Manic Depression: The Definition vs. The Reality

Definition

manic depression noun
a mental illness causing someone to change from being extremely happy and excited to being extremely sad: He suffers from manic depression.

manic depressive noun
a person who has manic depression
(from Cambridge Advanced Learner's Dictionary)

The Cambridge Learner's Dictionary definition of manic depression (or bipolar disorder for those who believe a different label helps) is a bit disconcerting. After all, almost all of us change from being extremely happy and excited to being extremely sad. But translating manic into happy and excited is like using the phrase "dust up" to describe an F5 (incredible) tornado. Equally as questionable is equating depression with being extremely sad.

Extremely sad doesn't cover not getting out of bed for a week except to go to the bathroom. It doesn't cover letting one job after another slip away because it's too much effort to call in sick. It doesn't describe the sad clown face produced by a flat affect. It doesn't begin to get at the truth of the depression part of Manic Depression. And you should know. You have been or are now contemplating living with it.

Here are some facts to prime the discussion:

• The primary symptoms of bipolar disorder are dramatic and unpredictable mood swings. If you look at the DSM-IV and the diagnostic criteria, it calls for one or more Manic episodes for a diagnosis of Bipolar I. To be Bipolar II you should have had at least one major depressive episode and one hypomanic episode.



• The median time to diagnosis from the time folks first get into the medical system is 22 months. A large study conducted from 2000-2002 found nearly a third of bipolar diagnoses did not occur for four years or more. It took 10 years for Mr. Manic to get his diagnosis.



• According to the NIH, Bipolar Disorder affects somewhere around 5.7 Million American Adults



• Somewhere between 10-15% of folks diagnosed as Bipolar I commit suicide. The only more fatal mental illness is Anorexia

So, to be diagnosed you have to fit a check list. Even trained mental health professionals, when faced with a real live person to evaluate against that list, generally miss the boat for months (if not years). How could they not when bipolar behavior masquerades as "willfully bad behavior," charming but irascible behavior, blowing off steam, a little touched. Millions of people have it, and hundreds of thousands are going to die as a result. Pretty scary, huh?

Take a deep breath. Really. Right now. Breathe.

Living with a bipolar spouse or significant other isn't easy, but few things in life are. Yes, it is a mental illness. Yes it means you will make choices in life you may not have anticipated. But, it is not a death sentence. It is not a reason to panic. It certainly isn't a reason to be embarrassed.

If it isn't the worst thing that ever happened to you (and even if it is), what exactly is it? Let's start with some of the things you're going to read on the Internet. You're going to stumble across lists like this, this or this. You're going to see a lot of discussion about the efficacy of lithium (making a comeback). You're going to hear about episodes, as though mania and depression float in on little clouds at odd moments and settle on those of the bipolar persuasion rather than being an amplification of the normal manic mind. You're going to see a lot of statistics about things like comorbidity, hallucinations and potentially violent behavior. Then if you dig deep enough you'll find folks like Stephen Fry who are wending the path, afraid medication will take their creativity away.

It's all very confusing, and not very helpful to figuring out how to live the manic life with the one you love. So I'm going to try to give you some guide posts to living with your manic. They boil down to the following;

• If they are bipolar, they aren't just bipolar when they have an "episode." They are bipolar. Period. There is no getting over the accident of birth that dealt them a manic brain.
• If they are bipolar, it isn't just highs and lows of mood, it's highs and lows of energy. That's were mixed states come from.
• If they are bipolar, the first thing that goes in an "episode" is judgement.
• If they are bipolar, they will self medicate.
• If they are bipolar, they will lie.
• If they are bipolar, support matters.
• If they are bipolar, drugs can be wonderful, but all they do is provide an opening to learn new behaviors.
• If they are bipolar, living a life where the highs and lows are tamped down, doesn't have to inhibit either art or creativity.
• If they are bipolar, sleep matters. It matters enormously...much more than you think.
• If they are bipolar, stress wins all arguments. But you can't count on what stresses you to stress them.
• MedPros have very limited expectations of their bipolar charges. You will often have to discount these expectations.
• When you do not take care of yourself your bipolar other will start to spiral.
• Coddling your manic will not help them navigate the world.
• If they are bipolar, they will have tells. You will get a masters degree in them, and it may help your poker game.
• If they are bipolar, they will have triggers. Some they will pull themselves.
• If they are bipolar, you will have to find your own peace with the burdens you will be asked to bear. After all, life isn't fair.

Hey, it's a start.

Living the Manic Life

In February, a dear friend lost her son to suicide. In April, another lost his son. Today, on one of the blogs I read, a frequent poster talked about the grief he felt at losing his nephew, who left behind a wife and baby.

I think a lot about bipolar disorder. It's part of the fabric of my life. My father was a manic-depressive who hung himself as his brother had before him. I never knew my uncle, but I did know my cousin who struggled mightily with the disease. She left a husband. My uncle left seven children. My father left six and two ex-wives.

My mother ultimately could not navigate my father's madness. He checked into the VA hospital for an extended stay and they were divorced when he left many months later.

Once she admitted to me that she wished she had been stronger, or known more.

I would like to start this conversation on bipolar disorder and manic depression to act as a guide for those who find themselves living the manic life, without the benefit of being bipolar themselves. I would like to dedicate this effort to my lost father, uncle, cousin and my very present husband. It is possible to live a joyful, satisfying life full of possibility as well as lithium, Abilify and Remeron. In fact it is more than merely possible.

We'll talk about lying. We'll talk about sleep hygiene. We'll talk about medication and self medication. We'll talk about addiction, heredity, Kay Redfield Jamison and the artistic side of Manic Depression. We'll talk about early warning signs, bad behavior and an appropriate team of advisors and medpros.

We'll talk about what the medical profession misses when it delights in watching the bear dance. And we'll talk about how you have to keep yourself steady and in good health to make the grand trip. We'll look at the latest research, argue about labels and discuss what happens when the diagnosis comes, as it always comes, far too late.

And sometimes, we'll just remember the ones we've loved who, like moths pulled to the flame, circled the dark too closely and were consumed.