I’ve got a mental illness, Bipolar II Disorder. It’s a mood disorder, a combination of prolonged depressive episodes interspersed with cycles of hypomania. Know that this isn’t simply poor mental health. It’s an illness, a chronic illness. Left untreated, people can die. I almost did.
Part I: What is a Chronic Illness?
Chronic illnesses are long-term incurable illnesses. They’re defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both. They frequently last a lifetime. Medication or therapy can often control them.
In my case, I’ve struggled with Bipolar II Disorder since my teens (if not earlier). I take a variety of medications to control my disorder and I see a psychiatrist. I’m currently 56.
Part II: Depression
One element of Bipolar II Disorder is depression. Depression kills. Nearly 4,000 people in Canada die by suicide each year. In the United States, it’s almost 45,000 deaths annually. For every death, 25 attempts are made. That’s some 100,000 attempts in Canada and 1,125,000 attempts in the United States. These are sobering numbers as each represents a life lost or at risk. Even though more women than men attempt suicide, considerably more men (3,000 annually) than women (1,000 annually) die by suicide in Canada. Not all who are depressed attempt suicide or die by suicide; the majority, however, are. I was depressed when I attempted.
Part III: What is Depression?
DSM-5 defines depression as: A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
There has never been a manic episode or a hypomanic episode.
Part IV: What is Hypomania?
Once again, we turn to the DSM-5 for the definition: A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
Part V: Bipolar II Disorder and Me
Depression is one of the two defining elements of Bipolar II Disorder. It’s the dangerous element, the one that may cause hospitalization. The sad truth is that those who suffer from Bipolar II spend significant amounts of time depressed. This state, this chronic illness, places them at risk. The horrific statistics about suicide above show this risk. While less dangerous, hypomania does cause significant impairment. At least it does in my case. But there’s no doubt that it’s the depression that’s cost me the most. As I’ve said, I suffer from Bipolar II Disorder. I have since my teens. For much of my life, the disorder was undiagnosed which meant it grew worse. In 2014 I attempted to take my own life due to a lengthy depressive episode that had lasted years. Prior to that, depressive episodes cost me my job and my family. By 2014 I’d lost all friends. Job, family, friends, and nearly my life, all put at risk by the depression that’s part of my chronic illness.
Part VI: Tying it All Together
So, where do we stand?
- Do we have a long-term illness? Yes
- Is it incurable? Yes (although it is controllable by medication or therapy)
- Does it place you at risk? Yes
The key question: is Bipolar II Disorder a chronic illness? Without a doubt, the answer is a resounding yes.
For more on depression, please visit my series “What is Depression?”; for hypomania, please visit my series “What is Bipolar II Disorder?”. Just use these terms in my search box.
Image by Gerd Altmann from Pixabay