Bipolar I and Bipolar II Disorders

Bipolar Disorder is a commonly misunderstood, and misdiagnosed, mental health disorder.  According to the National Alliance on Mental Health, about 2.6% of the US population has been diagnosed with Bipolar Disorder.   It is often difficult to diagnose due to its symptoms overlapping with the effects of substance abuse, certain medications, and other mental health diagnoses (e.g. ADHD, schizophrenia).   Additionally, there are four types of BD:  Bipolar I, Bipolar II, Cyclothymia, and Bipolar Unspecified.   

This post will focus on the first two types.      

According to the DSM-V, this is the breakdown on Bipolar I and Bipolar II criteria, categorized by letter.   

Bipolar I

Bipolar I is characterized by manic symptoms of abnormally elevated/energized mood or irritability that must last at least one week nearly every day (A).  For a person experiencing elevated/hyper mood to meet full criteria for Bipolar I, they must meet three of these seven symptoms (B):  

grandiosity (unrealistic beliefs about oneself)

less need for sleep without feeling tired

an unusual level of talkativeness for the person’s personality

high distractibility

flight of ideas (random, racing thoughts)

increased goal-directed activity (e.g. excessive planning, sexual promiscuity) or purposeless agitation

impulsive behaviors (e.g. spending, high risk sexual behaviors)

If a person’s mood is more irritable than elevated/energized, four of the above criteria must be met.  

Additionally, the manic episode must cause significant social or occupational dysfunction OR psychotic symptoms are present OR hospitalization is required to prevent harm to self or others.   (C)

These symptoms must not be caused by the effects of a substance, medication, or medical condition (D).   

Although common with Bipolar I, a major depressive episode is not required to be diagnosed with Bipolar I.   

Bipolar II

Bipolar II is similar but characterized by a hypomanic episode (See below for criteria).   Also criteria for at least one major depressive episode must been met (A).   

The person has never had a manic episode (B).

The hypomanic episode and the major depressive episode are not better explained by another disorder (e.g. schizophrenia, other psychotic disorder, delusional disorder) (C).

Depression and/or alternating moods between depressed mood and hypomania cause significant distress (not severe) in the person's life socially and/or occupationally (D).  

Criteria for a hypomanic episode:  

A hypomanic episode must last at least 4 days and the person's mood must be abnormally elevated or irritable nearly all day, every day (A). 

The category B requirements are the same as listed above for manic episode (B).  

The changes must be out of character for the individual (C).  

The changes must be noticeable to others (D).  

The effect of a hypomanic episode on a person socially or occupationally is not severe and there is no psychosis or need for hospitalization (E).   

The episode is not caused by use of a substance or another medical condition (F).  

Major Depressive Episode

A major depressive episode must occur during a 2 week period of time.   Five of the following symptoms must be present during this period (A):

Depressed mood most of the day, nearly every day (this can be a feeling of emptiness or hopelessness).

Significant decrease in activities or interests 

Weight loss or gain due to appetite change

Insomnia or sleeping too much

Physical agitation or retardation

Loss of energy/fatigue

A feeling of worthlessness or excessive guilt

Decreased ability to make decisions or concentrate

Recurring thoughts of death or suicidal ideation (without a specific plan)

Additionally, these symptoms must have a significantly negative affect on a person socially, occupationally, or in any other major area of a person’s life (B).  

These symptoms must not be caused by another medical condition or by the effects of a substance (C).  

Bipolar diagnoses become more complicated when severity, various features such as onset, and other types disorders in this category are factored in, but these are the basics and I hope its helpful. 

Sources:  

NAMI. (n.d.). Retrieved November 14, 2017, from https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder

American Psychiatric Association. (2013). Diagnostic and 

     statistical manual of mental disorders (5th ed.). Washington, DC: 

     Author.

Holiday Mania

I love this time of year.   From pumpkins through the Christmas rush this season provides so many fun ways to make new memories and take comfort in traditions.    But I've noticed a trend in recent years that borders on commercial mania.    The fall stuff is now out in August, Halloween stuff in September, and by the time the kids break out their costumes, the pumpkins are passe.   On Oct 31st, a local grocery store was already promoting snowman decor - the fall stuff being relegated to the discount aisle. 

