the alphabet.
How could we possibly be same, with the same symptoms? Yet, how easy it is to overlook the obvious. Thank you, Lori, for bringing this to our attention.
Published On: October 28, 2012
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