Bipolar Disorder, Personality, and the Meaning We Make of Mania
When people talk about bipolar disorder, the conversation usually centers on symptoms: mania, depression, changes in sleep, racing thoughts, impulsivity, psychosis, medication, and hospitalization. Those are important subjects. But there is another, more difficult question that often receives less attention: What does living through bipolar disorder do to a person’s outlook on life?
That question is different from asking whether there is a “bipolar personality.” There really isn’t. Bipolar disorder is fundamentally an episodic mood disorder, not a personality type. A person can be outgoing or introverted, highly social or solitary, emotionally expressive or reserved. Those characteristics may have existed long before the first manic episode.
Yet saying that bipolar disorder does not determine personality does not mean that experiencing severe bipolar illness leaves a person unchanged.
The Person Between the Episodes
In Bipolar I disorder, a person may experience severe manic episodes and then return to remarkably normal functioning between them. With effective treatment, someone who has experienced profound psychosis may spend months or years thinking clearly, maintaining relationships, handling ordinary responsibilities, and showing none of the distorted thinking that characterized the manic episode.
This distinction matters.
A person who is naturally introverted, for example, should not automatically attribute that characteristic to bipolar disorder. If someone preferred a small circle of friends before developing the illness and continues to prefer one afterward, introversion is probably part of that person’s underlying temperament.
The same is true of emotional sensitivity. Being deeply affected by a movie, music, another person’s suffering, beauty, or a spiritual experience is not inherently a symptom of bipolar disorder. Neither is being a man who experiences or expresses those emotions strongly. Cultural expectations about how men are “supposed” to respond emotionally can sometimes cause perfectly ordinary human sensitivity to be mistaken for pathology.
Solitude is more complicated.
Some people simply enjoy being alone. There is a considerable difference between solitude and isolation. Isolation can arise from depression, fear, shame, or withdrawal from life. Solitude can be chosen and nourishing. A person may genuinely prefer a quiet life, a few close relationships, and considerable time alone.
There can also be more than one explanation operating at once. Someone may be naturally introverted while also having learned early in life that keeping some distance from people reduces the possibility of rejection. What begins partly as self-protection can eventually become a comfortable way of living.
Bipolar disorder does not necessarily create that personality. But the experience of the illness may reinforce it.
When Mania Becomes Psychosis
Severe mania is something altogether different from ordinary emotional intensity.
Sleep often provides one of the clearest warning signs. A person may become intensely absorbed in an idea, project, spiritual question, or perceived mission. Sleep begins to seem unnecessary. This is not merely insomnia in the ordinary sense of wanting to sleep but being unable to. During mania, the individual may feel extraordinarily energetic despite sleeping very little.
Thought itself accelerates.
Connections between ideas appear everywhere. Events may seem unusually significant. Confidence in one’s interpretations can become enormous while the ordinary capacity for doubt diminishes.
When mania progresses into psychosis, hallucinations and delusions may become part of the experience. At that point, insight can deteriorate severely. The person does not necessarily experience himself as becoming irrational. From inside the episode, the developing reality may seem completely coherent.
That is one reason severe psychotic mania can become impossible to control through willpower or reasoning alone. Hospitalization and medication may be necessary to bring the episode to an end.
For someone who has experienced repeated psychiatric hospitalizations—sometimes lasting a week or several weeks—the institutional experience itself can also become part of his biography. Hospitals, treatment programs, schedules, shared spaces, restrictions, and dependence upon other people cease to be abstractions.
Curiously, even that can produce unexpected consequences later in life. Someone who has already experienced periods of institutional care may find that the possibility of needing residential care in old age carries less fear. It is no longer entirely unknown territory.
That does not make hospitalization pleasant. It simply illustrates how difficult experiences can alter one’s relationship with future possibilities.
You Cannot Unexperience Psychosis
Perhaps the most interesting questions begin after the episode has ended.
