The stories we tell often tell me as a therapist the most about the human condition than a diagnostic manual is likely to do. I have recently sat on my sofa watching an episode of the Modern Love series called Take Me as I Am, Whoever I Am. In it, Anne Hathaway stars as a woman Lexi who is going through the unpredictable waves of the bipolar disorder.
I have one scene that I have always remembered: Lexi is at a supermarket wearing a sequined top and so joyful it is contagious, she makes me feel that she is from a different wave than the rest of the world. She is a good-looking, bright and apparently unbeatable lady. But then, the light shifts. In the next consecutive sequence we find her not being in a position to get out of her bed as the burden of a leaden depression makes it difficult to even pick up the phone and call a couple.
When Lexi was going through her career as an entertainment lawyer and her fledgling love life, I was impressed by the sheer weariness of the invisible fight that she was going through. It is one of those moments that embody the painful polar opposite of having a bipolar disorder the sky-soaring highs and the earth-shattering lows. It is a gut wrenching reminder that, behind our clinical terminology in my office are vivid and complicated lives being lived in the eye of a neurological storm.
We have used the term bipolar as an adjective against anyone who thinks this side and that side, or is a bit of a grouch. It is so bipolar today, someone might say. However, to people who experience the condition, it is a trivial use of a very complicated medical fact.
Bipolar disorder cannot be seen as a train of mood swings as we generally understand them. Good days and bad days we all have. After promotion, we are all up, and after a break up, we are all down. Bipolar disorder is otherwise. It is a chronic mood disorder, which has notable, usually disabling changes in energy, cognition, and action. It is a biological state, just like diabetes or asthma, which is based on the mechanism of managing emotion and arousal by the brain.
In order to gain an insight into the lived experience of a person like Lexi, one will need to consider the specific states that characterize the disorder.
This is the elevated of Bipolar I. It is much more than being happy. It is an extreme irritability or extreme euphoria. The person with a manic episode might have days of sleep deprivation, speak in such a fast manner that others cannot keep pace, and be impulsive to an extent that they risk their lives by spending thousands of dollars or making life-altering decisions without looking at the risk.
This is a less serious form of mania, which is typical of Bipolar II. To an external observer, a person in a hypomanic state may appear simply too prolific, social and energy-filled. Nonetheless, to the individual it may still cause bad judgment and is nearly always preceded by a great crash.
The depressions. Depression in bipolar is atypical and heavy. It is not only sadness, but complete lack of interest in life (anhedonia), that affects appetite, physical inactivity, and in many cases, worthlessness or even suicide.
When I view an expression such as that of Hathaway in the role of Lexi, I am able to see the invisible labor which is involved in a visible life. Bipolar does not merely remain within the head, but it extends to all aspects of life.
Trust is based upon consistency. Since bipolar disorder may make an individual a different version of himself based on his or her cycle, a partner and friends would tend to feel like they are walking on a thin ice. This month, the individual is the life of the party and the next month, he or she is ghosting all the text messages.
Having a 9-to-5 job means one needs some degree of cognitive stability, which the disorder actively opposes. Through mania, an individual may commence ten projects and complete none. It is difficult even to open a laptop when one is in a depressive state.
During maniac states or hypomanic states, the biological brakes of the brain usually malfunction. This may result in the so-called high-risk behaviors. It is not a character deficit or a party-girl-ish life, it is a brain-based incapacity to calculate the consequences in the present.
Stories such as Modern Love are what I as a clinician feel we owe a debt to. Long enough, bipolar disorder was being brought up in the films as either the evil, villainous creature, or the mentally ill, unstable genius.
The Lexi episode makes the condition humanized since it dwells on the solitude of secret. The relief on Lexi face is felt when she finally makes a friend know the truth and the friend just tells her, tell me more. Media is able to transmit the gap between the clinical definition and the human empathy. It makes us remember that it is not the case that bipolar disorder people are unstable individuals; they are struggling to be stable in a unstable internal environment.
To really help the individuals with this diagnosis, we need to demystify the culture.
Myth: "It's just being moody."
Reality: Moodiness is a personality characteristic. Bipolar is a medical disorder that is associated with brain chemistry and Circadian Rhythms. It entails physical imitation of sleep, speech and movement.
Myth: "Individuals with bipolar are unstable at all times.
Reality: It is common knowledge that in most instances bipolar disorder sufferers go through phases of euthymia or a state of consistency and balance of mood, particularly when they are taking a treatment program.
Myth: Mania: a fun, productive time.
Reality: Mania can be terrifying even though it is good to start with. It might include paranoia, persistent thoughts that cannot be halted, and a post traumatic guilt headache after the event is over and the individual discovers the amount of damage he/she has caused to his/her bank account or relationships.
Why does this happen? It is known that bipolar disorder is very hereditary, which means that genetics contribute very significantly. The parent is at a high risk, and, in this case, the child is more likely to contract the disease.
Nonetheless, it is not that biology is destiny. We also look at:
The neurotransmitters (dopamine and serotonin) are in an unbalanced state.
Bipolar disorder patients tend to be sensitive to their internal clocks. The loss of one night sleep or a change in the time zone can cause a manic episode.
Stressful work or traumatization in the past can serve as a kindling, ensuring that the brain becomes more prone to mood swings.
The greatest thing that I can convey to my clients is that Bipolar disorder can be controlled. It is not life imprisonment in anarchy.
Treatment involves three processes- a three legged stool:
The drugs (such as Lithium) or antipsychotics serve as the floor and the ceiling that keeps the individual from falling too low or rising too high.
In particular, Cognitive Behavioral Therapy (CBT) or Interpersonal and Social Rhythm Therapy (IPSRT) can be used to ensure that the patients are aware of their triggers and can deal with the psychological consequences of their outbreaks.
It is the unspoken secret of the healing process. One should have a firm sleep routine, no alcohol (alcohol is a mood destabilizer) and a wrap-around support system of friends and relatives that will be aware of the red flags.
In the conclusion of the episode in Modern Love, Lexi chooses to disclose her condition on her dating page. It is a time of extreme self-acceptance.
What her story and the story of the many Lexis I observe in my practice taught me as a therapist is that bipolar disorder is a severe challenge to the resilience of human beings. It is a weight that cannot be perceived and has to be handled by a Herculean effort to cope with it in each and every day.
We should stop playing the superficial game of the mood swing and understand the richness of the neurological experience. When it comes to viewing an individual as a bipolar person and viewing him or her as a person living with bipolar disorder, we start opening the gate to the empathy and knowledgeable support that they are indeed in need of.
Since, at the end of the day, a diagnosis is merely one of the chapters of a person, it is never the entire book.
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