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Tuesday, January 12, 2010

Treatment Tuesday - Making Bipolar REAL, not a Prop

This week's assessment came courtesy of Denise. She wrote in and indicated that she wanted to give one of her secondary characters a vice or some sort of problem. She said she was twiddling around with giving her bipolar and asked for some pointers.

I responded with the following:

DO YOUR RESEARCH. (To which anyone might argue that Denise is indeed already doing just by emailing me.) :) It's too easy to explain away someone's erratic behavior by using bipolar disorder. I've seen it done in many books, both CBA and ABA ,which makes me wonder why this disorder gets "picked on" and abused. Maybe because its so unusual? It is a fascinating disorder for sure, and it's very nature makes for an interesting character...when done realistically. So let's dig in. I'm going to simplify things a bit, but the essence remains the same.

There are two types of Bipolar disorder, Bipolar I and Bipolar II. The main difference in the two is that a person with Bipolar II doesn't experience full-blown mania (which impairs functioning and lasts at least 7 days), but hypomania, which generally lasts only 4-7 days and just means the person has an elevated mood. Both types experience depression, but only Bipolar I sufferers experience psychotic symptoms like hallucinations or paranoia. Bipolar II is more common, but no less severe. The depressions experienced by both type individuals is usually debilitating.

It's important to know that it's far more common for depression to dominate the person's life than mania or hypomania. When the person is experiencing the mania, they don't admit that anything is wrong. They might actually look forward to it, as generally people will have endless energy, need little sleep, and be very creative and productive. But sadly, they also usually max out credit cards, dwindle away their savings by gambling, or get into car wrecks for recklessly driving too fast. That's because manic people don't use the cognitive part of their brain to make good decisions, and overindulge or "binge" on whatever their vice might be.

The prevailing opinion about bipolar is that the person suffering from it will swing from extreme mania to extreme depression quickly, and this just isn't always the case. When a person makes this swing, it's called cycling. Usually, there are periods of normalcy in between the two extremes, which often gets left out of literary depictions of this disorder. Characters with this disorder don't always have to act erratic or unpredictable. They can be "themselves," and rather than work against their character, this can strengthen them.

No two people are going to have the same course (or process) for this illness. While 2.5% of the population might suffer from bipolar, only 10-20% of those people have what is called rapid cycling. Rapid cycling means that the person experienced at least 4 episodes of depression, mania, or hypomania (less severe form of mania) a year. A YEAR, folks. Not every couple of pages in your manuscript. It's far more likely that the person lingers through each stage a bit longer. And let's not forget the periods of normalcy in between.

I found a great explanation of rapid cycling here. Put in layman's terms, it's very easy to understand how even rapid cycling can look very different. While one person might cycle every 3 months, another person might switch from mania to depression in one month, be fine for ten months, and then switch again from mania to depression in the next month. This still gives them four episodes a year, but that's a very different course of rapid cycling.

Rapid cycling is a controversial topic in the field. There are those who make a direct "switch" (as its called) from one extreme to the other, but this isn't real common. Then there are those who make a direct switch from mania to depression back to mania with no normal in between. This is "multiphasic." Even less common. But someone who goes back and forth between the two extreme multiple times during a day, something some call "ultradian cycling," is really, really rare. It's not recognized by the Diagnostic and Statistical Manual (the psychology world's Bible) as a valid qualifier for the disorder.

So if I had to give anyone my recommendations for how to write realistic bipolar into a manuscript, I'd say this:

1) Don't overdo it. A little bipolar goes a long way.

2) Learn to pass time by utilizing the cycles. It's just not probable for a character to be terribly depressed in one page, bouncing around like a ping pong ball the next page, and then crying again by the very next page. I've read this actual scenario, and it just made me roll my eyes.

3) Become familiar with what can trigger a switch into the opposite extreme. If you're bound and determined to have ultradian cyclers in your books, then you should know what can realistically cause someone to cycle into mania or depression. Just to name a few, use of drugs--antidepressants as well as "street" drugs--alcohol, and life stressors like death, loss of job, etc.

