Dialogue Responses

"Don't look at me like that."

"I can't help it."

"Simply impossible."

"Just don't look back."

"I'm not looking at you."

"Then stop being so cute."

"How am I looking at you?"

"Why? Does it bother you?"

"Can't take my eyes off of you."

"Sorry, but it will happen again."

"How would you like me to look at you?"

All the Dialogue Responses can be found here.

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Writing Research Notes: Bipolar Disorder

I was diagnosed with bipolar disorder at age 19 and had a psychotic episode at age 21, so I'd like to say I know a bit about what I'm talking about. And I'm a writer! So today, I'd like to provide some facts about bipolar as a jumping-off point for your research.

Things we'll discuss:

A note of caution

Types of bipolar disorder

Phases of bipolar

Warning signs of mania

Symptoms of mania

Symptoms of psychosis

How bipolar is treated

Common myths about bipolar

Characterizations to avoid regarding bipolar

How to create an authentic bipolar character

This is just my opinion as someone who has lived with bipolar for a long time. Everyone experiences bipolar a bit differently, so not everything I mention will apply to everyone, and my own story may not reflect every single bipolar person. With that disclaimer, let's go.

A Note of Caution

This is a guide to help people who want to write about bipolar. It should NOT be used for self-diagnosis or to diagnose anyone else.

If you think you have bipolar, you need to speak to a professional as soon as possible. Bipolar disorder is not a cute quirky accessory. Both mania and depression literally cause brain damage, as I've discussed in my post about the Myth of the Martyr-Artist.

This is not something to play around with or to use to build street cred or whatever. It is a serious, severe mental health condition that causes untold hardship for sufferers, including increased risk of suicide, homelessness, addiction, and even dementia.

So please don't read this and go "oh I probably have bipolar lol." If you do read through this and go "oh shit this sounds like me," then get thyself to a physician as soon as possible and go through a real, actual, professional screening.

Alright, anyway, let's get into it.

Types of Bipolar Disorder

Bipolar is typically separated into two types. What kind you have depends on your predisposition to either extreme: mania or depression.

Bipolar 1

People with Bipolar 1 tend to have more severe manic episodes and less severe depressive episodes. They are more predisposed to experience psychotic episodes, though psychosis can happen in Bipolar 2 as well. Bipolar 1 patients may only have very brief depressive episodes or they may only experience their "baseline" and mania. (As an aside, I have Bipolar 1.)

Bipolar 2

People with Bipolar 2 lean more toward depressive episodes. They may experience hypomania, which is a less severe form of mania, but their primary symptom will be depression.

It's important to note that while many say Bipolar 1 is more severe because of the manic episodes and risk of psychosis, this does not discount the extreme suffering that can result from Bipolar 2. Patients with Bipolar 2 have just as many struggles as Bipolar 1 patients.

Phases of Bipolar

Depression

This works much the same as the typical depression that people with Major Depressive Disorder experience, but bipolar patients may be more agitated, self-destructive, and aggressive when depressed.

Hypomania

This is the "less severe" version of mania. In the chart above, it's demonstrated by DIG-FAST: distractibility, impulsivity, grandiosity, flight of ideas, activity increases, sleeplessness, and talkativeness. These happen in full mania too, but to a greater extent.

Many people with Bipolar 2 welcome hypomania because, well, it feels a lot better than the depression they are usually stuck with. However, it's important to note that hypomania, like mania, can cause brain damage. It's not something to screw around with.

Mania

A more severe, destructive version of hypomania: everything is dialed up to 11. People may become hypersexual, spend money they don't have, destroy relationships, make inappropriate comments at work, or even fly into destructive rages.

Mania can be terrifying, both for the sufferer and for those around them. You can be so extremely happy that it's almost painful, or so angry that you feel like you're going to tear your own skin off.

Psychosis

This typically is the "end result" of mania which happens to about 50% of people experiencing a manic episode. It is typified by delusions and hallucinations. We'll discuss these a bit more later.