Once treatment has restored stable thinking, the individual may recognize that his perceptions during mania were unreliable. He may understand perfectly well that hallucinations were hallucinations and that conclusions reached during psychosis cannot simply be accepted as facts.
But intellectual recognition does not erase experience.
A person cannot unexperience what his own consciousness once presented to him as reality.
That creates a peculiar philosophical problem.
Suppose a person experiences powerful religious imagery or a profound sense of the divine during psychosis. Once stable, he does not need to choose between two simplistic positions: either “everything I experienced was literally true” or “because I was psychotic, the experience can have absolutely no meaning.”
There is a third possibility.
The perceptions may have been products of an abnormal mental state while the subsequent reflection on those experiences remains entirely rational.
That distinction is crucial.
A dream is not an objective event in the external world, yet a dream can cause someone to think seriously about his relationships, fears, mortality, or priorities. A novel is fictional, yet it can permanently change someone’s understanding of compassion or justice. Likewise, recognizing an experience as psychotic does not dictate what a recovered person must eventually think about having undergone it.
The episode and its later interpretation are two different things.
God, Death, and Meaning After Mania
Religious and spiritual themes can occur during severe mania and psychosis. Grandiosity may transform an ordinary religious conviction into a belief that one has been personally selected for some extraordinary divine purpose. Coincidences may acquire supernatural significance. Internal thoughts may seem to originate outside oneself.
Those experiences deserve clinical caution while they are occurring.
But years later, when the person is stable, a different question can legitimately be asked: What did confronting such an extraordinary state of consciousness do to the person’s understanding of God, mortality, and existence?
There may never be a scientifically provable answer to the metaphysical questions raised by the experience. Psychiatry can explain why certain perceptions occur during mania without being able to settle questions about God any more than cardiology or neurology can.
That leaves room for intellectual humility.
A recovered person can say, in effect: I know that my mind was psychotic. I therefore do not regard what I perceived as reliable evidence about external reality. But having experienced it nevertheless changed the questions I ask.
That is not the same thing as continuing a delusion.
It is reflection.
The experience of losing one’s ordinary relationship with reality can make consciousness itself seem less straightforward afterward. It can sharpen questions about what constitutes the self, how much confidence anyone should place in perception, what death means, and whether spiritual meaning depends upon certainty.
For some people, those questions may deepen an existing faith. For others, they may complicate it. Still others may become more uncertain than they were before.
There is no psychiatric rule dictating which conclusion a stable person must reach.
Illness, Personality, and the Life That Follows
The useful distinction, then, is between personality, illness, and biography.
Bipolar disorder does not explain every characteristic of someone who has it. Introversion may simply be introversion. Emotional sensitivity may simply be sensitivity. Enjoying solitude may reflect temperament rather than disease. A small circle of friends can be a preference rather than a symptom.
But bipolar disorder becomes part of a person’s biography, particularly when it has included severe psychosis, hospitalization, and periods in which ordinary reality seemed to unravel.
Biography shapes people.
A person may become more cautious about sleep because he knows what losing sleep can precede. He may become more attentive to the limits of his own certainty because he has experienced absolute certainty while profoundly mistaken. He may become less frightened of institutions because he has already lived within them. He may think differently about God or death because he has encountered states of consciousness that most people never experience.
And he may value solitude more deeply—not necessarily because bipolar disorder made him a loner, but because solitude is where he finds quiet, clarity, and room for contemplation.
The important thing is not to make bipolar disorder the explanation for everything.
A person is more than a diagnosis.
At the same time, it would be equally artificial to pretend that profound experiences of mania and psychosis leave no mark once the medication works and ordinary thinking returns. Stability does not erase biography.
Perhaps the most balanced position is to take neither extreme: do not mistake psychosis for revelation, but do not assume that surviving psychosis has nothing to teach the person who experienced it.
The episode may be over.
The work of understanding what it meant to live through it can continue for a lifetime.