"Bipolar with rapid cycling" is BPD. I suspect some of these people are just trying to avoid admitting they have a personality disorder. Those are still generally looked down upon, even by the most progressive among us.
The only truly unforgivable disorder is being unsociable. As long as you're pretty/charismatic/martyred enough to get by, your actual problems are irrelevant.
As I have commented on a previous thread, in Australia the "social justice movement" perspective on autism has gone beyond what you might hear at a party in one of our Greens-voting inner suburbs and has been picked up seamlessly by our national public broadcaster. Hence the feelgood story on the morning news show about a kid in Queensland who had set a world record for pogo stick jumping, accompanied by an interview with the articulate (albeit quirky) kid and a comment by the reporter that "because [name of kid] is autistic, he has a few superpowers" that enable him to set world records. For people who don't trouble to dig deeper about the issue, or who have no experience of friends or family with less glamorous versions of the condition, this has become the cultural orthodoxy about autism.
Sure. Or similarly, you could be me, a gay parent of an ebullient daughter who told me at 11 she was gay and then at 12 told everyone that she was trans and miserable. And it took thousands of dollars of therapy for her to be deprogrammed back to just being a happy gay kid again. Woke identity politics is a grotesque curse. (Ban me for talking about my family. I don't give a shit).
This is not me shit-stirring: genuine question. How did your 11 year old get exposed to woke identity politics? Like, I just don't remember engaging with political stuff at that age. I know a 7 year old who says they're a girl now, and I don't know what to make of that claim, but I'm pretty sure they didn't get it from tik tok influencers.
Between TikTok and middle school teachers, 5% of her class changed pronouns for a year or two. I asked her therapist to try to get my kid happy again number one, and number two to make sure that she was exquisitely educated on gender and sexuality because where my kid told me she got her info was TikTok, Internet, and other middle school kids. Maybe the 7 year old really is trans. It happens.
I don't doubt your personal experience here, but I think it's fair that Freddie asks people to stay on topic in the comments - especially as he is one of the only writers talking about the stuff about, while there are hundreds and hundreds of writers talking about whether kids are being indoctrinated into being trans or not.
The same woke identity politics that Freddie complains about here celebrates fake "ultra-rapid" bipolar cycling, as well as celebrating fake rapid onset gender dysphoria. The connection was obvious to me when I replied.
2. No, it really isn't. By that standard you could bring it up in every thread that has anything to do with social trends or the left. Which I guess people do.
Years ago, I asked my doctor if I might be bipolar. His response, “No, you’re just extremely neurotic.” I’ve always related this to friends as a charming joke. But it’s not, and he was right.
I am curious - how would the support groups from before this change have refused to tolerate someone who showed up with a fashion diagnosis? How would that have manifested? (Or, if you saw it happen, how did it?)
At the risk of broaching The Forbidden Topic, I feel it, even if it's not an identical pain of course. Tiny obscure majorly life-altering diagnosis -> fight for tolerance if not acceptance via biologic basis etc -> suddenly self-diagnosis and social contagion -> And That's Good Actually, who would want to be [normie], how oppressive and unliberated. And it's like...what the fuck happened? Why would you *want* to roll this particular Sisyphian rock if you don't actually have to? There's so many other less-destructive, less-disrespectful ways to throw off the shackles of stodgy conformity, man. (While so often being boringly stereotypical, just in the opposite direction.) People volunteering themselves for a disorder may or may not actually have *that* disorder, but they certainly *are* disordered. It's just tragic all around, and yet I still check myself from eye-rolling when ~40% of young coworkers introduce themselves with some DSM or other. Fine line to walk between patient rebuttal and mockery; there's still some sort of real suffering going on behind that cluelessness, sadly.
(Nevermind the whole coming up with backhanded non-falsifiable rationalizations like "internalized ____phobia/ism", which is a whole other tallcircle of surprise noodles...)
We had a (thankfully now former) young boss awhile back who'd literally announce over the store's PA system "don't talk to me while I'm counting money in the office, I have ADHD and get distracted easily". And made sure similar notices were posted to the official company bulletin boards, etc. Alternatively it was prefacing/suffixing conversations with "I have anxiety and/or depression" as an explanation for...anything really. Simply could not be held to the same standards as anyone else, you see.
