Few of us give thought to the names we grant our diseases. William Styron complained that the word “depression” didn’t aptly describe the all-encompassing void that was his illness. Rarely do we relate our cancer to the crab-like appearance after which the swollen tumours are named.
Our greatest error is not recognising the power in these titles. Names allow us to identify and understand something not only between one another, but also for ourselves. Imagine if we failed to acknowledge the cause of our symptoms by not assigning them a disease. So much more overwhelming would our suffering seem as a hacking cough, congested sinuses, unwillingness to eat, pounding headache and unshakeable fever, rather than the “the Flu”.
Naming our diseases allows us not only to explain to our friends why we can’t go for a pint, but to identify and rationalise the source of our discomfort. It fuses our own muddled experience into a common enemy that we can combat, or at least withstand.
How we choose to name illness is then worth considering. For most illnesses, their official title is much more intimidating than their common names. In some cases, even an abbreviation succeeds in lessening the blow. Telling a seven year old they have contracted influenza seems only warning them of their imminent death. “Sorry Timmy, that coughing fit spells the end, you may say your goodbyes now.” Much more pleasant to assure them it’s only the ‘flu, and their runny nose will be helped with some chicken soup and bedrest.
This same difference can be seen in Manic Depressive disorder, also known by the term bipolar.
While there are important differences between Bipolar 1 and 2, the public understanding of the disorder seems straightforward. Characterised as a simple mood disorder, it is seen by many as simply switching between happy and sad. One friend recently dismissed it as a disorder entirely, as just being an excuse for people to be “moody”.
Little could be further from the truth. Just as depression is a world apart from sadness, Mania rarely entails happiness. Dealing with someone in a manic period is to see them experience anxiety, agitation and insomnia. Word association can become heightened, and they see patterns that have little-to-no basis in reality, something which might sound benign but for those not experiencing the mania can be disconcerting and downright terrifying. Someone who is usually empathetic and patient might become cold and act completely out of character.
The list of symptoms and signs are varied and the diagnostics surrounding them change as the field of psychiatry evolves. A fundamental harm in this evolution though, was the reclassification in 1980 of these issues as Bipolar from the traditional “Manic Depressive disorder”.
To describe someone as Bipolar is to suggest there are two, simple sides to their symptoms. On Monday, they might be funny, outgoing and interesting. By Friday however, they’ll have crashed and switched poles, swapping their extroversion for a sullen and withdrawn doppelganger. They’ll revert back though, they always do.
While everyone’s experience is different, this hasn’t been what I’ve seen. Living with family members and friends with the disorder, the truth is much more muddled and this is what “Bipolar” fails to convey. In reality, the symptoms will meld and blend into each other, feelings of hope giving way to elation,then to anxiety and to depression.
Even that is to simplify. When that feeling of hope begins to shift, when that giggling fit goes on a bit too long – at what stage have you shifted to a “pole”? And when that excitement brings with it an underlying sense of anxiety, where do you stand then? North, or south? Up, or down? Polarising these emotions belies the spectrum of the disorder.
A two-storey house
When I was a child, my mother used the analogy of a two-storey house to describe her feelings. On the bottom floor were the initial emotions. Be these happiness, sadness, grief or pride, they were raw and original. The second story however, was more complex. These emotions were in response to “downstairs”. Why am I feeling sad? Why can’t I get over this? Why am I so angry?
It was these emotions that she, and many others, found so crushing. Not merely feeling these basic emotions, our minds insist on compounding our pain by questioning and often blaming ourselves. Not only do we feel bad, but we feel bad about feeling bad.
This is what Manic Depressive disorder brings with it.
The relief of a dark spell lifting contains within it the threat not only of the despair returning, but of shifting into hysteria. A good day might signal the return to one pole, while a foul humour could be an indicator of a slip back. There is a constant “second storey” of attempting to classify what is being experienced and having feelings about that.
After all, constantly assessing and judging one’s own behaviour seems to promise control; if you know “where” you are, you can act accordingly. Not only does this bring fear however, it is often simply inaccurate.
To live with Manic Depressive disorder is to experience these emotions in their fluidity. “Bipolar” suggests an emotional map that allows one to identify exactly where on is. In truth, it resembles more a muddied, complex ball of feelings. Trying to map one’s emotions will often only lead to further distress and confusion.
Condemning self-awareness completely would be foolish. I’ve no doubt that making an effort to recognise a manic period before it arrives is beneficial. Being aware of the mania allows one to act accordingly, whether that be seeking help, or making an effort to avoid manic tendencies. As is recognising that suicidal thoughts aren’t an indicator of one’s worthlessness as a human being but are symptoms of depression. If the symptoms are recognised, they can be dealt with.
Constantly monitoring one’s own emotions in an effort to figure out whether you’re “happy”, or “sad” however, only feeds paranoia. Human experience is more complicated than a “Bipolar” system. Mania is not separate from depression, but exists as its companion. While the two will rarely manifest simultaneously, neither will they flick so simply from one to the other.
The term “Manic Depressive” recognises this. It conveys better the difficulties and complexities of the disorder, and the interrelated, fluid nature of mania and depression. Bipolar isn’t moody. Bipolar isn’t a lightswitch. Bipolar is a complex array of emotions that is belied by its own name. Recognising this weakness of terminology, and correcting our language to better reflect the reality is essential to empathy and understanding.