I want to talk about bipolar disorder. Bipolar disorder is a condition that brings unusual shifts in mood, energy, and a person’s ability to function. What makes it difficult is that the shifts are not small. They can be intense, and they can affect the person’s life in ways that are hard to control without treatment. And one thing that I have come to understand is that bipolar disorder is often chronic. That means it is long-term. It is not something that comes and ends once and for all.
For many people, it is something they manage over time, and sometimes management is needed for a long period—possibly even a lifetime. Because it is long-term, it also means treatment is not usually a one-time thing. Many people need ongoing medication and ongoing support. This is not because they are weak. It is because the disorder is strong, and the brain needs steady help to remain stable.
Bipolar disorder is mainly described through two major phases. One phase is depression. The other phase is mania. So a person with bipolar disorder can experience both—depressive episodes and manic episodes. These two sides can be very different, and when you see them, you begin to understand why this disorder affects mood, energy, and functioning so deeply.
Mania is a state where a person has an excessively elevated mood that can be persistent. Sometimes it is not only elevated. It can also be irritable—meaning the person becomes easily annoyed, easily angered, easily provoked. The point is that the mood is no longer stable. It has shifted away from the person’s normal level.
When I talk about “normal level,” I mean what we call baseline. Baseline is how a person normally behaves when they are well. Everyone has their own baseline. Some people talk a lot naturally. Some people are naturally energetic. Some people are naturally outgoing. But in bipolar disorder, the shift goes beyond baseline. It becomes more than what is normal for that person. It becomes a change that others can see clearly.
During mania, increased energy is common. You may see a person pacing. You may see them moving constantly. You may see them become more active than usual, as if their body cannot settle down. There can also be increased fidgeting. Fidgeting is like unconscious movement. You sit with someone and their feet keep moving, their hands keep moving, their body keeps shifting. It looks like restlessness that will not stop.
A person may also have a mood that looks excessively happy, or excessively excited, or sometimes excessively irritable. This is not a normal happy mood. It is elevated and intense. It can come with loudness, constant talking, and energy that feels like it has no breaks.
Another common sign is reduced need for sleep. The person may not feel like sleeping. They may sleep very little and still feel full of energy. This is one of the signs that a shift is happening, because sleep is part of how the brain resets. When sleep is reduced and energy is still high, it shows that the brain is in a different state.
During mania, a person can also develop unrealistic beliefs. This is where you hear people saying things that do not match reality. Someone might say, “I am Michael Jackson.” Another might say, “I am the Prince of Wales.” Another might say, “I am the president.” Another might claim they are a professor or someone famous. They may talk as if they have special powers or special abilities that they do not actually have. These are signs of how the mind can move away from reality during intense episodes.
Mania can also lead to poor judgment. The person may make decisions without thinking through consequences. Risky behavior may increase. Sexual activity may increase. The person may become very impulsive, doing things quickly, spending, moving, acting, talking—without the usual self-control.
Another sign is increased talking. Some people naturally talk a lot, but in mania the talking becomes more than their baseline. The person talks faster, talks louder, talks more, and sometimes it becomes difficult to interrupt them. It is as if the words are racing out of them.
Racing thoughts can also appear. This is where a person moves from one idea to another quickly. There is no consistency. One thought jumps to the next, and the next, and the next. It becomes hard for them to stay on one topic. And because their thoughts are racing, their concentration becomes poor. Even though they seem energetic, their mind may not be focused.
Another thing that can happen is denial. Sometimes when people around them begin to notice something is wrong, the person in mania may deny it completely. They may insist there is nothing wrong. They may become suspicious of the concern. They may refuse help. That denial can delay treatment and allow the episode to grow.
The second side of bipolar disorder is depression. I have already talked about depression in the previous chapter—persistent sadness, withdrawal, hopelessness, changes in appetite, changes in sleep, loss of energy, and even suicidal thoughts. In bipolar disorder, this depression becomes part of the cycle. The person can move from high mood and high energy into low mood and low energy. That is what makes bipolar disorder difficult. It is not only one direction. It is the movement between extremes.
There is something else that can happen when bipolar disorder becomes severe—psychotic symptoms. When it reaches an extreme, the person can become disconnected from reality. It can look like the person has left the world everyone else is living in. They may talk and behave as if they are in a different reality. I know a person who used to talk about “underground people,” as if he was communicating with people who are not visible. This is what I mean when I say the person is no longer in touch with reality. When this happens, two major experiences can appear: hallucinations and delusions.
