A patient of mine, Henry, recently told me his girlfriend asked “Is bipolar disorder ‘real’?” Bipolar disorder certainly was having a real effect on my patient’s life. But Henry’s girlfriend might have been asking for a way to help her “see” the bipolar disorder—to recognize the signs and symptoms of bipolar disorder in everyday life.
The most visible signs of bipolar disorder are the changes in mood, personality, and behavior. Most people now recognize that dramatic changes in behaviors including sleeplessness, restlessness, euphoria, intense irritability and uncontrolled risk taking are possible signs of bipolar disorder. These visible signs make it clearer to other people that you might not be well, and that your behavior may not be under your immediate control. The physical nature of the disorder is visible.
But dramatic changes in behavior are the signs of undiagnosed, uncontrolled, or relapsing bipolar illness. There are effective treatments to help bring many of the underlying symptoms under better control. The problem is that even when the condition is under better control, bipolar disorder still has effects on your brain and nervous system. You may still feel effects on your ability to function and feel well, but the causes are less easy to see.
So Henry’s girlfriend might also be asking: “When Henry is having a hard time, how do I know what’s wrong? Two weeks ago he was fine and social, we went out with friends. But this week, he says he can’t come with me to visit my family. He says he just can’t do it, and he won’t talk about it. How do I know he is not just being stubborn or selfish?”
Bipolar disorder affects many different aspects of brain functioning, including mood quality and mood regulation, sleep and circadian rhythms, and attention, memory and organizational thinking. These changes in the brain cause changes in the internal cues we feel as we go about our daily life. We get cues about our mood, our ability to concentrate, and our energy level. These cues push us through the activities of the day: they get us up in the morning and help us recognize that it is time to wind down at night.
Even when we can’t quite put them into words, we use these cues to make judgments about our ability to cope. We avoid new activities when we can’t quite trust the stability of our mood or the clarity of our thinking. We take on new tasks when our internal cues tell us that we can count on our mood and energy.
For most people, the cues are reasonably consistent from day to day. But with a cycling disorder like bipolar disorder, it’s not so easy. The signs and symptoms don’t stay the same. They vary with mood cycles. And mood cycles can be triggered by many different factors: changes in the season, changes in medications, and small and big stressors – even positive ones.
When mood, energy and thinking shift because of a cycle (even a small cycle), then those internal cues don’t stay the same. Without these consistent cues, it is much harder to stick to plans, form new habits, or follow a schedule. So Henry might have been worried about being anxious in front of his girlfriend’s father, and worries his anxiety will affect his ability to think clearly. Or, he might feel an underlying irritability coming on. He worries the stress of the big family gathering might trigger an episode. Even if Henry and his girlfriend have a hard time seeing these cues, they are real and they have real effects on his behavior.
In these blog posts, my goal is to help make the underlying disorder a little more visible. We will examine the effects of bipolar on thinking, feeling, energy and personal relationships. When you can “see” these effects, you can manage them more effectively. Many, many people with bipolar disorder, including the patients in my practice, have productive, satisfying and healthy lives. They have learned to “see” the disorder clearly and to figure out how to manage it on a day-to-day basis.