It's not usually that blatant, but as a synecdoche...just too perfect. Took me awhile to figure out, no, this is not some ironic bit she's performing, this is like actually happening. People like this actually exist! Yet still took months of complaints and a huge backlog of HR paper trail to get her <s>fired</s> to voluntarily step down. Those protected-class accommodations were hard-fought, which I'm grateful for, of course (God knows the company puts up with lots of, uh, "quirkiness" from me)...but it feels, I dunno, weird/wrong/breaking kayfabe to just so blatantly weaponize it that way.
Right! It's sad that things have gotten to the point that having ADHD or something like that is the only acceptable reason why you wouldn't want to be interrupted while counting money. I hate being interrupted while I'm trying to do things. Some have suggested I have a condition like ADHD or autism. I'll do something about my ADHD or autism that I don't have when they do something about the raging case of the pushy pushy gimme gimmes that they do have.
Being Oppressed is a positional good. Call it grievance politics, call it victim mentality, call it decadence. People insist on adding moral axes to things that never should have had them in the first place.
Call me conservative if you wish, but I long for a time when people just wanted to be normal. People who are in great pain from something they can't control usually just want to be normal.
There's a line in the tween-targeted movie "Ruby Gillman, Teenage Kraken" where she and her crush both simultaneously declare proms to be "a social construct" and I cringe every time I hear it because it's such a great representation of an annoying kind of knee-jerk pseudo-intellectualism that has taken hold in progressive culture.
Like, yeah, pretty much everything we do is "just a social construct"...that's called human society. So while it does mean many of our practices and beliefs are based on nothing more than convention, that also doesn't make them worthless and void of meaning.
There's a certain kind of person around whom I make a point of declaring how normal I am. I tell anecdotes about the ways in which I'm similar to other people or make observations about such-and-such a personality trait of mine is boringly typical. I particularly like to do this when I know the personality trait is something they admire or are envious of or is by convention supposed to evoke a sense of exclusion. (e.g. "Like everybody else, I've have periods in my life when I was really depressed." "Sure I write a little but hey we've all gotta have hobbies, right?" "High school was okay I guess.") This isn't false modesty. I do it because I sense the person has built an identity around being a social outcast and wants me to affirm it by declaring myself a social outcast too. I can sense their discombobulation when I refuse to play along. It's about the only time I'm deliberately mean. I really should stop, but I can't help myself.
Boutique diagnoses remind me of interactions with people who are ostentatiously religious, spiritual, woo, etc, where one is coerced into nodding along purely as a polite social agreement. People shouldn't be harassed for their private beliefs sua sponte, but when they implicitly opt others into their version of reality, I draw the line. It's coercive for someone to say "I have [insert fake diagnosis]" knowing that propriety forbids correction.
I also have bipolar 1, but I demographically fit the "diagnosis as identity" cohort - young, female. I have found this fuzzing of the meaning of bipolar disorder to be deeply frustrating in my personal life. I don't discuss my history much, but when I do want to open up to a new partner or friend, I need to block out a long discussion to explain that my bipolar disorder is not at all like their friends' ex's "treatment resistant rapid cycling bipolar 2." I have a pretty classic presentation of bipolar 1 and my extended family has been landing in hospitals in our late teens and early 20s floridly manic for over a century, with full recovery for years between episodes, but that is no longer what any of my peers imagine when they hear bipolar disorder or manic episode.
I once had a friend who'd been diagnosed with rapid cycling bipolar attempt to armchair diagnose my brother with schizophrenia because he did not believe that you could have grandiose religious delusions from "just bipolar."
A bad therapist or psych NP, most likely. A lot of them are lax with diagnostic standards, as are a fringe of psychiatrists. He'd also picked up Autism, ADHD, and BPD labels.
Thank you. Everyone's mileage varies, of course--but your experiences are kinda sorta similar to my own. So thanks for describing the indescribable as articulately as possible, and for your courage in sharing your insights with a wide audience.
A few points from 30 years of psychiatric practice.
1) In psychiatry we are supposed to distinguish between mood and affect. Mood is the overall tone of a person's emotional experience and it changes slowly. Affect is the emotional tone of the moment. The analogy often used is that mood is like climate and affect is like weather. (So "bipolar affective disorder" should really be called "bipolar mood disorder".) "Rapid-cycling" bipolar disorder is considered a subtype of bipolar disorder but "rapid cycling" means four mood changes per year. Any emotional shifts that occur on the time scale of minutes or hours are not from "bipolar disorder".