Finally, here's a little .pdf file you can download that's all about bipolar and goes into a little more detail than I wanted to go in here. You can access it, courtesy of the Depression and Bipolar Support Alliance, here.

Hopefully this helps you make your decision, Denise, as well as helps other writers contemplating using this disorder. Thanks for writing in!

Q4U: What was your perception of Bipolar Disorder before reading this post? Afterward?

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist (at) hotmail (dot) com.

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Stephanie Faris said...

I've learned that bipolar can often be misunderstood. People are afraid of bipolar people...I guess we all fear that which we don't understand.

Kristen Torres-Toro said...

Wow, I didn't realize it was so misunderstood. Thanks for clarifying it!

Nishant said...

Hope you have a good day.

Work from home India

Tamika: said...

You've taught me a lot in this post. Sadly, I had a lot of sterotypes of this disorder floating around in my mind. I thouht they cycled every couple of days, or maybe even a few times a day. That they are easily triggered.

Thanks for sharing your expertise!

Jessica Nelson said...

Interesting info here. I don't know much about this so it's great to learn more.

Jemi Fraser said...

As a teacher, I've come across bipolar disorder in both students and parents. It's a challenging condition and would definitely be a challenge to write well.

Tara McClendon said...

This is a disorder my family understands better than most. I've found that people with little exposure to it tend to treat it like it's PMS. Thanks for the informative post.

Anonymous said...

Thanks for this, Jeannie. I suffer from SAD, which certainly has the depressive elements. I appreciated the information.

Patti Lacy said...

With an afflicted brother, I could write a book on bipolar. A great resource is "The Unquiet Mind."

Blessings for your take!!


Tess said...

Here you are! I somehow lost you. Did you move or change or did blogger just mess my list up? Anyway - good to *see* you again. :D

I have a friend and a cousin who suffer from this disease/condition. It is a challenge and I think there are a lot of misconceptions about it out there. Kudos to you for setting the record straight on some of them.

Jeannie Campbell, LMFT said...

tess - i changed my old blog address from to i wrote a post about it and thought i went to everyone's blog about it after the fact to let them know. might have missed yours...but i was commenting on over 100. :( but i'm so glad you found me again on this blog!

Anonymous said...

Oh my goodness! Thank you so much for writing this entry, finally someone who gets bipolar disorder and isn't making it seem worse or lesser than it actually is. I am bipolar,(bipolar 1) and it is so hard to get people to understand all the symptoms, how our moods change and just all of it. This is so helpful especially since one day I want to write a book about my life living with this disorder and for people to understand the cycles of the mood swings. Mine mostly go with the season but thats more due to the tramatic events that happened when I was younger. Anyways, thank you for posting this and tell your friend if she wants to really get the character right, talk to someone who is bipolar. If she can get one who is willing to share their personal thoughts and feelings like through a diary or something then she can really understand everything. Thank you again. Have a great day!! :)

Unknown said...

Nice post. I am currently writing a book about a teenager dealing with the blow backs of her brother's bipolar disorder. Luckily both me and my son have the illness (or not so lucky actually) so it's quite easy for me to write it from an honest perspective. Still there were some things here that helped. i'm sorry I read it so late!

Anonymous said...

This really enlightened and enriched my knowledge about bipolar disorder. I'm tacking the issue in my current manuscript. I want to shed light and steer away from the stereotype, depict it realistically. And my mc is a teen at that, so problems arise around any corner. I want to be true to the disorder and give a different (actual) perception because it's become so prevalent nowadays.

Thanks for this! said...

Hi Jeannie,

First off, I came across your site and wanted to say thanks for providing a great resource to the mental health community.

I thought you might find this bipolar disorder fact sheet helpful for your readers, as it shows symptoms, treatment and stats about the disorder:

Naturally, I’d be delighted if you share this embeddable graphic on , and/or share it with your followers on social. Either way, keep up the great work Jeannie!

All the best,

Nicole Lascurain | Assistant Marketing Manager
p: 415-281-3100 | e:

660 Third Street, San Francisco, CA 94107 | @Healthline

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Both comments and questions are welcome. I hope you enjoyed your time on the couch today.