The Biggest Bipolar Mistake, Explained

John McManamy | Dec 4th 2015

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People around us love to lump everyone with a bipolar label into one category, as if we are all the same, and to be treated accordingly. Here is why they are wrong …

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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) to describe the constant state of flux our brains are in.

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But our cycles are not the same.

Some of us are abruptly whiplashed from one extreme to the other. Others almost imperceptibly slide from up to down to in between at the pace of continental drift. Some of us skyrocket into mania. Others barely rise above depression. But cycle we do.

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Moreover, our cycles are tied into 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 combined with molasses. “Excited depression,” and “manic stupor” were two of the terms he used to describe these exotic but actually very common “mixed” states.

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On top of that, our cycles interact with our personalities.

Kraepelin also touched on this, and current experts, such as Hagop Akiskal of UCSD, are taking it further. Cycling is all about transiting into temporary states. Personalities, by contrast, are based on heritable traits that remain fairly constant 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.

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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 type of brain is more likely to experience runaway depression or mania?

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And just to confuse matters, we need to take the situation into account.

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.

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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 elements of substance abuse, alcoholism, ADD, psychosis, PTSD, sleep disorders, eating disorders, various phobias, assorted personality disorders, not to mention physical conditions, and it’s clear that bipolar is not just bipolar.

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Just a handful of variables leads to infinite complexity.

Twelve notes in the chromatic scale yields everything from Beethoven to Elvis. Twenty-four letters produces the alphabet and all of written English. It only takes a few minor variations in our cycles, our personalities, and our environment to ensure that no two bipolar conditions are the same.

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Bottom line: You are unique.

And thank heaven for that