2) Part of the blame for the self-diagnosis is shared by the psychiatric profession. The ever-expanding list of diagnoses over the last 3 decades seems to involve quite a bit of invention by the psychiatric profession, so why shouldn't other groups get in on the action?
3) The DSM is the diagnostic manual for identifying mental illnesses. It contains lists of symptoms that can be used to identify each mental disorder, and distinguish mental disorders from each other or from medical disorders which have psychiatric symptoms. People often use these checklists for making a diagnosis, however, the DSM itself warns that it is not to be used as a checklist of symptoms. The patient's symptoms must be seen in a clinical context and the symptoms and context must both be consistent with the diagnosis. This means that is takes a lot of clinical experience to sort out whether someone has recurrent major depressive disorder, bipolar disorder depressed, adjustment disorder with depressed mood, depression secondary to a general medical condition, or substance induced depression.
4) People who report rapid shifts in mood do not always have a personality disorder. Borderline personality disorder, or BPD, as one commenter mentioned also requires a number of other symptoms. The symptoms must have been present since adolescence or young adulthood and be present in a variety of contexts. Just because someone is emotionally disregulated in some contexts doesn't mean they have BPD or any other personality disorder.
5) Years ago I was working with a patient who had rapid emotional swings (in minutes) and a tendency to react very abrasively to people who she felt had crossed her. In one session she said "Maybe I'm manic". We had a good relationship and I responded "You know, have you thought of the possibility that maybe you're just an asshole?" She stopped, paused a bit and then laughed "You're right maybe I'm just an asshole." I replied "And that's a good thing because we can fix that without medications." She went on to make significant positive changes.
Thank you for this informative post. I have a question about your 5th point. Some people do seem to react very quickly and abrasively to perceived slights. We have to walk around on eggshells around them. Your story about them merely being assholes was amusing--and I'm sure true with some people--but certainly there must have been some conditioning or trauma that causes them to have such sudden shifts in mood and hypersensitivity. Is there a name for this type of personality? How can it be treated? You said you had success treating the one patient. What did you do?
Your question is insightful. Part of the answer is from Frank's post below that people function on a spectrum and that someone can be treated for low functioning in one aspect of life without needing a diagnosis (though without a diagnosis insurance won't cover the treatment.) People who react quickly to perceived slights can have a number of correlated conditions. The reactivity may be conditioned from bullying or other trauma, i.e. an over-protective response. Some people seem to have a hyperactive fight/flight response that is innate, i.e. present from early childhood. Some brain injuries from impact, disease, or chemical insults can also cause this. I find that a diagnosis according to the DSM 5 is not very helpful. Instead, when I work with such a patient I try to discover as much detail as possible. What stimuli are they perceiving? How are they organizing their perceptions related to threat? What response is their autonomic nervous system making in the moment? How fast does it recover? What are their reflex responses? I teach patients how increase parasympathetic activity and decrease excess sympathetic activity. I do this using meditation, relaxation, or biofeedback. We then look at changing from conclusion-based thinking to observation-based thinking. We then apply these to deconditioning prior trauma responses, training more appropriate responses and reviewing successes and redoing mistakes. I did all these with the patient I mentioned. By the way, I have never suggested to any other patient that they might be an asshole. But she and I had a good therapeutic relationship and she was pretty hardened so I used that to both get through and as a joke. The key was that when she said "Maybe I'm manic" she was giving up agency. When she accepted "asshole" then she also accepted responsibility and a readiness to work on changing. That is why she was successful.
"Just because someone is emotionally disregulated does not mean they have BDP or any other personality disorder"
This gets to my view of everything related to cognitive behavior being on a spectrum where people can be high to low functioning, and the need or benefit of cognitive behavior therapy for low function is much more ubiquitous than is the justified diagnosis of mental illness.
