Show me a woman with a real serious shopping compulsion and I'll show you a bipolar woman. If that woman's mother found her life's greatest pleasure shopping, I'll show you the closest genetic link, though there will be many in the lineage of that family. It's probably the most under-diagnosed of the mental illnesses and yet it seems everyone's bipolar these days. It's one of the few genetic illnesses with two genetic markers, which means that if there is one bipolar person in your family, there will be many more, diagnosed or not.
Compulsion (mania and psychosis) and the complete absence of compulsion (depression) are the two poles of bipolar disorder. With compulsion comes boundless energy. The joy of having both energy and the purpose of compulsion feels great and no one in a slightly manic swing will want to come back to earth. The compulsion to shop takes me when I'm transitioning into hypo-mania. That's when I have boundless energy and feel a strong sense of well being and optimism. "Money's like a river; it has to flow. Spend it and more will come." It's the "zen like" place where I have absolute faith that it will all work out and I need those Gucci high heeled boots. It would be great if I used that energy to clean my closet and scrub all the floors since I don't have enough money to quite pay all my medical bills. The impulse to shop, especially shopping without a list (for things I don't really need) should be a signal for me to check in with my therapist and see if I need an appointment with my shrink for a med check. Problem is, it feels so good. Hypo-mania is like the very best drug. This is how life is supposed to feel. I feel charming, but I'm probably a little too intense, a bit too loud for most people. It might be that's when I start thinking that my sex drive isn't dead after all. Another red flag for those with bipolar disorder is an intense and perhaps inappropriate sexual appetite that might lead to disastrous sexual encounters. Yes, encounters with an S. Yes, without protection. Yes, with much younger men. Yes, possibly married younger men. Yes, maybe married to your sister.
A lack of impulse control and a high tolerance for chaotic disorder is a another symptom of someone in the hypo-manic phase of the illness. All these things might seem to you like personality. And yes, there might be a narrow line between being a charming, flirtatious, fast-talking smarty-pants, but then if you have no boundaries at all, and you feel compelled to fuck your sister's husband, you are probably at risk of driving the bullet-train that is your "personality" off the cliff. We can be incredible drama queens. We can be very destructive and self-destructive. But then our lives have probably been quite trying, not to mention embarrassing for our families. As children (if female) we are the ones who get bullied and abused. We may be the family's scapegoat. We might be the child who is sexually abused. And as we grow into our teens we will likely become the ones who cut ourselves so we can feel something, so numbed by stress and psychic pain are we. That's not to say that every child who is bullied at school and abused at home is going to be bipolar. But a high percentage of female bipolar adults had that kind of childhood. We are the vulnerable ones, no matter how brash we may seem.
So what does this have to do with you? Bipolar disorder is under-diagnosed, and if diagnosed, often kept secret. And in the early stages of depression you do feel sick. Depression may begin with a strange fatigue, a headache that won't go away, a low grade fever that lasts for weeks. You ache all over. These symptoms have sent me to the doctor many times, and each time tests have been run and one of the things they check is my thyroid. Before any doctor diagnoses depression other things have to be ruled out. And in the testing phase, they may find a thing or two. I once had a one-time sugar spill in a urine sample. This was so perplexing to my doctor that she had a complete endocrine work up done. I was desperately hoping that it would be an endocrine problem, anything but another depression. But there is nothing wrong with my endocrine system. I do have heart problems, but they have never been mistaken for bipolar symptoms. Depression is serious. It can't be dismissed as just laziness. If you're the only one in your family who's ever been seriously depressed, it might be that other members of your family tend to be a bit on the manic side. If mania is the predominant side of bipolar disorder for those in your gene pool, chances are those folks will never be diagnosed. Because who ever thought dynamism was a bad thing? Those who mostly swing towards mania are energetic, fun in a breathless sort of way, and productive powerhouses. They are often greatly admired. And they can be mean, so woe to the depressive bipolar child who lives in a family of manics, for there will be no sympathy there. We just seem terribly lazy to the rest of our lunatic relatives.
Bipolar disorder can be managed quite well with the right drugs. But finding the right drug might take a bit of trial and error. And once the right drug is found compliance is often a problem. Few bipolar drugs are weight-neutral. I carry forty pounds of drug weight. Zoloft makes me lose weight, but I tend to get a bit manic on it. Wellbutrin can help you quit smoking but made me psychotic. Most bipolar drugs keep me from dreaming, and for me, dreaming is one of life's little miracles. So I'm willing to trade being thin for being able to time-travel in my sleep. For most women the weight gain may make compliance problematic. For men, just admitting that they have a problem that needs medication is astonishing in itself. Men experience bipolar disorder differently than women. Or at least they shop for different things like cars and boats and tools and such. Men may be violent when manic. The high of a manic stage can manifest as aggression for both men and women, but men express their aggression more often with fists, and most bipolar men think having an insatiable sex drive is the ideal anyway so what's the problem there? Inappropriate sex? Are you kidding?
I've been in a lot of group therapy for bipolar disorder and I have never seen a man in any of those groups. And it's not because they were women-only groups. Men don't seek treatment unless repeated incarcerations find them negotiating further jail time for therapy and enforced drug treatment. A lot of men would rather do jail time than admit they have a mental illness and have to take drugs that take the thrill of risky compulsions out of their lives. Because the compulsion for risky sexual behavior is a lot more fun than feeling just normal.
We still live in a time of shame when it comes to mental illness. Many of us just self-medicate to try to feel normal. We smoke cigarettes (which are a mild antidepressant) and drink too much. We smoke pot and drink too much. We do meth so we can have the energy that depression takes away, and drink too much. We will try damn near anything to feel "normal," except take an antidepressant or anti-psychotic that will stigmatize us as crazy and make us gain weight. But remember, along with a high degree of creativity we also have the highest rate of suicide for any illness. It is our leading cause of death before the age of fifty. After that we're the real experts on the illness.