“Diagnosis: Mental Lite!” — Chapter 33 of David Leite’s self-deprecating Notes on a Banana: A Memoir of Food, Love, and Manic Depression — reminded me of the two decades it took before I was diagnosed bipolar type 2.
For twenty-five years Leite was treated (unsuccessfully) for depression and anxiety. Like Leite, I was an overachiever who cyclically crashed. From eighteen to thirty-nine, I was diagnosed dysthymic (chronically depressed). Finally as a mother of a toddler, I recognized my euphoric callings from God as symptoms of hypomania and called for help.
After seeing numerous psychiatrists since he was fourteen, Leite sought and got an accurate diagnosis of bipolar II from Neil De Senna, who at the time was a Columbia University Medical Center professor of psychiatry.
Here I excerpt as bullet points the questions Dr. De Senna asked that led to Leite’s diagnosis. Buy the book to read his life story and answers to these questions — you won’t regret it.
- Did I ever have rapid, repetitive thinking?
- Did I ever talk fast, sometimes so fast people couldn’t understand me?
- Had I ever been so irritable, I shouted at people or started fights or became violent?
- Had I ever had a decreased need for sleep? If I slept just a few hours, did I feel great?
- Did I ever engage in risky behavior that endangered my life?
- Had I felt unusually self-confident in myself and my abilities? Did I ever experience grandiosity?
- Had I ever had morose, violent thoughts?
- Had I ever contemplated suicide? Had I ever attempted it?
- Had I ever lost interest in things because nothing gave me pleasure?
- Were there times when I was very interested in being with people, and other times when I wanted to be alone?
- Did I have crying jags, anxiety and panic, trouble falling asleep or staying asleep, bad feelings about myself?
Now I quote without editing, De Senna’s description of bipolar I and bipolar II:
He explained that there are two types of bipolar disorder. Bipolar I is the more severe form, what Kay Redfield Jamison, the author of An Unquiet Mind, has. In it, the manias are screechingly amped up and oftentimes dangerous. They’re emblazoned with inflated self-esteem and billowing grandiosity, a marked decrease in sleep, a pressing need to talk, sometimes with odd features such as “clanging,” where speech loses meaning and follows a pattern of rhymes or sounds. Someone suffering from full-blown mania can be grossly distracted; battle racing, looping thoughts; and engage in potentially dangerous and deadly activities, such as unchecked buying sprees, risky or anonymous sex, foolish business dealings, and reckless driving. All the while, psychosis—a disconnection from reality—can be skulking in the background, just waiting for a pause, an opening. These manias can disrupt a person’s life to such a degree that jobs are lost, relationships implode, families disintegrate. Hospitalizations usually follow.
“What you have, bipolar II,” he continued, “is a milder form of the illness.” While the depressions can be just as deep and disabling, disabling, he said, what makes the difference is the quality, degree, and length of the high times. With bipolar II, a person suffers from hypomania. Elevated, expansive moods that are seductively attractive to the sufferer and the people around him, hypomanias are a watercolor version of bright-neon manias. Through it all, life isn’t disrupted to the same degree, and there’s never a psychotic break. Hospitalizations aren’t common.
“It can be very, very difficult to diagnosis hypomania,” Neil said. “Especially in type-A people who are normally goal-oriented, high energy, and creative. Their personalities can mask the illness at times.”
By quoting from David Leite’s memoir, published by HarperCollins, I do not intend to avoid copyright law. My hope is to educate, and as an added bonus to Leite and HarperCollins, to promote a great memoir of a creative soul living with manic depression.
Hope that your illness responds well to treatment. Wish you the best with your mental health recovery. As you’ve had family members with bipolar, you have a good understanding of how the illness affects loved ones and how important treatment is.
I just got diagnosed at 34, but it wasn’t a huge surprise since my mother and sister had Bipolar type 1. I always figured I escaped the Bipolar gene because I didn’t have psychotic breaks or extreme mania, but I was wrong 🙁
Good read ! It definitely does take forever (at least it feels that way) to get the right diagnosis.
The book is an enjoyable read. Leite is hilarious.
My library just got this book. I’m excited to read it! I also have Bipolar II, but I wasn’t misdiagnosed for nearly as long – just a few years, but I was also young and with a strong family history of bipolar disorder diagnoses. That was really helpful!
Yep. Quite common. Diagnostic criteria changed, too, over the years.
Leite is hilarious.
Wow, I keep being amazed at how often Bp II is misdiagnosed. I was diagnosed and treated for depression for over twenty years, and finally sent to a psychiatrist who diagnosed me as Bp II. So here I am, almost 50, finally knowing what is really going on! I wish you all the best.
I am definitely purchasing the memoir after reading this, and checking out your website!
Thank you for sharing your posts. Wish you the best with your current treatment regimen.
Hi Kitt and David, I have Bipolar 1 and have had a couple of psychotic episodes due to it, both of which involved sedation and straight jackets. I wrote about them and will put the links here. I have been on lithium now for a year, again, and it is really helping me. It is an incredible disease in how it turns me into someone I don’t even recognize….when it takes hold. I’m hoping never again, now that I am reliably taking the meds. Your writing is so important to help lift the stigma. Thank you.
Locked Up in DC
Crazy Train (Part 1) All Aboard
Crazy Train (Part 2) All Aboard
I agree with you. He’s just using the same terminology used commonly. I’m sure he’d agree with your logic, as well. Just acknowledging that some have it even worse, in terms of having compassion for them. But no need to compare and contrast. Bipolar II is dangerous and life threatening, for sure.
