Bipolar disorder research highlights
In my novel, My Year Zero, one of the most important characters has bipolar disorder. Since that’s not my disorder, I set about researching it before I started drafting and throughout the editing. I read a half-dozen books, plus tons of blogs and studies. I also worked with a consultant who both has bipolar disorder and writes about it. I wanted to make sure that the character of Blake came across as realistically as possible.
Of course doing all this research, I discovered great insights and tips that I want to share. I started using some of these with my friends and myself. They work not just for bipolar disorder, but for a variety of disorders and plain old challenging day-to-day mental states.
Yes, you can date people with bipolar disorder
Natasha Tracy’s blogs: Bipolar Burble and HealthyPlace’s Breaking Bipolar
I found Natasha online while looking at popular bipolar blogs. I liked what she was writing, but the decision that I definitely wanted to work with her came after viewing her video about dating people with bipolar disorder. I thought she’d be an ideal advocate for Blake.
And if you’re curious about that video, here it is:
Do you have insight?
Welcome to the Jungle: Everything You Ever Wanted to Know About Bipolar but Were Too Freaked Out to Ask by Hilary T. Smith
I loved the tone of this book: friendly, approachable, pragmatic — with chapter headings like: “Hippie Shit That Actually Works.”
My key takeaway came from her use of the term “insight.” She writes: “In psychiatry, insight means the ability to recognize when your behavior and thought patterns are coming from your mental illness as opposed to your regular self. For example: ‘I realize that the voices in my head aren’t coming from real people, even though it really feels like they are.’”
At points in the book she recommends asking, “Do I have insight?” as a way of finding out if you’re really cognizant of what’s going on or if you’re wrapped up in dysfunctional thought patterns. She’s talking about bipolar, of course, but this practice works for all kinds of situations including those without a diagnosable mental illness. For ADHD, I find it’s a useful way to figure out when I’m acting impulsively and I think it would work nicely for any situation where you’ve gotten your buttons pushed and aren’t using your full brain power.
Here’s a wise quote from her to give you more of the flavor of the book:
“True wisdom is invariant. It’s there no matter how you feel or what’s going on in the real world. A lot of it is in how you respond to the twists and turns of your mood. Just having depression doesn’t make you wise, but calmly weathering it does. Having mania doesn’t automatically give you shamanistic powers, but developing insight does. With this in mind, you realize that taking medication doesn’t prevent you from having wisdom or an ultimate experience, because those things are created by you, not by mania or depression. If some outside force like meds can take away your wisdom, it wasn’t real wisdom.”
Doing what works
Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner by Julie A. Fast and John D. Preston PsyD ABPP
I got two great tips from this book: the use of the “what works” list and the practice of treating the disorder first.
A what works list is a set of procedures or questions you go through when someone you love is in the grip of their mental illness. You create this list with them when they’re in a good place. It can be as simple as asking, “When you’re depressed, what can I do that works?” I’ve asked this to two friends of mine who deal with depression on a regular basis and had very insightful, useful conversations.
Most of us don’t get a good education about what to do when someone is struggling with a mental illness, which can leave us afraid, uncertain and guessing about what to do next. It was super helpful for me to learn tips like, “When you say that you love me, even if I don’t respond, it’s really helpful. Telling me to do something like eat or take a walk doesn’t work, but asking me if I’ve eaten, does.”
The second great tip, “treat bipolar disorder first,” means that when someone you love is in the grip of bipolar (or another disorder), you don’t engage them about issues in your relationship, work, life, etc. First you work with them — ideally using your what works list — to get them back to an insightful place. Then you can talk about issues if any remain.
For example with anxiety it can be very easy to get caught up in someone’s worries and not realize that most or all of those worries are self-generated. (Yes, I just gave myself a significant, I’m-taking-about-you look while writing that.) If you instead focus on helping them reduce anxiety (assuming you have a relationship set up where they want your help), then after the anxiety is back to a normal range, you can see what the real issues are, if any, and tackle those.
Manic and mixed states
An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison
I first discovered Jamison through her book “Exuberance: The Passion for Life.” (There’s a chance this was recommended to me because hyperactive ADD enthusiasm can resemble a hypomanic state in short doses.) Jamison is a Professor of Psychiatry at the Johns Hopkins University School of Medicine and has studied bipolar disorder extensively in addition to having the disorder.
Her memoir is an elegant description of how the disorder feels from the inside. Being more familiar with depression, I was drawn to her descriptions to her manic and mixed states. Mixed episodes in bipolar disorder include symptoms of both depression and mania and can include: high energy, irritability, racing thoughts, agitation, sadness, feelings of worthlessness and guilt, and suicidal ideation. Mixed episodes can be the most dangerous.
Here’s an elegant description of Jamison’s early experiences:
“By the time I was sixteen or seventeen, it became clear that my energies and enthusiasms could be exhausting to the people around me, and after long weeks of flying high and sleeping little, my thinking would take a downward turn toward the really dark and brooding side of life. … On occasion, these periods of total despair would be made even worse by terrible agitation. My mind would race from subject to subject, but instead of being filled with the exuberant and cosmic thoughts that had been associated with earlier periods of rapid thinking, it would be drenched in awful sounds and images of decay and dying: dead bodies on the beach, charred remains of animals, toe-tagged corpses in morgues. During these agitated periods I became exceedingly restless, angry, and irritable, and the only way I could dilute the agitation was to run along the beach or pace back and forth across my room like a polar bear at the zoo. I had no idea what was going on, and I felt totally unable to ask anyone for help. It never occurred to me that I was ill; my brain just didn’t put it in those terms.”
