"Cycling," Not "Bipolar" or "Episodic" - My Answer to an Edge Question
Recently, I began doing pieces based on an Edge question. Edge, which bills itself as an online salon, annually asks a provocative question of some 250 people who engage in the practice of thinking for a living (such as scientists and philosophers and writers). The answers are published as a book.
The books in the series make compelling reading. These include: “What Have You Changed Your Mind About? Why?” and “What Scientific Concept Would Improve Everyone’s Cognitive Toolkit?” You can find my bipolar take on these questions here and here.
Okay, new question: What Is Your Favorite Deep, Elegant, or Beautiful Explanation?
It’s amazing how simplicity and elegance can underlie complexity and chaos. We see this in Einstein’s E=MC2, Watson and Crick’s double helix, and Darwin’s theory of natural selection. In bipolar, for me, the answer is simple: We need to view our condition as a cycling illness.
This is hardly a new idea. The French physician, Jean Paul Falret, came up with “le folle circulaire” in 1851. The pioneering diagnostician Emil Kraepelin back in the early twentieth century coined the term manic-depression, which embraced Falret’s outlook. What really got me thinking about the issue a number of years ago was Jim Phelps' 2006 book, “Why Am I Still Depressed?”
Dr Phelps - who is inspired by Gary Sachs of Harvard and Nassir Ghaemi of Tufts and others - makes a forceful case that we need to be treating the cycle rather than the symptom du jour. This asks us to reconceptualize the illness as one in which our brains relentlessly cycle through different and overlapping phases.
The conventional wisdom is that bipolar is an “episodic” illness. We have a depressive episode, we have a manic (or hypomanic) episode. An “episodic” view encourages physicians to treat the episode, typically at the expense of the cycle.
Nowhere is this more evident than in using antidepressants to treat depression. For one, the medication may induce a switch into mania. It may also speed up one’s normal cycle. Dr Phelps points out that this may create the ironic effect of bringing on depressions at a greater frequency.
So - if we have a cycling illness, we always need to be anticipating the next phase of the cycle. For instance, if we spot mania on the horizon, we need to realize we are not going to be “up” forever. What happens when we have to contend with the inevitable depression on industrial strength sedatives?
Moods are only one wheel in our bipolar clockworks. Kraepelin also referred to our energy levels and cognitive processes. When these are out of sync, we find ourselves dealing with mixed states such as agitated depressions and dysphoric manias.
Thus, a cycling mindset encourages us to pay close attention to even the slightest changes in the bipolar weather.
So, even if we do feel stable, we need to recognize that our brains are always in constant motion. If we leave the house at eight in the morning, we need to be mindful of how we are likely to be functioning at that important meeting at three in the afternoon and whether we will be in any shape to deliver on our promises later in the evening.
There are no easy answers here, but I submit that if we start thinking in terms of managing our cycles rather than our episodes - if we think of our condition as “cycling illness” rather than “bipolar disorder” - we will come up with personalized strategies that will make our lives a lot less frustrating and a lot more rewarding.
You can’t get any more deep, elegant, or beautiful than that.
Please free free to come up with your own bipolar take to this Edge question. Comments below ...