Madness

1. Bipolar disorder is a complex mental illness characterized by extreme mood swings

Madness will push you anywhere it wants. It never tells you where you're going, or why. It tells you it doesn't matter. It persuades you.

Unpredictable nature: Bipolar disorder is a mental illness that causes dramatic shifts in a person's mood, energy, and ability to function. These mood swings can range from manic highs to depressive lows, often with no clear trigger or warning.

Impact on daily life: The disorder affects every aspect of a person's life, including relationships, work, and self-perception. During manic episodes, individuals may feel invincible and engage in risky behaviors, while depressive episodes can leave them unable to perform basic tasks or even get out of bed.

Complexity of symptoms: Bipolar disorder is not simply a matter of being "up" or "down." It can involve mixed states, rapid cycling, and varying degrees of severity. This complexity often makes it difficult to diagnose and treat effectively.

2. Early signs of bipolar disorder can manifest in childhood and adolescence

I am four years old and I like to stay up all night. I sing my songs, very quietly. I keep watch. Nothing can get me if I am awake.

Childhood indicators: Early signs of bipolar disorder can appear in childhood, often mistaken for normal childhood behavior or other conditions such as ADHD. These may include:

• Intense mood swings
• Periods of hyperactivity followed by lethargy
• Difficulty sleeping or irregular sleep patterns
• Unusual levels of creativity or productivity for their age

Adolescent manifestation: As children enter adolescence, symptoms may become more pronounced and disruptive. This can include:

• Risky or impulsive behavior
• Substance abuse
• Academic struggles despite high intelligence
• Intense emotional reactions to relatively minor events

3. Substance abuse often co-occurs with bipolar disorder as a form of self-medication

I drink up all the liquor in the world, all the booze in several men's liquor cabinets, all the wine in my own collection and then all the wine in the collection I buy to replace the first one, all the wine and martinis in the bars in the city. Anything I can get my hands on. There is never enough.

Self-medication: Many individuals with bipolar disorder turn to substances as a way to manage their symptoms. Alcohol and drugs may be used to:

• Dampen the intensity of manic episodes
• Lift mood during depressive phases
• Slow racing thoughts or induce sleep

Dangerous cycle: While substance use may provide temporary relief, it often exacerbates bipolar symptoms in the long run, leading to:

• More severe mood swings
• Increased risk of psychosis
• Interference with medication effectiveness
• Additional health and legal consequences

Treatment challenges: The co-occurrence of substance abuse and bipolar disorder complicates treatment, requiring integrated approaches that address both issues simultaneously.

4. Manic episodes can lead to reckless behavior and impaired decision-making

I am triumphant. I have arrived. I am torn apart with grief. Brian is dead. BBC London loves me. The book critic loves me. I hold court at a publication party, pouring wine down my gullet like a pelican, the table littered with bottles, everyone laughs.

Euphoria and grandiosity: During manic episodes, individuals may experience:

• Extreme elation and optimism
• Inflated self-esteem and sense of importance
• Rapid, pressured speech and racing thoughts
• Decreased need for sleep

Impulsive actions: The heightened energy and reduced inhibitions of mania can lead to:

• Excessive spending or gambling
• Risky sexual behavior
• Ill-conceived business ventures or creative projects
• Reckless driving or other dangerous activities

Cognitive impairment: Despite feeling highly capable, individuals in manic states often experience:

• Poor judgment and decision-making
• Difficulty concentrating or following through on tasks
• Irritability or aggression when challenged or contradicted

5. Depressive episodes can be debilitating and lead to suicidal thoughts

I do not have the energy to pull myself free. I do not have the energy to even care that I am trapped. This is beyond caring, beyond a will to die, beyond will. Death is there, but you can barely lift your hand to reach out for it, and you cringe at the faintest suggestion of light.

Profound despair: Depressive episodes in bipolar disorder can be severe, characterized by:

• Overwhelming sadness or emptiness
• Loss of interest in previously enjoyable activities
• Extreme fatigue and lack of motivation
• Feelings of worthlessness or guilt

Physical symptoms: Depression affects not only mood but also physical well-being, causing:

• Changes in appetite and weight
• Sleep disturbances (insomnia or excessive sleeping)
• Psychomotor retardation or agitation
• Physical aches and pains

Suicidal ideation: The intensity of depressive episodes can lead to thoughts of death or suicide, requiring immediate intervention and support.

6. Proper diagnosis and medication management are crucial for managing bipolar disorder

Dr. Lentz tells me that once I've had a major manic break, I'm likely to have one again, and the more I have, the more I will have. He tells me the bipolar has already progressed quite a ways. No, it's not going to go away. No, there's no cure. Yes, you'll always have to take the meds. Yes, always. Yes.

