Then manic, then depressive: in bipolar disorder, these moods alternate. But it’s not ‘Johnny crying, Little Johnny laughing’ – sometimes there is a long time between the two moods and the intensity of those episodes can vary enormously. It can therefore take a long time before a bipolar disorder is recognized, says Tineke Mollema, who is both an expert by experience and a board member of the patient association Plus minus.
“Especially the manic episodes are often mistaken for reckless youth behavior. As long as you don’t go into a psychosis, people will only see the depressive episodes.”
She herself was diagnosed at the age of 26, after several severe depressions. Her GP had a dark brown suspicion and sent her to the bipolar outpatient clinic of the hospital: “He knew that my mother has bipolar disorder. She never told me and my brother that.”
Bipolar disorder can appear out of the blue, for example with major life events, but susceptibility to it can also be hereditary, as is the case with Tineke. After she was diagnosed with the disorder, more family members were found to suffer from it. Her brother has now also been diagnosed. “There is still a lot unclear about why one gets it and the other doesn’t.”
A little relieved after the diagnosis
Tineke was relieved after the diagnosis that the animal had been given a name. “Now I can take a pill and that’s it, I thought.” But it wasn’t that simple. None of the drugs she tried had any effect.
At one point, her moods shifted so rapidly that she could be depressed one day and hypomanic the next (a milder version of manic, more on that later). Such a mixed episode is also known as “rapid cycling,” she explains. “In the evening I was very hyper and stayed awake until late at night, the next morning I could hardly get out of bed and felt very down.”
It led to Tineke being hospitalized for six weeks, during which she received a higher dose of medication and followed intensive therapy. “I had to recover from it for a year. In the end I had to learn to accept that I have to organize my life differently. For most people – including me – bipolarity cannot be solved with just a pill.”
think magically
With Tineke, her disorder sometimes manifests itself in magical thinking: she is then convinced that the whole universe comes together to arrange good things for her. “When the traffic light turns green or when I get hold of the right key in one go, I believe that’s special for me. That’s very special.”
Tineke has never been really manic, but she sometimes has so-called hypomanic episodes. “On a mood scale of -10 to +10, where major depression is -10 and mania is +10, hypomania is about +5. I feel great, but I also know that if I don’t act I’ll be depressed afterwards .”
In such hypomania, she may also make impulsive decisions that she later regrets. “In the past I once spent a lot of money in one go, and I’ve also walked into the hairdresser’s with the message ‘do something nice’. I came out with a mohawk.
In a hypomania you are still open to reason, says Tineke. “You realize that you’re in it. That’s not the case with a mania. My brother had that – he got very angry and in denial when he was called to account for his behavior.”
Kanye West
According to Tineke, you can see that manic very clearly in someone like Kanye West – who has stated that he has a bipolar disorder. “He completely loses touch with reality and starts saying very strange things.” The fact that his actions are so visible in the media increases the stigma on bipolarity, Tineke fears.
“People then think that that is bipolarity. While the disorder is very diverse. In a small proportion of patients, a mania sometimes leads to a psychosis. But some patients never suffer from mania, and others never from depression. And one has it is well under control with medication, while the other has to limit his entire life in order to maintain the balance. The majority of patients work very hard to be able to participate in society in a stable way.”
Bipolar disorder affects every aspect of your life; from your relationships and friendships to your work and possibly parenting. Tineke deliberately chooses not to have children because of her illness. “I don’t want to pass it on. Moreover, it takes me enough effort to keep my own life stable; I can’t have the care of a child with that.”
Stimuli and depressions
Work is also difficult. “I was rejected because I got recurrent depression and can handle much less stimuli than other people.” Tineke does work on a voluntary basis as a board member for the Plusminus association, of and for people with a bipolar disorder and their loved ones, and for a European patient organisation. That way she also came into contact with many fellow sufferers. “I have gained valuable friendships. People who have the same thing understand you perfectly. Sometimes one word is enough. That recognition is very nice.”
But the disorder has also cost her some friendships. “I’ve let the contacts that didn’t go that deep dilute a bit and mainly invested in people with whom I can talk honestly about how I’m doing.”
Bipolar disorder can stand in the way of a harmonious love relationship, but Tineke and her boyfriend have found a good way to deal with it. “Of course he worries about me sometimes, but we’ve been together since I was 18 and he knows my manual by now. He sees how I’m doing better than I do.”
“‘Life is a bit out of your sight’, he sometimes says. And when I go off and on, he tells me that I am very busy. We have agreed that he only signals what he sees in me and that it is then up to me what I do with it. That works very well. This way the direction remains with me and that is very important with bipolar disorder, because in those episodes you lose control. “
Behave in the opposite way
Tineke has now found medicines that do work and has been stable for a year and a half. She takes an antidepressant, two mood stabilizers (one to stabilize the manic side and one for the depressed side), and sleep medication. She also learned to bring more balance to her days: not to do too much, and not to be immediately afraid of depression if she doesn’t feel well for a day.
“Now if I get a bit busier or feel a bit more depressed, I consciously start behaving in the opposite way so that such an episode doesn’t continue. For example, if I don’t feel like getting out of bed, I go out for a walk or do something fun.”
She has now reconciled herself so much with her diagnosis that she might not even want to get rid of it if she could. “In the documentary The Secret Life of the Manic Depressive Stephen Fry asks people at the end if they would press a button to make their bipolarity go away. Almost everyone answers no, and I didn’t understand that before. But if you asked me now, I don’t know if I would press.”
“My bipolarity has made me the person I am. I have a job that I really enjoy and that gives me a lot of meaning, I got to know myself very well through all the therapy and my relationship has become deeper. So the disorder has affected me also brought a lot.”
Show interest
Do you have people close to you with bipolar disorder? Then show genuine interest in their state of mind, advises Tineke. “Ask how they are doing, and don’t settle for a perfunctory ‘good’. You can also say that you are concerned about certain behavior and ask if something is wrong. I think some of my fellow sufferers feel quite lonely feel; sincere interest from others can help.”
Manic depressed
Bipolar disorder is also known as manic-depressive disorder and can be recognized by extremes in mood and activity. It occurs in about 1 to 2 percent of the Dutch population. The disorder often begins between the ages of 15 and 30, but can also manifest itself later in life. Little is known about the cause.
Type 1 en type 2
There are two common types: type 1 and type 2. Type 1 is the ‘classic’ type, in which manic episodes alternate with severe depression. In type 2, from which Tineke suffers, depressed periods and hypomanic periods (the milder variant of mania) alternate. An episode can come on gradually, but it can also come on suddenly. Violent events or stress can trigger episodes. The severity of the complaints and their duration varies per period.
Do you recognize symptoms of bipolar disorder in yourself? Then you can do the self-test here of the Knowledge Center for Bipolar Disorders.
Sources: Plus minus in Thuisarts
