The Double-Edged Ring


 As the fingers press harder on my carotids, I struggle to keep my eyes straight. I cough, and try screaming, only to realize that even I could hardly hear the little bit of air escaping my compressed trachea. I have around ten seconds before I lose my consciousness and a couple of minutes before I lose my soul. What’s the use of all this knowledge when all I can do is wriggle, a test to see if that powerful hold would ever leave my throat? My heart loses the race to match the oxygen void in my brain as I struggle…struggle…. and wake up.

Years later, I met a friend who’d gone through a similar incident. Although it wasn’t real for either of us, we shared the same panic and distress of thinking we were being strangled. I, however, got to wake up from my sleep; she was awake, in the middle of class, suffering an acute manic episode, and still doesn’t know how she survived. Although the diagnosis of having bipolar disorder gave her the comfort of at least identifying her condition, living with that label was a whole new challenge.  

The medical concepts of mania and depression are as old as medicine itself.1 The descriptions of its features are fairly consistent, while our methods of treating them, and our understanding of the boundaries between and causes of them, have changed over time. Early writings from ancient Greece, Rome, India, and Egypt focused on demonic possession as the cause, while Hippocrates used the notion of an imbalance of ‘humors’ (bodily fluids) combined with environmental factors to explain ‘polarities’ in mental states.[1]

Bipolar disorder is generally understood to be a chronic mental health condition with strong changes in mood and energy, but within the broad category of manic depressive illnesses, minute parameters are required to distinguish the many variations. The bipolar-unipolar distinction by Leonhard was a large step in the evolution of our understanding of these conditions, where he termed patients with mania and depression as bipolar and those with only recurrent depression as unipolar.1 As opposed to understanding these characteristics as independent, this placed mania and depression on the same affective axis, with hyperactivity, boisterousness, and euphoria on the one hand, and a lack of pleasure, hopelessness, and sleep and energy changes on the other.[2]

It was and is a momentous struggle to help communities to understand that mental health disorders are ”real health issues”, and it’s equally important to accommodate them in our health and legal systems. Most importantly, we must understand that sufferers can live completely normal lives. Around 1 in every 100 Australians is affected by bipolar disorder.[3] These numbers not only show how common the condition is, but also how impractical it is to stigmatize the pool.

Diagnosing and treating the condition can be a tedious process, with a very high rate of misdiagnoses. A comparative study showed that in the year 2000, over a third of bipolar patients had to wait at least 10 years or more before receiving an accurate diagnosis.[4]  After the (often long) wait to find the cause, patients embark on an extended journey to control the symptoms. From medications, talk therapy, support groups, and hospitalisations, symptomatic control is a continual, and taxing, commitment. Despite these hurdles, many individuals find the negative impact of bipolar disorder on their families, social relationships, and employment greater than the exhausting medical process of diagnosis and treatment.[4 ]This is why widespread communal knowledge of this condition could really help to make their lives better.

Often, our understanding of bipolar disorder is driven by popular media, and can become conflated with other psychiatric conditions. Common portrayals of bipolar individuals are serial killers wielding axes, awkward boys with dramatic hallucinations, or melodramatic girls with borderline caricatured PMS symptoms - and this is where the problem starts. The character Rebecca in The Roommate (2011) as a protagonist with bipolar disorder and schizophrenia, for example, was a violent murderer and a sexualised seductress; here, as in many other cases, it is not difficult to see where popular media contributes to the stigma around the condition. Importantly, not only are these portrayals inaccurate, but they are also one-sided. The condition doesn’t manifest in a universal way. Even the close friends of an affected person don’t get to witness the full range of emotional shifts the person will experience regularly. The most confusing presentation of bipolar disorder, for example, is the “mixed phase”, a combination of manic and depressive states, leaving the sufferer physically and emotionally disoriented.

After reading the above paragraph, if you are suddenly tempted to diagnose bipolar disorder in every reckless driver and grief-stricken person, you are again mistaken! The fluctuations are characterised by how difficult they are to control, and how extreme the induced emotions are , often being somewhat independent of the events in a person’s life (although this is not a strict rule).[5] Additionally, these fluctuations don’t stop at the type of mood present in an episode; significant variations are also observed in the combinations of episodes and their regularity. Some experience multiple episodes of altered mood a day, while others experience a single episode that lasts for multiple days. Some have no signs or symptoms for many weeks. These extremities are why calling a friend who’s having a difficult day “bipolar” is an unfair and uninformed mischaracterisation.

The amount of variation in bipolar disorder is evident when we consider how the disease is actually classified by professionals. This gives a lot of insight into the need for public education on the condition, as it is so often treated inaccurately or as a monolith. According to the Diagnostic Statistical Manual of Mental Disorders (one of two core texts used by psychiatrists in forming diagnoses), there are four main types of the disorder [6]:

  • Bipolar I Disorder: Featuring a manic or mixed episode that lasts at least a week, or is severe enough to require immediate hospitalisation. This is usually accompanied by depressive episodes.

  • Bipolar II Disorder: Featuring both depressive episodes and hypomanic episodes (a less severe variant of mania), but without any full manic or mixed episodes.

  • Bipolar Disorder Not Otherwise Specified (BP-NOS): Featuring symptoms of bipolar disorder that don't meet the criteria for any other specific type.

  • Cyclothymia: Featuring hypomanic and depressive symptoms that don't quite fit the criteria for mania, hypomania, or depressive episodes (lasting on and off for at least two years).

Most scientists agree that there is no single cause for Bipolar. The disorder tends to run in families and genetic factors are a probable cause, but multiple other confounders influence the likelihood of being affected. Treatment methods have been increasingly focusing on building adequate social support as the usual age of onset is late teens and early twenties, an age group highly impacted by social pressures.[6] The disease, its effects, treatment, and its social impacts all sit on spectrums, which is why it’s much more than “crazy or depressed”. Trying to fit in the experience of bipolar into a binary definition is like trying to find the ends of a circle.

“I don’t blame myself for being Bipolar anymore. I believe that I have an immature child inside me, who needs a bit more care and attention”

                                                                                   -The friend who shares a dream and opinion-


[1] Jamison, K., & Ghaemi, S. (2007), Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2.ed., Oxford University Press, Oxford, United Kingdom.

[2] MITCHELL, P. B., LOO, C. K. & GOULD, B. M. 2010. Diagnosis and monitoring of bipolar disorder in general practice. Med J Aust, 193, S10-3.

[3] Headspace “Bipolar Disorder Assessment & Treatment”(2018). Retrieved 4th July, 2018. Available: https://headspace.org.au/health-professionals/understanding-bipolar-disorder-for-health-professionals/

[4] Hirschfeld, R., Lewis, L., & Vornik, L. (2003). Perceptions and Impact of Bipolar Disorder. The Journal Of Clinical Psychiatry64(2), 161-174. doi: 10.4088/jcp.v64n0209

[5] lack Dog Institute “What is bipolar disorder?” (2018). Retrieved 4th June, 2018. Available: https://www.blackdoginstitute.org.au/clinical-resources/bipolar-disorder/what-is-bipolar-disorder

[6] NIMH “Bipolar Disorder” (2018). Retrieved 4th July, 2018. Available: https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml#pub14

















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