What I Wish the World Knew About Bipolar Disorder

Last week we celebrated World Bipolar Day. This is what I wish the world knew about the diagnosis millions of people like me live with.

Dear Readers,

Last week we celebrated World Bipolar Day.

What do I wish the world knew about bipolar disorder? In short:

1. Bipolar is chronic, not curable.

2. Bipolar can surface in rapid cycles, but is not defined by them.

3. Words matter. Choose them carefully.

4. Bipolar can be a scary superpower.

5. Bipolar can be completely destructive and debilitating.

More on these themes below. Thanks in advance for reading. One request in the spirit of World Bipolar Day: if this post deepened your understanding of bipolar disorder, please forward it with just one person in your life and/or hit “share” on a social media platform.

Happy weekends, all.

Tyler

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World Bipolar Day

According to the organizers:

“The vision of World Bipolar Day (WBD) is to bring world awareness to bipolar disorders and to eliminate social stigma and discrimination. Through international collaboration, the goal of WBD is to bring diverse populations around the world information about bipolar disorders that will educate and improve sensitivity towards the illness, including access to the latest research and the best treatments.”

So, here is a stab at bringing awareness, eliminating stigma, mitigating discrimination, disseminating information, and lifting up research and treatments. Here are five things I wish the world knew about the illness seven million Americans live with.

1. Bipolar is chronic, not curable.

Bipolar disorder is not something you outgrow, overcome, or “beat.” It’s a chronic condition with biological roots that demands lifelong management — not a temporary state to snap out of.

The science is clear: bipolar disorder has genetic and neurological origins. It’s not caused by bad choices or character flaws. Just like your heart or liver can malfunction, so can your brain — and doctors agree that’s what happens with bipolar.

There is no known cure for bipolar disorder. Current treatments — primarily medications — aim to manage symptoms, not eliminate the illness. And the medications themselves often come with heavy tradeoffs: difficult side effects that tempt people to stop taking them, especially during stable moods when the illness feels far away.

But treatment is more than medication. Therapy, meditation, EMDR, journaling, sleep hygiene, social support, and mood tracking all play a role. Still, no combination of those things “fixes” bipolar. At its worst, the disorder can override even the strongest willpower or mental discipline. Sometimes, it’s not mind over matter — it’s matter over mind.

That’s why we need to aim higher. We need research investments not just to manage bipolar, but to cure it. Just like we’ve rallied national efforts to find cures for cancer or HIV/AIDS, we need a moonshot mentality for mental illness. Because seven million Americans deserve more than survival. We deserve hope.

(Image Credit)

2. Bipolar can surface in rapid cycles, but is not defined by them.

“Rapid cycling” in bipolar disorder patients refers to periods of time — days, weeks, months — in which diagnosed individuals quickly toggle back and forth between states of hypo-mania and depression. This is indeed part of what defines the illness; yet, this type of experience is not the full definition of bipolar disorder.

What is much more common in bipolar disorder is that there are long periods — several months and sometimes years — in which people experience prolonged periods of hypo-mania, mania or depression. These experiences can often follow each other: long periods of depression are common after manic episodes.

Some of that is jargon. Let’s break it down:

• “Mania” refers to a severe psychiatric break from reality marked by symptoms like: threatening to kill yourself or others; excessive gambling and irresponsible financial decisions; sleeping very little, if at all; hallucinations.

• “Hypo-mania” refers to less severe symptoms like having more energy than useful, having racing thoughts, increased sex drive, or experiencing paranoia.

• “Depression” symptoms include feeling sad, fatigued, hopeless, worthless, distractable, and more.

• People with “Bipolar I” (like me) experience all three. People with “Bipolar II” experience hypo-mania and depression. See “Bipolar 101” for more information on this illness.

It is a misunderstanding that bipolar disorder is defined by rapidly cycling through these states. That certainly can happen, and it does. Yet there are many people who experience these symptoms for significant periods of time. And, very importantly there are periods of time — often months, years, or even decades — when people with bipolar disorder do not experience these symptoms more or less than someone without the disorder.

As it relates to my personal experience: I did not know I had bipolar disorder in 2019 when I had my first manic episode. That episode was followed by a nearly year long depression. Then, I had a period of about three years without any significant mood challenges, including no experiences of rapid cycling. Following my 2023 manic episode I also experienced depression — but only after a period of rapid cycling following my hospitalization. My depression was shorter and more manageable, and I’m proud to say my mood has been stable since mid-2023. See “Advocacy as an Outlet for Anger” for more about my lived experiences.