Hallucinations are when a person sees or hears things that others cannot see or hear. Some hallucinations are auditory—hearing voices, hearing conversations, hearing sounds. You may find someone speaking as if they are responding to a voice that you cannot hear. Other hallucinations are visual—seeing things that are not visible to normal people. A person may tell you, “I am seeing people coming,” and they may react with fear, even running away, while you cannot see anything. In the past, many people interpreted these experiences as magic or “juju,” because they did not understand mental illness. But what I understand now is that these can be symptoms of a serious mental health episode.
Delusions are different. Delusions are false beliefs—strong beliefs that do not match reality. A person may believe they are being persecuted, that people are planning to harm them, that others are plotting against them. They may believe they have great wealth when they have none. They may believe they are famous when nobody knows them, even in their own village. They may believe they are in love with a powerful person or a celebrity, claiming a relationship that does not exist. They may accuse partners of unfaithfulness without real evidence. These beliefs feel real to the person, even when others see that they are not true. This is why bipolar disorder is serious. It can move beyond mood changes into a place where a person’s relationship with reality is disturbed.
Another thing I must mention is that many people with bipolar disorder struggle with suicidal thinking, especially when the disorder becomes severe. The risk of self-harm and suicide attempts can be high. This is why early treatment and close support matters. It is not something to take lightly.
When it comes to causes, one major factor is heredity. Bipolar disorder can run in families. If a parent has it, the chances increase. If a sibling has it, the chances increase. That does not mean it must happen, but family history matters. There are also biological factors. Bipolar disorder involves disturbances in brain chemicals—chemicals that regulate mood and activity. Mood is affected because of depression. Activity and energy are affected because of mania. So there is a disturbance in the systems that keep a person stable.
Environmental factors also play a role, mainly as triggers. Stressful situations may not create the disorder by themselves, but they can trigger symptoms. Stressful events can bring out manic episodes or depressive episodes. That is why people with bipolar disorder need support not only in medication but also in managing stress.
There is medication for bipolar disorder. There is medication to manage mania. There is medication to manage depression. There is also medication used when psychotic symptoms appear. Treatment is usually long-term, and that is why side effects can also appear over time. When medication is taken for a long period, side effects may emerge, and sometimes those side effects need treatment as well. That is part of the reality of long-term management.
Another thing I believe is important is the role of caregivers and people close to the affected person. Someone living with a person with bipolar disorder should observe patterns. They should notice how the person woke up, how the day went, what symptoms showed up, and how the person’s mood shifted. These observations help mental health specialists adjust treatment. Without that information, it becomes harder to tailor medication properly. Support is not only about being present—it is also about noticing changes and helping the professional team understand what is happening.
Bipolar disorder is mainly described through two major phases. One phase is depression. The other phase is mania. So a person with bipolar disorder can experience both—depressive episodes and manic episodes. These two sides can be very different, and when you see them, you begin to understand why this disorder affects mood, energy, and functioning so deeply.
Mania is a state where a person has an excessively elevated mood that can be persistent. Sometimes it is not only elevated. It can also be irritable—meaning the person becomes easily annoyed, easily angered, easily provoked. The point is that the mood is no longer stable. It has shifted away from the person’s normal level.
When I talk about “normal level,” I mean what we call baseline. Baseline is how a person normally behaves when they are well. Everyone has their own baseline. Some people talk a lot naturally. Some people are naturally energetic. Some people are naturally outgoing. But in bipolar disorder, the shift goes beyond baseline. It becomes more than what is normal for that person. It becomes a change that others can see clearly.
During mania, increased energy is common. You may see a person pacing. You may see them moving constantly. You may see them become more active than usual, as if their body cannot settle down. There can also be increased fidgeting. Fidgeting is like unconscious movement. You sit with someone and their feet keep moving, their hands keep moving, their body keeps shifting. It looks like restlessness that will not stop.
A person may also have a mood that looks excessively happy, or excessively excited, or sometimes excessively irritable. This is not a normal happy mood. It is elevated and intense. It can come with loudness, constant talking, and energy that feels like it has no breaks.
Another common sign is reduced need for sleep. The person may not feel like sleeping. They may sleep very little and still feel full of energy. This is one of the signs that a shift is happening, because sleep is part of how the brain resets. When sleep is reduced and energy is still high, it shows that the brain is in a different state.
During mania, a person can also develop unrealistic beliefs. This is where you hear people saying things that do not match reality. Someone might say, “I am Michael Jackson.” Another might say, “I am the Prince of Wales.” Another might say, “I am the president.” Another might claim they are a professor or someone famous. They may talk as if they have special powers or special abilities that they do not actually have. These are signs of how the mind can move away from reality during intense episodes.
Mania can also lead to poor judgment. The person may make decisions without thinking through consequences. Risky behavior may increase. Sexual activity may increase. The person may become very impulsive, doing things quickly, spending, moving, acting, talking—without the usual self-control.
