Perhaps You Would Be a Little Touchy Too

all that is solid melts into air

Sometimes people respond to my stuff about disability talk and mental health culture by affirming that I’ve made some points but asking why I would care. Sure, you may be right about X or Y or Z. But isn’t the stuff you’re complaining about harmless? Who cares if self-diagnosis becomes ubiquitous and no longer subject to criticism? Who cares if teens on TikTok change our shared understanding of dissociative identity disorder? Who cares if those with severe autism are increasingly excluded from our shared cultural understanding of the disorder? Who cares?

Well I think the social costs of the things that I’m talking about in this space are pretty clear, actually, and I work hard to explain why. It also happens that there’s no writing I do that results in more genuinely grateful messages than my work on disability. It’s a discursive world where a small cadre of screaming activists has gotten used to dictating terms because most people are afraid of being screamed at; I don’t have that problem, so I speak to a lot of frustrations and fears that many people have. It means a lot for me to be in that position. Still, it might be helpful to be a little more personal, so let me talk to you about so-called “ultra-rapid cycling.”

Bipolar disorder is a condition defined by moving between extremes of mood, from the extreme unsettled excitatory state of mania to the deep and lethargic hopelessness of depression, with periods of normalcy in between. What many people get wrong, though, is the timeframe. The shift between moods takes time, and the moods themselves last for a long time, often building to a more and more extreme state over time. And when I say that it takes time, I mean that for most people, transitions between states and the states themselves take weeks or months. Bipolar disorder is very much not a matter of moving from feeling very sad to very happy in short sequence, a matter of minutes or seconds. Sometimes people who don’t know anything about the disorder will playact it by grinning and then frowning and then grinning and then frowning, by laughing maniacally to sobbing theatrically in quick sequence…. It ain’t like that. In fact, that misconception has sometimes been used by the police to tell when a suspect is attempting to use a phony insanity claim to get out of trouble.

Being diagnosed with a mental illness is now frequently represented as some sort of liberatory practice, something to celebrate, but for many of us it’s a deeply traumatic event. And the way that you deal with that trauma - if and when, in fact, you are finally ready to deal with it - is by learning what you can learn. You learn the diagnosis, you learn the disorder. You learn your disorder. You try to learn your own rhythms, although that knowledge always seems to skitter from your hand. You learn how to make excuses and how to hide what you can hide while you can hide it. You learn the meds; you learn which ones people dread the most. You learn the therapeutic culture, you learn the cliches. You learn the way that people who know about such things treat you when they know your diagnosis and how it’s different from the way they treat people with other diagnoses. You learn what therapists and social workers always say. You learn how to work an ER shrink. You learn, as much as you can. Some people are so debilitated that they can’t learn much. Many are so deeply in denial at the start that they don’t allow themselves to learn anything. But when you can you try to learn whatever there is to be learned because having this kind of condition is so relentlessly destabilizing that you need something, anything, to stand on.

Some things that I learned, over time, included that bipolar disorder was not about being happy or being sad, that I could survive the depression but wasn’t always sure that I wanted to, that I personally never felt elation or euphoria when manic but only grindingly paranoid and desperate, and that I was never capable of judging my own state of composure but was also never capable of remembering that I couldn’t when it mattered. And one thing I really learned, really could lean on, was that bipolar cycles were slow. Some cycles were faster and some were slow, because every patient is different, and some people end up in mixed states of both mania and depression, but nobody walked around laughing and crying from moment to moment because they were cycling. It was so hard to know what my disorder was; it was handy to have some idea about what it was not.

For years of my life, in group therapy or support groups, that understanding was never challenged. I’ve been inpatient a half-dozen times in my life and inpatient means group, and while outpatient group has been rare in my personal experience I’ve done a little of that too. I’ve also done a bunch of different support groups over the years, both in person and online. After my crisis in 2017 I was fairly religious about going to support group but nowadays, with my life going much better, it’s more of an as needed kind of thing. Well, it’s only been in the last few years, since the pandemic, that people started showing up claiming that they have bipolar disorder with “ultra-rapid cycling.”

