2/08/2005

I'm tempted to take up mountain climbing.

People with bipolar disorder have a suicide risk ranging between 19% and 24%. Of all mental illnesses, bipolar disorder is associated with the highest risk of suicide, higher even than depression. Somewhere around .31% of bipolar patients kill themselves every year.

For those of you who need a few terms defined:

Bipolar disorder is what we now call the disease once known as Manic-Depression. Those of us with bipolar II enjoy depression and hypomania rather than depression and out and out mania, as is experienced by those with bipolar I.

The OED defines hypomania thusly "A minor form of mania, often part of the manic-depressive cycle, characterized by elation and a feeling of well-being together with quickness of thought." Mania is defined as "...one of the aspects of bipolar (manic-depressive) mood disorder, characterized particularly by euphoria, grandiose thought, rapid speech expressing loosely connected thoughts (flight of ideas), decreased need for sleep, increased physical activity, and sometimes delusions or hallucinations." Those are fine definitions, but they don't much assist the layman in comprehending the difference. So let me see if I can be more instructive.

This is hypomania: You wake up in the morning; make four lunches, preparing three individual sandwiches (one peanut butter, no jelly. One turkey with mayo, one turkey without mayo but with tomato, blotted dry so it doesn't make the bread soggy) and a thermos of soup. Each lunch gets a drink, two snacks, and a piece of fruit. You wake, dress, and feed four children, reminding everyone to take vitamins, and Omega III. You sign permission slips, and load up carpool. Then you go to the gym, do email, make plane reservations for family vacation, copy-edit essay, put finishing touches on novel, revise short story for submission to anthology, drop off meal for family with new baby at preschool, and order new bathing suits for everybody because, suddenly, despite the fact that it is February you decide that everyone needs new bathing suits and that if a single day passes without each and every member of the family having a new bathing suit the well-being of the family will collapse. Then you reorganize the kitchen hell drawer, go online and order nine superpacks of size 4 diapers (and swim diapers for the baby, too, because, after all, what's a bathing suit for a baby without a swim diaper underneath it?). Then you pick up the children from school. You never, never, do anything without talking on the phone at the same time. Most of these phone conversations should involve volunteering for things you don't actually want to do but feel you should. That is a day in the life of the average hypomanic.

Mania. Well, hmm. I've never actually suffered from a manic episode, but here's one I've seen fairly close-at-hand. Imagine if you will, Bloomingdales, circa 1982. 10,000 dollars is spent in approximately 11 minutes. Think grandiosity, agitation, inability to focus, hostility, and complete and total lack of control.

All in all, hypomanic is what you want to be. Hypomania is why I can do things like write three books in seven months. Hypomania is, in fact, the bomb. Hypomania is also linked to a 24% suicide risk. You heard me. Us bipolar II folks have an even higher risk of suicide than those with bipolar I.

Twenty-four percent. That's almost a quarter. A one in four chance, if you'll permit me the indulgence of rounding up. Let's put that number in perspective. The chances of dying while attempting an ascent of K2 are approximately 5%.

Awareness of the suicide risk, awareness of the subtleties of the disease and its chemical nature, do nothing to alleviate the risk of death. It does not help to know that one's mood is a mystery of neurochemistry when one is tallying the contents of the medicine cabinet and evaluating the neurotoxic effects of a Tylenol, topomax, SRRI and ambien cocktail.

All in all, as heritable diseases go, I think I would have preferred something else. Diabetes, say, or color-blindness. Wait, I forgot, we've got both of those. The former is on my husband's side of the family, and Zeke can't tell his reds from his greens.

This is what happens when you insist on marrying people from the same few square miles of Jewish Pale. Michael and I might as well be cousins for all the genetic diversity we've got going on. I'm going to force my children to travel to the far reaches of the globe when it's time for them to marry. We need to shake up this gene pool a little.

185 Comments:

Blogger Cricket said...

Yeah, hypomania can be great. I've always said I feel ripped off, b/c I'm an artist and I didn't get the Sistine Chapel version of mania.

