Bipolar and Behavior: Which Comes Wrapped in What?

Ask the Expert Patient Health Guide
  • If anyone thinks there is a such thing as garden variety bipolar, my recent “mailbag” should put paid to that notion:

    “I've been wondering for months if I'm bipolar,” writes Chrispy. She describes her worsening ups and downs, and admits that “I constantly feel like I'm losing my mind. I KNOW something is wrong.”

    But just when it seems she has talked herself into having bipolar disorder, she asks: “Could it be some kind of hormonal imbalance?”

    If Chrispy is harboring personal doubts, Abacus has no such qualms about her husband: “My husband has bipolar and all the doctor is treating him for is depression... Is there some kind of brain scan that will prove he has it?”
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    If only. Brain scan technology is vastly increasing our understanding of the brain and mental illness, but for right now it is a research tool, not a diagnostic one.

    Rapunzel wonders about the competence of doctors in teasing out differences in the brain for proper attention and treatment. She gives this example: “ A person who is highly stressed and highly motivated with the symptoms of being a bipolar, whatever, would wind down with an orange with vodka at the end of her day, but at the same time couldn’t take wine because that would make her more angry and aggressive? Or what about smokers that feel much better? There has to be a connection...”

    As if our illness isn’t complex enough, Rapunzel wants to know: “I know I am bipolar but which one?”

    And maybe we’re being one-dimensional in how we look at our illness. Rapunzel goes on to say: “I think we need to talk about the good things of bipolar and the funny things, because to be honest, I think us bp are more interesting than the ones that are not because I get bored with some people, could that be they are not bp and we need other bp to bounce off on?”

    In other words, despite everything, who the hell wants to be normal, anyway?

    And RedFairy queries whether bipolar “causes anyone to become sociopathic or psychopathic.” She doesn’t think so, but an acquaintance is making her wonder.

    BroadwayGirl, 11, is wise and compassionate way beyond her years.
    “I have an adult friend who is bipolar,” she writes. She figured this out from her observations and research. The problem is, “She does not know that I know.” Her adult friend has been acting uncharacteristically angry, but instead of nursing a grudge, BroadwayGirl wants to help:

    “I want to tell her i know so i can help. Is there any way i can help without telling her i know? Is there any way to show her I care when because I am so young it is hard? And is there a way when things do happen I can make my self realize it is not her but the illness?”

    First, BroadwayGirl, when you grow up you can be my psychiatrist. I really mean that. But as you can see from those who have written, bipolar is a very difficult phenomenon to pin down. Is it bipolar or a hormonal imbalance? Or is it bipolar PLUS a hormone imbalance? Your guess to Chrispy’s dilemma is as good as mine.

  • As for poor Abacus, my guess is she is diagnosing her husband better than her husband’s psychiatrist. Individuals tend to visit psychiatrists when they are feeling down, not up. As a result, those with bipolar disorder often find themselves getting misdiagnosed with unipolar depression. It can take years and several doctors before one is diagnosed correctly. Abacus’ husband may well have unipolar depression, but she would be wise to talk her husband into getting a second and even a third and fourth opinion.
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    Rapunzel has a fine appreciation for the complexities of the brain. In her question, one gets a good sense of how an illness may come wrapped in other illnesses and behaviors. But even if one can isolate the bipolar, what kind is it? If only life were more simple.

    And when a person behaves badly, is it the bipolar or something else? Or is it a bit of both? This is the nub of RedFairy’s question. Believe me, from my own personal experience, bipolar can make us do things we are not proud of. But no, it won’t turn me into a sociopath or a psychopath. Sociopathy is cold-blooded. There is nothing cold-blooded about a manic rage. But sociopathy and bipolar can reside in the same brain, much to the detriment of humanity - just ask Hitler.

    So there are no easy answers. Our best tool is self-education. We need to know thyself. Only then, can we carry on a conversation with our clinicians, which vastly improves the odds of a favorable outcome. Friends and family can help enormously in the know thyself process. Abacus raised the bipolar issue with her husband, but I would advise against you doing this with your friend, BroadwayGirl. Adults have a hard enough time with this issue. Just show your friend you care. You already know more than I do.


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    Please keep in mind that I am not a physician. I cannot diagnose or give medical advice. This section is for sharing information and offering support as a nonphysician "Expert Patient."
Published On: December 02, 2007