Bipolar Disorder for Writers: Does Your Character's Mood Swing From One Extreme to the Next?

 (Photo credit: Wikipedia)

Your character is on a wild ride. Instead of the normal hills and bumps in the road, she is instead on a roller coaster and is seeking help from a physician and a mental health provider. I would like to go over some of the diagnostics that you might be describing in your character if she has bipolar disorder

There are two components to bipolar disorder. The lows and the highs. The difference between schizophrenia and bipolar disorder can be difficult to distinguish especially in adolescents since, according to the DSM, they share many of the same criteria including: irritability, agitation, grandiosity, persecution delusions.
To learn more about schizophrenia go HERE 

The two criteria for Bipolar Disorder include periods of depression and periods of expressed manic episodes.

Depression

* Find a complete blog article HERE

Manic Episode.

The criteria for a manic episodes require:

Manic (Photo credit: Wikipedia)

1. A distinct period where the persons mood is
    elevated, expansive, or irritable

    and lasts for at least a week. 
    (or if it is so acute, that hospitalization
    is required, this time frame is not required.)

2. During the period of time that the individual is
    experiencing a mood disturbance, there has to 
    also be at least three items from the following list
    (remember you character would not have them all. Just pick
    three.)

   * inflated esteem or grandiosity

   * decreased need for sleep (3hrs)

   * uncharacteristically talkative

   * racing thoughts

   * distractability

   * increased goal-directed behavior

   * excessive pleasure seeking (sex, buying sprees, etc.)

3. This is not mixed episode - a mixed episode is when an
     individual cycles very quickly from manic state to

    depressive state nearly every day.

4. The mood change is severe enough as to interrupt the subjects
     life - their work, relationships, and social

     interactions. OR their behavior requires hospitalization to
     prevent harm to self or others

5. The symptoms aren't caused by substances such as drugs and/or
    alcohol, medicine or a medical condition

    such as hypothyroidism. *** This is why a complete physical
    with blood workup should be conducted PRIOR to a mental
    health diagnosis

   

(This information comes from the DSM IV which was not significantly revised with the new DM V. The DSM - Diagnostic and Statistical Manual - is the bible for mental health workers evaluations)

Painted Lady (Cynthia cardui) (Photo credit: bbusschots)

In order to help you understand how this chemical imbalance effects a person, I chatted with Cynthia Forget. 

I am including both the official questions and some of the aside back and forth so you get a good picture. 

Many people with psychological disorders are very private and self-protective about sharing their experiences. I am very grateful that Cynthia was so open about her experience. There is a lot of stigma that comes with a psych disorder diagnosis - I think you
will see and agree with me that
Cynthia is a lovely person who
is in a daunting position.

Fiona - 
Hey sweetie. How are you today?

Cynthia - 

I'm "phine" as opposed to "fine" - it's the word used when you say "fine" but don't mean it.

Fiona- 
Boo! Are you on a low swing?

Cynthia - 
Very much so - but life goes on.

Fiona - 
Are your meds taking the edge off?

Cynthia - 

Not as much as I'd like, but I'm sure they're helping.

Fiona - 
I'm so sorry - is it okay for us to talk today or would you rather wait?

Cynthia - 
No today is okay - I've actually been looking forward to it, and there's not much I look forward to.

Fiona - 
Okay, good, so we'll start: Hi Cynthia, thanks for being here today. Today, we are talking about the psychological disorder called Bipolar Disorder. Can you tell me about your connection with this diagnosis and your advocacy?

Cynthia -
I was diagnosed with bipolar disorder in 2005. I have bp1. Fiona - my mind is running quite slow so I'm afraid you're going to have to pull the info out of me.

Fiona - 
Not a problem. And if you need to do this in several interviews, that's okay too.

Cynthia - 
You're so kind.

Fiona - 
Not at all - I truly appreciate your helping me. So here is a question: You said to me your mind is working slowly - is that a function of your meds?

Cynthia - 
I believe it is due to my meds and just the actual state of depression.

Fiona - 
You've been living with a diagnosis for 9 years. What are some of the difficulties that this has created for you?

Cynthia - 
The main difficulty I have encountered is that I am unable to work. I am currently on a disability pension. My job required extreme executive functioning - memory - decision making etc - they are impaired by the bp. 

This is a link to a blog article that Cynthia and I did on Criminal Trial Coordination, her position prior to her disability pension. Link

Fiona - 
Your diagnosis is BP1 can you tell us about the difference between BP1 and BP2?

Cynthia - 
Bipolar disorder is basically a brain disorder where the neurotransmitters - serotonin, dopamine and noradrenaline - create episodes of mania and depression effecting mood, emotions and behavior. BP1 is when there are extremes of mania and depression BP2 is when you have hypomania rather than mania - a milder form.

Fiona - 
And the swing between the polar events - is there a predictable cycle?

Cynthia - 
There is for some people, but generally no - it tends to be an unpredictable illness - but with mood charting patterns can be identified.

Fiona - 
What might a typical cycle from low to high to low look like in terms of time span?

Cynthia - 
That's too difficult to say - everyone is so different - if a person cycles 4 or more times in a year, they are considered as rapid cycling - from days to weeks is called ultra rapid cycling and within a day/hours is called ultradian cycling

Fiona - 
How long would a peak or trough last? You are experiencing a depression, can you tell yourself - just 2 weeks, and I'll pull out of this...

Cynthia - 
Unfortunately not - sometimes it's a few days or weeks, but I personally had a 2 year episode some time ago.

Fiona - 
Of depression? Do you experience manic episodes that last as long?

Cynthia - 
BP is so individualized, I did have one manic episode that was 2 years as well - that was before I was diagnosed and before I was medicated.

Fiona - 
Are there times when you feel like you are stabilized at what you would consider to be a normal affect?