What is this merry go round of holiday madness?    Obviously marketers are out to maximize their profits but they wouldn't bother if we weren't willing to jump right in and buy seasonal things way out sync with the actual seasons. 

We live in an age when there have never been so many ways to be distracted and the demands for our attention have never been so, well, demanding.   I think the holiday madness reflects a deeper issue in our culture.    With so much distraction and demand, we are at risk of losing out completely on the gift of slowing down and savoring the present.   If you think about it in practical terms, the present is all we have at any given moment.    We can only grow and learn in the present.   The message from the barrage of holiday decor is essentially this - the present is not satisfying enough so we have to keep rushing toward the next "big" thing to be.....what exactly?  happy? satisfied?

Counseling is helpful for a long list of reasons, but I believe part of its effectiveness is that a person chooses to spend an hour in a quiet, comfortable environment exploring deeper issues and reflecting on the things that truly matter to him or her.    God wants us to slow down and take stock of our own hearts and minds so we can grow and know Him better, but we cannot do that unless we are very deliberate about it.   We can embrace the holiday rush in a healthy way but it is essential for our spiritual, emotional, and mental health to carve out these "spaces" for ourselves.  Otherwise, we will just remain swept up in the chaotic flow of distraction and demand. 

Where Character Grows

I want my children to have character when they are grown - the kind that requires grit and guts and might set them apart if it comes down to it.   Yes, I want them to be able to stand alone if they must.   I'll hazard a guess that most parents want their children to be like this.  

It's a lovely thought.   But integrity of this kind costs something.   How I wish I could just give it to them, but I know I can't.    And that is where I stumble and waver at heart. Character doesn't come easy; it comes mostly through trials and tribulations.    Yes, "trial and tribulation" sounds Old Testament-y.   I doubt they'll face the threat of stoning or be carried off by foreign invaders.    No, there are lesser trials and these will be enough.  

Most likely, they will face the following things that will hurt:  being misjudged, being treated unfairly, not receiving credit when it's due, guilt, rejection, loneliness, subtle snobbery, blatant snobbery, discouragement, temptation, failure, disappointment, embarrassment, etc.   Basically, the universal stuff of life.   Some of it will come to them from forces outside of their control and inevitably some from their own choices.      

As a mom, it's is hard to accept that I cannot protect them from this type of pain.  But I can prepare them.   That's all I can do.   Pray and prepare.   I will do those things with all my heart.   Then my role will change and they will go out own their own.  

My hope is that they will have discernment and humility to push through these things. Courage to face pain head on when necessary.   How they navigate the real world is where their own character will grow.  

Perseverance, character, and hope.  Romans 5:3-4

Thirst

The Samaritan woman at the well was bewildered that a Jewish man was speaking to her, asking her for a drink.   

Jesus answered her, “If you knew the gift of God, and who it is that is saying to you, ‘Give me a drink,’ you would have asked him, and he would have given you living water.” The woman said to him, “Sir, you have nothing to draw water with, and the well is deep. Where do you get that living water? Are you greater than our father Jacob? He gave us the well and drank from it himself, as did his sons and his livestock.” Jesus said to her, “Everyone who drinks of this water will be thirsty again, but whoever drinks of the water that I will give him will never be thirsty again. The water that I will give him will become in him a spring of water welling up to eternal life.”  

Never thirst.

Thirst for what?   For the feeling of significance, the feeling of being safe, the feeling of belonging?  We will have feelings of longing for these things at times.  We are designed to long for them. 

But Jesus isn't talking about feelings.   He is not saying we will never feel insignificant in a certain situation, unsafe in a dangerous place, or lonely and wanting companionship. 

Feelings are temporary and sometimes not to be trusted.   This deep thirst must be quenched by more than just emotional satisfaction from our circumstances.

   

"Living" is a grammatically present progressive, implying that it does not stop and start or just end - like feelings do.    If we base our lives on efforts to secure emotional satisfaction, we come to a dead end.   We will strive, manipulate, and eventually exhaust ourselves.  