I’ve come to really dread introductions in Zoom support groups. Depending on the size of the group, they may ask you to talk about your current mood and how you’re doing, etc, but if a group’s beyond a certain size there may not be enough time. In that case you would just say your name, where you’re from maybe, and your diagnosis. Once upon a time that last part was really simple, if you were in a group specifically dedicated to bipolar disorder - people would say “bipolar I” or “bipolar II” or simply “bipolar.” But since mental health culture has ceased to be about medicine and has become instead about identity, such introductions have tended to become a laundry list of boutique diagnoses. You can’t just be bipolar. You’re “depression-dominant bipolar I,” which I thought was bipolar II but I guess not, or “bipolar with psychotic features,” which I thought was just implied for a lot of us, or “mood disorder not otherwise specified” which inevitably ends up being said by someone with prototypical regular bipolar symptoms….

And then there’s bipolar with “ultra-rapid cycling,” the people who claim to go through multiple cycles a day, sometimes an hour. Again, this has always been pretty straightforwardly not a thing, a parody of the disorder, a misconception, a fraud. But I’ve now seen at least a dozen people claim to have it in the past five years, suddenly, as if there’s a new strain or something, defying the etiology that’s been more or less understood for 150 years. A thing that I thought I knew for sure I apparently didn’t know at all. All that is solid melts into air. If I had gone to a group session in 2005 and someone said they had “ultra-rapid cycling,” they would have been rejected by the room. People wouldn’t have tolerated it; that’s not what bipolar disorder is. I could rely on people not to tolerate it. Because our diagnoses meant something, they were real. They weren’t fashion.

But something has changed, not something medical, not a change in diagnosis, not a change in psychiatric best practices, but a change in progressive culture. There’s been a lot of yelling by the aforementioned disability activist class, which settled in well with the ethos of the modern liberal, which is, “I’m going to accept every claim of oppression because otherwise I’ll get yelled at.” And that’s all congealed into a scenario where, in the midst of this “anti-woke” moment, it remains the case that liberal people just don’t challenge claims people make about disability. That’s where we’re at, with disability culture now: anything goes. Whatever any individual says goes. People with ADHD are realer and truer and more emotional and better artists and live fuller lives than everyone else? Sure. A self-diagnosis of autism not only proves that you actually have autism, but entitles you to deliver a lecture about what autism is to a parent who has exhausted themselves caring for a severely autistic person for decades? Sure. Dissociative identity disorder, an extraordinarily rare condition that’s notoriously been misrepresented in popular culture and which has traditionally resulted in total debilitation, suddenly afflicts tens of thousands of photogenic and high-achieving adolescent women with TikTok accounts? Why not? Anything goes. If someone makes a claim that, they say, stems from their own understanding of their disability, decent people cannot challenge that claim, no matter how implausible, contrary to medical evidence, or socially irresponsible.

I know what you’re thinking; we’ve returned to the question at the start. Who cares? Why does this matter to you? If people are inventing cool new forms of bipolar disorder to feel unique, that’s a problem for them and their doctors. You can’t do anything about it. Who cares?

I might point out that psychiatry, unfortunately, is a customer service field, and committed groups of patients can warp diagnosis and practice, which threatens the rest of us. But instead I’ll just ask for your sympathy. I never say this, but… you don’t understand. You don’t understand what this is like. Maybe you can try to imagine, though. Imagine that you’re me. Imagine that before you were old enough to legally drink, you had a traumatic and painful manic crisis that resulted in hospitalization and the disorientation and shame of a diagnosis. You spent the next fifteen years ruining your life thanks to your inability to force yourself to actually confront the depths of your problems. You finally had a crisis big and public enough to force you into treatment and for you to stick with it, a crisis that did professional and personal damage that will never heal. And throughout this whole process, you built yourself a little castle of understanding, of your own limited knowledge about your illness and how to overcome it; you’ve tried to learn because there has been so little else you can control. Then, in the span of a decade or so, the world of psychiatric medicine and disability generally has been flooded with a uniquely aggressive form of identity politics and policed by an extremely aggressive activist class that says that you have no right to object to anyone else’s “truth.” And then people change the most basic things you know about your condition, and tell you that you better not object.

I’m healthier and happier than I’ve ever been before. But even in the midst of that growth, if you read the previous paragraph, can you maybe understand why this all feels like a violation?