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project on the Beatles, and by the end of the term you thought you were one of the Beatles. Maybe you were trying to find a girlfriend, and at the end of a futile year of looking you were trying to die. Maybe you were having a perfectly happy summer that turned into an ecstatic summer or a winter sadness that never lifted when spring came. The sun was shining, cars were honking, the radio was playing something catchy. You were toasting a bagel, playing Xbox, talking to your best friend about the afterlife, or tuning your guitar.

      Then the mothership landed.

      You were diagnosed with bipolar disorder. This big whale of a diagnosis slid over the sun, and your world was suddenly held hostage. A hatch slid open and out came doctors, psychiatrists, pills, hospitals, and self-help books. They strapped you to a gurney and scrawled “bipolar” on your chest in permanent marker. “I'm not bipolar!” you shouted, struggling in your restraints. “She's bipolar! He's bipolar! Anyone but me!” They gave you two Depakote and a glass of water. “Misdiagnosed!” you snarled, gulping it down.

      Eventually, the mothership flew away, but left its cargo behind. Medication, doctors, and bipolar were here to stay. You picked your way out of the rubble, the last one standing after an earth-shattering encounter. You're alive, but now you have bipolar. Your ray gun is strapped to your side; your freshly acquired jar of anti- psychotics and mood stabilizers is on your other hip. You step out of the doctor's office.

      WHAT JUST HAPPENED?

      Dealing with a bipolar diagnosis can be just as hard as the unfettered depressive or manic episodes that led up to it. It's like you've been hit by a truck, only to be told at the scene of the accident that you're going to be hit by several more trucks of steadily increasing size over the course of your life (have fun with that). For a while, it's hard to think about anything else but the fact that you're screwy enough to be considered mentally ill, and especially hard to accept a diagnosis of mental illness if you've always considered yourself a happy, healthy person. The diagnosis looms over your life, and you just want to rewind to a time before it happened. Can anything be the same again? How did they even decide I was bipolar?

      Being told you have a serious mental illness is a colossal mind fuck. What does “bipolar” even mean? And what does it really say about who you are? This chapter is about understanding what the people in white coats were thinking when they made the diagnosis. Even if you hate everything to do with jargon and psychiatry and labels like “bipolar,” you should know this stuff so you understand what (and who) you're dealing with'because, after all, there's a good chance you are going to be dealing with it for the rest of your life.

      BIPOLAR? SAYS WHO?

      Your doctor didn't just look at you and decide you had a bipolar face. Unfortunately, there's no blood test for bipolar disorder, but there are fairly rigorous guides in place to reduce the odds of being misdiagnosed (though people get misdiagnosed all the time). Doctors try to avoid a misdiagnosis by ruling out all the other possible causes of your symptoms before making a diagnosis of bipolar.

      There are four things a psychiatrist takes into account before making a diagnosis of bipolar disorder: your current symptoms, your medical history, your family history, and your psychiatric history. Doctors see hundreds and hundreds of people and know what to look for. They look for patterns (“Wow, that guy talks in a constant stream without any pauses, and he hasn't slept for a week. And his uncle is bipolar, and he's taken four jobs”) that are consistent with bipolar. You, of course, are a beautiful and unique snowflake, but like it or not, there are a number of classic behaviors and indicators (big and small) that people experiencing mania, hypomania, or depression in our culture tend to present. Quibble over details all you like, but if the shoe fits in five places, they're sticking that sucker on your foot. P.S. Hope you like Velcro.

      THINGS THAT GO INTO A BIPOLAR DIAGNOSIS

      1. CURRENT SYMPTOMS

      Do you seem depressed or manic? Have you mentioned being unable to sleep, unable to think straight, or crying all the time? Are you talking fast? Of course, you may feel that you are acting normally, but it's very hard to reflect accurately on yourself. Over time, a psychiatrist will be able to compare your “manic” or “depressed” behaviors to your “baseline.” (For example, the psychiatrist might figure out that you just always talk fast. It's just who you are, no big deal.) But for a first diagnosis, the only thing they can really compare you to is the general population.

      2. MEDICAL HISTORY

      Do you have another disease, like epilepsy or diabetes, that might be causing your symptoms? Are you on crack? Pregnant? Have a brain tumor? Or are you just hungry? Many medical conditions share symptoms with bipolar. You want to rule these out as possible causes before deciding the diagnosis is bipolar.

      3. FAMILY HISTORY

      It's taken as a given that your uncle Bernie is off his rocker, but has anyone else in your family been diagnosed with a mental illness? Have any of your relatives been hospitalized for depression, mania, or psychosis? Anyone receiving counseling or taking meds for a psychiatric disorder? Bipolar has a strong genetic component, and bipolar in the family can predict bipolar in you.

      4. PSYCHIATRIC HISTORY

      Did you get diagnosed with unipolar depression three months ago, and now you have so much energy you can't sleep? Have you ever been diagnosed with another psychiatric disorder? The doctor will want to rule out unipolar depression, schizophrenia, and other possible psychiatric causes for your symptoms. The doctor might ask you to draw a “mood chart” of the past twelve months or several years. (I know, he's lame, but he can probably help nonetheless.)

      “BIPOLAR” IS A WORD FOR A PATTERN

      You didn't get diagnosed with bipolar because you're ugly or because the doctor doesn't like you. Let's face it—he's uglier, and his personality needs improving. You got diagnosed bipolar because your symptoms more or less fall into a common, distinct pattern, observed in millions of people. We're currently calling that pattern “bipolar” and treating it with pharmaceuticals and talk therapy. In the past, the same pattern has been called by a different name (hello, “hysteria”) and treated by different means (like lots of cold showers). In the future, it will undoubtedly be called something else entirely and treated with mind melding and cosmic nanoprobes. In other cultures, what we call “bipolar” has other names and other symptoms and explanations entirely.

      Psychiatric illnesses aren't like herpes. You can say, “You have a cold sore, therefore you have oral herpes,” but you can't say, “You have insomnia, therefore you are bipolar.” Insomnia can be explained by a hundred different reasons; cold sores are always due to herpes.

      A bipolar diagnosis doesn't extract something hidden in you and reveal it (“All along she was a mutant!”); it merely describes what's already there (“Ah, these symptoms are part of the bipolar pattern.”). Being diagnosed bipolar doesn't change you and make you into something you weren't before; it just says, “Hey, you're a person who could probably benefit from taking mood stabilizers!”

      Thinking of your diagnosis this way is much less painful than thinking of it as a life sentence or a siege on your identity. No matter what the psychiatric community wants to call it, you're still you—whether you have bipolar, hysteria, a wandering womb, or just plain sand madness. Everybody else changes their mind about what to call it, so there's no reason why you can't too. Don't think “bipolar” is an accurate description of your experience? How about Chronic Sleep Taxationitis or Acute Porn Star Overidentification Syndrome? No matter what you call it, no matter how you think about it, no matter how you treat it, you're a person—not a collection of symptoms or an entry in the DSM-IV (the hefty diagnostic manual produced by the American Psychiatric Association that you've probably seen lurking under your psychiatrist's desk). Nothing can change that. Don't dwell on whether or not “bipolar” is the perfect

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