Inside Bipolar Podcast: How Is Bipolar Disorder Diagnosed?

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe: Hey everybody. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: Dr. Nicole, you have pointed out many times on this series that I am not a doctor and I agree with you, I don’t. I in all seriousness, I do not think that I have the level of knowledge that you have. But people living with bipolar disorder, we do have a level of knowledge. We have lived experience and I think that is important and we want to understand our illnesses, and I’ve learned a lot along the way. But there are a couple of gaps that apparently medical school fills in, and there’s a couple of gaps that people in the community, in the bipolar community have reported that they don’t understand. And there was a big glaring one that came up over and over again that kind of handcuffed me a little bit, where people online when I said, what do you want to know about bipolar disorder? If you could be taught anything by a board-certified psychiatrist, what do you want to know? And honest to God, the number one thing that came up is how is this even diagnosed?

Dr. Nicole: Hmm.

Gabe: What makes them decide that you have bipolar disorder? How does a Dr. Nicole look at you and be like, you have that? And I thought I don’t know.

Dr. Nicole: Well, hopefully we’re not just looking at you and saying, you know what? He’s got the look. He’s got that look. He’s bipolar. There are criteria. And I am amazed at how often I see somebody for a new evaluation. And I ask them, what have you been diagnosed with before? And they say, oh, bipolar disorder. And I say, okay, tell me what kind of symptoms you have. And they look at me as if I’m speaking a different language, or if I say, tell me about your manic episodes. And they say, well, I don’t I don’t know what that is. I have no idea what that is. So obviously the diagnosis is being made, but where we’re falling short, I think is in the explanation as to why it’s being made.

Gabe: In this little online discussion, I really wanted to drill this down and figure out what people knew, because I wanted to make sure that we did a good job and not just had some generic conversation that nobody learned anything from. And I said, okay, how do you think that bipolar disorder is diagnosed? And the number one answer, pretty much the only answer is, well, you experienced mania and then depression. You had highs and lows, highs and lows, mania and depression, mania and depression. And therefore you have bipolar disorder. And I, I want to confess my ignorance to you, Dr. Nicole. I was like, that’s it, that’s it. This is this is dumb show. We don’t we don’t need to do this podcast at all. If you have mania and depression, you have bipolar. Anybody can diagnose it. You don’t need to go to medical school. That’s all Dr. Nicole is doing. I want my tennis court and I want my yacht right now, but I suspect that there’s more to it than that.

Dr. Nicole: I mean, at the core of it, mania and depression. At the core of it. The problem is people have no idea what that even means. I ask people all the time about mania and they don’t know the term mania. They say. I mean, I don’t know, I just know I was diagnosed with bipolar disorder and I have mood swings. I think that that’s where a lot of people fall. They don’t even get to the oh, I have mania. And then there’s depression. They don’t have a good understanding of bipolar disorder in general. And I know that because a lot of people will say, oh, I have bipolar disorder and I have depression.

Gabe: I hear that a lot too, in support groups where people will say, well, I live with bipolar disorder, mania, grandiosity, anxiety. I’m like, you’re just you’re just you’re just naming the symptoms,

Dr. Nicole: Right.

Gabe: Right? It’s a little bit like saying, I have the flu, a runny nose, congestion,

Dr. Nicole: Mm-hmm.

Gabe: A cough, like, nope, you just have the flu. You don’t have multiple things. So I agree that there’s definitely a misunderstanding among people who are diagnosed. And I imagine if they don’t really understand their illness, they really don’t understand why they were diagnosed with it.

Dr. Nicole: Yes. And in addition to even having the symptoms. So yes, you have to have the mania. You have to have the depression, or the hypomania if we’re talking bipolar 2, you have to have those things. But then we also have to do the what is it not you know, it’s not bipolar disorder if it’s only caused when you use methamphetamines, you know, that that

Gabe: Right, right.

