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Are You Bipolar?


Personally, I’d never thought of my symptoms as “symptoms,” unusual though they sometimes seemed. Many people dealing with a bad breakup might cry in the tub for a couple of weeks—even months—but eventually return to their normal life. When this happened to me, however, I, in the course of a week, sublet my apartment, packed up my belongings, and took off to Southeast Asia for three months. Hypomania? Possibly. Fun? Definitely.

For another, there was the fact that I am an excitable person. I’d always thought that my explosive outbreaks, usually directed at some unsuspecting member of the service class, particularly if he happened to work for my cell-phone provider, were a release valve for a stressed life, or at least understood them as depression turned outward, as any lay psychologist would. If a construction worker whistles at me on the street, I give him the finger; the other day, I was walking through Tribeca when a truck driver screamed some hideous profanities at me out his window, and I got so angry I tried to pick up a garbage can and throw it at the cab of his truck (I’m five foot two and 105 pounds—lifting the can wasn’t a realistic expectation).

But what if this kind of slight mania, this volatility and exuberance, is not a gift but a symptom? “The distinctions between hypomania and a state of exuberance can get very blurred,” says Kay Redfield Jamison, a professor of psychiatry and author of several key manic-depressive texts, including a memoir of her own experience with the illness, An Unquiet Mind. “Exuberance—high energy, high mood, ebullience—is very understudied and extremely underappreciated as a vital emotion. It’s tied up with curiosity, adventure, and scientific discovery; it’s getting reignited when you would otherwise fall over; it’s adaptive. But hypomania, when it’s associated with depression, the worsening course of a disease, increased alcohol and drug use, financial ruin, or constant emotional turmoil—none of those things are adaptive. It’s easy to romanticize a pathological state, to say this is the result of a very romantic temperament. Certainly, in my own life, I spent a long time saying ‘This isn’t so bad,’ and nearly died because of it.’”

For Jamison, hypomania meant thinking that she could go off her medications—which led to mania, psychosis, and attempted suicide (bipolarity has one of the highest suicide rates of all mental illnesses—a remarkable 10 to 20 percent of unmedicated bipolar patients, as estimated by the National Institute of Mental Health). “The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity,” she writes, in An Unquiet Mind. “Everything previously moving with the grain is now against—you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.”

“I want to get my nosed pierced, but my doctor doesn't want me to,” says a 26-year-old banker. “Is this manic? Or am I lightening up a bored life?”

These caves are a place that mild bipolar patients hope never to visit, though there is always the chance. “For ten years, I was told I had dysthymia—mild depression—and now I feel like one of them,” says a fashion-editor friend of mine, who was diagnosed as bipolar last year, at 36, after a heady pregnancy (“I was eight months pregnant, decorating a new apartment, running to Chelsea and hoisting plants into cabs”) followed by a severe postpartum depression. “I’ve heard about bipolar people running naked through the night, and they don’t know who they are or where their shoes are. I’m like, ‘Is this what’s in store for me? Am I going to get worse?’”

If one does not go on a mood stabilizer, say psychiatrists, there is a possibility of “kindling” the hypomania, a two-sticks-rubbing-together concept borrowed from the etiology of epilepsy, whereby applying a low-threshold stimulation to a particular part of the brain, repetitively, eventually causes that part of that brain to have spontaneous electrical activity, or seizures. In the same way, there is some evidence that repetitive mood episodes might lead to the development of more frequent, more spontaneous, and more manic moods, and hypomania as a harbinger of that is far less appealing.

“I find this ‘kindling’ thing the most horrible concept,” says a friend. “I’m so nervous—I was going to have a colonoscopy, and I didn’t do it, because I was worried that with the stress I’ll be kindled! I got a leak in my ceiling: I’m going to be kindled!”

The person who sat on the couch the snowy day that my psychopharmacologist prescribed a new regimen of medications was far from kindled; in fact, I was getting more depressed by the minute as I was briefed on the benefits and side effects of each new medication, gathering a little clump of white slips that put me solidly out of the world of dysthymia, the world where you take one antidepressant and wonder sometimes if you even need that. Since there was some concern that Zoloft could be “kindling” my hypomania, I was to stop it immediately, but it would take a while to introduce Lamictal into my system—if it is not taken in bit by bit, by about 25 milligrams a week, one can develop a fatal rash (a fatal rash? This was getting creepy). So I was supposed to shift to Wellbutrin, a milder antidepressant that I could tolerate without cycling, and Neurontin, an anticonvulsant. I also had Ambien, for insomnia, and Xanax, for anxiety. Anxiety was, of course, what was produced when I lined up all those little bottles on my kitchen counter. Now that I had the drugs, I didn’t take them. In fact, I did little more than peer tentatively into the bottles for a few months. (My psychopharmacologist informed me that this, too, was likely a symptom.)

Like any subculture, subtle bipolars had a significant presence on the Internet, and I soon became addicted to mood-disorder bulletin boards, scrolling through messages with subject lines like “That Bitch Bipolar II” or “Update on My Broken Brain and Its Treatment” late into the night. I’d wondered what tribe it was that I’d joined: The talk always seemed to be about “meds” or “pdocs,” with a disproportionate emphasis on pinning down one’s exact diagnosis, often rendered in a shorthand, like “mild bipolar, OCD tendencies, inattentive ADHD.” The language that people used to describe their emotions sounded eerily similar to the criteria for their diagnoses listed in the DSM—who describes themselves as irritable or hypersexual?—and that weird semantic smoke screen made it hard to relate. It wasn’t exactly the cave described above, but it wasn’t a place I wanted to linger.

The Mood Disorders Support Group, which met on Friday nights at Beth Israel Medical Center, brought real people with these problems into my life. It was still strange to break bread with people who had been hospitalized, more than once, or the pixie with black pigtails who kept nine medications in her handbag, pulling them out one by one to expound upon the benefits, and stranger still when I realized how distinctly some people’s moods shifted from week to week, sometimes black, sometimes benign. But there were also some people there who sounded familiar, in particular a 26-year-old banker, a graceful Indian-American woman with long black hair and onyx eyes that didn’t seem so much to give off light as refract it. She was energetic, and talkative, and sincere; she had been diagnosed over the summer, during what she thinks was a four-month period of mania, which was followed by a four-month depression, and now, according to her psychiatrist, she was in a mixed state, experiencing the agitation of hypomania coupled with the emotions of depression. “I want to get my nose pierced, but the doctor says that he doesn’t want me to do it in a mixed state,” she said, at an East Village tea salon after the group meeting. “It’s like, ‘Is this manic? Or am I just trying to lighten up a bored life? Dude, I want a little excitement—I’ve spent the last four months depressed.’ ”

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