Tell that to me when I’m on a roll and soon heads will.
The human mind is a complex beast. Our understanding of it is minimal and usually when the neurologists says they understand something what they really mean is that that they can measure something against a hypothesis. It’s not often that science is able to answer why something is observed in one population over another.
We know the what and how of Bipolar disorder, but the why is sketchy at best and more often than not an educated guesses. The DSM tries to isolate those whats and hows of the disorder. Two of the criteria in the diagnostic application of the DSM-V for both Bipolar I and II are:
3. More talkative than usual or pressure to keep talking
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
4. Flight of ideas or subjective experience that thoughts are racing.
Once more we find that the criteria are subjective. How much more talkative is more than usual? How many ideas are enough to be concerned? Are racing thoughts not merely an expression of passion? It’s standing right there in criterion four – “subjective experience”.
Signs
So, I’ll share a recent interaction I had that, subjectively, satisfies both criteria.
The triggering event for me to become conscious of the symptoms of looming hypomania was expressed as a simple observation of my speech. We were constructing a database design in a Teams call. As the call progressed it was necessary to count the columns such that each column had a matching field. There were five columns.
“One. Two. Four. Five. They’re all there.” I said. To be sure, we doubled checked the count: “One. Two. Four. Five. Told you!” We moved on to more exciting things after setting this up, only to discover later we’d misspelled a field in the table so had to go back, fix it and recount, “One. Two. Four. OK we’re good.”.
My colleague interjected, “Do you know you’ve skipped saying the number three every time we’ve checked this table?” I thought nothing of it for the rest of the call. As is typical for the impending brush with hypo-mania, I went back to fiddle on the application, totally locked on to finish it.”
The table resurfaced. As did the memory of my colleagues random interjection. Now intrigued, I went back to recording and ‘s true as nuts I’d missed saying out aloud the number three, three times. All at once it dawned on me that I was heading for some brand of hypomania – two of the symptoms were ticked off the list (and it was full-moon, just saying).
By now ya’ll know I try to understand. By ‘understand’ I mean make assumptions based on arbitrary research of the science. So, one sciency tool for measuring “more talkative than usual or pressure to keep talking” is Verbal Fluency Performance. Very posh.
Sciency Things
The performance is measured using standardised tests published by some very clever people in publications hiding behind paywalls… but I digress.
A few of the indicators for poor verbal fluency are: switching subjects in rapid succession (one study said rapid was between 3 and 5 minutes), distractability, over-activation (I haven’t found a definitive definition here. Best guess is overactivation is that “locked on” feeling to a specific task), verbosity and clang associations (a pattern of speech that joins like-sounding, often rhyming, words together – sometimes unrelated to the conversation).
Browsing through articles marked ‘Free’ on Google Scholar seem to agree: Bipolar II, more often than Bipolar I, have reduced verbal fluency performance. Across the board though is the finding that reduced verbal fluency is most apparent during a hypo-manic episode (as determined by the DSM-V).
Subjectively
I can confirm that all of the following are a feature of pretty much all my hypo-manic episodes. For some reason “clanging” seems to be a predominant indicator of a current or looming episode – with an interesting twist. It’s not so much rhyming words but rather concepts or subject associations, such as naming all alternative words for a concept, or rapidly rattling off all the associated tasks matching the one at hand.
And I’m not alone, isolated, an outlier… sorry, getting back to it. A thorough study in Scientific Reports, and published on Nature.com, found similar indications in so-far-as ‘concept clustering’ was more prevalent in the hypo-manic sample as opposed to their zen and depressed counterparts and, importantly, the sample of non-bipolar folk. Cool, right?
Summing up
So, why care? The long and short of it is that knowing the signs of a current or impending manic or hypo-manic episode helps one prepare and consciously action a strategy to mitigate the crap elements of the episode.
In my case it was militant timing of my evening meds, getting to sleep on time and using the Pomodoro technique to escape the clutches of getting locked on to something and keeping at it until 3 in the morning. Full disclosure the last of those was frequently flouted…
So yeah, know the signs, take action, and take your damn pills!
Slippery snakes win a fizzer when they see it.