Contrary to popular belief, psychotic hallucinations are typically auditory, not visual, though visual hallucinations can occur as well. Other strange and less common hallucinations include olfactory (smelling things that aren't there), gustatory (tasting things that aren't there), or sensory (feeling people touching you).

Euthymia

This is the normal, calm state in between depressive and manic episodes, where one has a sense of well-being and stability. It is the goal of therapy and medication management.

However, experiencing euthymia doesn't mean that the bipolar disorder is gone: it just means that it is in remission. Bipolar patients must always be on alert for warning signs of mania and be active participants in their own care.

Warning Signs of Mania

Manic episodes often come with prodomes, symptoms that appear before full-blown mania.

Bipolar patients and their families should be on alert for these warning signs and, if they continue to occur for more than a week or so, schedule an appointment with the patient's psychiatrist to see if they need a higher medication dosage.

Here are some common signs that happen before full-blown mania:

Feeling either really great or really terrible for no reason. Sometimes you can feel really great and really terrible at the same time. It's a very weird feeling.

Functioning well on little sleep for days on end. Not just one sleepless night, but being able to go to work and function on like 4 hours of sleep night after night.

Increased or decreased appetite. Either you hate food or it's the most important thing in your life. Can fluctuate day by day.

Increased productivity. You're getting soooo much done and so quickly! (It probably sucks but we'll put that aside for now.) You just want to work on your passion projects constantly.

Sudden interest in multiple new hobbies all at once, and throwing yourself into them with such passion that it's scary.

Weird physical symptoms. You may find yourself locked into a position and not want to move, or your skin may feel odd, like it's too tight or prickly.

Sudden bouts of tinnitus. It sounds really weird, but it's been proven to be a sign of impending mania along with the skin symptoms I mentioned before.

Your eyes look different. Your pupils are always dilated.

Not everyone will get all of these, but most people will have at least one trigger that happens to them every time before a manic episode. For me, it was hypergraphia (because of course it was).

Symptoms of Mania

Not all of these symptoms will happen to everyone, and every manic episode can be a little different. It all really depends on who you are. Now, I must say that anyone, bipolar or not, can have these symptoms. It is the intensity of them that defines mania. A manic episode can ruin your life because you just get. so. extreme. about whatever it is.

Becoming extremely focused on random things and projects. For me, it was cleaning the house: I started throwing out old photos that I thought we didn't need because I didn't want any clutter. I would sweep the floor for hours at a time. Sudden and intense interest in random subjects. I got really obsessed with Neolithic Scotland of all things. Now I can't even remember half the shit I learned. Spending way too much money. Many people will go into extreme debt because of their mania, especially if they don't have family support. I spent like $300 on a kitchen knife set despite having a full set of perfectly serviceable kitchen knives. I also bought a professional-grate ukulele that I very much could not afford and very much did not need. Worsening of any addictions or developing new addictions. Especially seen in gambling addictions because, well, you already want to spend a lot of money and it's an extreme dopamine hit. Sudden and intense aggression or emotional volatility. Normally calm and relaxed people will go off the deep end about pretty much anything: screaming, throwing things, and then bursting into tears out of guilt. I'm normally a pretty chill person, but one time I threw a phone at my mom's head because she pissed me off so much. I can't even remember what she said to make me mad. Feeling invincible. Manic people are convinced that nothing bad could ever happen to them and they can do whatever they want. Think of someone running into traffic, sure that no one will hit them. Or, on the other hand, feeling terrified of everything. This can happen to the same person, sometimes simultaneously. You may believe everything is a threat, even when there is no clear and obvious threat. Being physically incapable of sleeping. It's not insomnia like normal people experience, where you pop a melatonin or do some breathing exercises and manage to fall asleep. You cannot fall asleep. Normal sleeping pills do not work. You may need heavy-duty tranquilizers. One time, I combined like five Benadryl and a whole bottle of whisky and STILL couldn't get to sleep. I was crying because of how tired I was. Talking extremely fast and in an extremely disconnected way. This is called flight of ideas; you start jumping from one discussion to another in ways that other people can't follow. Your brain has made that leap but can't articulate it for other people. Shiny eyes. You really can see mania in the eyes; it's very unsettling. Manic eyes look dark, wide, and shimmery. Hypersexuality. I did not have this problem, but I have talked to bipolar people who wrecked their marriages because they could not control their urges. That's not an excuse, of course, nor does it lessen the pain that the other person felt. But it can indeed happen. Unintentional pregnancies, STDs, and a whole lot of bad feelings can come from this. Kleptomania. I also did not experience this, but I have heard of other bipolar people who felt an uncontrollable urge to steal things they didn't even need to: they could afford it, they just wanted the thrill of stealing it.

