News Day Tuesday: Bipolar Awareness Day!

Happy Tuesday, readers! Today (October 4th) is Bipolar Awareness Day, so I wanted to share an article with you that outlines the basic symptoms (for the uninitiated, as I know there are some new readers here) as well as what’s on the horizon in terms of treatment.

First of all, let’s hear about what bipolar disorder actually is. I’m referencing bt.com for the purposes of this tidbit, as the article I found gives a really great Reader’s Digest condensed version of the illness.

National charity Bipolar UK characterise the condition as “a severe mental health illness characterised by significant mood swings, including manic highs and depressive lows”, and note that, “the majority of individuals with bipolar experience alternating episodes of mania and depression”.

According to this article, it takes 10.5 years on average (in the UK) for people with bipolar disorder to be properly diagnosed. The National Depressive and Manic Depressive Association (NDMD) paints a similarly grim picture: it can take ten years or more for a diagnosis to be reached, and 69% of cases are misdiagnosed.

What are the symptoms?

There are two sides to bipolar: mania and depression.

During a bout of depression, it is possible to feel: grumpy, without hope, guilty, self-doubting, suicidal, pessimistic, worthless, lacking curiosity and concentration.

And with mania: elation, full of energy, ideas and plans, easily distracted, feeling invincible, risky behaviour including spending huge amounts of money.

Both can feature: lack of appetite, insomnia and delusions.

-bt.com

My experience began very early. I remember fits of agitation and depression as early as eight years old, which at the time was chalked up to the incredibly rough hand I was dealt–a broken home, a mother who struggled with bipolar disorder herself as well as alcoholism, extreme bullying, and persistent nightmares (which were later diagnosed as a feature of PTSD). NAMI states that rapid-cycling bipolar disorder, the most severe form of the illness, seems to be more common in individuals who begin exhibiting symptoms early in life.

From NAMI.org:

Early Warning Signs of Bipolar Disorder In Children and Teens

Children may experience severe temper tantrums when told “no.” Tantrums can last for hours while the child continues to become more violent. They may also show odd displays of happy or silly moods and behaviors. A new diagnosis, Disruptive Mood Dysregulation Disorder (DMDD), was added to the DSM-5 in 2014.

– See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder/Overview#sthash.l0XKtkSy.dpuf

When I was eighteen, I decided to see a therapist and psychiatrist for the intense mood swings that had plagued me for most of my life. I was initially told that my deep depressions were the result of PTSD. I was prescribed fluoxetine (brand name Prozac), which only made the agitation worse. And I was still depressed.

At 22, I relocated to Wisconsin and began the search for something, anything, that would finally help me feel “normal.” The misdiagnoses continued: major depressive disorder, for which I was prescribed Abilify and trazodone. I felt amazing on Abilify for about two weeks, and then I crashed. Trazodone made me a zombie. (Note: It is not atypical for antipsychotics to be prescribed to treat both MDD and bipolar disorder.)

Bipolar disorder is most often misdiagnosed in its early stages, which is frequently during the teenage years. When it is diagnosed as something else, symptoms of bipolar disorder can get worse. This usually occurs because the wrong treatment is provided. Other factors of a misdiagnosis are inconsistency in the timeline of episodes and behavior.

-healthline.com

When I was 24 and in my first “adult job” with health insurance, I found a wonderful psychiatrist who, over the course of several sessions, examined my family history and asked very specific questions to find the root of my illness. At first, I didn’t even think to mention my “up” periods, because even with the agitation and sleeplessness, I actually felt good–and no one goes to the doctor when they’re feeling well. But upon deeper probing, he came to a conclusion: first bipolar II, then, after further investigation and a few weeks of mood tracking in a journal, rapid-cycling bipolar I.

That first year was rough. I cycled so frequently that the days were exhausting. One day, I bounced between depression and mixed episodes several times in a single 24-hour period. Slowly but surely, the medications my doctor had prescribed (venlafaxine/Effexor, lamotrigine, and lithium) began to take effect. I began to stabilize. There were no more florid creative periods, but I was also able to sleep for more than an hour a night for the first time in weeks. My misery began to ebb, and though it didn’t disappear completely (a dysfunctional marriage contributed, among other things), I began to feel like a person again instead of a defective thing that needed to be turned off and fixed.