Cynthia - 
Yes - but not nearly as long as I would like - I have good days and bad days.

Fiona - 
How does your mania express itself?

Cynthia - 
Well, I become the smartest person I know - I believe I can do anything -  get pressured speech / stuttering - my thoughts go off on tangents constantly and my mind races - I have great needs to shop and spend money - I drive recklessly - I am enthusiastic and generally feel terrific, confident and invincible - very wired - very creative - a general feeling of euphoria - restless and unable to concentrate - sleeping very little - promiscuous.

Fiona - 
Is that something you feel like you want to medicate to have stop or does that feel like a high you'd really like to ride?

Cynthia - 
A high that I love to ride. Only thing is, it tends to get me in trouble. "I wish I were manic," that's a mantra you'd hear many people with bp say.

Fiona - 
That's very interesting. I'm sure it feels much better than the troughs. Tell me about some of the trouble it can get you into (and others you know have experienced).

Cynthia - 
You can get into trouble with poor judgment, irritability and aggression, also promiscuity can wreak havoc on a marriage, work problems...

Fiona - 
Do you (and others) skip medications to prolong the manic periods? If not, how do you get yourself to take pills that might make you feel less good?

Cynthia - 
I am medication compliant - I take my meds as directed - some people, as you say, may try to control their moods by skipping meds - this usually leads to problems - as time goes on, I think most people realize they need their meds.

Fiona - 
"Promiscuity can wreak havoc on a marriage" Tell me about consequences - will the law understand if you drive too fast, commit petty crimes, buy drugs etc.? Do the people in your life understand that you are not in control of your brain and give you a get out of jail free card in the relationship?

Cynthia - 
The answer to all of that is no. No get out of jail free cards.

Fiona - 
So how does that impact people's ability to stay in long term relationships?

Cynthia - 
It's challenging - the divorce rate for a marriage with one party has bp is 90% (compared to 40%)

Fiona -
You run a blog about bipolar disorder -  http://cynthiaforget.weebly.com/ what is your goal?

Cynthia - 
It started as an outlet for myself - something to write about - but it has evolved into providing information to people about bipolar and as a support for people with bipolar

Fiona - 
And I'm sure those who love them are looking for answers as well. What is the most common misunderstanding you run into?

Cynthia - 
I guess that if you take your meds, you'll be better - like there's a cure - there's not - it can only be managed, not cured.

Fiona - 
When you read books that include characters with bipolar disorder, or on TV and in movies, etc., do you feel that this condition is fairly represented? What would you have writers change?

Cynthia - 
I think they try to portray the condition properly - some shows do better than others - people have different opinions of what is a good portrayal - I like the "Black Box," but it's getting a lot of negative feedback on Twitter - I personally think they're doing a good job.

Fiona - 
I'm not familiar - what is Black Box?

Cynthia - 
It's a show where the lead character is a neurologist with bipolar disorder - New this season.

Fiona - 
And who is panning it? People in the bipolar community? Or those outside?

Cynthia - 
In the community, I believe.

Fiona - 
In the responses you are reading - do people in the BP community not like it because it stereotypes, or does not educate, what are their concerns?

Cynthia - 
If I remember (memory is an issue), I think it is because it stereotypes.

Fiona- 
Are there any books that you've read that you thought, "Wow! This author nailed it - that's exactly what I experience."

Cynthia - 
Yes - An UnQuiet Mind - by Kay Redfield Jamison - she has bipolar disorder and is also a psychiatrist at Johns Hopkins University - an expert in her field

Fiona - 
Here is an absurdly broad question - What do you want writers to understand when they are construction characters with bipolar disorder?

Cynthia - 
That each person is different and unique - to avoid the stereotypes - it is unpredictable and exhausting - there is a lot of self care involved.

Fiona - 
Tell me about a self-care routine.

Cynthia - 
Mood charts, routine, sleep, nutrition, walking, meds, pscychiatrist, therapy, support system, light box, avoiding drugs/alcohol, avoiding personal triggers, monitoring symptoms biggest one: avoid stress. And education.

Fiona - 

Cynthia distinguishes between her psychiatrist and her therapy. A psychiatrist is someone who has a medical degree and has a psychology background. They monitor the physiologic state of a patient. While psychiatrists can provide therapy, typically this is done (for cost containment reasons) by a trained psychologist, social worker, or counselor. The therapist can then inform the psychiatrist of changes that might necessitate a review of the medication regiment.

Cynthia, are people with BP disorder generally considered to be at high risk for self-harm?

Cynthia - 
Yes.

Fiona - 
The light box is to avoid depression with a lack of vitamin D from the sun?

Cynthia - 
Yes.

Fiona - 
Do people with BP disorder trigger like a person experiencing PTSD? Can you give me an example of a trigger?

Cynthia - 
Triggers are very personal and different - my biggest trigger is death - any involvement in death spirals me into depression

Fiona - 
What kinds of psychotherapy is the most common/most effective with BP disorder?

Cynthia - 
CBT - cognitive behavioral therapy

Fiona - 
Do you run into a lot of snake oil salesmen? People who can "cure" you if only you would follow this diet take these supplements etc.?

Cynthia - 
I've read about it, but personally I have not come in contact with it.

Fiona - 
Our hour is coming to a close, my last question:

What do you wish I had asked you?

Cynthia - 
What's the best part about having bipolar? Creativity.

Fiona - 
Oh, good one! I lied. I have another question - is there any scientific research that gives you hope that your chemistry can one day be corrected?

Cynthia - 
Good question. I guess all the neurological studies they're doing are hopeful, but truthfully, I'm not sure I'd take it away if I could. It's me.

Fiona - 
What a self-loving, wonderful answer.

Again, a huge thank you to Cynthia for sharing her life experience with BP1.

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