Dr. Nicole: Of course, you’re going to look that same way. You’re going to have a manic episode, for all intents and purposes, a manic episode, but you’re intoxicated. So then it’s not a bipolar manic episode. It’s a substance induced manic episode. So a lot of things come into play.

Gabe: Just to clarify, for those who may not know, I believe everybody understands this, but I want to make sure there’s no definitive test, right? There’s no blood test, urine test, hair test, skin sample. You can’t you can’t swab us. None of that is available. This is observational.

Dr. Nicole: Yes. I mean, I wish I had my magic wand. I tell people my magic wand is in the shop and I don’t know, I sometimes it’s very clear. And then there are times where it’s a little bit more complicated, but we don’t have blood tests. I can’t just draw a blood level and say, oh, yeah, it says right here. Came back positive. You have bipolar disorder. It takes a lot of time. Which is why I’m usually recommending that people find a Dr. Nicole and stick with that person, because a lot of times it’s the time that helps us out. It’s the being able to see you month in and month out for a long time, where I can see the patterns, where I can see the behaviors, where you can tell me, oh, this happened or that happened, or oh, my mom said, I did this. A lot of times that may be where the diagnosis comes in, especially. I know we’ve talked before about diagnoses changing. That’s where that comes up because we learn more information. It really is about history and being able to put together a great timeline of symptoms. And as we all know, when you do have an illness like bipolar disorder and you have these manic episodes and the depression episodes, sometimes things run together and it’s hard for people to give me a history that can lead to a diagnosis.

Gabe: The episode that you’re referring to, and I highly recommend it if you want to learn more is called Diagnosis Flip Flop, and it came out a couple of years ago, but I just recently listened to it in preparation for this episode, and it holds up it completely explains why this is going to go back and forth and back and forth and back and forth, and why that’s not a sign of anything going wrong. So I don’t want to rehash that episode, but just real quickly, I’m glad that you explained that you never know how you’re going to present because it is observational. And one of the examples that we gave in the diagnosis flip flop episode is that a lot of people end up hospitalized when they have depression, suicidal depression. You’re a danger to yourself or others. You can very much end up in a crisis situation. A crisis situation is where you’re going to see a doctor. Nicole you’re probably not reporting your symptoms too well because you got a lot going on. You’re really sick, and you can get that initial diagnosis of major depression and not bipolar disorder because you didn’t present as manic, you didn’t report any manic symptoms.

Gabe: And the only thing that the Dr. Nicole or the hospital staff, etc. is seen is this suicidal depression. And that’s the that’s where they’re acting. So this, this when they observe you longer and they start to see grandiosity, they start to see hypomania or mania. They start to hear more stories. When you get more stable and more information comes out, the diagnosis very well could change.

Dr. Nicole: Yes, if I had a nickel for every time someone told me, I didn’t know what I was doing, and I was just guessing because I changed their diagnosis, I might have that tennis court that you always accuse me of having in my backyard.

Gabe: And the yacht? Don’t forget the yacht.

Dr. Nicole: Oh, yes, don’t forget the yacht. Don’t forget the yacht.

Gabe: As listeners of the show know, I like to talk. I’m very gregarious. I like to tell stories. There is no answer that I can’t stretch into a 45-minute show. But what I’m experiencing depression. All of my answers are a couple of words.

Dr. Nicole: Mm-hmm.

Gabe: I’m not telling a story. I’m not giving an example. I’m not pulling out analogies. It’s yes. No. Yeah, I guess maybe. Sure. Probably. Once.

Dr. Nicole: I don’t know.

Gabe: I don’t know.

Dr. Nicole: I don’t know is a big one. I don’t know.

Gabe: Yep, yep. And this is me talking I’m using this isn’t an example. This is how I am when I’m experiencing very severe depression and I’m in crisis. And that’s one of the ways that my family knows when it’s bad, when when you ask Gabe a question and he just kind of, you know, grunts at you, something is going on. And

Dr. Nicole: Mm-hmm.