Aside from pharmaceuticals, NAMI’s website mentions cognitive-behavioral therapy, psychotherapy that focuses on self-care and stress management, and, in rare cases, electro-convulsive therapy (ECT). Learning to recognize the triggers for each type of episode is key; one suggestion offered by the numerous therapists I’ve seen over the years is mood tracking/journaling.

However, I had to stop at one point because, in the heyday of my illness, I began to obsess over the cycles, sometimes tracking up to ten or eleven times a day. Instead of the journaling soothing my mind, I began to worry that I was untreatable. I found my mood journal during a recent move and it was difficult reading, to say the least. But it was also a reminder of how far I’ve come and how much my quality of life has improved since receiving a proper diagnosis.

These days, I’m doing much better. My medications have been adjusted slightly to accommodate the deep depressive episodes I’m prone to during the fall and winter months, but I am proud of myself for being able to recognize that the winter storm was a-comin’. Three years ago, I would not have been able to see the symptoms for what they are: a warning sign and a signal that I need to not only keep up with my medications, but to practice good self-care. In the past, I saw fall and winter as something awful that I had to endure. Now, I realize that I can still enjoy life even when the days begin to get longer and darker. The seasons are no longer a metaphor for the overall “climate” in my head.

How long did it take for you to receive a proper diagnosis, readers? Are you taking care of yourselves as winter approaches? I hope you’re all doing well and staying healthy and safe. And spread the word–this illness is massively misunderstood, even by mental health professionals, so it’s our job to reach out and counter-strike against the misinformation and discrimination.

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Five stigmatizing/problematic phrases and why you should stop using them.

I’m generally a pretty tolerant and patient person when it comes to talking about mental illness— I want to be polite and educate people and I think it’s counterproductive to get pissed off about every single thing (also, I don’t have the energy for that). That being said, there are a couple of phrases I hear on a regular basis that make my blood boil. They’re often used out of ignorance, not actual malice, which is why I believe it’s so important to call people out and use the mistake as a teachable moment.

1. “I’m so OCD about that!”

What people usually mean: “I have some quirks and like to have some things a certain way.”

Why it’s hurtful: Obsessive-compulsive disorder is a mental illness, and by misusing this phrase, you’re essentially invalidating the everyday struggles of those living with the disorder.

One of the main characteristics of the disorder is obsessive, invasive thoughts, ideas, or behaviors that often interrupt other thoughts or activities. In order to alleviate these thoughts, the person typically has to partake in a certain behavior or set of behaviors (sometimes called rituals)—this is the compulsive part of the disorder.

For example, I’m sure you’ve all heard of the fear of being contaminated/hand-washing obsession/compulsion. What people don’t realize is that many people living with OCD find the disorder distracting, disruptive, and embarrassing. By saying things like “I’m so OCD!” you’re minimizing their very real concerns and struggles and turning it into a cutesy one-liner. Don’t do that.

2. “I don’t want to go to that party; I’m so antisocial.”

What people usually mean: “Well, ‘social’ means you like being around people, right? So ‘antisocial’ must mean the opposite!”

Why it’s hurtful: This one actually does piss me off because the people who say this are completely misusing the word. It doesn’t even mean what you think it means so in addition to trivializing a very real and serious disorder, you’re also making yourself look like an uneducated ass-hat.

In reality, “antisocial” refers to a specific personality disorder, the hallmark of which is a persistent disregard for the rights and feelings of others. There’s a whole list of diagnostic criteria at the linked page, but the most common example/trope used to describe this disorder is the person who hurts people and feels no remorse for what they’ve done.

People with antisocial PD are not bad people. It’s problematic and can cause a lot of emotional damage, but again, the thing to remember with any mental illness is that the person suffering from it did not cause it.

3. “I’m so bipolar!”

What people usually mean: “I had, like, one mood swing today and it took me off-guard so I’m going to misappropriate a mental illness because of my very general and poor understanding of what it actually is.”

Why it’s hurtful: Like most of the examples on this list, “I’m so bipolar!” is problematic because it minimizes another really serious disorder by presenting it as one-dimensional, and that one dimension everyone knows about is the mood swings. If you ask a person on the street what they think bipolar is, nine times out of ten they’ll say “mood swings.”

