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Does Bipolar Disorder Make It Difficult to Move?

Personal Perspective: Motor impairment may be a feature of the illness.

This is embarrassing to admit, but the word most people have used to describe me—in my presence, at least—is “poised.” After a speech or a court appearance or a public reading, I always hear it: “You seem so poised.” And it’s said with just a touch of surprise, as if no one expects a bipolar person to come off as calm and unruffled. But what people don’t know is how huge that little word “seem” really is. The truth is, I have difficulty initiating movement, and that usually comes off as self-possession.

I brought this up with an old friend of mine recently. We were discussing an episode of Downton Abbey, and I told him that Lady Mary Crawley is my all-time favorite character. “I think of her as my role model,” I said.

“That makes sense,” he said. “She reminds me of you a lot.”

I was flattered and should have shut up right then but my ego demanded more. “Really?” I said. “You mean, because she’s poised?”

“No,” he said. “Because she’s still. Like her, you don’t move your body much.”

I felt seen straight through, and horrified. But my friend was right: I don’t make grand arm gestures when I speak, I’m hyper-conscious all the time of the room my body occupies. When I dance (rarely in public), I command maybe a foot of space, and only my upper half moves unless I think about it.

I remember once at Vassar, a boy I liked asked me to slow dance. The floor was crowded, and we were pressed up close together. That was fine, but then the music changed to disco, and everybody started gyrating to the beat. I did my best to keep up, but my partner just stared at me. “At least move your body,” he said. I was mortified, and he never asked me to dance again.

Some of this makes sense to me now that I’m older and have more insight into my bipolar disorder. This isn’t discussed much in scientific circles, but in my opinion the illness affects one’s ability to move as much as it impacts mood. A study published in the Journal of Neuropsychiatry and Clinical Neurosciences hypothesized that, “If disturbances in basal ganglia functioning are important in bipolar disorder, then it is possible that patients with the condition might show abnormalities in aspects of motor physiology that have been considered to relate to the functioning of these structures.” In short, I move less.

The authors acknowledged, however, that few studies have actually focused specifically on motor abnormalities in bipolar disorder: “Motor problems in bipolar disorder may be underreported because they can be subtle and difficult to assess using conventional assessment means.” I’m convinced that when more research is done, scientists will discover that bipolar is also a movement disorder. I look forward to that day, so I won’t feel so alone with my self-perception.

Actually, I’m not really alone. I wrote a blog post once about my difficulty, called “When Your Mind Won’t Let Your Body Move.” In it, I described how hard it is when I’m in a bipolar depression to do anything physical, even seemingly small and non-demanding tasks like stepping into the shower. I shared with my readers the clinical name for this phenomenon: it’s called “psychomotor retardation”—a slowing of physical and mental processes, almost (in my case, at least) to the point of actual paralysis.

I was totally unprepared for the flood of responses I received. To date, that post has elicited more attention than anything else I’ve written for my blog. Readers were thrilled to know that they weren’t the only ones going through this hell—and they were especially grateful to learn that it had a name.

But I don’t just feel stiff and immobilized when I’m depressed. I’ve always had trouble initiating movement. There’s also a term for that, I’ve learned: “hypokinetic.” The only time it goes away is when I’m floridly manic, and then I experience the joy of easy movement I imagine most people feel. I swing my arms when I walk, I punctuate my speech with exaggerated gestures, I even take up lots of space when I dance.

Fortunately or unfortunately, I don’t get manic that much anymore, so I don’t know that freedom of movement very often. Instead, I feel trapped inside the confines of my body. I have to will myself to pick up the phone, to type, to brush my hair, to walk. I’m lucky that such stillness, while repugnant to me, is interpreted by others as poise. I’d rather be a little less poised and a lot more free just to move the way others seem to take for granted. A little less Lady Mary Crawley, a lot more Lady Gaga.