Gabe: I think a lot of people may be like that. But for the diagnosis process, this means it’s really important for the doctor to calls to ask an incredible amount of follow up questions. Because if you’re just like, hey, I see that you’re depressed, is anything else going on? The answer is probably going to be, I don’t know or no, or I’m fine or go away

Dr. Nicole: Yes.

Gabe: Or. And if the Dr. Nicole stops, then you’re probably not going to get a good diagnosis.

Dr. Nicole: No. That’s 100% accurate. In the depression phase. And then even when asking about the manic phases, you know how much y’all like your mania? Sometimes. Like, sometimes it because it feels so good. It’s hard for me to get people to admit that the symptoms that led to their diagnosis in the first place were actually a problem. We’re actually excessive. We’re actually expansive.

Gabe: I am now almost 50 years old, and I can’t remember the last time that I stayed out after midnight.

Dr. Nicole: Oh!

Gabe: When when I was in my early 20s. I can’t remember the last time I went to bed before 2 a.m., I closed down everything I could find. I loved the nightlife. So if somebody’s sitting in front of Dr. Nicole and says, yeah, I stayed up all night, Taylor Swift was in town.

Dr. Nicole: Mm-hmm. Exactly.

Gabe: I imagine you can’t just say, oh, you stayed up all night partying. That must mean mania. Or it could mean you’re 22.

Dr. Nicole: Right. Right. Developmentally it gets tough because in that age you’re late adolescents, your young adulthood, you’re testing all the limits of the freedom that you have. So maybe you do risky things because that’s what young people do sometimes is risky things. So if I’m asking questions about risky sex practices or periods of risky spending or impulsivity, I may get well, yeah, I mean, I, I mean, yeah, sometimes I go out and a lot and sometimes I don’t and sometimes I do spend money, but sometimes I don’t. It’s very hard for me to know what of that is just developmentally normal. And you testing the waters and what of that is a mental illness. And so that’s why I have to ask all the other 50,000 questions that annoy you, because all I have are questions. Which brings me let me just say this. I can’t tell you how many times patients get mad at me because I’m asking them questions. And I just want you to know that’s all we have. It’s all we have are questions. That’s all I have. All I have is to dig all up in your business and ask you all these 50 million questions about your history and all these things. And I know it’s annoying because usually when you’re in front of me and we’re answering these questions, it’s not a pleasant time, but I have to. It’s literally all I have. So be nice to your to your doctor, Nicole, because we’re just doing the best we can. It’s all we got. All we have are questions. That’s it.

Gabe: Oh, yeah, yeah, yeah. Make your life easier.

Dr. Nicole: Yeah. Be nice.

Gabe: We just have to be nice to you.

Dr. Nicole: Yes. And one of the biggest complaints people have is you’re asking me all these questions. Don’t you have this in your records? I know I’ve answered these same questions a thousand times before previous hospitalizations. Heck, earlier in this hospitalization, I have answered these same questions. Why are you asking me the exact same questions over and over again?

Gabe: But that’s important, right? It’s important to ask the same question because you want to see if it changes. It’s like polling. Right. Let’s think about we’re in election season. Let’s talk about where they call this same group of people. They’ve got a list of a thousand people. The representative sample I’m making air quotes and they call them once a month and ask them who they’re voting for, how they’re leaning or how they feel about stuff. But the specific thing that they do is they ask in polling the exact same questions and the exact same order to the exact same people multiple times to see if public opinion is shifting.

Dr. Nicole: Mm-hmm.

Gabe: This is the exact same mechanism as at work for you, Dr. Nicole when you’re diagnosing am I is that a good analogy?

Dr. Nicole: That is a good analogy because things change when you think about specifically in a hospital setting, the answers you gave day one within an hour or two of you showing up may not be consistent with the same answers that you’re able to give. Day four once you’re medicated, once we can start to have some more reasonable conversations about things. I may get so much more from you. So much more detail in the outpatient setting.

Gabe: I’m starting to get the feeling that that asking us these questions is how you gather the data, and then the data is what you use to determine if we have bipolar disorder or not.