My DSM label is "Mood Disorder - Not Otherwise Specified", but I suspect that my psychiatrist is just being a bro by not labelling me as Bipolar II. There have been some situations that caused me to experience very rapid mood swings from the depressive end of the scale to the hypomanic -- rapid, as in <immediate>. One was when I used to have to travel across twelve time zones for work. A second was when I was prescribed Naltrexone in the hopes that it would help with some non-chemical addictive behaviors -- I was raging, and I mean really raging, within thirty minutes of taking the first tab. I had to take 2.5 mg of Zyprexa to calm down. The third was when I was hospitalized for hyponatremia, and they cut off my meds and kept me awake all night taking blood samples every two hours. I was in a mixed state by the next afternoon. These are just my N=1 experiences that I would see as "rapid cycling".
Some people experience radical and sudden shifts in mood when their sleep cycle is disrupted. The shift usually is in the manic or hypomanic direction. That sounds like what you experienced.
“ Being diagnosed with a mental illness is (…) 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.”
This one sentence is worth my paid subscription for the whole year. Thank you.
I'm really sympathetic to this piece in some ways, but—and I hope this isn't too picky—haven't you considered the possibility that many of these folks reporting "ultra-rapid cycling" are suffering from things that haven't yet been named as discrete mental illnesses, and perhaps never will be? What about the reality that mental illness can manifest in ways that our diagnostic framework can't contain?
Example: what has happened, and can still happen, to me has been called "mania," "hypomania," "psychosis," "dysphoric mania," and probably other things that I've now forgotten. I was once diagnosed with "Bipolar Type II," and when I reported symptoms that invalidated that diagnosis, the shrink appended "atypical presentation" to it.
All I know is that when It happens, I have loud, racing thoughts, acute physical repulsion, strange and scary physical symptoms, and yes, a fast and recurrent alternation between euphoria and horror. The most succinct and accurate way to describe It is, "like being on acid without having taken acid." There are similar instances of atypicality when it comes to my cognitive abilities and other issues of "neurodivergence." Maybe there is a diagnosis for It, and possibly for the whole cluster of mental problems I have; I kind of doubt it, though.
Experiences like yours show the downside to gatekeeping. I generally believe gatekeeping is necessary when it comes to medical issues. However, the downside is that there really are some rare conditions out there that will be missed. Some people who have strange and severe recurrent medical symptoms are not suffering munchausen's, even if 99% of them are.
It's also the case that the dirty little open secret of psychology and it's related fields is that their understanding of the human mind is based on research that rarely replicates and uses tools like fMRI that have assumptions about their usefulness that we're just not sure hold up. While those things don't mean they know *nothing* about how the brain/mind work, it does mean they're still at a point in these fields where they should be cautious about the level of confidence they exhibit. Psychology/Psychiatry are young sciences compared to other medical fields.
Beyond the personal insult to people who really suffer with severe forms of mental illness, trivializing mental illness and insisting "its all good" or "society needs to adjust to me" makes it easier for society to not come up with the support that's needed.
My nephew recently got into a board and care for people with mental illness and drug problems. He was institutionalized for four years. Two years was necessary to stabilize him, but he should have been in a less restrictive environment a long time ago. It took so long because there weren't the facilities.
All the cute "vibes" and "I'm so cool" garbage has real world effects. We aren't a particularly generous society and it is further excuse to keep the wallet closed tight.
I don't really know what to do with this. Best I've got is to try to clear a little space for those who have it bad and a little extra space for those whose bad is made that much worse by others.
My stuff is small potatoes. I don't really know what to do with that either except state it and try to not to conflate occasional, deep frustrations with real suffering. But fuck. It is tempting.
I find myself in kind of a similar situation. I used to conflate (a lot), but thanks to reading Freddie (and thanks to things I've observed over the years), I now don't do that anymore.
"Bipolar with rapid cycling" is BPD. I suspect some of these people are just trying to avoid admitting they have a personality disorder. Those are still generally looked down upon, even by the most progressive among us.
The only truly unforgivable disorder is being unsociable. As long as you're pretty/charismatic/martyred enough to get by, your actual problems are irrelevant.
I'd definitely add "rich" to your list :-)
As I have commented on a previous thread, in Australia the "social justice movement" perspective on autism has gone beyond what you might hear at a party in one of our Greens-voting inner suburbs and has been picked up seamlessly by our national public broadcaster. Hence the feelgood story on the morning news show about a kid in Queensland who had set a world record for pogo stick jumping, accompanied by an interview with the articulate (albeit quirky) kid and a comment by the reporter that "because [name of kid] is autistic, he has a few superpowers" that enable him to set world records. For people who don't trouble to dig deeper about the issue, or who have no experience of friends or family with less glamorous versions of the condition, this has become the cultural orthodoxy about autism.