Timothy Keller, one of my favorite authors, puts it this way in his book Encounters with Jesus:

Everybody has got to live for something, but Jesus is arguing that, if he is not that thing, it will fail you.  First, it will enslave you.  Whatever that thing is, you will tell yourself that you have to have it or there is no tomorrow.  That means that if anything threatens it, you will becomes inordinately scared; if anyone blocks it, you will become inordinately angry; and if  you fail to achieve it, you will never be able to forgive yourself.  But second, if you do achieve it, it will fail to deliver the fulfillment you expected.

The first step to finding living water is to realize that we have a deeper longing, a thirst of the soul that can only be satisfied by the supernatural - never the earthly.   Its a state of being - of being "athirst".   

Jesus uses this word again in Revelation 21 when speaking to John in a vision:  "And he said unto me, It is done. I am Alpha and Omega, the beginning and the end. I will give unto him that is athirst of the fountain of the water of life freely."

What a relief that we do not have to, and cannot if we try, find a way to satisfy the deepest needs of our soul.  

Fear No Evil

When I tuck my daughters into bed at night, or check on them one more time, a feeling of helplessness can sometimes creep in.    

What kind of world might they face someday?  Will they suffer in any way due to radical Islam or the power of our own ever-expanding government?   Will our own country be so hostile to the faith I hope they profess it will put them at risk in some way?    

It used to seem less likely and yet...I don't know.    

The people at the Boston Marathon or at a Paris concert surely thought that what happened to them was very unlikely.  When the US Ambassador was murdered in Libya in 2012 and when Americans are beheaded for all the world to see by an organization that makes Al-Quaeda look almost quaint, I felt a sense of horror and helplessness.   When it seems all precedents of evil are set, a new terror comes along for us to grapple with.  

Global things aside, we have our own self-inflicted mess, too.   I saw a fake election bumper sticker the other day that read, "Giant Meteor 2016 - Just End It Already".   It made me laugh.   It also seemed to express a collective "ughh" that most of us are feeling on either side of the election.    A speck of unity at last!  

But I don't want to be cynical.  I'm patriotic and believe in the founding principles of this country.   After a year and a half (has it been two?) of political predictions, its impossible not to wonder - could the long-range impact of the election results really affect my children's future in a negative way?   I'm an optimist by nature, but I have to accept that its possible (Supreme Court justices come to mind).    Its also impossible to put it out of mind since we must accept one of two deeply-flawed people to be our next leader.   

Whatever my children's world looks like in 20 or 30 years,  I've decided to not worry about it.  What will my worry accomplish anyway?   I have to set my sights on a firmer foundation, whatever the outcome of anything and everything, and spiritually prepare my heart and mind.

Matthew 24:6-8:  "You will hear of wars and rumors of wars, but see to it that you are not alarmed. Such things must happen, but the end is still to come.  Nation will rise against nation, and kingdom against kingdom. There will be famines and earthquakes in various places. All these are the be ginning of birth pains."

2 Timothy 3:1-5a:  "But understand this, that in the last days there will come times of difficulty. For people will be lovers of self, lovers of money, proud, arrogant, abusive, disobedient to their parents, ungrateful, unholy,  heartless, unappeasable, slanderous, without self-control, brutal, not loving good, treacherous, reckless, swollen with conceit, lovers of pleasure rather than lovers of God, having the appearance of godliness, but denying its power." 

So basically things going very badly won't be a surprise.   This perspective is not an invitation for us to sit around being cynical though.   There is good news, too.  

Psalm 23:4 promises, "Even though I walk through the darkest valley, I will fear no evil, for you are with me; your rod and your staff, they comfort me."

2 Peter 3:13, "But in keeping with his promise we are looking forward to a new heaven and a new earth, where righteousness dwells."

John 14:27, "Peace is what I leave with you; it is my own peace that I give you. I do not give it as the world does. Do not be worried and upset; do not be afraid.” 

There are so many more scriptures that assure us good will overcome all evil.   This is just a little handful.   When your heart grows faint and fearful, open God's Word and find comfort, guidance, and peace.