Dr. Nicole: Absolutely.

Gabe: But the disconnect that I don’t have, again, because I didn’t go to medical school is. But now you’ve got all this data which you collected from all of the questions which we’ve been talking about for the last little while, and now you’re here. So now you have data. You don’t have a diagnosis yet. So what do you apply that data against? What is going on in Dr. Nicole’s brain where she’s like, this data equals this diagnosis. There’s got to be a middle step that we, the patient, don’t see or understand.

Dr. Nicole: Yeah. There there’s a little bit I guess maybe you would say a checklist or an algorithm that I’m going through in my head. A lot of times I’m already going through it as I’m asking you these questions. So when I ask you about depression I’m going to ask you what’s the longest period of time you’ve ever been depressed? Well, I know that I’m looking for at least two weeks, so that’s why I’m asking you the longest. If you tell me, oh, I’ve been depressed for months before. Check that that box is checked. Right. We know that that box is checked. Then I’m asking you about the symptoms that you have. I know that there is a list of depression criteria symptoms, and I know that I’m looking for five of those, at least five of those. So that’s why I’m asking you all those questions. I’m not asking you about your appetite just for the heck of it. Or because, you know, I’m hungry. I am asking you because that is one of the symptoms. So low mood loss of ability to enjoy things, loss of interest in things that you used to enjoy. Lower energy weight changes up or down. So, you know, have you lost weight unintentionally? Have you gained weight unintentionally? What’s going on? I’m asking about eating.

Dr. Nicole: Is your appetite increased? Is your appetite decreased? I’m asking about your sleep. Some people with depression don’t get enough sleep. Some want to sleep all the time. Some people feel very negative about themselves when they’re depressed. Lots of feelings of worthlessness or blaming themselves for things and feeling guilty about things that couldn’t even possibly be their fault. But that’s how they feel. Some people tell me I can’t make a decision when I’m depressed. I just can’t focus. Well, I feel like my short-term memory is off. I’m I, I’m struggling with concentrating. I’m at work. I’m having to read something four and five times. I’m. It’s just taking me longer to send emails, you know? So I’m asking all those kinds of questions. I’m asking you about suicide. And don’t get offended, not because I think that you would do something to yourself, but it’s one of the criteria, and I have to ask. It’s my job to ask you if you see a psychiatrist for an evaluation, and they don’t ask you about suicidal thoughts at any point during that evaluation, I don’t know what to tell you. They should be thrown away because that is I mean, I would tell students all the time, like, I don’t care if somebody said, hey, you can only ask this patient one question, my question is going to be about suicide is 100% of the time.

Dr. Nicole: That’s going to be my question. So when I’m asking you all of those things about depression, I’m putting a puzzle together. So as you say, yes, I have that. I’m like, okay, check. That’s number three. Okay. That’s criteria four, all right. That’s number five. And then I’m going to ask you about substances because I have to make sure that all of that wasn’t caused by some substance. So I’m going to ask you about substances. I’m going to ask you about your medical history. Sometimes people get frustrated with me about asking about their medical history. I’m like, well, I am a doctor, so I do need to know these things. And sometimes there may be medical things going on or just physical symptoms going on. That might be a sign of a medical something that that might explain some of this depression that you’re feeling or some of this what looks like depression. So that is how we would do depression. And then similarly we do the same thing for mania.

Sponsor Break

Dr. Nicole: And we’re back discussing how psychiatrists arrive at a bipolar diagnosis.

​​Gabe: You said before, look, I’m not trying to get up in your business, but you also said that in order to figure out if somebody is living with serious and persistent mental illness or having a mental health issue, you have to figure out if their personality has changed in order to figure out if something has changed in your life, you have to know what their interest is, what they normally do, and is this decision different

Dr. Nicole: Mm-hmm.

Gabe: So you can’t figure out how to diagnose them based on a change if you don’t have a baseline. So

Dr. Nicole: Mm-hmm.

