Note: Many authors on BP Swing Sets reference that they have Bipolar Type I. Bipolar Type I is often referred to as the "most severe form" of BP. The following article explains the specifics of BP Type I, although other forms of BP also exist.
From the DSM-5, the formal diagnostic manual that clinicians use to diagnose bipolar disorder and other mental illnesses (abridged):
“For a diagnosis of Bipolar Type I disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded and may be followed by hypomanic or major depressive episodes.
A) A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy lasting at least 1 week and present most of the day, nearly every day.
B) During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms are present to a significant degree and represent a noticeable change from usual behavior:
C) The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or if there are psychotic features.
D) The episode is not attributable to drug use.”
Bipolar disorder (BP) is a lifelong, chronic disease. Someone once told me that about 1 in 3 people with BP end up committing suicide. That’s a horrifying mortality rate—for comparison, the current suicide rate across all Americans is about 13 in 100,000 (according to the American Foundation for Suicide Prevention).
I’m not positive how accurate that “1 in 3” statistic is; this type of data is extremely hard to track. This is actually a key limitation of evaluating and resolving the prevalence of mental health problems in our society. Especially because many people with mental health problems go undiagnosed throughout their lives.
If “1 in 3” really is the case, though: F*** off, brain, I’m still in the world of the living.
I rarely have opportunities to speak candidly about my experiences with BP. The social stigma, misinformation, and emotional heaviness that surround serious mental illness (SMI) make it a sensitive and awkward topic to grapple with in everyday conversation. Sometimes, I offhandedly mention past manic experiences to my friends and they’re not really sure how to respond, despite having known me for many years.
The only people I always feel comfortable discussing the disastrous, bizarre, and sometimes even morbidly funny throes of BP with are my psychiatrist and therapist.
At the time of this writing, I have been relatively mentally stable for about five years. I emphasize “relatively” because there are mild mood lifts and drops that I still experience throughout the course of each year. This is normal for people with BP, even for people like me who take mood stabilizing and antidepressant medications. I guess these fluctuations would be most accurately referred to as “low grade depression” and “hypomania.” I have not experienced a full manic episode in about five years, but I did experience a major depressive episode that lasted three to four months within these past five years.
From the DSM-5 (Abridged): Major Depressive Episode:
A) 5 (or more) of the following symptoms have been present during the same 2-week period. At least one of the symptoms is either depressed mood or loss of interest or pleasure.
B) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C) The episode is not due to other medical conditions or drug use.
“Baseline” is what doctors and therapists call a person’s normal functioning level. Some people tend to be more calm and mellow when they’re at their baseline, others like me tend to be more active and hot-headed but not in a way that would be much different from a mentally healthy (i.e. “neurotypical”) person.
Bipolar (which translates to “two opposing poles”) means that sufferers periodically experience major drops in mood (depression) or major lifts in mood (mania). These periods can last for weeks and even months. The vast majority of people with BP do not experience the stereotypical “laughing one minute, crying the next” type of symptoms that you may have seen in television shows and movies. Often, symptoms will remain dormant for long periods of time and a person with bipolar disorder will appear no different than a neurotypical individual.
Even though the mood shifts become extreme, they creep up on you and you often do not notice them until your symptoms start becoming exponentially worse over a very short period of time and reach a dangerous, intense level for long periods—at least, that’s how it works for me; everyone with BP experiences these shifts a bit differently.
“Hypomania” is simply the clinical term for what can be thought of as “mild mania.” Some people have a form of bipolar called “Bipolar Type II,” wherein they only experience hypomania and depression but not full manic episodes. This does not mean that Type II is “better” to have than Type I (I have Type I); they are equally disruptive but in different ways.
You may have noticed in the excerpts from the DSM-5 that when we say “mania” or “depression,” we do not necessarily mean “happy” or “sad.” The symptoms are far more complicated and often involve different aspects of negative feelings and positive feelings simultaneously. For example, when I experience severe manic episodes, it feels euphoric but like everything is happening very rapidly, I talk nonstop, I feel full of energy but also strung out and highly anxious…it’s really not great…
Bipolar disorder tends to have comorbid disorders as well. “Comorbidity” is the clinical term for when you experience multiple disorders at the same time and that are related to one another. To use physical illness as an analogy: it’s like having cancer and also an associated heart problem. Using myself as an example, I have experienced Obsessive-Compulsive Disorder (OCD) as a comorbid condition with my Bipolar disorder.