That’s why this phrase is so damaging—it completely ignores all the other symptoms of this very complicated illness. I’m assuming most of you have been following this blog for a while, so I’m sure you’re familiar with what goes on in the brain of someone who’s bipolar. (I prefer the term “manic depressive” because while it’s technically outdated, it’s more descriptive than “bipolar,” implying a range of emotions rather than two strict “poles.”)

If you’re new or need a refresher, check out NIMH’s website for an awesome and relatively simple description.

4. “He’s so schizo/psycho!”

What people usually mean: “He is behaving erratically or in a way that does not make sense to me.”

Why it’s damaging: This is two-fold.

First of all, schizophrenia is a particularly severe mental illness; there is no cure, and treatment options are kind of dismal at the moment. When you call someone “schizo” when you’re referring to nonsensical or erratic behavior, you are (once again) minimizing the actual severity of the illness and all of its nuances.

This is bad for one simple reason: it perpetuates misinformation and makes it seem like having a mental illness makes someone “bad,” which perpetuates the stigma.

The same goes for the term “psycho.” I’ve actually cut people out of my life for repeatedly using the term after I’ve explained why it’s so harmful and offensive. “Psycho” usually refers to “psychosis,” which is a break from reality. It can happen for a variety of reasons—trauma, substance abuse, or mental illnesses like schizophrenia (the one most people associate with psychosis) or bipolar type I (psychosis/hallucinations/delusions are not at all uncommon during severe manic or depressive episodes).

You say “He/She is psycho/schizo,” and what happens? People laugh. When you misuse those words (and really, you shouldn’t be using them at all because they’re offensive abbreviations that are always used in a derogatory manner), you’re telling people that it’s okay to laugh at people with mental illnesses because they’re “different.” They’re “crazy.” I’d like to think that the people who fall into this category are simply misinformed, but the reality is that there are a lot of terrible people out there who are unwilling to learn or change their behavior.

5. “She’s crazy!”

What people usually mean: This can mean one of two things. It’s sometimes used as a positive descriptor, in which case it means something like “She’s wild and uninhibited, which makes her fun.” I really don’t have a problem with it being used in that context because “crazy” is one of those words that can be used in a variety of ways, and this one happens to be complimentary. If you want to use that term to refer to yourself as a coping mechanism/making light of the situation, that’s totally fine. It’s when other people begin to use it that it becomes an issue (if you haven’t given them permission to do so). But in general, I still believe that people who aren’t mentally ill have no right to use that word to describe someone.

When it becomes problematic: When it’s used to hurt people or make a generalization about someone’s mental health. I’ve had “You’re crazy” thrown at me hundreds of times in the last twenty-some years, and it has almost exclusively been used to mean “You’re unhinged, you’re different, you’re not like us, there’s something wrong with you.”

That’s what stigma is—perpetuating the idea that the mentally ill are somehow “different” or “wrong,” not like the general public and certainly not worthy of being treated like people who are mentally healthy.

I’m sure you’re having the knee-jerk “Jesus H. Christ” reaction when you read it broken down like that—or at least, I hope you are. I hope you realize that it’s definitely not okay to discriminate against another human being for any reason, and I hope you’re doing your part to call people out and be more mindful of your own phrasing.

What to do when you’re called out: This is pretty simple. There are three steps to dealing with being called out for saying something problematic:

1. Listen to what the person is saying and make every effort to understand why they’re upset.
2. Apologize sincerely. Say something like, “I’m sorry for saying x. I didn’t realize it was hurtful, but now that I know, I am going to do my best not to say it anymore.”
3. And then move on. Don’t get butthurt or dwell on it (“Those mean social justice people! They’re too uptight, they made me feel bad, bawwww.”) Just take it as a learning experience and try to use what you’ve learned to educate other people.

That’s really the only way we can fight this thing, the gigantic stigma-beast that makes life unpleasant, if not downright hellish, for most of us. At some point, we’re going to need people on the outside, allies who aren’t mentally ill (and remember, “ally” is a verb, not a noun) to help spread the word and back up what we’re saying.

The sad reality is that a lot of people are dismissive of our experiences with mental illness because we’re mentally ill, and therefore we’re apparently not credible sources about our own oppression. (Lollll.) And common sense tells us that the more people are fighting this battle, the more people we’re going to reach and the more minds we’re going to change.