Gabe: I want to ask the question in this way. Sincerely. I just please don’t take offense, Dr. Nicole, but.

Dr. Nicole: [Laughter] Which usually follows by something very offensive. But go ahead, go ahead.

Gabe: Not very offensive, just a little bit offensive.

Dr. Nicole: Uh-huh, Uh-huh.

Gabe: But I think our listeners I think they honestly want to know, do you actually care what people do for a hobby or for fun, or what their interests are? In your personal life, are you out there judging people based on what their interests are? Because I know a lot of people change the answer to this question here. Here’s the example that I use when anybody asks me what my favorite book is. It’s always a 1984. Right. It’s 1984. The dystopian future. I’m, I’m I and I love philosophy. Right? No. My favorite book is Green Eggs and Ham. I love that book. All right.

Dr. Nicole: [Laughter]

Gabe: But I cannot be taken seriously in the workplace. If I tell people that my favorite book is Green Eggs and Ham by Doctor Seuss, but that’s the real answer.

Dr. Nicole: I’m not going to judge you. I don’t care what your hobby is. I just want to know what you enjoyed before. And do you still enjoy it now? Really? That’s all I. That’s all I really want to know. Did you have a thing that you enjoyed and now you don’t? That’s what I want to know.

Gabe: So that’s the diagnostic criteria for depression. But obviously since we’re trying to find the diagnostic criteria for bipolar disorder, that means you need to delve into the mania.

Dr. Nicole: Yes, yes.

Gabe: Right. And then how does that fit in to lead us to bipolar disorder.

Dr. Nicole: And that’s where it gets tricky. I feel like depression is always so much easier to diagnose. Everyone has a really great idea of what depression looks like. I don’t usually have to explain depression to a lot of people. Some, but not a lot. But man, when it gets to mania and hypomania. Woo! This is where it gets tough. And to make it even more complicated than we have to figure out mania versus hypomania. So I usually start with the foundational criteria for both which is we’re looking for a period of time, a distinct period of time, okay. A period of time that the person has behaviors different than who they normally are. So that’s what I’m looking for at the core of mania hypomania. During that period of time, the person has to have elevated mood, expansive mood or irritable mood, and they have to have an increase in energy or an increase in activity. Most of the time during that time. So what does that look like? That’s a lot of words. What does that look like? I’m looking for a period of time for mania at least a week for hypomania at least four days. Hypomania is the hardest to identify because that four days people are like, well I mean maybe I’ve had like two days, maybe three, maybe I’ve had like three and a half days, I don’t know.

Dr. Nicole: I mean, it gets so difficult when it comes down to hypomania. And actually severe mania is easy. If a person has ever had like a real big manic episode, we don’t have to question if they’ve had a period where they acted differently than they normally do, or if they had an expansive mood, or if they were, as I would say, meaner than a junkyard dog, irritable, or they had lots of energy. It’s so obvious that we don’t have to ask the I mean, it’s obvious. It’s so obvious. It’s like, oh, slam dunk. That’s a textbook manic episode. Got it. It’s the lesser severe ones that really trip us up. So we we’ve talked about needing it to be different than who you normally are. Lots of energy. Your mood is expansive, irritable, elevated. Now I am also creating my checklist for mania and hypomania as well. What I am looking for is a number of symptoms that goes along with mania. So I’m asking you about grandiosity. Did you feel like you could do anything? Was your self-esteem inflated? Were you out here trying to pick up every woman in the bar because you thought you were the best thing since sliced bread? Did you think that you were so hot and you were out here trying to do all this stuff that you would never do on a regular basis? Did you not need as much sleep? And I’m not asking you, did you not sleep? Because those are two different things.

