Wednesday, March 30, 2011

Forget Bipolar - We're Really Talking About Cycling Illness

I'm head down-ass up replacing my old bipolar diagnosis articles on mcmanweb with new ones. Following is an extract from one of my drafts ...

When I step out of the house, I go through the same mental checklist as everyone else - keys, wallet, phone, on and on. But I'm also performing a systems check on my brain. This sort of thing runs in the background all the time, but when I'm headed out the door the exercise assumes a quality of anal high drama, like a shuttle launch countdown ...

Make sure my head is screwed on right.

Ha! If people only knew. I live with bipolar. Most of the time I go about my life as if I don't have it, but that is only because I take nothing - including an operational brain - for granted. Breathe! I remind myself. All systems go. I'm ready to face the day.

It's Really All About Cycling

Bipolar is entirely the wrong term for my illness, your illness. "Cycling" is far more apt, suggesting the brain in perpetual motion - moods, thoughts, perceptions, everything - nothing standing still, everything shifting, nothing predictable.

But is there there anything up ahead I can at least anticipate?

Day slips into night, the moon waxes and wanes - my brain is a veritable I Ching. I may head out into the world cool, calm, and collected, but will my brain be working for me two hours from now when it really matters? I already know what I'll be like on the way home, a wrung-out dish rag, too spent to stop off at Trader Joe's. Is there enough food in the fridge?

Breathe! I remind myself. Breathe.

Way back in 1854, the French psychiatrist Jean-Pierre Falret came up with "la folie circulaire" (circular insanity) to explain the extreme mood changes he observed in his patients. The pioneering German diagnostician Emil Kraepelin coined the term "manic-depressive insanity" to describe what he saw as a much wider and more complex phenomenon. Nevertheless, cycling was a central piece to the puzzle. In the 1921 English translation to his classic "Manic-Depressive Insanity," Kraepelin describes the illness as including "the whole domain of so-called periodic and circular insanity."

What we call bipolar is an enormously complex illness, but strip it to its most essential element and what we're left with can be best described as a "cycling illness." Simply knowing that we have ups and downs is not sufficient. What we need to know is how these ups and downs relate, what is driving them, and what else is interacting with the dynamic.

Our "episodes" (depressed, manic, hypomanic, and mixed) only make sense in the context of the cycle that propels them. Is our hypomania (mania lite), for instance, a prelude to a crushing depression, or is it a warning that we are about to get swept up in a full tidal mania?

And what about the type of things that play havoc with our cycles, such as staying up all night to complete an assignment or cross-country travel?

In the second edition to "Manic-Depressive Illness" (2007), Goodwin and Jamison make it clear we are talking about more than one cycle, from the glacial pace of the shifting seasons to daily circadian rhythms. Kraepelin emphasized that there was a lot more to cycling than just mood, including intellect and volition, and not necessarily in sync. This would account for seemingly exotic but in fact fairly common variations to our moods such as "excited depressions" and "inhibited manias."

Let's rephrase: We are talking many cycles, not just one. Cycles within cycles, if you like. Throw any one of them out of whack and there goes your precision timing, your sense of being in control. Then life becomes a mad scramble, like juggling spinning plates. Inevitably, it happens - the plates crash to the floor. But always in a perverse slow motion that gives you just enough time to make the horrible realization - yet once again - that things have slipped away from you. And there you are, alone in the awful bitter aftermath, left to pick up the pieces.


polarbouncer said...

I don't think that most people understand the need to do a "brain" check on a daily basis. Sometimes I need to check in several times a day just to make sure I'm not going to go into a spin cycle, either up or down or sideways.

John McManamy said...

Hey, Polarbouncer. Ye, exactly. The brain-check is crucial. I suppose mindfulness is another way of saying brain-check. Keeping a daily mood journal is also highly recommended (I confess to being way too disorganized to do this.)

To readers: I would love to hear from you on your own form of brain-check.

Gledwood said...

Ha! You just reminded me what I forgot to do. Screw my head on today!!

John McManamy said...

Hey, Gledwood. Dang! Where did I put my head?

Joanne said...

Oh yes! I ultra-rapid cycle. A friend I met at DBSA asked me recently if there is ever a day that goes by that I forget my bipolar diagnosis. Fact is that if a 3-hour period goes by without such a thought I am definitely buzzing with hypomania at that time. Even in my hypomanic states I rarely forget. You've clearly stated the reason why. Constant appraisal of state of mind, state of body, what I'm about to do, what I'm about to say, and how well I was functioning during whatever I just did. My service dog helps too. She REFUSES to get in the car with me when my hypomania has got me really buzzed.