Mania can cause amnesia afterward, and the person may not remember large swathes of what happened, or it will feel "dream-like" and confusing. Of course, they've got some major damage control to do that can plummet them into depression.

Symptoms of Psychosis

Again, just like with mania, not everyone will experience all of these. If a person has multiple psychotic episodes, each one may be a bit different every time.

I'm going to separate this into several sections: common delusions, common hallucinations, and Other symptoms (which are often not discussed as much).

Common Delusions

Delusions can shift throughout the course of a psychotic episode, seamlessly morphing from one to another without clear cause.

With psychoanalysis, one can often find that there are "seeds" of a delusion in the person's everyday life, and they may be connected to current events. For example, someone may think they're the reincarnation of a previous president during a presidential election.

Being god or a reincarnation of a famous person

Extreme religiosity

A belief that they have found the "key" to the universe and that everything is connected by some vast conspiracy

Being surveilled by a government entity, sometimes with the belief that they have had tracking devices installed without their consent

Being stalked, harassed, or tormented by unknown entities or by strangers (gang-stalking)

Being persecuted for a certain identity

Having some special role to play or a special status

Being a member of a special community

Having special knowledge or insight into issues, like world affairs

Being ill with another disease, like cancer or dementia

Being ageless, immortal, or invincible

Having a special connection with a celebrity, famous person, fictional character, people you know, or even strangers

A sense that loved ones have been replaced with clones or copies

Believing that there is a secret "play" going on and other people are playing along with a secret "script"

Believing other people can hear your thoughts, or that you can hear theirs

Common Hallucinations

Repeating noises, words, or phrases, often in distinct voices

Spectral, unhearable music

Environmental noises that don't exist, like train whistles or construction sounds

Repeating jingles or "ear-worms" that get stuck and may continue for days or weeks off and on

Humming, whirring, or ringing

Mutated or blurry faces, even of people you know well

A sense that a person's face is not their "real" face and they are wearing a mask

Haloes or auras around people or animals

Sparkles, flashes, and black spots

Colorful lights, ribbons, or strings

Seeing people you know who could not feasibly be there, like old coworkers, old partners, or deceased relatives

Vague blurry shapes, or distinct monster-like entities

Strangely shaped or mutated animals or people

"String people" or "stick people"

Black "void people"

Shadows that aren't there, typically around doors or windows

Skittering bugs, rodents, or snakes, often black or blurry

Bugs or small creatures crawling on the skin

Itchiness or grittiness on the skin

Light feathery touches along the skin, especially on the back or hands

Goosebumps with no clear cause that don't go away

Bad smells, like feces, garbage, body odor, or burning plastic

Good smells, often those from childhood

Losing sense of smell or taste

Sense that the mouth is full when nothing is there

Prickly tongue

Metallic taste (may be a medication side effect)

Other Symptoms

Muscle stiffness

Catatonia

Slurred or fast speech

Lack of appetite

Weight loss

Migraines

Parkinsonian symptoms (tremors)

How Bipolar Is Treated

Bipolar is treated in a few ways, with the most important and prominent being medication.

Medication

Bipolar is typically treated with mood stabilizers, which is a vague class that includes anticonvulsants, SSRIs, SNRIs, and other groups of medications. (The medication I use, Lamictal, is an anticonvulsant.)

Psychiatrists must be very careful when prescribing antidepressants for Bipolar I patients because too much can bring on mania. Bipolar 1 patients will often have an antipsychotic added to their regimen as well. There are new classes of drugs that combine antidepressants with antipsychotics for a one-and-done deal.