Another sign is increased talking. Some people naturally talk a lot, but in mania the talking becomes more than their baseline. The person talks faster, talks louder, talks more, and sometimes it becomes difficult to interrupt them. It is as if the words are racing out of them.
Racing thoughts can also appear. This is where a person moves from one idea to another quickly. There is no consistency. One thought jumps to the next, and the next, and the next. It becomes hard for them to stay on one topic. And because their thoughts are racing, their concentration becomes poor. Even though they seem energetic, their mind may not be focused.
Another thing that can happen is denial. Sometimes when people around them begin to notice something is wrong, the person in mania may deny it completely. They may insist there is nothing wrong. They may become suspicious of the concern. They may refuse help. That denial can delay treatment and allow the episode to grow.
The second side of bipolar disorder is depression. I have already talked about depression in the previous chapter—persistent sadness, withdrawal, hopelessness, changes in appetite, changes in sleep, loss of energy, and even suicidal thoughts. In bipolar disorder, this depression becomes part of the cycle. The person can move from high mood and high energy into low mood and low energy. That is what makes bipolar disorder difficult. It is not only one direction. It is the movement between extremes.
There is something else that can happen when bipolar disorder becomes severe—psychotic symptoms. When it reaches an extreme, the person can become disconnected from reality. It can look like the person has left the world everyone else is living in. They may talk and behave as if they are in a different reality. I know a person who used to talk about “underground people,” as if he was communicating with people who are not visible. This is what I mean when I say the person is no longer in touch with reality. When this happens, two major experiences can appear: hallucinations and delusions.
Hallucinations are when a person sees or hears things that others cannot see or hear. Some hallucinations are auditory—hearing voices, hearing conversations, hearing sounds. You may find someone speaking as if they are responding to a voice that you cannot hear. Other hallucinations are visual—seeing things that are not visible to normal people. A person may tell you, “I am seeing people coming,” and they may react with fear, even running away, while you cannot see anything. In the past, many people interpreted these experiences as magic or “juju,” because they did not understand mental illness. But what I understand now is that these can be symptoms of a serious mental health episode.
Delusions are different. Delusions are false beliefs—strong beliefs that do not match reality. A person may believe they are being persecuted, that people are planning to harm them, that others are plotting against them. They may believe they have great wealth when they have none. They may believe they are famous when nobody knows them, even in their own village. They may believe they are in love with a powerful person or a celebrity, claiming a relationship that does not exist. They may accuse partners of unfaithfulness without real evidence. These beliefs feel real to the person, even when others see that they are not true. This is why bipolar disorder is serious. It can move beyond mood changes into a place where a person’s relationship with reality is disturbed.
Another thing I must mention is that many people with bipolar disorder struggle with suicidal thinking, especially when the disorder becomes severe. The risk of self-harm and suicide attempts can be high. This is why early treatment and close support matters. It is not something to take lightly.
When it comes to causes, one major factor is heredity. Bipolar disorder can run in families. If a parent has it, the chances increase. If a sibling has it, the chances increase. That does not mean it must happen, but family history matters. There are also biological factors. Bipolar disorder involves disturbances in brain chemicals—chemicals that regulate mood and activity. Mood is affected because of depression. Activity and energy are affected because of mania. So there is a disturbance in the systems that keep a person stable.
Environmental factors also play a role, mainly as triggers. Stressful situations may not create the disorder by themselves, but they can trigger symptoms. Stressful events can bring out manic episodes or depressive episodes. That is why people with bipolar disorder need support not only in medication but also in managing stress.
There is medication for bipolar disorder. There is medication to manage mania. There is medication to manage depression. There is also medication used when psychotic symptoms appear. Treatment is usually long-term, and that is why side effects can also appear over time. When medication is taken for a long period, side effects may emerge, and sometimes those side effects need treatment as well. That is part of the reality of long-term management.
Another thing I believe is important is the role of caregivers and people close to the affected person. Someone living with a person with bipolar disorder should observe patterns. They should notice how the person woke up, how the day went, what symptoms showed up, and how the person’s mood shifted. These observations help mental health specialists adjust treatment. Without that information, it becomes harder to tailor medication properly. Support is not only about being present—it is also about noticing changes and helping the professional team understand what is happening.
This is what I want us to remember: bipolar disorder has hope. It has treatment. It has medication. But early support matters. If you recognize these characteristics in yourself, seek medication early. If you notice them in someone else, encourage them to seek help early—before it becomes extreme. Because when it becomes extreme, it becomes more complicated, and treatment may not work as smoothly as it would have earlier.
