Many people with bipolarity do not recognize themselves in its classic description. Some of the most frequent criticisms of the diagnosis of bipolar disorder are “I am always depressed, I never have euphoric phases”, or “my phases are in a bad mood, irritability, I feel neither depressed nor euphoric”, or “depressions nor I also had severe euphoria sometimes but little “.
Let’s try to reconstruct a map of bipolar disorders that helps better understand what we are talking about, which is not an alternation of euphoria and depression or, better, not always in this “commuter” form between two opposite poles in the quality of mood ( sad-elated).
Phases “up” is not synonymous with “euphoric” phases and vice versa, and on the other hand the depressed mood is not synonymous with “down” phases. If the course of a bipolar syndrome is represented with the up and down phases represented in a linear way (see figure below), however, the problem arises of how to represent the so-called “mixed mood states”, in which depressive and manic symptoms coexist . We therefore represent the state with a series of parallel vertical bars.
Combinations of Mixed Mood States in Bipolar Disorder
However, there is no single mixed mood.
Inhibited or excited mood
At this point we are getting closer to what is the original conception of bipolar disorder and we have to change geometric references. Let us introduce a third dimension and try to consider a sphere, in which we contrast the hemispheres of “inhibited” and “excited” (otherwise called slowed down and accelerated).
Mood understood as quality becomes only a multi-faceted state and joyful euphoria is only one of these facets, as does melancholy. Positive pole and negative pole that intersect with two other hemispheres (right and left, which indicate poor or rich thinking).
We could therefore have different “inhibited” combinations and different “excited” combinations. A classic craze aligns rich thinking and acceleration, and the quality of mood ranges from joy to irritability.
The phases of bipolar disorder from a two-dimensional point of view
The movement from phase to phase in two-dimensional representations is a curve that rises or falls (the amplitude and the gravity), and in the mixed phases it rises and falls so rapidly to represent the “contemporaneity” of depressive and manic symptoms.
The phases of bipolar disorder seen in three dimensions
In the three-dimensional representation the trend of the phases corresponds to an orbit, which can have different orientation, but also different amplitude,
The three-dimensional geometry, in addition to making the various phases representable in the same way, does not distinguish the mixed phases from the others, due to graphic necessity, but instead identifies each phase with three coordinates: width, latitude, longitude .
The diagnosis of mood temperaments: the orbits
The orbits correspond, reducing their amplitude to a minimum, to the affective temperaments . It is in fact known that the temperament as it was and is outside the phases of illness corresponds to the quality of the mood: hyperthymic temperament is coupled with euphoric mania, cyclothymic with impulsive mania, depressive with dysphoric mania, cyclothymic temperament with excited depression.
From diagnosis to therapy: what are the drugs for bipolar disorder Bipolar orbits
are affected by treatments in different ways:
- there are drugs that move the person from one point of the orbit to another, but do not alter the orbit ( antidepressants );
- other stabilizers that slow down the orbiting movement and stabilize it according to the underlying temperament, that is the physiological orbit;
- antipsychotics that reduce the amplitude of the orbit but do not necessarily slow movement from one point to another in the orbit .
Polarization is a common factor of the phases
As in the mechanism by which satellites orbit around a planet: the farther they are from the planet itself, the more they tend to widen the orbit . In other words, there is a mechanism by which excitation or inhibition, in bipolar disorder, tend to “magnetize” on their respective poles, feeding themselves. An excitatory movement does not automatically induce a compensating one, but rather tends to induce a reverberant one, accentuating the distance of the orbit from the center of the sphere.
The “polarization” is therefore the common factor of bipolar disorder, beyond the phases, and is common to the excited ones (excitatory polarization) and to the depressive one. In other words: in the first case a tendency to accelerate alone, in the other to brake alone.
By rethinking your phases in this way, it will also be easier to follow the evolution of your disorder and treatment , no longer from phase to phase but from state to state according to three coordinates, and without the misunderstanding of necessarily having to consider depression in relationship to euphoria or to believe that excitement means euphoria.
Incidentally, the most frequent form of depression is the agitated one, as well as the most frequent form of mania is the irritable one.