Bipolar patients may also have antianxiety medications added to their regimen.

Psychosis is a medical emergency and must be treated as soon as possible. Fast-acting antipsychotics can be injected in the emergency room to stablize a psychotic patient. They may also use tranquilizers to calm a paranoid or combative patient.

Like with schizophrenia, patients who are not medication-compliant may opt for a long-lasting antipsychotic injection that only needs to be done once a month or once every three months.

Therapy

A history of trauma is one of the things that predisposes a person to bipolar disorder, so working on this can help reduce symptoms. EMDR therapy can be a safe and effective way to process trauma for bipolar patients.

However, Cognitive Behavioral Therapy (CBT) doesn't work very well for bipolar patients because, well, their cognitive distortions are brought about by chemical changes in the brain, not just seeing the world "wrong."

Dialectical Behavioral Therapy is a better choice for bipolar patients because it helps them become more aware of their thoughts and, therefore, better able to manage their emotions.

Other options include equine-assisted therapy (my favorite!), art therapy, and family therapy to help build a stronger support system.

Lifestyle Changes

All the stuff that helps "normal" people can help bipolar patients, too. For example, having a set routine, eating well, setting and keeping a bedtime, getting exercise, and eating well are all crucial for managing bipolar, in addition to medication and therapy.

Weight management is a critical component of bipolar treatment. A lot of antipsychotics and mood stabilizers can cause weight gain, even when someone isn't overeating; they can also cause cravings for sweet foods or an increased appetite.

Because bipolar is often comorbid with other conditions worsened by excess weight, such as diabetes, heart disease, and PCOS, care must be taken to keep one's weight down. Excercise, because it has neurogenic benefits, can be enormously helpful in helping to heal the brain.

Some medications also cause vitamin deficiencies because they affect the way that the body processes nutrients, and they may block absorption of certain nutrients. Multivitamins can counteract this and even reduce symptoms because some deficiencies have a marked impact on mood.

Bipolar people should not drink, as it reduces the efficacy of medications and can lead to nasty side effects. They also should NOT smoke weed, especially if they have a history of psychosis. Yes, marijuana-induced psychosis is very real and far more likely for a bipolar person.

Additionally, bipolar people should nurture their support system, as having family support is a key factor in whether a bipolar person can stay stable.

Common Myths About Bipolar

Bipolar people are dangerous. Not necessarily true, though common media depictions show this as if all bipolar people are roving murderers.

In fact, bipolar people are more likely to kill themselves than anyone else: it has the highest suicide rate of any psychiatric illness, about 20 to 30 times more than the general population.

Medication is a crutch and bipolar people can get better by themselves. Wrong. Just like someone doesn't magically get better from Type I Diabetes without treatment, bipolar people need medication.

Bipolar can be treated just with lifestyle changes. Again, just like someone with Type I diabetes, you can't just will the bipolar away. You need treatment. No amount of supplements or sunshine will fix it. It's a brain disorder.

Medication turns bipolar people into emotionless zombies. Incorrect, with a caveat. The wrong dosage or type of medication very much can make someone into a zombie; I've certainly felt that way before. However, the correct treatment allows bipolar people to thrive and stay stable for years to come.

A bipolar person can never become stable and will always have symptoms. Sorta not true. Bipolar comes with other issues, like executive dysfunction, that cannot always be managed or treated. BUT bipolar people very much can become stable and mostly asymptomatic with the right treatment.

Bipolar people are always having some sort of crisis. It can feel that way, but once a person is stable, they can look just like anyone else.

Bipolar can go away. No. Even if you are in remission, you still have bipolar disorder and can relapse at any time. It is a brain dysfunction that causes measurable structural differences in the brain which do not go away.

Once you snap out of psychosis/mania, you're right back to normal. Wrong. You don't just wake up and are not psychotic anymore. It takes time for your brain to equalize and come back to baseline. I remember it as feeling like I was rising out of a long, long sleep. Once someone is stable, it's like nothing ever happened. Mania or depression causes brain changes that can last years after the episode. On average, the brain damage from mania exists for up to seven years after the last episode, and it worsens with each subsequent episode.