What would be an appropriate way for that kid to be treated then?
"Wow, look at this amazing kid who's really good at jumping on a pogo stick."
Delusion: kinda something we all have to deal with. I guess it's the intensity of the delusion that separates us.
Sure. Or similarly, you could be me, a gay parent of an ebullient daughter who told me at 11 she was gay and then at 12 told everyone that she was trans and miserable. And it took thousands of dollars of therapy for her to be deprogrammed back to just being a happy gay kid again. Woke identity politics is a grotesque curse. (Ban me for talking about my family. I don't give a shit).
This is not me shit-stirring: genuine question. How did your 11 year old get exposed to woke identity politics? Like, I just don't remember engaging with political stuff at that age. I know a 7 year old who says they're a girl now, and I don't know what to make of that claim, but I'm pretty sure they didn't get it from tik tok influencers.
The past four years forced identity politics on everyone in the United States. There wasn't even an opt-out scenario.
Between TikTok and middle school teachers, 5% of her class changed pronouns for a year or two. I asked her therapist to try to get my kid happy again number one, and number two to make sure that she was exquisitely educated on gender and sexuality because where my kid told me she got her info was TikTok, Internet, and other middle school kids. Maybe the 7 year old really is trans. It happens.
I don't doubt your personal experience here, but I think it's fair that Freddie asks people to stay on topic in the comments - especially as he is one of the only writers talking about the stuff about, while there are hundreds and hundreds of writers talking about whether kids are being indoctrinated into being trans or not.
The same woke identity politics that Freddie complains about here celebrates fake "ultra-rapid" bipolar cycling, as well as celebrating fake rapid onset gender dysphoria. The connection was obvious to me when I replied.
They say a fanatic is someone who can't change their mind and won't change the subject.
I'm not going to try to talk you out of your views, but maybe you could make at least a token effort to stay on topic?
I respect Freddie's desire to keep this conversation out of his place; however:
1) Is it really necessary to take a potshot at someone, calling them a fanatic on your way to "keeping them on topic"?
2) This is on-topic. It may be verboten, but it is on-topic.
1. Necessary or not, it was warranted.
2. No, it really isn't. By that standard you could bring it up in every thread that has anything to do with social trends or the left. Which I guess people do.
I'd never typed the word "trans" in a Freddie comment before last night. But sure, I'm fanatical about the wellbeing of my children. Go pound sand.
Years ago, I asked my doctor if I might be bipolar. His response, “No, you’re just extremely neurotic.” I’ve always related this to friends as a charming joke. But it’s not, and he was right.
I am curious - how would the support groups from before this change have refused to tolerate someone who showed up with a fashion diagnosis? How would that have manifested? (Or, if you saw it happen, how did it?)
At the risk of broaching The Forbidden Topic, I feel it, even if it's not an identical pain of course. Tiny obscure majorly life-altering diagnosis -> fight for tolerance if not acceptance via biologic basis etc -> suddenly self-diagnosis and social contagion -> And That's Good Actually, who would want to be [normie], how oppressive and unliberated. And it's like...what the fuck happened? Why would you *want* to roll this particular Sisyphian rock if you don't actually have to? There's so many other less-destructive, less-disrespectful ways to throw off the shackles of stodgy conformity, man. (While so often being boringly stereotypical, just in the opposite direction.) People volunteering themselves for a disorder may or may not actually have *that* disorder, but they certainly *are* disordered. It's just tragic all around, and yet I still check myself from eye-rolling when ~40% of young coworkers introduce themselves with some DSM or other. Fine line to walk between patient rebuttal and mockery; there's still some sort of real suffering going on behind that cluelessness, sadly.
(Nevermind the whole coming up with backhanded non-falsifiable rationalizations like "internalized ____phobia/ism", which is a whole other tallcircle of surprise noodles...)
I'm kind of mind-boggled by the idea of people telling their coworkers about their DSM labels...we're really not in the 1980's anymore....
