people, you'd get ten different answers: “Christmas is a Christian holy day celebrating Jesus's birthday.” “Christmas is a consumer holiday about buying stuff.” “Christmas is a pagan winter solstice festival co-opted by Christianity.”
You figure out pretty quickly that “Christmas” is not something that exists independently of people's ideas and fantasies: there's no scientific test for Christmas (“ah, there are ten units of Christmas in the air today!”). On the contrary, Christmas is an idea; a thing that's real because a bunch of people have agreed to talk about it a certain way and accord it a certain structure (Christmas always has a tree and a snowman, even if the snowman is made of plastic).
In this sense, bipolar disorder is a little like Christmas. It's an idea—an idea with lots of research and science and history backing it up (just like Christmas!) but also a construct dreamed up by our culture's medical system and influenced by very specific cultural values and assumptions. (Up until very recently in human history, they didn't have “bipolar” in Egypt or Samoa or Belize any more than they had “Christmas”—they are both ideas that got exported; interpretations of reality, not scientific facts.)
So before we get into anything involving mania or depression or any of those things you expect to find in a book about bipolar, please review the following reminder: “Bipolar” is a word.
It is a word psychiatrists made up so they would have a way to bill insurance companies. Insurance companies won't reimburse psychiatrists for treating suffering, but they will reimburse them for treating “bipolar.”
It is a word psychiatrists made up because it is easier to give patients medication for “bipolar” than to say “you are suffering and I think this pill might help.” People in our culture are uncomfortable taking a pill because it will help them feel better (it feels like cheating), but we're OK with taking a pill if it's treating an identifiable and socially validated disease.
It is a word psychiatrists made up because it would take too long at psychiatry conventions if everyone talked about “my patient who is really sad but also agitated and also can't sleep and also sleeps too much and also drinks too much and also can't quite hold down a job and is also a genius at painting and also had a terrible childhood”—it's more convenient to say “bipolar.”
It is a word our culture uses because we're comfortable with medical problems, and definitely not comfortable with problems that imply there is anything wrong with our social and economic systems. It is easier to say, “You have bipolar!” than to say “The modern world demands people to be rigid and efficient, ambitious and desensitized, and if you are not those things, you're going to have a very hard time.”
It is a word our culture uses because we are comfortable with medical problems, and definitely not comfortable with spiritual experiences. It is easier to say, “You are psychotic!” than to entertain the possibility that someone really did see God, or levitate, or have a profound insight into the Kabbalah, or whatever.
This is not to say that bipolar is a meaningless word or an arbitrary word or a word some kooky psychiatrist cooked up just for the hell of it—but all words have limits, and when we're talking about a word as powerful as bipolar, it's essential to keep an eye on the context.
“WHY ARE YOU HARPING ON THIS STUFF, YOU WIZENED OLD HAG?”
Because it's true, and it's important. Yes, this book is going to talk about bipolar disorder in the “normal” sense (in the very next paragraph, in fact!) But if you don't understand the social and cultural context of this diagnosis, you're missing a whole lot.
BIPOLAR? SAYS WHO?
There are four things a psychiatrist takes into account before making a diagnosis of bipolar disorder: your current symptoms, your medical history, your family history, and your psychiatric history. Doctors see hundreds and hundreds of people and know what to look for. They look for patterns (“Wow, that guy talks in a constant stream without any pauses, and he hasn't slept for a week. And his uncle has bipolar, and he's taken four jobs”) that are consistent with what we're calling bipolar. You, of course, are a beautiful and unique snowflake, but like it or not, there are a number of classic behaviors and indicators (big and small) that people experiencing mania, hypomania, or depression in our culture tend to present. Quibble over details all you like, but if the shoe fits in five places, they're sticking that sucker on your foot. P.S. Hope you like Velcro.
THINGS THAT GO INTO A BIPOLAR DIAGNOSIS
1. CURRENT SYMPTOMS
Do you seem depressed or manic? Have you mentioned being unable to sleep, unable to think straight, or crying all the time? Are you talking fast? Of course, you may feel that you are acting normally, but it can be very hard to reflect accurately on yourself especially if your symptoms have been creeping up on you over weeks or months. Over time, a psychiatrist will be able to compare your “manic” or “depressed” behaviors to your “baseline.” (For example, the psychiatrist might figure out that you always talk fast. It's just who you are, no big deal.) But for a first diagnosis, the only thing they can really compare you to is the general population.
2. MEDICAL HISTORY
Do you have another disease, like epilepsy or diabetes, that might be causing your symptoms? Are you on crack? Pregnant? On the autism spectrum? Have a brain tumor? Or are you just hungry? Many medical conditions share symptoms with bipolar. You want to rule these out as possible causes before deciding the diagnosis is bipolar.
Of course, it can be difficult to rule out other conditions if those conditions are undiagnosed (maybe nobody's realized you're autistic, or pregnant, or anorexic, or have some obscure vitamin deficiency that is either causing or exacerbating your “bipolar” symptoms) or if those conditions are not recognized by your culture as being valid (like having a spiritual awakening or emergency.)
Unless you're on a really cushy medical plan, it's unlikely your doctor will run the dozens of tests necessary to exhaustively rule out other possible causes for your distress. It is therefore important to take as thorough an inventory as possible of your own health before you go to your doctor's office. Write down a year-by-year health inventory, as far back as you can remember. Include anything that seems significant, whether or not it seems relevant to “mental” health (after all, physical health and mental health are closely entwined). Have you ever had seizures? Insomnia? Childhood anxiety or depression? Self-mutilation? Stress-related conditions like eczema? Had a traumatic injury that still causes you pain? Other chronic illnesses? Frequent fevers or flus?
This might all seem a little over-the-top, but the more of an expert you can become on the working of your own mind and body, the happier you will be in the long run. Even if the doctor looks over the list and decides your symptoms are still mostly due to bipolar (even though you do have anemia and PTSD and a few other things with bipolar-esque symptoms), the inventory can help you see the bigger picture and help you come up with a plan to improve your overall health, not just the “bipolar” part of you. Mind and body are related—a fact which gets overlooked too easily in the drama of a mental illness diagnosis.
CONDITIONS THAT SHARE SYMPTOMS WITH BIPOLAR
Believe it or not, bipolar disorder doesn't have the market cornered on things like insomnia, grandiosity, and suicidality. Here are just a handful of conditions that share these symptoms:
Condition: Aspergers/Autism Spectrum Disorder
Bipolar-esque features: Depression, anxiety, obsessions, socially inappropriate behavior, periods of intensely focused activity, social burnout and withdrawal, loneliness, hypersensitivity, suicide attempts, seeming “grandiosity.”
Condition: Temporal Lobe Epilepsy
Bipolar-esque features: Bouts of paranoia and confusion, overwhelming