Uncovering the myths about bipolar disorder

Sinéad Keating doesn’t say, “I am bipolar”, she says, “I have bipolar”.

Because she won’t let herself be defined by her mental health condition.

"Even though bipolar can affect my moods and how I think, it doesn't fundamentally change who I am as a person," says the 31-year-old, who lives with her husband in Maynooth, Co Kildare.

Bipolar disorder is described as a “mood disorder”, which causes moods to swing from extreme highs to severe lows.

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Extreme highs are also described as manic symptoms and can involve increased energy, excitement or agitation, as well as impulsive behaviour. Depressive symptoms include low mood, lack of energy, and feeling worthless. However the disorder also comes in other forms.

“People with bipolar can have what’s called mixed affective symptoms as well,” says Dr Séamus O’Ceallaigh, consultant psychiatrist at St Patrick’s University Hospital in Dublin. “So that can be a mix of symptoms of mania, hypomania [a milder form of mania] and depression at the same time.”

Mixed episodes are in fact common in people with bipolar disorder, and those who develop the condition at a younger age are known to be more susceptible to them.

Mixed episodes

Sinéad, who has type 2 bipolar disorder, is someone who suffers from mixed episodes rather than the isolated euphoria or depression commonly associated with the condition.

So how does it manifest in her?

“I feel like I have a lot of energy – it’s like there’s an itch under my skin. I can’t sleep and I’m highly irritable, which is deeply unpleasant for me and my husband,” she says. “But I’m also very stressed, crying and panicking.

“It’s like it goes in waves; it might happen for a few days and then ease off. I’ve had really the guts of the last 20 years just going in cycles like that. Having a mixed episode, and then feeling okay again.”

Sinéad wants people to have a better understanding of the condition, which is why she is an ambassador for See Change, an organisation that works to combat mental health stigma.

You could be prone to making reckless decisions, for example in terms of spending or relationships

“It might seem really unimportant, but sometimes when I have conversations with people about not using the word ‘crazy’ or not calling somebody ‘schizo’, they’ll say things like, ‘It’s not anything against people with mental illnesses. Relax, it’s not that big a deal.’ But it really is.”

Judgment

While bipolar disorder is rarely accompanied by psychosis – experiencing hallucinations or delusions – the way it impacts mood can cause sufferers to see situations in an overly negative or positive light.

“Our decision-making and our judgment is affected by our mood,” says O’Ceallaigh. “So that if your mood is very elevated, you might only see positives in any particular scenario. And you don’t think very much about the negatives or potential risks to you. So you could be prone to making reckless decisions, for example in terms of spending or relationships, which you regret afterwards. You get the opposite problem when your mood is very depressed, when you might let good opportunities go.”

However it’s y important not to conflate bipolar disorder with the regular mood swings everyone experiences, he says.

“The mood swing that someone experiences in bipolar disorder is very different to what we would all experience day to day. The swings are more severe, they’re longer lasting and – of critical importance – they lead to significant disruption in day-to-day life. There can be difficulties in work, with family and your social life.”

Untreated

If left untreated, says O’Ceallaigh, an episode of depression in bipolar disorder can last from six to 12 months, and mania can last from three to six months.

“If you think about that level of disruption and it lasting over that length of time, that can have a major impact on a person’s life. Fortunately, we have very good treatments available.”

Ray Treacy (50), who lives in Dublin, wasn't diagnosed with bipolar disorder until his early forties. Initially diagnosed with OCD aged 22 and later on with depression, he knew something still wasn't right.

“That was the lowest point in my life,” he says. “You think the worst, you’re consumed with negative thoughts. I was really afraid.”

Up until his early 30s, when he was diagnosed with depression, Ray had been self-medicating with alcohol. But as soon as he stopped drinking, his issues with spiralling thoughts got worse.

“When I put down the drink I would’ve thought, ‘That’s grand, my problems are over’. But actually, what it did was take away a terrible scaffolding.”

I started to feel a deeper connection again with the people I love the most. I'd kind of lost that

He was finally diagnosed with bipolar by his psychiatrist (“a smashing man”) when he was in his 40s.

“So many things made sense, and I could make lifestyle changes. The medication for bipolar disorder is different to that for depression, so my medication was adjusted to something where I could finally appreciate a difference.

“I started to feel a deeper connection again with the people I love the most. I’d kind of lost that. Unfortunately for me, that’s how isolating it became. You still love your family, you still like your friends – but you just feel like an islander. The way they live their lives seems so different to how you’re living yours, and you’re hiding so much.”

Stigma

Both Sinéad and Ray say that although their families are very supportive, they have experienced stigma in the workplace in the past.

“A lot of the shaming experiences I’ve had have been with people in positions of responsibility or authority,” says Sinéad. That’s really tough to deal with, and it can impact my idea of myself. Whether or not I’m a good person, whether or not I’m a good worker... Language in particular has a big impact on me still.”

Both say an important part of managing the condition and improving their mental health has been implementing a personal treatment plan.

“I look after my wellness now,” says Ray. “I play music in a small band, I walk the dogs, play indoor soccer and watch my diet. I’m careful to avoid negative situations and I to try and be around positive people. I’m at a stage now where I’m just content in my own skin finally.”

The people around me have a massive impact on how well I am

Sinéad no longer works in the retail sector and has a part-time role with the charity Shine, which supports people who have suffered from mental ill-health.

“I have arranged my life in such a way that the people I’m surrounded by are wonderful,” she says. “Whether I like it or not, the people around me have a massive impact on how well I am, or whether or not I can function well. Other people’s language, invalidation or dismissal is definitely half the battle.”

Contact Samaritans on 116 123 for round the clock support. Contact Pieta House on (01) 628 2111 if you are experiencing suicide distress. Visit yourmentalhealth.ie for nationwide listings of support services.