We had a (thankfully now former) young boss awhile back who'd literally announce over the store's PA system "don't talk to me while I'm counting money in the office, I have ADHD and get distracted easily". And made sure similar notices were posted to the official company bulletin boards, etc. Alternatively it was prefacing/suffixing conversations with "I have anxiety and/or depression" as an explanation for...anything really. Simply could not be held to the same standards as anyone else, you see.
It's not usually that blatant, but as a synecdoche...just too perfect. Took me awhile to figure out, no, this is not some ironic bit she's performing, this is like actually happening. People like this actually exist! Yet still took months of complaints and a huge backlog of HR paper trail to get her <s>fired</s> to voluntarily step down. Those protected-class accommodations were hard-fought, which I'm grateful for, of course (God knows the company puts up with lots of, uh, "quirkiness" from me)...but it feels, I dunno, weird/wrong/breaking kayfabe to just so blatantly weaponize it that way.
I have to laugh at that...as if anyone can count money accurately while someone is talking to them.
Right! It's sad that things have gotten to the point that having ADHD or something like that is the only acceptable reason why you wouldn't want to be interrupted while counting money. I hate being interrupted while I'm trying to do things. Some have suggested I have a condition like ADHD or autism. I'll do something about my ADHD or autism that I don't have when they do something about the raging case of the pushy pushy gimme gimmes that they do have.
Being Oppressed is a positional good. Call it grievance politics, call it victim mentality, call it decadence. People insist on adding moral axes to things that never should have had them in the first place.
Call me conservative if you wish, but I long for a time when people just wanted to be normal. People who are in great pain from something they can't control usually just want to be normal.
ThErE Is nO noRMaL yO, it’S aLl sUbJecTivE all tHE WAy dowN
There's a line in the tween-targeted movie "Ruby Gillman, Teenage Kraken" where she and her crush both simultaneously declare proms to be "a social construct" and I cringe every time I hear it because it's such a great representation of an annoying kind of knee-jerk pseudo-intellectualism that has taken hold in progressive culture.
Like, yeah, pretty much everything we do is "just a social construct"...that's called human society. So while it does mean many of our practices and beliefs are based on nothing more than convention, that also doesn't make them worthless and void of meaning.
There's a certain kind of person around whom I make a point of declaring how normal I am. I tell anecdotes about the ways in which I'm similar to other people or make observations about such-and-such a personality trait of mine is boringly typical. I particularly like to do this when I know the personality trait is something they admire or are envious of or is by convention supposed to evoke a sense of exclusion. (e.g. "Like everybody else, I've have periods in my life when I was really depressed." "Sure I write a little but hey we've all gotta have hobbies, right?" "High school was okay I guess.") This isn't false modesty. I do it because I sense the person has built an identity around being a social outcast and wants me to affirm it by declaring myself a social outcast too. I can sense their discombobulation when I refuse to play along. It's about the only time I'm deliberately mean. I really should stop, but I can't help myself.
Boutique diagnoses remind me of interactions with people who are ostentatiously religious, spiritual, woo, etc, where one is coerced into nodding along purely as a polite social agreement. People shouldn't be harassed for their private beliefs sua sponte, but when they implicitly opt others into their version of reality, I draw the line. It's coercive for someone to say "I have [insert fake diagnosis]" knowing that propriety forbids correction.
I also have bipolar 1, but I demographically fit the "diagnosis as identity" cohort - young, female. I have found this fuzzing of the meaning of bipolar disorder to be deeply frustrating in my personal life. I don't discuss my history much, but when I do want to open up to a new partner or friend, I need to block out a long discussion to explain that my bipolar disorder is not at all like their friends' ex's "treatment resistant rapid cycling bipolar 2." I have a pretty classic presentation of bipolar 1 and my extended family has been landing in hospitals in our late teens and early 20s floridly manic for over a century, with full recovery for years between episodes, but that is no longer what any of my peers imagine when they hear bipolar disorder or manic episode.
I once had a friend who'd been diagnosed with rapid cycling bipolar attempt to armchair diagnose my brother with schizophrenia because he did not believe that you could have grandiose religious delusions from "just bipolar."
How did he get "diagnosed with rapid cycling bipolar" in the first place?
A bad therapist or psych NP, most likely. A lot of them are lax with diagnostic standards, as are a fringe of psychiatrists. He'd also picked up Autism, ADHD, and BPD labels.