3. Words matter. Choose them carefully.

How we describe ourselves and those in our lives matters a lot. And, the words we use in non-medical contexts can have a negative impact on people with illnesses — including by contributing to misunderstanding. Let me illustrate.

• Tyler is bipolar vs. Tyler has bipolar disorder. Would you ever say “Tyler is cancer,” “Tyler is diabetes,” or “Tyler is the flu”? Of course not.

  • When friends, family, colleagues, and strangers use language like this to describe someone with my illness, the impact is that our illness becomes our identity. “Tyler is Bipolar” is like saying “Tyler is confident” or “Tyler is annoying.”

  • This type of framing also matters in explaining psychotic events. If a family member explains away my behavior by saying “Tyler is bipolar” vs. “Tyler has bipolar disorder” the implied blame shifts from a behavioral flaw to a physiological problem with an organ in my body.

  • This language matters in how I (and others) describe ourselves, too. I always say: “I have bipolar disorder,” or “I am diagnosed with bipolar;” never: “I am bipolar.”

  • If you wouldn’t joke about cancer, don’t joke about bipolar or any other mental illness.
    

• “Bipolar” in colloquial senses. Have you ever heard the phrases “The weather is bipolar today?” or “He’s a maniac.” Or sentences like ““My boss is totally bipolar — he loves my work one minute and hates it the next” or “He’s in one of his manic phases again.” . At best, these colloquial phrases and mentions of bipolar disorder contribute to misunderstanding of an illness impacting seven million Americans. At worst, they make millions of people with the disorder feel ashamed of an illness they did not choose.

  • And, politicians can contribute to this misunderstanding. U.S. Senator and Democrat Elissa Stolkin, for example, tweeted this “graph” with medical terms to describe bipolar disorder as an analogy for a football game that went back and forth between two teams. Don’t follow this bad example; it may seem harmless, but it’s stigmatizing and misleading.

    

• Mental health language. Zoom out from bipolar.

  • Consider phrases like “She’s a psycho;” “That’s psychotic;” “He’s insane;” or “They must be off their meds”

  • All of these phrases invoke terms that were medical before they were colloquial: “psychotic” , “psychiatry”, “medication” , "insanity" are medical terms that are used by professionals today to treat mental illness.

  • When we weaponize them against people we do not understand or are upset by, we involuntarily contribute to stigmatizing mental illness.

  • The intellectual disability movement invested blood, sweat, and tears for decades to eliminate the R word from our vocabulary. Along the way, they increased awareness and understanding of people with disAbilities.

  • It’s time for a similar public campaign to change the way Americans talk about mental illness as a strategy to build political power, raise philanthropic resources, and motivate people to take action.

  • President Trump can lead on this issue, or he can keep fueling the fire. His constant tropes and lies about people who have spent time in “mental institutions” must stop. Full stop.

4. Bipolar can be a scary superpower.

Bipolar disorder can be harnessed by creators, entrepreneurs, and leaders to do a significant amount of good for the world, their networks, and themselves. This is very complicated.

Periods of “hypo-mania” can create an uncommon drive or motor in people. This phase of the illness can lead to flights of ideas, many of which can be quite thoughtful and out of the box. People experiencing hypo-mania may be motivated to meet new people, start new initiatives, and push themselves.

An estimated 2.7% of the American population has bipolar disorder. Studies have found that:

• 11% of entrepreneurs have bipolar disorder (four times higher!).

• 8.2% of artists are diagnosed with bipolar (three times higher!).

• 30% of writers have bipolar I (eleven times higher!)

Famous people from history were or have been posthumously diagnosed with bipolar including: Vincent van Gogh, President Theodore Roosevelt, Earnest Hemingway, Frank Sinatra, Prime Minister Winston Churchill, U.S. Representative Patrick Kenndy, Jr. and Kurt Cobain. Modern household names are, too. The long list of successful people living with bipolar includes: musicians Mariah Carey, Ye (Kanye West) and Selena Gomez; actors Demi Lovato, Russell Brand, and Catherine Zeta-Jones; entrepreneurs Ted Turner and Andy Dunn; and athletes Metta World Peace (Ron Artest), John Daly, Delonte West, Johnny Manziel, Darryl Strawberry, and David Feherty.

From these individuals, I simply can’t recommend three stories more: Andy Dunn’s “Burn Rate: Launching a Startup and Losing my Mind” is the bipolar memoir that spoke to me the most, as our stories have similar components. The “My Mind & Me” Apple Documentary on Selena Gomez is so, so, incredible. Her song and music video of the same name offers a powerful glimpse in just 3 minutes, too. Rep. Patrick Kennedy’s “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction” reminds the reader that mental illness impacts everyone — including members of America’s most famous political family.

