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