And, like Freddie said, it's a service industry.
I wonder if he went diagnosis shopping.
Thank you. Everyone's mileage varies, of course--but your experiences are kinda sorta similar to my own. So thanks for describing the indescribable as articulately as possible, and for your courage in sharing your insights with a wide audience.
A few points from 30 years of psychiatric practice.
1) In psychiatry we are supposed to distinguish between mood and affect. Mood is the overall tone of a person's emotional experience and it changes slowly. Affect is the emotional tone of the moment. The analogy often used is that mood is like climate and affect is like weather. (So "bipolar affective disorder" should really be called "bipolar mood disorder".) "Rapid-cycling" bipolar disorder is considered a subtype of bipolar disorder but "rapid cycling" means four mood changes per year. Any emotional shifts that occur on the time scale of minutes or hours are not from "bipolar disorder".
2) Part of the blame for the self-diagnosis is shared by the psychiatric profession. The ever-expanding list of diagnoses over the last 3 decades seems to involve quite a bit of invention by the psychiatric profession, so why shouldn't other groups get in on the action?
3) The DSM is the diagnostic manual for identifying mental illnesses. It contains lists of symptoms that can be used to identify each mental disorder, and distinguish mental disorders from each other or from medical disorders which have psychiatric symptoms. People often use these checklists for making a diagnosis, however, the DSM itself warns that it is not to be used as a checklist of symptoms. The patient's symptoms must be seen in a clinical context and the symptoms and context must both be consistent with the diagnosis. This means that is takes a lot of clinical experience to sort out whether someone has recurrent major depressive disorder, bipolar disorder depressed, adjustment disorder with depressed mood, depression secondary to a general medical condition, or substance induced depression.
4) People who report rapid shifts in mood do not always have a personality disorder. Borderline personality disorder, or BPD, as one commenter mentioned also requires a number of other symptoms. The symptoms must have been present since adolescence or young adulthood and be present in a variety of contexts. Just because someone is emotionally disregulated in some contexts doesn't mean they have BPD or any other personality disorder.
5) Years ago I was working with a patient who had rapid emotional swings (in minutes) and a tendency to react very abrasively to people who she felt had crossed her. In one session she said "Maybe I'm manic". We had a good relationship and I responded "You know, have you thought of the possibility that maybe you're just an asshole?" She stopped, paused a bit and then laughed "You're right maybe I'm just an asshole." I replied "And that's a good thing because we can fix that without medications." She went on to make significant positive changes.
Thank you for this informative post. I have a question about your 5th point. Some people do seem to react very quickly and abrasively to perceived slights. We have to walk around on eggshells around them. Your story about them merely being assholes was amusing--and I'm sure true with some people--but certainly there must have been some conditioning or trauma that causes them to have such sudden shifts in mood and hypersensitivity. Is there a name for this type of personality? How can it be treated? You said you had success treating the one patient. What did you do?
Your question is insightful. Part of the answer is from Frank's post below that people function on a spectrum and that someone can be treated for low functioning in one aspect of life without needing a diagnosis (though without a diagnosis insurance won't cover the treatment.) People who react quickly to perceived slights can have a number of correlated conditions. The reactivity may be conditioned from bullying or other trauma, i.e. an over-protective response. Some people seem to have a hyperactive fight/flight response that is innate, i.e. present from early childhood. Some brain injuries from impact, disease, or chemical insults can also cause this. I find that a diagnosis according to the DSM 5 is not very helpful. Instead, when I work with such a patient I try to discover as much detail as possible. What stimuli are they perceiving? How are they organizing their perceptions related to threat? What response is their autonomic nervous system making in the moment? How fast does it recover? What are their reflex responses? I teach patients how increase parasympathetic activity and decrease excess sympathetic activity. I do this using meditation, relaxation, or biofeedback. We then look at changing from conclusion-based thinking to observation-based thinking. We then apply these to deconditioning prior trauma responses, training more appropriate responses and reviewing successes and redoing mistakes. I did all these with the patient I mentioned. By the way, I have never suggested to any other patient that they might be an asshole. But she and I had a good therapeutic relationship and she was pretty hardened so I used that to both get through and as a joke. The key was that when she said "Maybe I'm manic" she was giving up agency. When she accepted "asshole" then she also accepted responsibility and a readiness to work on changing. That is why she was successful.
