Bipolar Grey Areas

I’ve been thinking a lot about some of the more subjective areas of bipolar disorder, and wanted to share a little bit of what has been going on in my head. I’ve seen many examples of grey areas in bipolar disorder lately, namely things that don’t easily fit into one category or another.

These grey areas are part of the reason I think bipolar disorder is so hard for people to swallow. How easy is it for us to understand things that aren’t easily categorized? At the same time, is it necessary for these categorical distinctions to be made, or would we all just be better off with one expansive grey area that encompasses everything?

Alright. I know I’m being a little vague, but that is because it is hard to simplify this topic and say it is one thing or another, because the very point is that many of these subjects are neither one thing nor another. They land somewhere in the middle.

There are grey areas in the spectrum of emotion (ranging from depression to mania).

There are grey areas in the interpretation of our symptoms (when one symptom can be present for either depression or mania).

There can also be grey areas in our symptoms themselves (which I’ll explain in a moment).

So much of the diagnosis of “bipolar disorder” is dependent upon our interpretation, and our experiences, beliefs, and norms will influence how we interpret those grey areas.

The Spectrum

In bipolar disorder (type 1, we’ll say) the spectrum of emotion spans from depression to normalcy, and then up to mania. In the range between normalcy and an episode of either depression or mania, there is a grey area. What are you experiencing when your symptoms do not technically (and by technically I mean via the definition in the DSM IV) meet the criteria for an episode of depression, but you still have some symptoms of depression? What are you experiencing when your symptoms do not technically meet the criteria for an episode of mania, but you are still having symptoms of mania?

In this range, we are kind of left to our own devices, and our own definitions or interpretation of what we’re experiencing.

Personally, I consider any symptoms of depression minus suicidality to be “mild depression” and everything including suicidality to be “depression.”

This is a skewed perspective, though, isn’t it? From my own experience, I don’t usually consider my depression to be a problem unless it comes with feeling suicidal. I have experienced this many times, and because of my experience, that is where I choose to draw the line.

To you it could be different. Maybe you rank your depression as mild, moderate, and severe. Maybe you just use depression and “not depression”. The point being… it is subjective.

The same thing happens in the area before you reach mania. This grey area is particularly nasty because while some doctors will aknowledge “hypomania” (as many call this area), others simply don’t. What makes things more tricky is that this area is often considered to be one of good symptoms, so most doctors wouldn’t consider this part of a “disorder” (as disorders, by definition, have to be a hinderance to you in some way).

I think hypomania is the biggest grey area of bipolar disorder because, in terms of a disorder (as I mentioned above) it really doesn’t make sense. Doctors are usually only concerned with the ways the disorder is harmful, so I don’t think much attention is paid to hypomania, except by those of us who have experienced it and can see the bigger picture.

Symptom Interpretation

Have you ever had insomnia?

I think insomnia is a confusing symptom, because insomnia can be a symptom of depression, or it can be a symptom of mania. So can going without eating, for that matter.

For me, I really depend on the presence of other symptoms in order to read why insomnia is present. I learned a couple months ago that I really can’t tell, just based on insomnia alone, if I am heading upwards or downwards… it really stuck me in a weird grey area where I had to wait for more symptoms to come before I knew what to do.

It could be that insomnia, for you, only comes on in times of mania. It could be that it only comes on in times of depression. Or, like me, you could find yourself stuck… unsure of how to interpret a symptom.

Symptom Definitions

Here’s one I’ve been running into fairly often lately. Both on a personal level, and in people I talk to on a regular basis.

Feeling suicidal is the feeling of wanting to die, right? Well what if you don’t want to die, but you don’t want to live, either?

I’ve been calling this phenomenon “suicidal limbo” because for me it seems to be a weird sub-symptom of suicidality.

Does not wanting to be alive mean that you want to die? Because I don’t think that is exactly the case. Again, we’re entering weird grey area territory, because if you were to say to a doctor that you didn’t feel like being alive, they will almost always undoubtedly infer that you are suicidal.

So why is there a difference between how I feel about that statement, and how a medical professional feels about it? Well, I’ve experienced the symptom myself, and I have experienced feeling suicidal myself, and they didn’t feel the same. For someone who hasn’t experienced those things, they might seem to be the exact same thing.

On a side note, I don’t want to sound like people who say they “don’t want to live” shouldn’t be taken seriously, because they should. That is sort of where this whole grey area confusion began for me. I agree that this statement should be taken seriously, and I understand why (to many people) this sounds exactly like, “I want to die.” There has been something in my own life that has led me to feel like the act of not wanting to live is not quite as severe (it feels more like resignation) as wanting to die (which feels more like taking action, to me), but it is certainly just as serious!

I suppose the point I am trying to make here is that there are many variations of bipolar disorder, but I think these grey areas add to that to some degree. I think it is definitely possible that, even when we experience the same set of symptoms as another person, we interpret them in a different way making them seem different. All of that making us feel isolated and alone and contributing to the fear that comes so easily with bipolar disorder.

Really, the fact that many of us experience (or interpret our experiences as) something different and all of those interpretations fall into the category of bipolar disorder leads me to believe the disorder itself (on a larger scale) is one big grey area. While part of me is saddened by this fact, another part of me is content, believing this conclusion makes sense when you consider how many grey areas are within the “disorder” itself, and how often my emotions linger in those grey areas because of it.

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