Jeff Muir

Bipolar Disorder: Dont Call it Mood Swings

Dont Call it Mood Swings

My Ride On the Cascade of Thoughts that is Bipolar Disorder

Part I

Text & Cover Art Jeff Muir 2013

April 2013

Jeff Muir

Bipolar Disorder: Dont Call it Mood Swings

When a psychiatric nurse practitioner diagnosed me with bipolar disorder I was relieved. One might think that being diagnosed with an incurable illness with one of the highest lethality rates of any disease known to man would be taken as bad news (one in four people with bipolar disorder commits suicide) -- but to me it just explained so much. I had been racking my brains for decades trying to find some sense of order or logic to the mess, the enigma, which had been my life. Very few challenges had proven unconquerable in life; very few conundrums had proven impossible for me to unravel. My own behavior and thinking, on the other hand -- contradictory, inexplicable was, however, a mystery. Expressing something coherent that reflects my actual experience with bipolar disorder has proven extremely difficult. How can one explain something to others that one hardly has a grasp of ones self? It seems like trying to describe the color of the sea during a hurricane. Or the actual flavor of a habanero pepper as it is being chewed. It's still all confusing to me. Ive made repeated fits and starts in an effort to get across something of what my perception and experience of the world is and has been like. Why? For one thing, it helps me to better understand what it is I am actually experiencing, since much of time that itself is questionable. Mostly, however, I would like those who have been hurt by my choices and behavior to have a little better understanding of some of the forces that have swirled inside of me all of these years. The subject of mental illness remains both misunderstood and controversial. There is, of course, a lot to it all < especially coming from the perspective of a sufferer who also has a degree in philosophy and has worked in the field of social work. This is going to be a multi-layered project. So, here goes < A baseline: The American Psychological Association, the American Psychiatric Association, the American Medical Association, the United States Government, all 50 United States, the United Nations, the European Union, etc., -- they all recognize the same basic
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classifications, categorizations and diagnoses of mental illnesses and mental disorders. There has been a multi-generational consensus among psychiatric, psychological, medical, biological and neurological experts as to what bipolar disorder is, how to diagnose it, the different ways it will affect a person, etc. Of course, there is the normal academic backand-forth -- the usual philosophical debates. But there's no question -- it's a legit condition. In the United States, the lingua franca for mental illness is the Diagnostic and Statistical Manual of Mental Disorders (DSM), developed and published by the American Psychiatric Association. The DSM presents a common set of disorder descriptions and diagnostic criteria, as well as a logical and categorical framework, for the entire theoretical concept of mental illness and developmental disabilities, as understood by the fields of modern psychiatry, psychology and biology, neurology, genetics, etc. In the DSM, bipolar disorder is part of a larger category (Axis I) that includes Anxiety Disorders (panic disorder, social anxiety disorder, post-traumatic stress disorder), Eating Disorders (anorexia, bulimia), Psychotic Disorders (schizophrenia), Dissociative Disorders (amnesia, multiple personality), Substance Use Disorders (alcoholism, drug addiction), and Mood Disorders (major depression, bipolar disorder). We won't get into all of these here, now -- but each condition is interesting and devastating in its own way; each one probably affects somebody you know, or somebody who is loved by somebody that you know.
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Surge Dale A. Muir, Ashland Art Center