Any fluctuation in mood is a symptom of bipolar. This is so, so, so annoying. Bipolar people are allowed to have bad days just like anyone else. If I'm having a shitty day but I'm not throwing phones at people, then I'm probably just having a bad day. If I'm really happy, it doesn't mean I'm manic.

Bipolar people can't help it and shouldn't be punished for their actions. No no no. What I like to say is that my bipolar doesn't excuse my behavior, but it does explain it. If you hurt someone while manic, you still hurt someone and it's still your fucking fault! Never use it as an excuse to be an asshole.

Everything about bipolar is terrible. Wrong! Bipolar can have benefits like creativity, empathy, good problem-solving, and a unique perspective on life. A stable bipolar person can be a delight to be around. But these don't discount the downsides and should not be a reason to refuse treatment.

Characterizations to Avoid Regarding Bipolar

Roving maniac. Kind of a duh. We have a bad enough rap anyway.

Evil murderer. Same as above.

Abusive evil spouse. I mean, yeah, a bipolar person can be abusive, but they're likely abusive because they're a shitty person and bipolar is just a side effect.

Manic pixie dream girl. Don't romanticize bipolar either.

Miserable cinnamon roll. We're people, okay? Complex, multifactorial, interesting people. We're not constantly miserable.

Total trainwreck. If you're going to show someone's nervous breakdown, please please please show them when they are stable too. Please don't just distil the bipolar person down to their symptoms. Show us as who we are: complex people just like you or anyone else.

Drama magnet. Frankly, a lot of bipolar people don't want to get involved in other people's shit. We've got our own stuff going on. We're not out to wreck your life, we're just trying to get through the day.

How to Create an Authentic Bipolar Character

Do your research. Read a mixture of medical journals, stories from bipolar people, and good depictions of bipolar disorder in the media. Go beyond what I have discussed here and seek out good, peer-reviewed research.

Don't add bipolar just for shock value. Annoying and shitty. If you're thinking of making an evil cruel murdermonster, stop. We have it hard enough and you're going to make it worse.

Create the character first, then add the bipolar. Every bipolar person is different, just like every person is different. Get a feel for your character and then determine how they might act when manic or depressed.

Use an array of symptoms. Don't just go for "ooooh scary monster in the corner of my eye" because that's boring and overdone. Look through the list I provided and consider how you can fit a few of them in there.

Remember that it takes time to recover from an episode. You should not just have your character wake up one day and be cured. They will feel "off" for a while after an episode, like a very very long hangover.

Consider medication symptoms. Decide what medication they will use and then look up the symptoms. Demonstrate how this makes them feel and whether it makes them want to continue treatment.

Think about how a character feels about their bipolar. Some people don't think it's a problem because they like the energy, and others are terrified of relapsing. Some see it as a challenge to be overcome, and others find it to be a burden that they want to be rid of. And many will feel all of these at different times.

Show the impact on other characters. Remember that your other characters are seeing and reacting to this. They may be terrified, frustrated, hurt, dismissive, or not want to deal with it.

Demonstrate times of stability, too. Too many people use bipolar as an "ooooh soo sad" (especially psychosis) and don't show the character just being a normal human being.

Show the ableism bipolar people face. Yes, we do face ableism. People calling us crazy, denying us medical care, passing us up for jobs, or my very least favorite, "have you taken your meds today?" UGH SHUT UP YES I HAVE LEAVE ME ALONE.

Remember that many people are not medication compliant. Medication compliance is one of the number one indicators of whether a person will stay stable long term. If your character refuses to take their medication, then they are more likely to relapse.

People have many reasons for not accepting treatment: they don't like the way it feels, they're embarrassed, they don't see it as a problem, or they can't afford it (some of these meds can be hundreds of dollars a month even with insurance). So make sure to explain why they are medication non-compliant.

I've created a masterlist of writing resources that you can peruse at your leisure, all for free.

The posts I write can sometimes take me hours - they're always intricate, always thoughtful. This one took me about three hours to complete.

I do this as a labor of love for the writing community, sharing what I have learned from almost 15 years of creative writing.

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