Diagnosis and Identity

A trusted friend who has bipolar and works in a mental health setting pulled me aside the other day; he said he’s observed some possible symptoms of mania in my behavior. He presented the information as something that might help explain some of what I’m going through, and more importantly as a tool I can use in my creative endeavors. Use the unbridled, chaotic energy to create; edit when the mind is calmer. I don’t think I want to edit when I’m depressed because then I’ll probably get rid of a lot of good material, but I digress.

To be honest I’ve been wondering about the possibility of there being a manic – or, more likely, hypomanic – component to my… madness. I do seem to have times when the depression lifts – just enough that I think I’m starting to get better, but not enough to say I’m “in remission” or “have recovered.” These times are often accompanied by a whirlwind of energy in which I become engulfed in a new project – which I tend to abandon completely when the next wave of depression hits.

I never really pursued the possibility of mania/hypomania being part of my madness for a few reasons:

• I thought it required elevated mood; to the degree that my mood becomes “elevated” it would probably fall within the range of “normal” non-depressed emotions.
• Questions on screening tools that explore the possibility of mania/hypomania tend to begin with “a period when you were not yourself and…” I’m always myself.
• I’m not comfortable talking about some of my experiences with mental health professionals because I don’t want them to pathologize experiences I consider(ed) to be spiritually meaningful.
  • Some of the voices in my head may become abusive, but others can be supportive. It might be different, but I often find it adaptive. I’d be lonely if they all went away.

But now I’m thinking this is a possibility worth looking into. I pulled out the DSM-IV-TR and reviewed the relevant symptoms with Fox. (We don’t have a copy of the DSM-5 and I’m inclined to keep it that way, considering the concerns people have raised about it.)

The DSM-IV-TR clarifies that the mood in mania/hypomania can be elevated, expansive (?), or irritable. We’ve both noticed that I seem to have some of the additional symptoms: (3) more talkative than usual or pressure to keep talking, (4) flight of ideas or subjective experience that thoughts are racing, (5) distractibility, (6) increase in goal-directed activity. Additionally, it is possible for depressive symptoms to be present at the same time as manic/hypomanic symptoms. Hypomanic episodes can be as short as 4 days and do not require there to be marked impairment in functioning (e.g. taking huge risks) to be diagnosed.

I’m not really in any rush to ask a professional to put a stigmatized label on me, but I do think this is important. It can help me understand myself and navigate my life and experiences. Awareness of it might help me find useful ways to channel the energy when it hits and possibly even cope better when it dissipates.

If I pursue treatment, particularly medication, it changes what I need; Fox said that medications for bipolar disorders are better understood and tend to be more effective than those available for unipolar depression. I’d need to do some research, but I do feel more hopeful about finding something that works for me (preferably with minimal side effects / other health risks).

Finally, it’s very important to me to represent myself as accurately as I can on this blog. One of my goals is to give people who have never experienced madness / mental illness an insider’s perspective of what it’s like (for me). If I say I have one disorder but I “really” have something else, I’m misrepresenting the first disorder and doing a disservice to everyone involved.

For now I just want readers to know that I’m not sure what my diagnosis should be. At the end of the day we’re all people with dynamic issues and behaviors that don’t really fit into neat categories.

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