Dr. Nicole: Did you not need as much sleep during mania hypomania? Your body doesn’t feel like it needs that much sleep because you have so much energy. You have so many things that you want to get done. So much work to do, so little time. You don’t need sleep. So a person might say, oh, I get like two hours when I’m manic or hypomanic and then I’m up. One of the questions I will usually ask is, what are you doing while everybody else in the house is asleep? Which usually gives me really great answers because people will tell me things like, oh, I was up, I was playing video games with people in another country. I was texting all my friends and they were getting real mad about it because they were all asleep. Oh, I went for a walk. I went for a jog. I’m like at 2 a.m. You went for a jog? Yeah, I went for a jog. Remember all that energy? They’re like, oh, yeah, I went for a jog. Sometimes during mania, people talk more than usual or they talk faster than usual.

Dr. Nicole: So I will ask, have people commented on your behavior? Have they asked you questions about why you’re talking so fast and things like that Sometimes people during mania have this sense of my thoughts are racing and their thoughts are just hopping from topic to topic. So that’s a question that I’m going to ask you about. People are more distractible when they are in the middle of a manic episode. It’s very difficult for them to stay focused on things. There is an increase in activity period increase in activity. A lot of times you’ll hear us use the word goal directed activity. So they are starting businesses. They’re, you know, writing their memoir. They’re writing a book. They’re organizing. They’re decorating. But to such an extreme degree that we know this has to be pathologic. They also might do things that are very risky. So, you know, maybe you’re not a person who spends a lot of money. Maybe you do very well with budgeting, but you blow $5,000 in a week during a manic episode because you’re doing lots of risky spending. You’re engaging in other behaviors where you don’t think about the consequences in the moment. Maybe you’re not someone who goes out and has, you know sexual episodes with random people, but during mania, maybe you do. Maybe you’re not someone who would ever consider cheating on a partner.

Dr. Nicole: But when you’re manic, maybe you do. Maybe you would not consider going out and partying and staying out and doing drugs. But maybe when you’re manic, you will. And that is where it gets tricky. Because what if you have a disorder where you’re impulsive and risky all the time? Then that’s not. That’s not mania. Maybe you have a personality disorder. Maybe you are working through trauma and you’re engaging in kind of risky, impulsive behavior. Maybe you have ADHD and you’re just an impulsive person in general. That’s where we have to figure out what is the difference between the risky things that are happening during this episode and what is just I’m a risk-taking person, and I just kind of always live my life on the edge. That’s where it gets complicated, because you aren’t always able to give me that information. I’m asking you, but is this is this typical? Like, is this something you do a lot? Is this just during these episodes? It gets so hard because you can’t give me the answers and you’re getting frustrated with me. And I’m trying so hard to get the answer because I need that information to be able to determine what to do, because the treatment plans are so vastly different that I don’t want to mess this up.

Gabe: Yeah, we haven’t even gotten to treatment.

Dr. Nicole: I was gonna say.

Gabe: We’re just talking about diagnosis at this point.

Dr. Nicole: And I still have to go through. Are there drugs on board? What about your medical history? What are those things? I will tell you if you’ve ever been hospitalized during mania symptoms, they don’t have to last that whole week. Like, if your symptoms were so severe that you end up in the hospital on day three, we’re still going to call it mania. Because it was so severe that you ended up being in the hospital, or if there’s psychosis present, if you’re hallucinating or paranoid or have other delusions. We will we will say, okay, this is clearly with all the other things at play with all of the other boxes being checked. This is a manic episode.

Gabe: Mania is fascinating to me, and one of the reasons that we cover it so much on this podcast is because there’s just so much misunderstanding, if you asked anybody to mime bipolar disorder, they’re going to mime a manic episode. Somebody talking really fast. Grandiosity, the overconfidence, the thinking. They’re a god. They’re starting 8000 businesses. The overspending, the hypersexuality that they’re gonna. If you ask anybody to describe bipolar disorder, they’re gonna describe mania.

Dr. Nicole: And on top of that, your memory for that mood state is just terrible. Like your memory for what actually happened. It’s. I can’t even come up with a word better than terrible. It’s just terrible. Like your ability to tell me what happened in those moments. It just isn’t there. It isn’t there.