She also experiences hallucinations in some of her manic states and describes how mania can feel worse than depression:
“Slowly the darkness began to weave its way into my mind, and before long I was hopelessly out of control. I could not follow the path of my own thoughts. Sentences flew around in my head and fragmented first into phrases and then words; finally, only sounds remained. One evening I stood in the middle of my living room and looked out at a blood-red sunset spreading out over the horizon of the Pacific. Suddenly I felt a strange sense of light at the back of my eyes and almost immediately saw a huge black centrifuge inside my head. I saw a tall figure in a floor-length evening gown approach the centrifuge with a vase-sized glass tube of blood in her hand. As the figure turned around I saw to my horror that it was me and that there was blood all over my dress, cape, and long white gloves. I watched as the figure carefully put the tube of blood into one of the holes in the rack of the centrifuge, closed the lid, and pushed a button on the front of the machine. The centrifuge began to whirl.
“Then, horrifyingly, the image that previously had been inside my head now was completely outside of it. I was paralyzed by fright. The spinning of the centrifuge and the clanking of the glass tube against the metal became louder and louder, and then the machine splintered into a thousand pieces. Blood was everywhere. It spattered against the windowpanes, against the walls and paintings, and soaked down into the carpets. I looked out toward the ocean and saw that the blood on the window had merged into the sunset; I couldn’t tell where one ended and the other began. I screamed at the top of my lungs. I couldn’t get away from the sight of the blood and the echoes of the machine’s clanking as it whirled faster and faster. Not only had my thoughts spun wild, they had turned into an awful phantasmagoria, an apt but terrifying vision of an entire life and mind out of control. I screamed again and again. Slowly the hallucination receded. I telephoned a colleague for help, poured myself a large scotch, and waited for his arrival. …
“I felt infinitely worse, more dangerously depressed, during this first manic episode than when in the midst of my worst depressions. In fact, the most dreadful I had ever felt in my entire life—one characterized by chaotic ups and downs—was the first time I was psychotically manic. I had been mildly manic many times before, but these had never been frightening experiences—ecstatic at best, confusing at worst. I had learned to accommodate quite well to them. I had developed mechanisms of self-control, to keep down the peals of singularly inappropriate laughter, and set rigid limits on my irritability. I avoided situations that might otherwise trip or jangle my hypersensitive wiring, and I learned to pretend I was paying attention or following a logical point when my mind was off chasing rabbits in a thousand directions. My work and professional life flowed. But nowhere did this, or my upbringing, or my intellect, or my character, prepare me for insanity.”
The Dark Side of Innocence: Growing Up Bipolar by Terri Cheney
I went back and forth about even using the term “hypersexual” in My Year Zero, but it felt like it needed to be in the book. The domain of sexuality, interest in sex and mental illness isn’t talked about much and I think this can be a problem. Hypersexuality is associated with mania or hypomania and is episodic, but my writer’s instinct about this is that people who experience episodes of hypersexuality, especially when they’re young, can tend to be more focused on sex in general. In the case of some disorders, this can be a really good thing because of the way that sexual activity and even thinking about sex produces more dopamine in the brain. But it can also be a source of guilt and shame because we don’t talk about it and don’t help people understand the sex–dopamine connection.
Terri Cheney’s memoir is great for a variety of reasons including her detailing what it’s like to have bipolar symptoms starting around age seven. The way her child mind thinks of the disorder as “the Black Beast,” is evocative. She also did an amazing job of portraying what it felt like to be hypersexual starting at the age of 10. Here’s one of the passages where she’s discovering sexuality:
“Climbing had quickly become second only to poetry in my pantheon, an amazing fact considering that I hadn’t a tomboy bone in my body. … That night, though, after the street lights came on and all the kids had gone home, I snuck out of the house and climbed that damned pole. … But by the time I reached the top of the pole, I couldn’t ignore what was going on between my legs. I was pounding and pulsing and throbbing, caught up in a mighty current. It was as if I were being thrust to the edge of a great waterfall: waiting, resisting, until finally . . . release. Then falling, falling, falling forever.
I held on to the sign pole for dear life, not sure when these incredible sensations in my body would end, and even less sure I ever wanted them to. I had a nagging sense that whatever this was, it felt too good to be good for me. It was on a par with rubbing up naked against my mother’s mink stole, or running barefoot in summer: too wickedly delicious to be allowed.
When my heart finally slowed to its normal rhythm, I slid down the pole—only to be assaulted by a dizzying rush of anxiety once my feet touched the pavement. I’d always known that my mind was capable of astonishing intensity. Now I knew that my body was too. I didn’t know how to feel about this discovery: exhilarated, proud, or terrified? Was I a freak or a prodigy? I saw no middle ground. I clung to the pole, trying to will myself into tranquility, which never works no matter how hard you try.
I didn’t know back then that heightened sexuality is a common feature of childhood bipolar disorder. As it was, I was left feeling lost and bewildered, certain of only one thing: whatever had just happened to me, I absolutely had to keep it a secret. Yet another secret. I wondered if by the time I became an adult, there would be any room left in my storehouse of secrets, or would I someday be crushed under the sheer weight of them?”
To be continued …
That’s about half of the research, so tune in next week for two more books on bipolar disorder and two other research books to share. If you’ve got favorite resources about bipolar disorder or other mental illnesses, please share in the comments!