Thank you again for a very insightful post. I hope again we can communicate here.
"Just because someone is emotionally disregulated does not mean they have BDP or any other personality disorder"
This gets to my view of everything related to cognitive behavior being on a spectrum where people can be high to low functioning, and the need or benefit of cognitive behavior therapy for low function is much more ubiquitous than is the justified diagnosis of mental illness.
My DSM label is "Mood Disorder - Not Otherwise Specified", but I suspect that my psychiatrist is just being a bro by not labelling me as Bipolar II. There have been some situations that caused me to experience very rapid mood swings from the depressive end of the scale to the hypomanic -- rapid, as in <immediate>. One was when I used to have to travel across twelve time zones for work. A second was when I was prescribed Naltrexone in the hopes that it would help with some non-chemical addictive behaviors -- I was raging, and I mean really raging, within thirty minutes of taking the first tab. I had to take 2.5 mg of Zyprexa to calm down. The third was when I was hospitalized for hyponatremia, and they cut off my meds and kept me awake all night taking blood samples every two hours. I was in a mixed state by the next afternoon. These are just my N=1 experiences that I would see as "rapid cycling".
Some people experience radical and sudden shifts in mood when their sleep cycle is disrupted. The shift usually is in the manic or hypomanic direction. That sounds like what you experienced.
“ Being diagnosed with a mental illness is (…) 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.”
This one sentence is worth my paid subscription for the whole year. Thank you.
I'm really sympathetic to this piece in some ways, but—and I hope this isn't too picky—haven't you considered the possibility that many of these folks reporting "ultra-rapid cycling" are suffering from things that haven't yet been named as discrete mental illnesses, and perhaps never will be? What about the reality that mental illness can manifest in ways that our diagnostic framework can't contain?
Example: what has happened, and can still happen, to me has been called "mania," "hypomania," "psychosis," "dysphoric mania," and probably other things that I've now forgotten. I was once diagnosed with "Bipolar Type II," and when I reported symptoms that invalidated that diagnosis, the shrink appended "atypical presentation" to it.
All I know is that when It happens, I have loud, racing thoughts, acute physical repulsion, strange and scary physical symptoms, and yes, a fast and recurrent alternation between euphoria and horror. The most succinct and accurate way to describe It is, "like being on acid without having taken acid." There are similar instances of atypicality when it comes to my cognitive abilities and other issues of "neurodivergence." Maybe there is a diagnosis for It, and possibly for the whole cluster of mental problems I have; I kind of doubt it, though.
Experiences like yours show the downside to gatekeeping. I generally believe gatekeeping is necessary when it comes to medical issues. However, the downside is that there really are some rare conditions out there that will be missed. Some people who have strange and severe recurrent medical symptoms are not suffering munchausen's, even if 99% of them are.
It's also the case that the dirty little open secret of psychology and it's related fields is that their understanding of the human mind is based on research that rarely replicates and uses tools like fMRI that have assumptions about their usefulness that we're just not sure hold up. While those things don't mean they know *nothing* about how the brain/mind work, it does mean they're still at a point in these fields where they should be cautious about the level of confidence they exhibit. Psychology/Psychiatry are young sciences compared to other medical fields.
Beyond the personal insult to people who really suffer with severe forms of mental illness, trivializing mental illness and insisting "its all good" or "society needs to adjust to me" makes it easier for society to not come up with the support that's needed.
My nephew recently got into a board and care for people with mental illness and drug problems. He was institutionalized for four years. Two years was necessary to stabilize him, but he should have been in a less restrictive environment a long time ago. It took so long because there weren't the facilities.
All the cute "vibes" and "I'm so cool" garbage has real world effects. We aren't a particularly generous society and it is further excuse to keep the wallet closed tight.
I don't really know what to do with this. Best I've got is to try to clear a little space for those who have it bad and a little extra space for those whose bad is made that much worse by others.
My stuff is small potatoes. I don't really know what to do with that either except state it and try to not to conflate occasional, deep frustrations with real suffering. But fuck. It is tempting.
I find myself in kind of a similar situation. I used to conflate (a lot), but thanks to reading Freddie (and thanks to things I've observed over the years), I now don't do that anymore.
" 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?"
Yes.