The Marriage Plot

Content Warning: This section of the guide includes discussion of mental illness.

Bipolar disorder is a neurological condition considered a mental illness that involves extreme mood differences. Individuals with this condition experience bouts of serious depression followed by periods of euphoria, elatedness, and bursts of physical and mental energy. Initially termed “manic depression” or “manic disorder,” bipolar can be a dangerous condition it not treated. Its depressive periods can lead to substance use, suicide, or other self-harm. By the same token, the patient can suffer hallucinations or delusions. Both depressed and manic states can have physical symptoms and can interfere with daily tasks or social functioning (“Bipolar Disorder.” National Institute of Mental Health, Dec. 2024).

There is no single, exact cause of bipolar disorder, but scientists have identified several factors that are at play in a person’s development of the condition. These include genetic factors—a person is more likely to have bipolar disorder if they have a parent with the diagnosis. Certain brain features have also been identified as being unique in people with bipolar disorder, such as differences in brain size and brain function. Finally, some scientists point to evidence that severe trauma or a traumatic event may contribute to bipolar disorder manifesting itself. Bipolar disorder sometimes presents itself in adolescence or teenage years, but the average age of onset is 25.

Symptoms of the condition vary, but its distinguishing feature is its bouts of mania:

Hypomania can be deceptive; it is often experienced as a surge in energy that can feel good and even enhance productivity and creativity. As a result, a person experiencing it may deny that anything is wrong. There is great variability in manic symptoms, but features may include increased energy, activity, and restlessness; euphoric mood and extreme optimism; extreme irritability; racing thoughts, unusually fast speech, or thoughts that jump from one idea to another; distractibility and lack of concentration; decreased need for sleep; an unrealistic belief in one’s abilities and ideas; poor judgment; reckless behavior including spending sprees and dangerous driving, or risky and increased sexual drive; provocative, intrusive, or aggressive behavior; and denial that anything is wrong (“Bipolar Disorder.” Psychology Today).

Presently, bipolar disorder is categorized according to four types: Bipolar I is characterized by its mania. A patient who is diagnosed with it has experienced at least one full manic episode lasting at least seven days. A person with bipolar I may never experience bouts of depression, though this tends to be rare. In bipolar II, a patient experiences fluctuations between highs and lows, but without the extensive, complete episodes of mania characteristic of bipolar I. Bipolar II is considered a subset of bipolar I. With the third category—cyclothymic disorder or cyclothymia—a person experiences an unstable mood for at least two years, consistently. One’s mood may “normalize,” but only rarely, and these normal periods last less than two months. Finally, people who fit the fourth category are those who do not fit into the other three but have had some experience of elevated mood or mania. Because hallucinations or extreme paranoia can accompany intense manic states, bipolar disorder can be misdiagnosed as schizophrenia. It can also be misdiagnosed as attention-deficit/hyperactivity disorder or borderline personality disorder.

Bipolar disorder cannot be cured, but it can be treated and managed. Cognitive behavioral therapy in combination with education about the condition can help a person recognize symptoms and warning signs. These are often used in conjunction with medications, such as mood stabilizers and antipsychotic drugs (“Bipolar Disorder.” National Alliance on Mental Illness, Aug. 2017).