Jeff Muir

Bipolar Disorder: Dont Call it Mood Swings

An important concept is the issue of what is called co-morbidity, the probability that a person diagnosed with one disorder is going to be diagnosed with another. In my case, I have bipolar, alcoholism and an eating disorder. Some people in my life have called me dramatic, or a fuck up but the statistics say otherwise there is an incredibly high comorbidity rate between these three disorders. When researchers notice very high comorbidity rates between specific disorders, red flags go up. Are certain disorders really distinct? Or are they merely shades of the same thing? What is the relationship of one to another? Those are just two of a thousand questions that could be, and have been, and are being, asked about these issues. In fact, very recent research, published in the Lancet (arguably one of the two most prestigious medical journals in the world) has demonstrated a genetic link between autism, bipolar disorder, depression, anxiety, schizophrenia and attention deficit hyperactivity disorder < which is, frankly, astounding. Interestingly, all of these conditions, as well as suicide, are present in my family going back one generation. Now, it had previously been proven that each of these conditions individually was genetically based -- meaning that every single person in the world who had one of these disorders shared a common gene (conversely, without the gene one didn't have the disorder). However, linking all five disorders to a single common gene was an earth-shattering development. Linking a mood disorder like bipolar to a perception and communication disorder like autism establishes a connection between a sufferer's perception of the world and his ability to process information and stimuli being perceived, and it links his ability to express the stimuli he perceives and processes. Think about that for a moment. Think about it in the context of some of the maddening, confusing, hurtful experiences you have had with bipolar disorder either your own, or somebody elses. Does it begin to change your perspective? It should
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Okay, so, even though the DSM places bipolar in its own little box within a static classification system, alongside other little boxes, all lined up in neat little rows ... recall the concept of co-morbidity. Here is a perfect segue into the idea that, rather than being a single disorder distinct from other single disorders, bipolar is instead a fuzzy thing alongside a bunch of other fuzzy things on a spectrum. Think of a rainbow, if you will. Yellow doesn't stop abruptly and just become green or orange ... it gradually blends into these other colors. So, too, with mood or psychiatric disorders. Even within a single diagnosis there is tremendous variety.

Take bipolar, for instance: it isn't one static thing; it isn't experienced the same way by every single person not by a long shot. In fact, I've never even heard of two bipolar sufferers describe their own condition in the same way. Yes, there are features of bipolar disorder that are the same. However, the experience of bipolar disorder is an exquisitely and excruciatingly individualized entity. The same holds true with the various mood disorders. It may or may not be the case that a person is either bipolar or he isnt. What the research published in the Lancet demonstrated is that people diagnosed with those five disorders, using a particular set of diagnostic criteria, share a common genetic feature. A thought experiment: Within those diagnoses, however, using totally different criteria, based on entirely different concepts or theories, there could be completely different diagnoses, perhaps dozens. And within these dozens of different alternate diagnoses, a person presently diagnosed as bipolar -- but not, say, autistic -- could very well share 10 or 15 or 40 other diagnoses with an autistic person.

Jeff Muir

Bipolar Disorder: Dont Call it Mood Swings

Spectrums. Or smudges. Gradations. Or dimensions. For the sake of diagnosis and treatment, however, there has to be some logic and consensus. Hence, the brief and direct and relatively simple diagnostic criteria of the DSM, which forces practitioners (psychologists, social workers, psychiatrists, medical doctors, nurse practitioners) to declare that a person is "this" or "that" ... rather than being able to say that a person is a little of this and a little of that -- which would be asking too much of an already overloaded healthcare system. But it is important for sufferers, their loved ones and their treatment providers to consider thinking about mental illnesses along the lines of a spectrum (actually, what I am describing is more like a scatter plot graph or a three dimensional chess board than a spectrum).

Now lets consider what it is, exactly, that would characterize a person as being bipolar. To be diagnosed by a clinician, a person has to have had more than one "manic" episode and at least one "major depressive" episode, these episodes must cause harm in ones life, and they must not be caused by any other drug or medical condition. So, lets break all that down. Manic episodes are really the defining characteristic of a bipolar person. During "mania" a person can literally be dissociated from reality; they can be hallucinating, psychotic, and completely out of touch with the world that everybody else is experiencing. In a very, very general sense, a person in a manic episode will be super-happy and energetic ("everything is great!"), grandiose and arrogant ("I know better than everybody!"), or really, really agitated by everything and eveApril 2013

