Welcome to the Jungle - Hilary T. Smith

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and “psychotic,” its accompanying adjective, are some of the most misused mental-health words out there. First of all, antipsychotics are commonly used for reasons other than psychosis (such as sleep and mood stability), so don't be freaked out if you get prescribed an antipsychotic if you've never been psychotic. Secondly, being psychotic is a totally different thing from being a psychopath. “Psychopathy” means the tendency towards violent, antisocial behavior. Psychosis is when you have delusional beliefs and hallucinations; it can range from experiencing a completely different reality from other people and having no insight, to experiencing voices and visual hallucinations and having some insight into the fact that this experience is not being shared by people around you. Psychosis is on a continuum: some experiences are very close to “normal” reality and some are quite far away.

      HALLUCINATIONS

      Hallucinations can be auditory, visual, tactile, or even olfactory. You might see people who aren't really there or hear voices giving you commands. Hallucinations can be more or less scary, and they can also be caused by lack of sleep. Like the other aspects of psychosis, hallucinations are on the spectrum of normal human experience and can range from interesting to terrifying and dangerous.

      DELUSIONS

      Delusions are tricky, because there is such a fine line in our society between which beliefs are considered acceptable and which are considered insane. For example, millions of people hold the same “perfectly normal” religious beliefs that would be considered bizarre and outlandish if they were held by a single person. The DSM-IV defines a delusion as “a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture.” A good example of a delusion is the belief that you're being help captive by kidnappers, when really the “kidnappers” are your stoner roommates who wouldn't even notice if you left the house. If you're delusional, it can be hard to believe friends who tell you your delusions are false. You might believe they're lying, thereby interpreting their comments in a way that confirms your version of reality.

      THOUGHT DISORDER

      Thought disorder is easiest to identify in a person's speech or writing. It's characterized by a person not making sense from one sentence to the next or making associations that don't make sense to anyone else. For example: “The plane left the airport at three o'clock, and therefore the daisies in the bowl were put there by the dragon.”

      LACK OF INSIGHT

      In psychiatry, insight means the ability to recognize when your behavior and thought patterns are coming from your mental illness as opposed to your regular self. For example: “I realize that the voices in my head aren't coming from real people, even though it really feels like they are.”

      Insight can vary drastically in psychotic episodes. A person experiencing a full-blown episode of psychosis may not realize that the person sitting next to them on the bus can't also see that the bus is being driven by the Hindu deity Ganesh. Another person experiencing psychosis might slip in and out of insight, alternately realizing that their reality isn't shared and believing that it is. A third person might be aware the whole time that nobody else can see what they're seeing.

      In some cultures, what we call psychosis is associated with shamanism and celebrated as a connection with the underworld. I'm just sayin'.

      Like with any other aspect of bipolar disorder, the boundaries of what we call psychosis are not firmly defined; what matters most is not how your experience is categorized by the DSM-IV, but whether it's having a positive or destructive effect on your life. For example, a lucky person with a great amount of insight, self-discipline, and support from friends and family might be able to treat psychosis as a spiritual experience. For a person who has no support system, no insight, and a comorbidity like substance abuse, psychosis might just be a hellish experience.

      OTHER ASPECTS OF BIPOLAR DISORDER

      RAPID CYCLING

      Rapid cycling means having four or more episodes of mania or depression within a twelve-month period. Rapid cyclers may also have more frequent changes of mood within a week, day, hour, or even minute; the ups and downs are accelerated, and therefore harder to treat. But here's the good news: rapid cycling is not a life sentence. Factors such as drug use and lifestyle can fuel the accelerated cycle of episodes, and a change in lifestyle can significantly slow down the cycles.

      MIXED STATES

      A mixed state is like a delicious sundae made with both caramel sauce and cod liver oil, served on a tantalizing waffle cone of rage. A mixed state is the term for when you experience both manic and depressive symptoms at the same time for at least a week. They generally fall into two categories: dysphoric mania and agitated depression'yin and yang. The former is mania accompanied by things like anger and thoughts of suicide, and the latter is depression with symptoms of hypomania. Not as much is known about mixed states as about vanilla mania or depression, and many people's real experiences of mixed episodes don't meet the diagnostic criteria. Like rapid cycling, this is one of those gray areas that will probably see its definition tweaked a lot over the next hundred years.

      CYCLOTHYMIA

      Cyclothymia, sometimes referred to as “bipolar lite,” is when you have normal moods interspersed with periods of dysthymia (depression too mild too qualify as major depression) and periods of hypomanic symptoms.

      “Hey, that sounds like everyone I know. Does the whole world have cyclothymia?”

      Not quite. The DSM-IV specifies that the symptoms must “cause the patient clinically significant distress or impair work, social, or personal functioning.” Furthermore, the euphoric highs and depressive lows in cyclothymia are not in response to life events, but come about for no apparent reason—at least one episode every two months. Cyclothymia sometimes develops into bipolar disorder and, like bipolar disorder, is genetic.

      LAST THOUGHTS ON THIS STUFF

      Remember, the DSM-IV is a tool for categorizing mental illness—not the singular and definitive description of your personal experience. You're a person, not a set of symptoms. When reading this book or any book about bipolar disorder, a “take the best, leave the rest” attitude is in order. Categories and definitions are a lot of cultural flotsam and jetsam that will change with time. The important thing is for you to feel happy, healthy, and cool, no matter what your “diagnosis” is or how the world wants to understand it.

      So if any of this technical diagnostic stuff sounds like bullshit to you, just move on down the chapters.

      THAT'S SO BIPOLAR: CINDY SHMOE'S GUIDE TO HOW EVERYONE IS, LIKE, SO BIPOLAR

      1 OK, so my manager at Tatlow's is, like, so bipolar. One day she's totally nice to me, and the next day she's like, “Why did you dump a pitcher of beer on that guy's head?”

      2 Shakespeare prof? Completely bipolar. In class, he's all really energetic and bouncy, and then when I went to pick up my brilliant essay I wrote about how Lady Macbeth is really hearing voices from Joseph Stalin, he acted all sad and depressed.

      3 My boyfriend is, like, the most bipolar person I know. When we're out at the club dancing, he looks like he's having such a good time. Then suddenly he gets all mad, and he's like, “Did you just steal my credit card and buy six bottles of hundred-year-old champagne?” And I'm, like, “Obviously.”

      4 The crazy neighbor lady is such a sad case. I really

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