Diagnostic challenges: Bipolar disorder can be difficult to diagnose due to:

• Similarity of symptoms to other mental health conditions
• Variations in presentation between individuals
• Lack of insight during manic episodes

Medication complexity: Treatment often involves a combination of medications, including:

• Mood stabilizers (e.g., lithium, valproic acid)
• Antipsychotics
• Antidepressants (used cautiously due to risk of triggering mania)

Ongoing adjustments: Medication management is an ongoing process, requiring:

• Regular monitoring of blood levels and side effects
• Adjustments based on mood cycles and life circumstances
• Patience in finding the right combination and dosage

7. Support systems and therapy play a vital role in coping with bipolar disorder

Ruth has seen me in all manner of states. She's seen me manic as hell, depressed, confused, sedated, incomprehensible, and everything in between. But she sits there calmly, agreeable, perfectly willing to follow the circuitous meander of my thoughts, or hold my head up when it's lolling, or sit on the floor with me when I'm under a table.

Importance of understanding: Having supportive friends, family, and partners who understand the nature of bipolar disorder is crucial for:

• Providing emotional support during mood episodes
• Recognizing early warning signs of manic or depressive episodes
• Encouraging treatment adherence and healthy lifestyle choices

Therapeutic interventions: Various forms of therapy can help individuals manage their bipolar disorder:

• Cognitive Behavioral Therapy (CBT) for identifying and changing negative thought patterns
• Interpersonal and Social Rhythm Therapy for stabilizing daily routines
• Family-focused therapy for improving communication and problem-solving skills

Peer support: Connecting with others who have bipolar disorder can provide:

• Shared experiences and coping strategies
• Reduced feelings of isolation and stigma
• Hope for long-term management and recovery

8. Bipolar disorder can significantly impact relationships and daily functioning

Jeff is a complete disaster area. I walk around his house in wonder. There is a dining room table, but no chairs. Dust covers every surface, an inch thick. There is no food in the refrigerator. Every room in his house is painted a different, hideous color, the doing of his ex-wife, who apparently liked to paint.

Relationship strain: Bipolar disorder can put immense pressure on relationships due to:

• Unpredictable mood swings and behavior
• Financial stress from impulsive spending or inability to work
• Emotional burden on partners and family members

Occupational challenges: Maintaining steady employment can be difficult due to:

• Inconsistent energy levels and productivity
• Difficulty managing stress and interpersonal conflicts
• Extended absences during severe episodes

Daily life disruptions: Even basic tasks can become overwhelming during mood episodes, affecting:

• Personal hygiene and self-care
• Household management and bill paying
• Social engagements and commitments

9. Stigma and misunderstanding surrounding mental illness can hinder treatment

Word gets out at school that I'm seeing a psychiatrist. My friends avoid the subject. But other kids whisper about it when I come into the room, kids I don't like and who don't like me, the rich kids and the snobs. One of them, egged on by the others—Go on, ask her—comes up to me: Is it true you're, like, crazy?

Social isolation: Stigma can lead to:

• Withdrawal from social interactions
• Concealment of symptoms and struggles
• Reluctance to seek professional help

Misconceptions: Common misunderstandings about bipolar disorder include:

• It's just mood swings that everyone experiences
• People with bipolar disorder are always unstable or dangerous
• Bipolar disorder is a character flaw or weakness

Internalized stigma: Individuals with bipolar disorder may internalize societal stigma, resulting in:

• Low self-esteem and self-doubt
• Resistance to treatment or medication
• Difficulty accepting the diagnosis and its implications

10. Recovery from bipolar disorder is possible but requires ongoing effort and management

When it comes, it comes quietly enough. One morning I am suddenly, acutely aware that I am extremely happy. It's a fine, bright day, and I'm feeling rather grand. I fling my arm out before me, which admittedly is a little odd, in a gesture intended to signify my magnanimous state of mind. Sally forth!

Lifelong journey: Managing bipolar disorder is an ongoing process that involves:

• Consistent medication adherence
• Regular therapy and psychiatric check-ins
• Lifestyle modifications (e.g., sleep hygiene, stress management)

Recognizing triggers and warning signs: Developing self-awareness is crucial for:

• Identifying situations or stressors that may trigger episodes
• Recognizing early symptoms of manic or depressive episodes
• Taking proactive steps to prevent full-blown episodes

Redefining success: Recovery often involves:

• Accepting the diagnosis and its limitations
• Setting realistic goals and expectations
• Celebrating small victories and periods of stability
• Finding meaning and purpose beyond the illness

Last updated: January 22, 2025