Bipolar II disorder is a topic of great interest and meaning to me. The illness is generally lumped together with bipolar I disorder; however, the two illnesses can be extremely different from each other. They are unique and interesting by themselves, but exploring bipolar 2 at depth will be the main purpose of this paper.
Bipolar I disorder (bipolar 1) is uniquely identified by severe swings in mood ranging from depression to mania. Individuals with bipolar 1 are most often quickly recognized as having the illness because their severe mood swings are easily noticed by family members, friends and others close to them. Type 1 bipolar can also cause those with the illness to experience psychotic symptoms such as delusions and hallucinations (Read, 2010) . Bipolar 1 can understandably be very difficult and tiresome to treat and cope with, for both the individual with the illness and those close to them. Bipolar 2 however, is much different.
Bipolar II (bipolar 2) individuals can often blend into society with little challenge. Bipolar 2 disorder is marked by bouts of depression and hypomania. The swing in mood experienced by individuals with bipolar 2 is not only less intense, but more often than not, less frequent than those experienced in bipolar 1 as well. Another markedly different aspect is the fact that individuals with bipolar 2 almost never experience full blown mania as those with bipolar 1 do regularly. The slow cycle swing of mood found in bipolar 2 allows individuals with the illness to cope and self regulate their illness. Often times, those with bipolar 2 are unaware of their condition and go untreated. Many individuals with bipolar 2 who are aware of their illness purposefully go untreated because they believe the benefits associated with having the condition outweigh the negatives. Any benefit found rests in hypomania; the positives therein include, increased energy, decreased need for sleep, feelings of happiness, euphoria and relentless optimism (MD, 2010) . These characteristics found in hypomania can make one with bipolar 2 a socially desired person. All people enjoy the company of a happy and optimistic person, and the level of those qualities found in a bipolar 2 individual with hypomania is often high enough to get those with “normal” levels, higher. So, the desirability of attributes found in hypomania causes many bipolar 2 individuals to be resistant to treatment, especially medication. This however, is not advisable.
While some individuals with bipolar 2 are fully capable of living a “normal” life through various self-maintenance skills, others are not so fortunate. The mix of hypomania and depression, though in slow, non-abrupt cycles, proves to be too much for some individuals to handle. Depression is the second half to the bipolar 2 coin. Depression, if not properly treated has been known to destroy lives, literally. In its worst stages depression can drive individuals to suicide contemplation, attempts and completion. If not differed or remedied by some force, whether it be medication, exercise and diet, therapy or some other form of treatment, depression can potentially spiral one further and further into sickness with no perceived hope for returning to the surface of balanced emotion. It is vitally important to maintain a balance in emotion for those who have bipolar 2, if not to cap hypomania then certainly to limit depression.
Bipolar 2, if not complicated already, is often further complicated by poor lifestyle and self-regulated coping decisions made by the individual with the illness. Many people with bipolar 2, regardless of being clinically treated or not, decide to self medicate through the use of alcohol and/or various drugs. This is extremely problematic. The already troublesome emotional swing and chemical make-up characterized in bipolar 2 causes a more severe reaction to mind altering drugs, including alcohol. ” Forty-eight percent of people with bipolar II disorder had a substance use disorder, 39.2 percent had an alcohol use disorder, and 21 percent had a drug abuse or dependence diagnosis” (Sonne & Brady, 2002) . Using drugs or alcohol is more threatening to an individual with bipolar 2 than people without the illness; mind altering substances do not only further disrupt the emotional state of the individual, but he/she also runs a higher risk of getting addicted to those substances than people absent of a mood disorder. A bipolar 2 individual in depression is further depressed by alcohol, and their hypomania is further increased by drugs like caffeine, nicotine, cocaine, methamphetamine and heroin. Whether someone with bipolar 2 is clinically treated or not, consuming alcohol and/or drugs is even riskier and less suggested than it is for “normal” individuals. It is also worth mentioning that a bipolar 2 individual being treated with medication could be at even greater risk of harm and complication if they decide to consume alcohol and/or drugs while their prescribed medication is in their system.
The personal lives of those with bipolar 2 disorder are also affected by the illness. For instance, hypomania has been known to cause hypersexuality (Dean, 2010) . Some people with bipolar 2 have had difficulty staying true to their spouse/partner for reasons related to hypersexuality. This symptom of hypomania is marked by an increased need for sexual pleasure. However, the desire for self gratification as a whole has been known to increase as a result of hypomania. Knowing and understanding these difficulties is important for those with bipolar 2 disorder and those close to them. For many people, especially those with bipolar 2 however, the most beneficial characteristic to learn and grow is self control. Without self control the inner child, or “id,” may come to take precedence over the ego and superego more often than allowable in those with bipolar 2. Self gratifying acts are most often selfish and harmful if done without balance and self control. The bipolar 2 individual needs to be aware of this and take ample precaution.