My hypomania can be rather nasty, sarcastic, negative. Not always, tho. Those are the days with 5 blog entries, always something so very interesting to chat about.

I didn't realize the stats. It makes sense, tho, that suicide coincides with the surge of energy. Thanks for presenting.

February 9, 2005 at 6:02 AM  
Blogger nita said...

Ok. While you've done a fine job of making the Bipolar II sound attractive, I'll take the Bipolar I.

Can I put in on a credit card?

February 9, 2005 at 6:51 AM  
Blogger Gina said...

Hi, Ayelet. Climb the K2 if you must, but please keep writing. I read your article on Salon today, and I wish everyone who speaks on behalf of the pro-choice movement were as smart, thoughtful, honest, and articulate as you.

February 9, 2005 at 7:11 AM  
Blogger TC said...

I was wondering why you'd gone so long without posting. I'm glad you apparently managed to escape the allure of "cocktail" hour.

So why do you think this is, this increased risk of suicide for bipolar IIs? I'd assumed it was because of the lows, not the highs, because of how much time, relative to hypomania, one tends to spend in major depression. (Sucks that you only get a break on the worst parts of mania, but not the worst parts of the depression, doesn't it?) But it sounds like you're saying here that you think there's a link between your hypomanias and your suicide risk, and I'm wondering what you think that risk is.

February 9, 2005 at 7:35 AM  
Blogger marrije said...

I had no idea of those statistics, and they scare me. Thanks for writing about this, even if it is such an uncomfortable subject. And stay well. And please get a lockable medicine cabinet with the key under care of a person you live with?!

February 9, 2005 at 8:43 AM  
Anonymous Anonymous said...

Hypomania can be great. You have me wondering if one can start out with one form of bipolar disorder (Type I, in college) and then have it evolve to Type II (like now, f'rinstance). The 10K at Bloomie's almost resembles some of my binges from the 80's. Sounds like fun, but it's not, b/c I would end up with lots of stuff I didn't really want b/c I just had to buy NOW. Now if only I could have that money back for some hypo-manic "splurges" ;-) Love reading your blog, Ayelet. I have a 10 year-old daughter, too and we have some of the same dynamics going on as you and Sophie. Please keep holding up that torch so I can kind of see the path ahead of me. -JJQ

February 9, 2005 at 9:00 AM  
Anonymous Anonymous said...

Ayelet-
Have you read The Best Awful by Carrie Fisher? She does a great job writing about having bi-polar.
Jennifer Gibbons

February 9, 2005 at 9:16 AM  
Blogger Psycho Kitty said...

Ayelet, I realize I don't know you to say this to you, but I'm sorry you have to deal with this. My ex has been diagnosed with this, and if I had a dollar for every time I've spent a wakeful hour worrying that he was driving off a cliff somewhere, I'd be rich (but I'd still have the crapped-out adrenal gland). And it is freaking terrifying to think that our kids might have to deal with it, too, especially since one of them is already having problems, so...yeah. It sucks. Hang in there. I hope writing about it helps.

February 9, 2005 at 9:32 AM  
Blogger Anshel's Wife said...

What does it mean if you can do all of that (except for obsessing about bathing suits) and you aren't bipolar?

February 9, 2005 at 3:28 PM  
Blogger ayeletw said...

Hey! Thanks for all the excellent comments...and for all the shout outs from fellows in hypomania. I've lurked for a while over at crazymeds.org, and even given him some money (he's a better source of info than my doctor).

February 9, 2005 at 7:45 PM  
Anonymous Anonymous said...

I've already read 4 of your books and I SINCERELY hope to read some 40 more, so please go back to your work.

February 10, 2005 at 4:45 AM  
Blogger Elianah-Sharon said...

I appreciate this post so much. My sister is paranoid schizophrenic with bipolar. Isn't that just a little ray of sunshine? It's nice to have such a well-written and descriptive glimpse into things she cannot tell me.

February 10, 2005 at 9:03 AM  
Blogger Edgy Mama said...