Gabe: It sounds like you do find this out with these extended question. I’m going to call them extended questions. These adjacent questions,

Dr. Nicole: Okay.

Gabe: These I what patients call nonsense questions. That’s where I believe that mania is probably diagnosed. Right.

Dr. Nicole: Yeah. The questions of, well, what are other people telling you that you did during this time? What’s your mom say? Who do you live with? What does your partner say? What have they told you? What kind of arguments have you had with them about your behaviors during this time? Did you get in trouble at work? Like what? What is happening? I have to ask all these little side questions and take you down these little side roads, because it’s just so hard to know. Your memory just isn’t there for it. And it’s nothing you did wrong. Your memory isn’t there for it. Have you ever had a dream? And you immediately wake up and you think, oh my God, I had the most fantastical dream. And then you go back to try to recall it, and you can only recall bits and pieces of it. But, you know, it was amazing and you can only recall bits and pieces. I think that’s kind of what it seems like my people who’ve experienced mania feel like at the end. They remember bits and pieces, but they don’t really remember a lot of the details of it, which then makes it that much easier for them to romanticize how great it was, because they just think. But I remember being so happy, I just I just remember being so happy. And I was so frustrated because no one wanted to allow me to sit in my happiness. And that is your version of it, because that’s how you recall it. But the little details that that’s, that’s where I need to get to, because that’s often where the problems lie.

Gabe: I have learned a lot. I want to say, I have learned a, it’s been a joy to do this episode because I have learned a lot, and I and I felt like I got to contribute a lot. I know that still doesn’t make me a doctor, but, but, but thank you for having this conversation with a layperson, because I know that you get to talk about this with other doctors, and that’s got to be a lot easier. But what I want to say is it sounds like the bipolar community got it largely right that a bipolar diagnosis is depression and mania. It’s just a bit like describing a thunderstorm as a hard rain. You’ve kind of left a lot out, but thunderstorms are in fact hard rain. Is that a good? Am I, am I nailing the analogy?

Dr. Nicole: No, you absolutely are. I mean, like we said, at the core of it, yes, you have to have the mania. You have to have the depression. And it’s the little things that you know about the weather. If you’re an enthusiast, a storm chaser, you know more about thunderstorms than they’re just a hard rain. When you have bipolar disorder, you need to be an enthusiast for bipolar disorder. So you need to know the little things. You can’t just say, well, Dr. Nicole said I had bipolar disorder, so that’s it. You have to be able to give them that information. The same with your depression episodes. These are things that you are going to have to figure out. As a person living with bipolar disorder, you need to become a little bit more of an expert than the average person.

Gabe: I could not agree with that more. If there is any key to my success, it’s what I have learned along the way. It’s from listening to Dr. Nicole, listening to therapists, listening to peer support. It’s learning about my illness and being able to speak intelligently about it. And I believe that people are doing that right now just by tuning into this podcast. But the only thing that I will advise you, and this pains me to say it, especially since I’m about to ask you for some favors, but listen to more than just this podcast. Learn from other sources. Learn from other people living with bipolar disorder. Learn from other Dr. Nicole’s. Read other articles and apply it to your situation. That is how you can have a well-rounded education and understanding about bipolar disorder, which will put you in the position to lead the best life. Now, after I’ve told you to go elsewhere, I now want to tell you to recommend our show, share your favorite episode on social media, bring us up in a support group. Share us in self-help settings wherever you know people who want to learn about bipolar disorder, share the show with them. Because sharing the show with people you know is how we’re going to grow. We also need another favor. Wherever you downloaded this episode, please follow or subscribe to the podcast. It is absolutely free and you don’t want to miss a thing. All right everybody, my name is Gabe Howard and I am an award-winning public speaker and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon, but you can get a signed copy with some free swag just by heading over to my website, gabehoward.com. You can also follow me on TikTok and Instagram @AskABipolar.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych or at my website, DrNicolePsych.com.

Gabe: And we will see everybody next time on Inside Bipolar.

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