“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.
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 🙁
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.
Good read ! It definitely does take forever (at least it feels that way) to get the right diagnosis.
Yep!
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!
The book is an enjoyable read. Leite is hilarious.
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
Thank you for sharing your posts. Wish you the best with your current treatment regimen.
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.
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.
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