The bipolar “superpower” that comes with hypo-mania is a very dangerous one. It can be super destructive, too. When hypo-mania turns into mania, life changes fast. And, hypo-mania can be severely problematic, too: it is not a superpower alone.

This is a part of bipolar disorder I have struggled with significantly. Every high achiever with bipolar must grapple with:

• When is it time to stop “riding” hypo-mania and make major interventions to stop the worst of the illness?

• And, even more challenging: when you have periods of energy, entrepreneurship, and excitement in your life, is that because of bipolar or because that is who you are? Because you are a person who seeks to do good? Because you are a person who is motivated?
  
  It is never possible to know. There’s no diagnostic trick to know if periods of productivity are because of bipolar or because of the skills, experiences, and motivations you have picked up throughout your life.

That leads to my final point.

5. Bipolar can be completely debilitating and destructive.

Each of my manic episodes that landed me in psychiatric hospitals were marked by months of increasing hypo-mania. I wrote long memos and white papers at work, met new friends, deepened existing relationships, came up with ideas for new projects (including writing a Substack about my experience), and more. Those periods of “highs” that felt good quickly turned into psychotic behavior that was very scary for myself and my loved ones.

Putting aside the relationship between bouts of energy and their relationship to manic episodes, bipolar disorder can be debilitating in many other ways — because of all the symptoms involved and how hard it is to manage.

• 80% of people with bipolar disorder are unemployed, according to an NIH study of nearly 10,000 individuals.

• $45 Billion was one estimate of the total societal cost of the disorder. And that figure is from 1991 — in the U.S. alone.

• 40-60% of individuals with bipolar disorder experience substance abuse disorder, and more than half people with Bipolar Disorder have alcohol abuse disorder. Those rates are significantly higher than the general population at 9% and 10%, respectively.

  • They are also more likely to have type two diabetes, metabolic syndrome, cardiovascular disease, and migraines.

• 50% or more of people with bipolar disorder attempt suicide and 15-20% die by suicide.

  • Among all deaths, one percent are suicides. That is way too many!

  • At the same time, people with bipolar are 15-20 time more likely to die by suicide than the general population. Someone with bipolar disorder has a 1 in 5 chance chance of dying by suicide.

  • Of those with bipolar committing suicide most are receiving no treatment. It is a misunderstanding that most suicides happen during acute crises (though they are prevalent). Being in treatment for bipolar disorder reduces suicide rates five times over.

Those are data points. Stories matter, too. There is tragedy every day, impacting people with lots of clout, resources, and visibility and those who are proceeding through everyday life — sometimes with the deep support of friends and family, and often with no one in their corner.

As a sports guy diagnosed with bipolar disorder, I interpret the actions of top athletes like John Daly, Daryl Strawberry (#LFGM), and Johnny Manziel differently. As a big fan of President Theodore Roosevelt, his crusade to run as a third party presidential candidate makes more sense.

As WebMD reports on some celebrities with bipolar:

• Russel Brand has co-occurring substance abuse disorder.

• Brian Wilson’s “bipolar disorder, which he'd learn about years later, left him physically and emotionally unable to compose or tour for decades.”

• “Despite success as the leader of Seattle’s grunge rock movement, [Nirvana’s Kurt] Cobain struggled with depression and committed suicide at age 27 in 1994.

• Jimi Hendrix “got expelled from high school, once stole a car, and lasted just a year in the Army after his commanding officers suggested an early discharge. He later wrote a song called ‘Manic Depression,’ which described his trouble with mood swings.”

The nearly seven million Americans and many more millions living with bipolar disorder all around the world have tragedies like this every day. Thousands of people with bipolar disorder will die of suicide this year; millions will struggle with co-occuring substance abuse disorders; a super-majority will be out of the workforce, making it very hard to access the health insurance they need to receive proper care.

Bottom Line

As World Bipolar Day comes and goes, I am both an optimist and a pessimist. I am optimistic because we are learning more about my diagnosis every day and conversations about mental health are destigmatizing a tough topic. At the same time, I am attentive to the fact that the most important indicators of mental wellness are trending in the wrong direction: suicide and anxiety rates are going up, loneliness and depression are becoming more common year after year, and much too easy to access hard substances are being abused more frequently than ever. I wrote about this paradox recently, with a deep dive on why we’re in a mental health crisis.

While we still have velocity in the wrong direction, we are no longer accelerating. So, I’m more optimistic than pessimistic. The tide is turning.

And, I’m grateful for all my readers, especially those who forward this along in the spirit of advancing understanding of bipolar disorder in the spirit of World Bipolar Day :)