Five Things Not to Say to Someone with Bipolar I or II

I have Complex PTSD and Bipolar II but have two friends who have Bipolar I.We were having dinner last Wednesday night and one of my friends was in a very cranky mood ! “The questions she said, people ask you when you are bipolar are so stupid they drive me up the wall. We laughed when she shared what she had been asked, but that led us to brainstorm the five top questions you should not ask someone who has bipolar !!!!  But first I’ll start with a quick rundown on the difference between bipolar I and II as that is one of my bugbears.  People assuming their the same.

Where bipolar I and II differ is the length and intensity of the high and the presence of major depression. Bipolar I requires one experience of mania but does not require an episode of major depression (however many people do experience symptoms of depression).The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies mania to be a period of abnormality, featuring an elevated, persistent or irritable mood, severe enough to impair functioning, with three or more symptoms of:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual
  • Flight of ideas
  • Distractibility
  • Increased goal-directed activity
  • Excessive involvement in activities that have high potential for painful consequences.

For an episode to be defined as manic it must last at least one week. Someone experiencing mania may not know they are ill or in need of treatment, and occasionally an episode will include an experience of psychosis or delusional thoughts.Many people who experience mania describe their actions as euphoric, a feeling of invincibility, where no idea is too big or too optimistic.

For bipolar II a person must experience at least one of major depressive episode lasting two-weeks, and one experience of hypomania that lasts at least four days.Similar to mania, a hypomanic episode features an elevated, persistent or irritable mood, with increased energy, and three or more symptoms of:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual
  • Flight of ideas
  • DistractibilityIncreased goal-directed activity
  • Excessive involvement in activities that have high potential for painful consequences.

Unlike mania, an episode of hypomania is not considered severe enough to impact social functioning or to require hospitalisation. It does not include psychosis and the impact of an episode is not considered a ‘significant impairment’. In fact, it is possible for people who experience hypomania to continue to operate within their regular, although modified, routine.This is not to say bipolar II is a ‘milder’ disorder. The impact and trauma associated with hypomania is just as real and just as debilitating. The experience of depression and the impulsivity associated with bipolar II can also contribute to suicide attempts.Because someone may not consider their highs to be ‘out of the ordinary’, symptoms of hypomania are not always easy to identify.

Now for the five questions you should never ask someone with bipolar:

1. “Pull yourself up by your bootstraps.”

If I had a dime for every time I’ve heard this, I could have personally financed Blackdog Institute  research into brain imaging of bipolar. If it were as simple as fiddling with footwear, there’d be nary a bipolar person on earth. Manic depression is a disease. No one would dream of going up to a diabetic, multiple sclerosis, or Alzheimer’s patient and saying this.

2. “Have you tried prayer?”

With all due respect to religious readers, you can’t pray the crazy away. (The same way you can’t pray the gay away, but that’s another topic for another post.) Momma and Poppa Leite are devout evangelical Christians and are part of a large and active prayer community. I don’t know what prayer can do, but I’m certain it can’t fix my illness, and (pun intended) Lord knows my parents have tried.

3. “Try vitamins.”

Or supplements, tonics, colon cleanses, sage smudging, reflexology, massage, etc. I’ve tried them all. In most cases, the results were at best benign, but in some cases, the outcomes were so toxic that I had to get medical help. It’s not that these tactics can’t soothe a crumpled psyche, but they’re not cures. And they should be administered by a qualified, certified professional. Salespeople at GNC don’t count.

4. “Oh, you poor thing. It must be awful to go through that.”

Ugh. We’re not to be pitied. Most of us have found ways of coping, strategies that help us through the darkest depth and the soaring, white-hot highs of our daily lives. And if we haven’t, we will. But pitying us and reminding us of just how hard it can be only does one thing: makes us detest our illness, and in some cases ourselves, even more than we do.

5. “What doesn’t kill you makes you stronger.”

Considering the galloping rate of suicide in the mentally ill, especially people who suffer from manic depression, who when rising out of the darkness suddenly have the energy to take their lives, few things are as insensitive as this. I’ve thought of suicide innumerable times and even came close to putting a plan into action. And when I was in the bleak basement of my soul, there was no way I could imagine things getting better or how in the hell this could make me stronger. What I did feel, with all my heart, was that it would eventually kill me.

Of course, this all begs the question: What do you say to someone with bipolar? That varies from person to person, but I believe the most important thing you can say is nothing. Just listen. We, along with every crazy, madcap, tangential, horrifying, maddening and illogical bit of our being, need to feel heard and understood. And we need to be heard without judgement. I don’t know one person who suffers from bipolar, or any mental illness, who hasn’t already done a hatchet job on him or herself. If you must say something, I think the most moving and deeply affecting thing to utter is, “What do you need from me?” And whether that’s met with a torrent of words or a simple shrug of the shoulders, trust me, we will feel heard. We will feel seen. We will feel not alone. And, in my experience, that is the first step to feeling well.

If you have any favourite questions of your own email them to me at erinfado@gmail.com

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