Friends and family often have questions about bipolar, so I invited mine to a BP Q&A! Here we address moodiness, heredity, and how to help someone you suspect is experiencing a mood episode.
Because we each experience the world from our own perspective, it helps to have open conversations about bipolar with the people around us. These can be challenging, of course. But they can also be informative—possibly even life-changing.
I invited my friends and family to an open Q&A—to ask me anything about bipolar—and I am delighted to continue sharing my answers to their questions:
#6 How is one diagnosed with bipolar? It’s probably a bit gray, but, in other words, where is the line between basic “moodiness” and bipolar? (I hope that’s not offensive!)
This is exactly the kind of question I want to hear—the kind that you’re worried about asking. And I appreciate the sensitive approach … because the answer isn’t easy to admit.
In a nutshell from the American Psychiatric Association (APA): “Several important features of bipolar disorder allow us to distinguish between the severe mental condition and the occasional mood swing. The first feature is whether the fluctuations in mood are caused by a situation, person, or event, or appear without cause. While the moods of people with bipolar disorder can be affected by situational variables, people with bipolar disorder also frequently become manic or depressed for no apparent reason. In comparison, for most people, moodiness is tied to a situational event, particularly stressful period, or even hormonal changes in the body.”
How is one diagnosed with bipolar? There are several criteria doctors use to make a diagnosis.
To put it simply, “if you experience X number of symptoms from this list, for Y number of days, then you have bipolar II disorder. If you experience R number of symptoms for S number of days plus at least one other thing from this other list, you have bipolar I disorder.”
In other words, you are right to guess that it’s a bit gray…. In fact, to me it’s downright swampy.
To understand the line between “regular” behavior and “bipolar” behavior, I think about a particular characteristic of the disorder: one can’t be diagnosed with bipolar unless or until they wreck their life to some degree.
As the APA puts it, the symptoms associated with mania “are significant and clear to friends and family. Symptoms are severe enough to cause dysfunction and problems with work, family or social activities and responsibilities.”
“Life wreckage” is literally a requirement.
This is not to say that all people who wreck their lives are bipolar; but all people with bipolar (or “PWB”) have, at some point, caused significant damage to their relationships, finances, career, or health.
So, what’s the difference between basic moodiness and bipolar, you ask? Life wreckage, that’s what.
Having “bipolar brain chemistry” is like having a “faulty good judgement” valve. It gets stuck closed … episodically … silently … repeatedly … until our behavior finally gets WAY out of line.
We are lucky if we get a diagnosis based on that first life-wreck because medications are VERY effective for PWB. With the proper meds, lifestyle, and mind-set we can totally return to stability, repair damages, and/or move forward on a more authentic path.
#7 What causes bipolar disorder? / Is it hereditary? / Can a child’s environment cause it to develop later in life, or, alternately, prevent it from developing—or is it completely biological and will show up no matter what?
A few friends asked a similar version of this question, so I thought it best to combine them.
Bipolar is genetic and hereditary. This brings up the whole nature-versus-nurture question because all children—regardless of brain chemistry—also are shaped by the environment of their formative years.
A history of childhood trauma is, indeed, common amongst PWB; but I don’t think there’s any proof of a direct cause/effect relationship. Many people experience childhood trauma and don’t develop bipolar disorder; by the same token, many PWB did not experience childhood trauma.
I don’t think there is evidence that it is completely, 100% guaranteed by biology, either. As far as I can tell, as a PWB and not a medical professional, it’s almost like some folks are born with a proclivity (the genetic possibility), and other folks are not. And of those who are born with a genetic proclivity, might still need a particular “recipe” of environmental stimuli in order to “activate” what I refer to as “bipolar brain chemistry.”
“Can a child’s environment prevent it from developing?” That’s a great question, and I don’t think science has been able to nail it down. I can’t even think of a good way to research this. You’d have to take a non-bipolar adult and prove that they would have developed bipolar, but they didn’t, because of a particular environment. (Wait a minute … this is my goal in raising my kids!!)
Since there isn’t any brain scan or lab test that can identify bipolar directly (although there are differences between “bipolar” and “normal” brains, as revealed by these scans), I don’t think there’s a way to know who will—unquestionably—develop it. Bipolar does run in families, and recent findings from the human genome support that bipolar disorder is highly heritable, but plenty of “normal” people have kids who develop bipolar; by the same token, plenty of bipolar parents raise “normal” kids.
For the record, this is a huge concern of mine. I’m doing my very best to teach my kids to seek a middle path, to develop coping tactics, and to be comfortable sharing their feelings.
#8 What should you do if you suspect someone you love (an adult) has it and needs help? Would someone with it even be receptive to the idea? Will it just push him/her away and/or deeper into the episode if I bring it up?
This really depends on the person, your relationship with them, and how you approach them.
We can be authentically excited about things, and we can be authentically passionate about things. We can be authentically sad, or happy, or tired—just like anyone else.
First, ask yourself: Does my hypothesis have merit? Get yourself a basic understanding of bipolar: it is a cognitive condition governed by undetectable changes in brain chemistry; it is considered a Serious Mental Illness (as opposed to Any Mental Illness) by the National Institutes of Health; and experiences vary widely from person to person with bipolar.
Second, ask yourself: Is there a reason for concern with this person’s mental health? (For example, Are they putting themselves in danger? Or are they behaving in a concerning way?)
This is an important factor in your decision about whether or not to open a discussion with them about bipolar. First and foremost, do anything you can to ensure their safety. If they’re truly on a destructive and dangerous path (which can happen during any type of bipolar episode—hypo/manic, depressive, or mixed), please talk them down from any ledges (literally and/or figuratively).
Once you’ve researched the disorder a bit, and once you’ve evaluated whether or not the person is putting themselves (or others) in danger—finally, ask yourself: Is this any of my business? Be respectful and check your own motives before confronting someone about the most core aspect of their life (their personality and cognition).
Finally, ask them: Can we talk?
A conversation could start like this:
“First off, I want to be clear that I’m not harboring any judgments or criticism of you, and I’m not trying to be a psychiatrist. I’m a friend and I care about you. I came across an article about bipolar disorder, and reading ABC made me think of you because of XYZ. Have you ever thought about it? . . .”
Would it push them deeper into a current mood episode? There’s really no way to answer that. I think that if you approach them in an honest and loving way—offering your nonjudgmental support—it could be a very helpful conversation. Of course, your good judgement … and back off if it’s clear they do not want to discuss it.
How might you answer these questions differently?
Stay tuned for the third and final installment of my AMA with friends, where I attempt to answer the rest of their questions, including “How does alcoholism or drug addiction affect bipolar?” and “Are there ways to manage bipolar other than with medication?” . . . Sounds fun, right?!
Brooke Baron has a BA in English, a minor in philosophy, and a lifelong obsession with language. She is the author of A Beginner's Guide to Being Bipolar.
Although born and raised in Alabama, she has been a proud California resident for 10+ years. During a professional stint in Silicon Valley—in both the corporate and private business sectors—she handled internal and external communications, office design and construction, photography and graphic design, executive assistance, and functioning on very little sleep.
Brooke now specializes in "New Human Orientation" from her home in the suburbs. She has a young, loving, growing family of five and is fueled by that love and coffee.
In addition to caring for the rest of Team Baron, she enjoys writing, reading, researching miscellaneous topics, and funneling manic energy into creative projects. With so many balls in the air—including bipolar II disorder—balancing her life is like balancing two kangaroos on a see-saw. She offers consulting services for the bipolar community at Better Bipolar Balance.
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