A dear friend and mentor of mine killed herself six years ago. This woman was my high school biology teacher and then my boss for two years (she hired me right out of college to teach and write, although I had limited experience doing either one). I didn't know she had been diagnosed bipolar until after her death. I was so confused and upset when she died, as she was extremely successful, well-regarded, charming, intelligent, and an amazing spouse, mom, and friend. She was clearly skilled at hiding her depressive times, and I just assumed she was incredibly driven when she was manic. Thanks, Ayelet, for some insight into this disease. We all have our genetic loads to bear, but this seems a particularly evil one. Best wishes.

February 10, 2005 at 9:46 AM  
Blogger Yana said...

Wait! Is the Topomax, Ambien, SSRI, and Tylenol combo bad? What about if I skip the Tylenol and hope my headache goes away on its own?
Seriously, this was a great post, something I want to print out, laminate, and hang around my neck from a string so that I can simply hand it to people instead of trying to explain why I work the way I do.

February 10, 2005 at 1:53 PM  
Anonymous Anonymous said...

Which leaves:

1.) 82%-76% of people diagnosed bipolar do not commit suicide.

2.) Suicide is not an option for any one with one or more small children.

3.) It is hugely disrespectfiull to all of ones ancestors and the struggles they endured to consider offing ones self, or even to whinge , which face it, illness or not really is a type of luxury not afforded to say people trying to outwit starvation, murder, torture etc. and survive another day.

February 11, 2005 at 11:29 AM  
Blogger Disgruntled goddess said...

Two years ago, my 16 year old daughter got up rode, the bus to school and hung herself from the bleachers on the football field.

She had BiPolar Disorder.

She wasn't in a depressive cycle which made it even more confusing.

She had just bought a new pair of shoes she had been saving up for, had her 16th birthday party with friends, sung at a school pageant, was filling out job applications. Her grades were excellent. She'd done all her school assignments on Friday and they were in her backpack ready to be turned in.

To rightwing nutcase and the one anonymous poster I am sending you a huge Fuck You!

You are obviously clueless idiots. The kind of people who went to school with my daughter and taunted her on a daily basis. The kind of people who made her feel even more worthless and like she had no worth, no value. The kind of people who made it easier for her illness to win the battle for her life.

Try educating yourself about mental illnesses and what they do to people. Try learning a bit about the risks of suicide and the hell those who are left behind live each day in. Try for a moment to understand the immense pain a person must be in to end their lives.

Live one day of their lives, or one day as a survivor. Then try to spout off such assholish comments.

February 11, 2005 at 1:22 PM  
Blogger Asher Abrams said...

Ayelet,

Thanks for sharing your story. My mom had some form of depression - I don't know all the clinical details. I've had my own little dark moments in life, but I count myself fortunate that I don't have to wrestle with something like this. You show great wisdom in channeling your energy in positive ways (including, but not limited to, this blog). I won't bother you with any of that "you are a child of G-d" stuff, but ... oh, okay, I will: You are a child of G-d and you are precious to the Creator and to your fellow human beings. Take care of yourself, and thank you, again, for sharing your thoughts on this blog. I'll be adding you to my regular reading list.

February 11, 2005 at 5:33 PM  
Blogger Asher Abrams said...

PS - The troll signing itself Rightwing Nutcase has managed to insult both conservatives AND the mentally ill. That's an accomplishment too, of sorts, I suppose. See, everyone has their own little contribution to make ...

February 11, 2005 at 5:35 PM  
Blogger Asher Abrams said...

Seriously, RWNC, read Janis' post and get a clue. And get a life.

February 11, 2005 at 5:36 PM  
Anonymous Anonymous said...

Hi. I realize you don't post here anymore, but I was wondering how you know you've got this disease.

I say yes to practically anything anyone asks of me, and for the past two weeks I haven't been able to sleep because my mind races with all the things I've got to get done. And like a lot of other folks, I have productive spurts and depressive spurts. How do you know that's an illness, per se? Who tells you?

February 14, 2005 at 1:00 PM  
Anonymous Anonymous said...