Helps to be stable on meds and therapy. Check out mental health recovery via NAMI Peer-to-Peer. I found it helpful. Best of luck.
This an all-too-common story, the delayed diagnosis part, that is. The questions he asked are quite similar to the HCL-32 checklist. I have to say though, and I’m not quite sure why, but I bristle at him saying bipolar ii is a “milder form of the illness.” He then goes on to say “the depressions can be just as deep and disabling.” Which is it? Maybe I just don’t think the word “milder” should ever be in the same conversation as an illness that can include suicidality, whether it’s bipolar i or ii. It seems there is still, even among care providers, a tendency to underestimate the destructiveness of hypomania. I get that mania can be more severe than hypomania, I just think don’t think it’s helpful to grade one form of mood disorder as somehow “milder” than another, and it may even perpetuate a harmful paradigm where a patient suffering from anything other than bipolar I is “just” bipolar II or “just” cyclothymic. Have you ever heard an oncologist say “well, it’s a milder form of cancer?” Left untreated, they will all kill a patient eventually. I don’t know what anyone gains from ranking them among each other. I’m open to debate on the issue, but for now, it leaves a bad taste in my mouth.
[…] via Diagnosing Bipolar II #DavidLeite #NotesOnABanana — Kitt O’Malley […]
I enjoyed reading this, thank you. I’ve just started blogging today, something that I have intended to do for some time. It’ll take me a long time to build up the full story on my site, but I’m looking forward to piecing the story together. I have bipolar ii and I am also “an overachiever who cyclically crashed”. I’m still in the crash, but now see that I can hopefully find a new, more enlightened path for the future. Great article, thanks
Thank you, Madelaine.
I admire your courage in wanting to tear down the stigma of mental illness. I learned something from your blog today that helps me understand loved ones who suffer from bipolar. Thank you.
Thank you, David.
Kitt, I think because you have used so little of it, and it’s bringing used in a teaching/educational capacity, it’s fine.
Yes, it is.
Thank you so much, David. I filled out HarperCollins online copyright form after the fact. Hopefully, they will not ask that I pull it down or pay. Obviously, I’m promoting your memoir, for it is both funny and educational.
Oh, my gosh! David Leite commented on a comment on my blog!!! I’m honored.
Well, now I feel very fortunate. It was eleven years diagnosed with major depression. Finally got in to see a psychiatrist considered a specialist in medication management. I could only answer four of these questions with yes. I remember he asked if the medications I had been on “pooped out”. Yes, that is exactly how he said it. My answer was yes, every one. He diagnosed Bipolar II. Management of BPII doesn’t happen overnight. But it is reachable!
Kitt, I’m honored you chose to post this. I hope it continues to help and encourage others on their journey to heath and full living.
Sober Tony, I feared the same thing when Dr. De Senna asked them of me. Where will David Leite go? But I am the same person, just not so extreme, which in the long run is so much more pleasant for me and everyone around me.
Thanks for the kind words, Susan. I hope you find the book helpful.
Paladin, as you say, the list as written won’t be found in the latest DSM. It’s my recollection of what Dr. DeSenna ask of me. I did pass the chapter by him, and he felt it accurately reflected his interview with me. I adds to the growing list of diagnostic tools.
Cinco de Mayo is all about celebrating. This is one fabulous post. You have provided Dr. Senna’s list to determine a Bipolar diagnosis. Believe this criteria will not be found in the latest APA DSM-5 version. Even though you reference David Leite’s autobiographic memoirs, your http://kittomalley.com/about/ section contains your autobiographic summary. Did not read this section prior to initiating my first comment a few days after Thanksgiving of 2015 when you provided one of the best two minute selfie videos of “Racing Thoughts” as a blog. Guess there was no need to worry for I see your “Contact Form” http://kittomalley.com/about/contact-me/ is straightforward without any disclaimer. Hope some of my comments have helped you the past few years with your geeky ways. Thanks for sharing your on-line blogs. They are well worth celebrating.
👍 Best Regards!!!
No wonder so many of us with bipolar 2 are diagnosed depressed.
Thanks! Lots of memoirs to chose from.
The questions are really good. “hypomanias are a watercolor version of bright-neon manias.” Great quote. I remember initially going to my doctor because I couldn’t remember my address. Thankfully, he sent me to a psychiatrist who asked many of those questions. And I’ve read another distinction: bipolar type 1 has a ratio of depression to mania of 4-1; bipolar type 2 has a ratio of depression to hypomania of 40-1.
Sounds like a great book. Thanks for the recommendation.
I heard great buzz about this book.
I’m reading a new memoir “My Lovely Wife in the Psych Ward” that’s also getting excellent reviews. It was written by a teacher, Mark Lukach, who writes about his wife’s bipolar disorder.
This link has an interesting video interview with the couple. Dr. Jennifer Payne (who is featured in the accompanying interview) works with Dr. Kay Redfield Jamison at Johns Hopkins.
One family’s journey through a mental health crisis
The line of questioning is helpful. Seeing it in writing. Whether or not treated, you are still the same person.
That list if questions is exactly relevant. Really similar to what my doctor walked me through, taking down my multiple examples for each.
The part that scares me a little – I always thought that was just who I am – that was what made me Tony.
That’s as good a description of bipolar 1 as I’ve ever read. Thanks for sharing!