I did something herculean today: I did all of the work I needed to do and then some. To most people this is nothing. They don’t feel accomplished by doing the bare minimum. For someone with bipolar disorder, the bare minimum can grow into a monstrous task that threatens to overwhelm us, often without warning. I sometimes worry about making commitments too far in advance because I regularly go into states where I find it difficult to feed myself, let alone deliver a multi-page report on top of all of my regular work.
One of the hardest parts of bipolar disorder is that when a mood swing hits, I almost never know what I’m going to get. For the first time in a while, I landed on across-the-board depression. Typically I experience hypomania or positive-affect depression.
Bipolar disorder is not a pendulum, manic to depressed, but a giant wheel of fortune. Depending on your current situation in life some slices may be larger than others. Some medications completely remove certain slices entirely. Others will affect their size. There are things every bipolar person can do to ensure that the best option is as big as possible. After a long enough time playing the game intentionally, you can even get a feel for how to spin the wheel to ensure you land on a more desirable option.
But even if you get good at “playing the wheel,” you’re going to spin it wrong sometimes. There’s an element of chance that your skills, your medications, your introspection will all escape and you’ll land on what’s worst for you.
And what’s worst does depend on the individual in question! I prefer to be depressed; my emotions are more manageable in depression, and I have more consistency of productivity. On the flip side, I know folks who much prefer mania in general; they enjoy the fast pace and strong emotion.
But that wheel is fickle, dear reader. And sometimes what we prefer is the smallest slice available. Often the point of therapy becomes increasing the size of that slice as much as possible, as consistently as possible through various means.
Despite everything I’ve noted, however, there is still a serious preference in clinical psychology to consider bipolar disorder a bipolar scale. “It’s in the very name,” after all! But the talk of a base-ten system for emotions with a baseline of zero being the end goal is a dangerous dilution. It makes the bipolar experience seem manageable and means that the clinician doesn’t have to think as carefully about the condition. The reality is that chasing that “zero-base-line” often makes things worse and can make simply surviving as bipolar difficult.
I’m pretty sure I’ve written about this before, but there are at least two levels to the experience of bipolar disorder: the emotional or affective side, and the physical side. While most people understand bipolar disorder to be either one or the other, it is a combination of those and often more. You don’t just “feel sad,” you can get physical symptoms of exhaustion. You don’t just “feel happy,” you can get physical symptoms of anxiousness. And these things can happen regardless of how you feel emotionally.
The term hypomania refers to the experience of an emotional depression and a physical mania. Hypermania relates to both emotional and physical mania. Depression refers to both emotional and physical depression. They don’t really have a term for emotional mania and physical depression, so I use “high affect depression” which works better than nothing.
There are, of course, multiple types of bipolar disorder; all of them experience mood swings, but the extent to which they experience mania dictates type. Type I refers to people who have experienced at least one mania in their lifetime. Type II refers to individuals who haven’t experienced a manic episode. Cyclothymia is a related mood disorder; it’s essentially the mood swings without either of the physical states (so mainly the affective side of bipolar disorder absent the physical side). Additionally, there is the moniker “rapid cycling” which can be tacked onto Type I or Type II; generally, this means that the physical side of the mood swings happens at least four (often more) times per year.
More recently they’ve added the type “Mixed Bipolar.” This is my type. At first glance, this type suggests that someone can experience depression and mania at the same time or (more regularly) in rapid succession. Most discerning readers, I know you’re now wondering “but wait, you said before this is a function of all bipolar types,” but I want you to think deeper. Mixed bipolar, as a type, indicates that someone can experience a hyper and depressed mood, or a hyper and depressed physical state at the same time or in rapid succession.
I find it useful to conceptualize my experience of bipolar disorder with four tiers; the affective, the physical, the microswing/mood, and finally the macroswing/pattern. These all intersect, of course, but the microswing level is how quickly and often my actual mood changes (as opposed to my current emotion) while my macroswing looks at how much overall energy it takes to exist (as opposed to how much I have access to).
Think of the affective/microswing and pattern/macroswing dichotomies as cost vs. tax. No matter what I’m paying both, but the tax is calculated differently (and is more steady) than the cost. I can sometimes be tricky and avoid paying the tax… but it might come back to bite me in the butt come tax season (when that macroswing shifts). I’ll give an example:
Before Friday, I was in what I conceptualize as a hypomanic depressed mania. To break that down: I had a low affect, mania, depressed mood, and high physical energy. Typically for folks that conceptualize this on a two-tier system, that’s what hypomania is. However, in the past, I’ve had hypomanic hypermania, or a low affect mania, elevated mood, and high physical energy. The main difference between these states is that while my affect is still generally low and negative, my internal sense of emotions is tempestuous and cycles quickly. That is, while I still generally seem “sad” because I don’t express emotion as quickly or visibly, I may experience anger, sadness, joy, and then depression again in very quick succession without acting on any of them.
And then Friday came around. I spun the wheel, like I do every morning, and watched in horror as the arrow bounced on a peg. It could have landed on what works best for me, that hypomanic depressed mania, or on full blown depressive depressed depression (what I call D3). A part of myself shriveled up inside as it tossed over to D3. All of this work, I thought, my exams next week, I cried. I found it difficult to get out of bed, to go and do even the simplest things.
And here I am, today having spun the same wheel with what looks like an ever increasing slice of D3. Because that’s how it works for me; I get comfortable in one state and my mood swings are sudden and often without warning. They don’t just happen overnight; sometimes I’m called up from the audience at random. Sometimes I’ve done something special to earn (trigger) it.
But despite it all, I managed to do work today and be proud of it. I managed to look this great big monster in the eye and say “alright. IF this is how it’s going to be, then we need to have a talk” and negotiate. I’ve managed to ensure that I’ll be able to survive.
Please, dear reader, understand how miraculous that is. Understand how lucky, not special, I am. Love the people in your life with bipolar disorder even if they lose that fight. It may not look like much to you, but every battle that I win is a minor miracle.
And never forget, I’m not battling my illness, I’m not battling my brain or my body, I’m not even battling the world. I’m battling society’s expectations that I function like a person without bipolar disorder. And that, dear reader, is fucking metal.