It’s Monday as I write this feature, which means I am flirting with my deadline, something that happens regularly these days because of my preoccupations with academia. Having spent a considerable amount of time advocating through this column for change on many levels these past few months, I decided last week to refocus on the health education aspect of mental health.
This requires drawing on the available scholarship and presenting the material here as basically as possible so we can learn and learn to act together. I’ve decided to begin by talking again about bipolar disorder and simply cannot get this song out of my head:
It's just another manic Monday
I wish it were Sunday
'Cause that's my fun day
My I-don't-have-to-run day
It's just another manic Monday
Have to catch an early train
Got to get to work by nine
And if I had an aeroplane
I still couldn't make it on time
'Cause it takes me so long just to figure out what I'm gonna wear
Blame it on the train
But the boss is already there
It’s one example for me of how glibly, without malice, society can make reference to things that matter and when they do, it matters little. I’ve never considered the song or its meaning but I have sung it many times over.
Written by Prince in the 80s and sung by US girl band, The Bangles, one commentary says lyrically, it describes a woman who is waking up on Monday, wishing it were still Sunday.
If that were my mania or the manic experience of any of us who are diagnosed and living with a bipolar disorder it would be a breeze. In real life we sometimes awake on a Monday wishing it were Monday. At another time we do not even want to wake up to figure out which day it is, depending on which “end of the pole” one finds oneself.
Bipolar disorder, like many mental illnesses, is sometimes a controversial diagnosis. While most (people experiencing bipolarity) consider the disorder to be a hardship, some appreciate its role in their lives, and others even link it to greater creative output, says www.psychologytoday.com.
I’m certain it accounts for my creativity and I also never discount its hardship in my life.
Bipolar disorder, also known as manic depression, is a chronically recurring condition involving moods that swing between the highs of mania and the lows of depression.
But that's not quite the whole picture; depression is by far the most pervasive feature of the illness, while the manic phase usually involves a mix of irritability, anger, and depression, with or without euphoria. The elation may manifest as unusual energy and overconfidence, playing out in bouts of overspending or promiscuity.
The disorder most often starts in young adulthood, but also occurs in children and adolescents. Misdiagnosis is common; the condition is typically confused with everything from attention-deficit-hyperactivity disorder to schizophrenia to borderline personality disorder. The Diagnostic and Statistical Manual of Mental Disorders, referred to as the DSM, the manual published by the American Psychiatric Association, considered the Bible of mental health disorders for both children and adults, defines manic as follows:
DSM-IV Criteria for a manic/hypomanic episode
The manual says:
“It’s a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalisation is necessary). During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
• Inflated self-esteem or grandiosity
• Decreased need for sleep (eg feels rested after only three hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility (ie, attention too easily drawn to unimportant or irrelevant external stimuli)
• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (eg engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Following this, the DSM-IV says the symptoms do not meet criteria for a mixed episode:
• The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalisation to prevent harm to self or other, or there are psychotic features
• The symptoms are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication, or other treatment) or a general medical condition (eg hyperthyroidism)
Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (eg, medication, electroconvulsive therapy, light therapy) should not count towards a diagnosis of Bipolar I disorder
What are the symptoms of a mixed features episode?
• Mixed episodes are defined by symptoms of mania and depression that occur at the same time or in rapid sequence without recovery in between says www.webmd.com.
• Mania with mixed features usually involves irritability, high energy, racing thoughts and speech, and over activity or agitation.
• Depression during episodes with mixed features involves the same symptoms as in “regular" depression, with feelings of sadness, loss of interest in activities, low energy, feelings of guilt and worthlessness, and thoughts of suicide.