Now nearing age twenty-seven, I can look back on the early stages of this disease and identify key moments where things started going south. Most of the red flags started between ages nineteen and twenty-two, which is the prime time when bipolar disorder begins to truly manifest (according to the National Institute of Mental Health).
It is still not understood exactly what causes bipolar disorder. It seems to be genetic, but environmental factors can greatly affect the progression of the disease. Researchers are still trying to whittle down the different components of brain chemistry (i.e. “neurology”) that are behind bipolar disorder.
Hunter Keegan is an author, musician, and visual artist based in Greater Washington, DC. His works have been featured by National Alliance on Mental Illness (NAMI) and Shatterproof. He recently published a new book about bipolar disorder titled, “My Brain Is Trying To Kill Me.”
His full works can be found at hhkeegan.com
What does it mean to be bipolar? If you asked me this question fourteen years ago my answer would be far from the definition I would give today. Fourteen years ago I had never even heard of a mental disorder or had I even been in the know about the notion that a mental illness existed. I would probably just shrug and tell you that it means you're off-the-wall crazy. A response of clear ignorance compared to what I know today. At the very start of the new year in 2007, I, myself, was diagnosed with Bipolar I Disorder, something that I continuously define and redefine to this day as I march forward and discover what this illness is truly all about. My first manic episode came when I was a sophomore in college at the age of 20, and it changed my life. At the start of the second semester, a year and a half into Boston College, I stopped eating and sleeping to an extreme extent. I got caught up in my own little world. It did not take long before my roommate suspected something was amiss. I was acting erratically, talking to myself, and skipping all my classes. Luckily my roommate was able to get into contact with my mom after about a week of strange and destructive behavior. She rushed out, pulled me out of school, and went about having me checked into a mental institution where I was diagnosed with Bipolar Disorder Type I.
The recovery after being diagnosed took five years. I was out of the hospital in three weeks and given a leave of absence from school for as long as I needed. Although I ended up graduating only one semester late from college, the road to recovery after the initial diagnosis took many years past graduation. First, I had to get ready to go back to school. With a new medication regimen, I quickly gained about seventy pounds. School was never the same. I lost a lot of who I
was after being diagnosed; I lost a lot of confidence. Confidence I really could have used as I went about fighting the negative stigma of this illness. Instead, I was a shell of myself. Even classes, something that always came easy for me and something I took for granted, became a tremendous challenge. It didn’t help that I was in an atmosphere where it seemed like the whole world knew of my bipolar diagnosis, and so many already had their own preconceived notions about what exactly was wrong with me. It felt like all eyes were on me for all the wrong reasons. For the first two years after sticking it out and graduating college, I ended up living back in my parents’ basement. I was still not prepared to take control and confront my bipolar disorder as I was still struggling to accept it as part of my life.
A change of scenery can really help put things in perspective. Early in my mid-twenties I moved to Hawaii. For the first time after being diagnosed with bipolar disorder, I was leaving the stigma behind me and getting a fresh start where no one could have these ‘preconceived’ ideas. I learned to feel like my old self after being in Hawaii for nearly a year. After being diagnosed you battle the stigma of mental illness with other people, but you also battle the idea of having a mental disorder with yourself. It takes a long time to come to grips with the diagnosis. You fight it until you can’t fight it anymore. Then you learn to live with it; oftentimes out of shame as you can cower from the sheer weight of the whole thing. Moving to Hawaii, getting a fresh start in a new place with new faces all around me, made me ready to own the disorder I was dealt with. It made me want to fight and able to fight the stigma I had been dealing with since the earlier
After my time in Hawaii came to an ironic and abrupt end (I ended up leaving due to a manic episode), life has taken me on twists and turns or ups and downs that have made me cry both of defeat and utter joy. They say that bipolar disorder will do this to you. I asked earlier what it means to be bipolar. Of course it means intense manic episodes filled with grandiose thoughts and some crazy stories that go with it. Of course it means being left alone in utter and intense sadness battling depression. More importantly, it means a constant battle to push onward, and have the resilience and fight from within to push onward despite the glaring obstacles.
Being bipolar means to have a story worth telling and worth listening to. It means being counted out but never crossed out. People with bipolar disorder, myself included, are faced with a challenge we sure as hell never volunteered for. We were chosen because we are strong, intelligent, and striving to change the negative light that bipolar disorder or other mental illnesses are stuck with on a daily basis.
Will Morro is the author of Nobody Believes Crazy
LinkedIn: Will Morro