Dude-Boys and Vitamins (Development in the Preschool Stage)

While playing wedding with her dolls, our proud-to-be-four-year-old stated that she does not want to marry a "dude-boy".   Her tone when saying "dude-boy" emphasized her distaste of the idea.   Its been amazing to see her change developmentally in so many ways from age 3 and a half to 4 and some odd months.   

I've been praying for this.  Actually, I've been praying for myself until we arrived here.   We are leaving behind the challenges of toddlerhood and moving into THE PRESCHOOL AGE.   Hallelujah.

This is my favorite stage.   Children this age understand so much, yet they still often use magical thinking (there's an example of this below).   It makes for interesting and often hilarious moments.  Erik Erikson labeled this stage the Initiative vs Guilt stage, lasting from about age 3-5.    

Socialization skills develop (e.g. cooperating, sharing, turn taking, role playing) that really expand their world.   The ability to manipulate develops, too, so we parents have to stay sharp and (hopefully) model how to get by in life without being devious.   

Imaginative play begins in earnest and you definitely want to eavesdrop on your child's conversations with herself while she's playing.   The names they come up with and songs they sing at random are worth writing down.    "I hear a dog ruffing!"  "Jingle bells, jingle bells, jingle all the way.   Old McFarm it is to ride..."

Kids need to develop a sense of purpose during this stage by finding a balance between taking initiative and developing the ability to feel guilt.   Getting dressed, choosing clothes, using the toilet, and expressing preferences are all part of this need to become an independent being.   If a child isn't allowed to make small decisions or is put down by others when he tries, an unhealthy sense of guilt can develop.   Not good.   Of course, well-adjusted people need the ability to feel guilty when they are wrong so this is not to say that a sense of guilt is all bad.   A five-year-old kicks the cat when he thinks no one is looking and feels no remorse?   Not good either. 

Balance.   From my little one's perspective, choosing whether she gets an orange lion-shaped vitamin or a pink monkey-shaped vitamin is one of the most important events of her day.   As a harried parent, this can be annoying ("You get what you get and don't have a fit" right?).   But it serves me well to remember what stage she's in.  

In developing a sense of purpose, children begin to understand themselves as separate from their parents.   My cousin is famous for declaring during this stage, "I'm American, my dad is Italian and my mom is Southern".    

Preschoolers are big on making plans.   Mine planned big-time weeks before her fourth birthday.   Driving along I overheard this conversation between big sister and little sister:   

Little S:  Where is Jesus?
Big S:  In heaven.
Little S:  Does Jesus do magic?
Big S:  Ummm, kinda.
Little S:  Do you think he could make me a dolly or something?

Purpose!?!  Well, forethought and planning at least and that's a start.

Here's a short video of an adorable little girl and her doctor.  The conversation highlights the doctor's understanding of child development and how she uses this knowledge to relate to the little girl.   

Kids this age hear "no" a lot so they need encouragement when they get things right.   Its ok to motivate them with simple rewards as long as its done in an organized way they can understand (e.g. getting a sticker on a chart when they pick up their toys, two stickers if they do it without whining or arguing).    

Most importantly, they love to be loved and to know that nothing can ever, ever move that mountain of love.  

On Grief

What is grief supposed to look or feel like?

jolting
raw
haunting
surreal
perplexing

These dark emotions give us different lenses to see the world, even though we're looking at the things that have always been there.   How can the world look the same when its so changed in one's heart?  

Grief can purify our minds from temporal, meaningless distractions and force us out of complacency.    When we do become bogged down, the jolt is usually there to snap us out of it and remind us of what really matters.   Reality, eternity, and an assortment of other existential thoughts invade and suddenly the long check-out line or that squabble with someone doesn't matter as much anymore.  

But instead of feeling despair forever, there is a silver lining.   The pain of grief can invoke hope in the eternal, in a God who is outside of time and to whom a day is like a thousand years and a thousand years like a day.  

The heart is free to surrender the things that are too hard to understand and too hard to bear on human strength alone.    It becomes easier to cherish people, and memories being made, and the end of an ordinary day.  

And somehow one can cherish life all the more, yet hang on a little more loosely.