Dear Ayelet,

I am a depressive (never get the hypomania) who has attempted suicide in the past. That was over a decade ago and I have found cognitive therapy very helpful in my recovery--better than meds.

I also have worked on a suicide crisis line and spent many a night on the other end of the line with a bipolar person. What we do works and I urge you and others to give crisis lines a try. If you don't like a particular counselor, call back for another shift. I have listened enough to know what a struggle it is to surf the moods of bipolar disorder. No one who has not experienced it is in a position to judge.

Thank you for writing honestly about your experience and enabling others to come forward with theirs. It's a step in the direction of getting our mental illness hating society to take a good look at itself.

Blessed Be

March 14, 2005 at 3:18 PM  
Anonymous Anonymous said...

Oy Ayelet,

I so relate!

I relate to the sandwich making, to the carpool driving, to the writing, to bringing food to another mother in the community, to the endless need to prove myself hyper competent, and oh-yes indeedy-do I relate to the hypomania that allows me to function so amazingly well.

One of my sisters had ovarian cancer, the other has MS -- they discussed me one day several years ago and agreed they were grateful for their own dreadful illnesses and while they might trade places with each other, they would NEVER in a million years trade places with me for a day of my depression.
Nothing is as painful or scary.
The hypomania just sets us up and makes us feel all the worse when we crash.

There is no worse hell for a hyper competent person than to not be able to function. Would that we could settle for moderate competence!!

The world would settle for us to be so -- our husbands could accept it -- our children might even prefer it.
But we are gifted.
Alas, alas, alas.

G-d help us.

Stay well, Ayelet Waldman!

March 24, 2005 at 11:09 PM  
Blogger mawgawrita said...

I thought I was just depressed.
I have four kids.
No husband.
It's my brother that's bi-polar, see.
I am just depressed.
Love your blog.

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Anonymous Anonymous said...

Hi--I have bipolar II as well and have taken tons of different medications to try to control it. Now that I'm breastfeeding, I decided to go a different route and am taking mega-doses of vitamins and 6000 mg. of Omega IIIs daily and it seems to be helping a lot.

The vitamins are called Empower Plus and they're from a website called TrueHope.com. My doctor, Katherine Falk, of NYC, put me in touch with them. She's Columbia trained and is well-respected in her field so I felt confident going a less traditional route under her guidance.

July 21, 2005 at 1:25 PM  
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where did you get your statistic about hypomania having a 25% suicide rate? (the link doesn't work.) This is alarming, but i'm pretty sure it's misleading, and it makes me angry to see this kind of information being put online and read by lots of people. what's dangerous about "bipolar disorder II" (mood instability is a spectrum, and people don't "HAVE" this or that disorder, although it is often existentially convenient to identify with one) is the potential to fall into a mixed episode: agitated depression or dysphoric mania. these are the worst of all worlds and the most dangerous mental hells to fall into...these are the states associated with the greatest risk of suicide--not hypomania itself. you're going to freak people out making them think that every time they have a delicious flight of ideas or go on a cleaning spree that they have some kind of glamorous, dangerous, mysterious disease of the mind.

you are the third writer i've encountered this month talking about her sortof bipolar gifts. makes me wonder: is it the illness that creates the grandiosity, or the grandiosity that creates the illness? the West has a Great Tradition of Artists craving Madness, and you certainly are doing your share of perpetuating this myth of the crazed genius. i do believe that creativity can come from altered states of consciousness, but you should really consider talking to a psychologist before you spread around this romantic bullshit information.

furthermore, if you are going to talk about this, why not mention the remarkably effective treatments available? aside from the trillions of methods of psychotherapy and self-regulation, there are also medications like lithium, lamictal and, if need be, zyprexa. mentioning how dangerous this illness is and then talking about how it enables you to write so effectively is not really giving people the full picture and i'm sorry to say, it seems pretty self-serving. sorry for the frustration, but i'm sick and tired of fellow artists building their egos on the back of the tragedy of virginia woolf.

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