ryone ("what is wrong with all of you people and everybody else in the entire known universe!?"). Sound familiar? It does to me. Ive been in one or the other of those three states for most of my life. My severe manic episodes typically last several weeks to two months. Once or twice per year I can have an extreme manic episode that includes paranoia and being just this side of being detached from reality. Several times in my life I have been completely detached from reality. For about a month I was convinced that I was a God who had decided to come to live with mortals as a mortal, but who had forgotten that he was a God, and so had been living here with only mortal capabilities; while I had remembered my divinity, however, I had not recovered my divine powers, and thus was cursed to walk the planet alone and misunderstood. I kid you not. It was an interesting, lonely, frightening experience. But I digress < To meet the diagnostic criteria for a manic episode, a person has to have experienced one or more of the above moods (energetic, grandiose, agitated) for at least a week. Just imagine. During that manic period, the person also must have had "three or more of the following symptoms to a significant degree" < inflated self-esteem; excessive talking or rapid speech; insomnia or little need for sleep; physical agitation or the opposite, very slow movement; "flights of ideas," skipping from one unrelated subject to another in rapid succession, mentally and/or verbally; lack of selfcontrol with pleasure-seeking activities, such as gambling, substance abuse, sex (even flirting inappropriately, etc.), shopping sprees, business investments; is easily distracted or can't focus for even short periods; alternately, obsessive behavior, getting "locked" on one activity, such as a specific random topic or interest for hours or days at a time. Again, sound familiar? When the nurse practitioner went over this with me I think I started to cry. This was my life, my inner thoughts, my entire existence she was describing to me. I hadnt experienced three of those features < I experienced all of those
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Jeff Muir

Bipolar Disorder: Dont Call it Mood Swings

characteristics, probably during 75 percent of in the same way that you have blue eyes or my waking hours over the course of my enare left-handed or prefer mustard to mayontire life < like studying how to make raw naise -- you hurt and embarrass the people goat wool hats, for no reason, out of the blue, you love, and you hurt and embarrass yourfor two days straight. That was my life. self. Who you are makes you want to not exIt is important to remember that mania is ist. Or to die. That's why more than 25 perexperienced very individually cent of people with bipolar in terms of duration, compresdisorder kill themselves, and Bipolar Disorder: sion, acuity of one feature vermore than half try to kill It's not "mood swings." sus another (say, rapid speech themselves. Actually, it's alversus flights of ideas) or the most a certainty that the numIt's not having sequence of the features of bers are much higher than that an "adventurous side". mania. Some will experience -- due to the statistical probaIt's devastating. mania for days, others weeks, bility of a large number of others months. Some people undiagnosed and improperly It's humiliating. will have cycles whereby they diagnosed. It's destroys lives. experience mania for a certain Another thing to consider: period of time, then when a sufferer is experiencIt kills people. "normalcy," for a certain periing mania (or depression) od, then depression for a certain period. they probably aren't even aware of it. In fact, Sometimes these cycles are like clockwork, especially during mania, the bipolar person other times they can be maddeningly random will likely argue with you all day long as to and unpredictable. The periods of the various the fact that there is something wrong with features within the mania have their own cyyou, not them. It will only be later, after the cles, which can be predictable, or not. The damage is done -- to the relationships, the job, differentiation goes on, and on, and on ... the bank account, the social standing -- that Next, the persons behavior has to have the sufferer begins to understand and comresulted in significant damage to his job, his prehend their behavior in the context of what social life and his personal relationships; or everybody else agrees is "normal". Remember physical harm to himself or others, or hospiwhat was written above about a bipolar pertalization (in the case of psychosis). Finally, son experiencing and perceiving and underthese behaviors or results cannot exclusively standing and communicating information very, have been attributed to substance abuse or very differently from people that do not some other medical condition. So, that's masuffer from a mental illness or developmental nia. disorder. Finally, to be diagnosed as bipolar, a As I stated at the beginning, everything sufferer also has to have experienced at least that lead up to my being diagnosed as bipolar one major depressive episode that lasted for no was excruciatingly painful. And I'll never, less than a week. To qualify as a major deever forget the moment in time when Sharon pressive episode, the experience must also Yeager, the psychiatric nurse practitioner, have caused significant harm to ones job, asked the questions that seemingly turned the relationships and social life; have resulted in inside of my mind and memory opaque -hospitalization or harm to ones self or others; and diagnosed me. I remember how the room and not have been the result of any other smelled, the color of the wallpaper, the temdrug or medical condition. perature of the air, the way her hair was sort Bipolar ... it's not "mood swings." It's not of blonde but streaked with grey, where the having an "adventurous side". It's not being calendar was on the wall in relation to the "impulsive." It's devastating. It's humiliating. sink ... everything. It explained so much. It's mentally and emotionally tortuous. Just by being the person you were created to be And I have so much more to explain ...
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