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.