For all of the reasons listed and explained above, it is important to integrate psychological understanding of bipolar 2 disorder and a Christian world view to better provide help and remedy to those with the illness. From a strictly psychological stance, those with bipolar 2 may become perceived as a nuisance. If that happens, the possible help that one with bipolar 2 can receive is limited by the reduced patience and understanding of the psychologist, psychiatrist, social worker or average citizen who may be trying to help, but comes up short due to lack of belief or practice of a Christian world view. Integrating psychological understanding and Christianity is very beneficial in the area of helping individuals with mental illness, namely, bipolar 2. With a Christian faith perspective, one is more apt to know and practice the fruits of the spirit: ” love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control” (Galatians 5:22-23). These nine characteristics provide what’s required to work with mentally ill people, and what mentally ill people need in order to be helped. It is amazing how God balances everything so beautifully; when people live according to His word and commands, quite literally, everyone is helped and benefited. Integration of psychology and Christianity should not be seen or understood as optional by Christian individuals, it should be seen as mandatory and honorable to God.
Some beneficial precautions that are helpful to put in place and depend upon if living with bipolar 2 disorder include the use of “code words,” consistent daily and weekly schedules, and healthy outlets. These actions are not only for helpful for precautious matters such as staying out of trouble and keeping self controlled, but they can greatly help balance mood as well. For example, a person with bipolar 2 disorder often does not recognize when he/she is depressed or becoming depressed. The metaphorical cloud of hazy darkness experienced in depression can easily prevent one from realizing the state of their condition. The use of code words can prove helpful in dealing with this aspect of bipolar 2. A code word is a specifically chosen word to be used by someone close to the person with bipolar 2 when he/she gets off track, such as overly manic or depressed. It is important this word only be used in the event that the person with bipolar 2 becomes overly unbalanced in their mental illness. Hopefully there will be enough established trust between the bipolar 2 individual and the one using the code word to cause deeper self reflection and awareness in the ill person. This can help one with bipolar 2 to better work at coming out of their unbalanced state of mind.
Consistent schedules can also greatly help those with bipolar 2 disorder. A consistent schedule, whether it is daily or weekly, helps to relieve the anxiety caused by uncertainty or spontaneous action. Consistency can provide a sense of stability that little else can. As a person with bipolar 2 disorder, hypomania and trends of depression can cause one to feel unstable and ungrounded. The anxiety created by the uncertainty of one’s own feelings and emotions is sometimes great enough to cause inflated levels of hypomania which results in worse or stronger anxiety. If balance is key then consistency is a keyhole (Federman & J. Anderson Thomson, 2010) .
Last but not least, healthy outlets. For a person with bipolar 2, a place to healthily expend extra energy is critical and extraordinarily beneficial. More often than not, hypomania creates feelings of grandiosity, creativity and overall increased ability. That energy is going to be used, one way or another, and a healthy outlet is obviously going to be helpful. Heightened levels of creativity have been reported in individuals with bipolar; finding or providing a healthy outlet for that creativity could be the difference between spray painting private property (vandalism) and drawing for an art competition. It could be the difference between poetry on bedroom walls or body art and writing a novel. If the bipolar 2 individual is more physically oriented, finding or providing a healthy outlet for their hypomanic energy could be the difference between getting in fights at school and practicing karate or playing sports. Regardless of the drive brought forth by hypomania, there are positive and healthy outlets for that energy.
Sometimes self regulation and management are not enough to ensure a balanced and productive life. In this occurrence it may be helpful for one with bipolar 2 to seek psychiatric therapy or counseling. Adding a therapeutic relationship to the coping process can be just the right mix for those using self regulatory methods but still having trouble. People with bipolar 2 have differing levels of severity, like most illnesses. For those who continue to struggle with balancing their mood while using self regulation skills and attending therapy of some sort, the last resort most often involves the use of psychotropic, or psychotherapeutic, medication(s). The most common of these drugs used to treat symptoms of bipolar 2 disorder are Lithium, Depakote, Lamictal, Neurontin, Topamaz and Trileptal. These medications are known as mood stabilizers. Lithium has the most supporting evidence for treating each aspect of the bipolar 2 continuum. The reason for its efficacy is unknown, but it lessens the severity of both manic (hypomania) and depressive phases and also reduces the number of emotional shifts.
There is much to learn about bipolar 2 disorder; hopefully this review delved deeply enough into the literature to increase the readers knowledge and understanding of the illness. Bipolar 2 has come a long way in every facet, from stigma to acceptance and institutionalism to treatment and self regulation. Perhaps one day, with further research and understanding, those with bipolar 2 can live an even more balanced, productive and normal life. Until then, literature reviews like this may help pave the way.
References
Dean, D. (2010, December 2). Bipolar Disorder. Retrieved December 14, 2010, from
Bipolar Disoder Facts: http://bipolar-disorder-facts.com/Bipolar-Mania
Hypersexuality.html
Federman, R., & J. Anderson Thomson, J. (2010). Facing Bipolar. Retrieved December
14, 2010, from BpHope.com: http://www.bphope.com/Item.aspx?id=708
MD, W. (2010, December 2). Bipolar II Disorder. Retrieved December 13, 2010, from
Web MD: http://www.webmd.com/bipolar-disorder/guide/bipolar-2-disorder
Read, K. (2010, October 4). Bipolar Disorder. Retrieved December 14, 2010, from
About: http://bipolar.about.com/cs/faqs/f/faq_bp2.htm
Sonne, S. C., & Brady, K. T. (2002, November). Bipolar Disorder and Alcoholism. Retrieved December 13, 2010, from National Institute on Alcohol Abuse and Alcoholism: http://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm
