Monday, December 12, 2011

Oscillating Wildly

Recently, there's been quite a bit of cyber-chatter about a certain author who posted an open letter on his blog, listing his frustrations with his (now former) publisher. Although he raised some valid issues, the method of delivery has been criticized by some as ... let's see ... some of the adjectives used: "misguided", "unprofessional", and "crazy." In that very long, f-bomb-laden post, the author mentioned that he has been diagnosed with cyclothymia.

I saw enough confusion in the comments attached to that post to wonder how much people actually know about the disorder. And now that the author has posted a shirtless diatribe on YouTube, well. I guess it's time to do a post on cyclothymia. Note: I'm going to focus more on the mania-hypomania continuum of symptoms here and leave the major depression-dysthymia continuum for another post.

To understand cyclothymic disorder, you should probably first understand bipolar disorder I and II, as well as the criteria for dysthymic disorder and a major depressive episode. What's that, you say? Why can't I just rattle off the criteria for cyclothymia? OK. They are:

1. For a period of at least two years, the presence of numerous periods of hypomanic symptoms and numerous periods of depressive symptoms that don't meet criteria for major depressive disorder.

2. The person has gone no longer than 2 months without either hypomanic or depressive symptoms.

3. At no point during the past 2 years has the person had an episode that met critiera for major depressive episode, manic episode, or mixed episode.

There are a few more, but you get the gist. Cyclothymia is as much about what's not there as it is about what's there. It's basically a lighter, less severe version of bipolar disorder. While the symptoms still cause distress and are impairing, they are usually not as life-threatening as those for bipolar disorder (especially bipolar I).

In the author's post, he talks about long periods of productivity, during which he has some reduced need for sleep and a lot of great ideas, sometimes for months at a time, interspersed with periods of general funk (which he described as severe enough to make me question whether bipolar II wasn't a more appropriate diagnosis, but obviously I don't have enough information to make that call). Here are the criteria for an actual manic episode (you have to have at least 3 of these):
  1. inflated self-esteem or grandiosity
  2. reduced need for sleep
  3. more talkative than usual
  4. racing thoughts
  5. high distractibility
  6. increase in goal-directed activity or psychomotor agitation
  7. excessive involvement in pleasurable but risky activities (buying sprees, sexual ... sprees)

Symptoms have to be present for at least a week, and are accompanied by peristently elevated or irritable mood (yes, a manic person might be irritable). The episode has to be severe enough to cause marked impairment or even hospitalization.

The criteria for hypomania are: basically the same. EXCEPT: the episode, although noticeable, is NOT severe enough to cause marked impairment. To accurately diagnose mood disorders, it takes a lot of good assessment and monitoring, because it's actually more complicated than it looks, and you have to pay attention to all these technical definitions. Well ... I guess we could argue about the definition of marked impairment in light of this. However, if you read this, you might make a different call.

The whole thing is pretty fascinating from a mental health perspective, not to mention a business/publishing perspective. Have you heard about this kerfuffle? If so, did you notice the mention of cyclothymia? Did it change the way you interpreted the post and the author's behavior? Do you think it was made more or less effective by the mention of cyclothymia?

You know who's probably really good at making those diagnostic calls? Laura Diamond, that's who. So go check out her Mental Health Monday post. Also, don't forget Lydia Kang's Medical Monday post. I love learning from these two!

33 comments:

  1. F bomb laden post? Shirtless diatribe? I don't know who you're talking about, and I'm not sure whether to investigate further or look away from the whole affair.

    And it sounds as if cyclothymia is a good reason to have somebody else check your blog posts and You Tube uploads before you click SEND.

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  2. Interesting...I hadn't heard about these events but I've always been curious about mood disorders and hadn't heard the term cyclothymia yet. Thanks sarah!

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  3. I guess one good thing about blogging less is that I miss out on some of the ... less inspiring situations that arise in the small little world known as publishing.

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  4. I didn't know about the author, but in a way this describes a lot of writers (and especially me). The only difference is our behavior isn't so extreme. We get excited about a new project, write like crazy, and don't need sleep (because this book is a guaranteed best seller and I'm too excited to sleep). Then we query and get the rejections and sink into a temporary funk. But this is normal behavior. Doing what the author did is definitely not normal.

    I hope he gets help soon.

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  5. Wow. Okay. So after reading the post he wrote after posting the video, he seems a lot less crazy, and maybe even a bit brilliant. Fascinating stuff, Sarah.

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  6. As someone with my share of psychological issues it really bothers me when people automatically assume that anything you say is untrustworthy, is flawed and twisted by your problems. Which seems to be what a lot of people are doing with this guy.

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  7. Sarah--I agree completely. That's why I was asking about whether the mention of cyclothymia changed the perception of his complaints. I read the post, thought he made some very valid points, and then the comments were ALL about whether or not he was in the grips of a manic episode (which does not seem to be the case, actually). Unfortunately, some of the choices he has made have made it easier to ignore those valid points, which is a shame.

    Thanks for bringing up this important issue!

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  8. oh man. i hadn't heard of this. but i don't think i'm going to look into it too much. i love how you handled this post. letting those who want to look further, look further, while not spreading a name around or sensationalizing a situation like this. but that's why i come to you for the psych info, because i expect no less than that. you are one classy chickadee.

    we both know how unsympathetic society tends to be to those who are different- how judgmental, narrow-minded, and prejudice the tendency is to be.
    i don't know what the comments were, but i'm not surprised at all.

    thanks for the education, miss! i really appreciate your classiness!
    keep it up!
    rah!rah! rah! :P

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  9. I'm boring compared to these symptoms. I need to get out more and try a few of these symptoms!

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  10. I hadn't heard about this at all! But wow. Yep, I think online ranting--esp. about your publisher--is a bad bad bad idea. Especially if you plan to keep trying to be a published author. And you're not someone like Stephen King or JK Rowling. :D

    What a fascinating post--thanks, Sarah! :o)

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  11. Sounds like cyclothymia would screw up a lot of things for a person. Very interesting.

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  12. OMG...why didn't you link the rant? How can you become epic if you don't LINK?????

    *grumbles*

    ~JD

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  13. It does sound sort of like Biopolar Disorder I, which a good friend of mine has, but it is different. I'm sorry to hear he went off the deep end. Even if he had valid points, sharing them the way he did just put a halt to his career. Maybe he'll put a positive spin on this drama and write a book about cyclothymia someday...?

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  14. I just had to come back, now that I'm done reading and watching all of this, to say:

    Both the video, and the open letter, made me feel high while watching/reading them. I don't know what that means, if anything.

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  15. Very interesting. No I hadn't heard of it. I've been so busy lately it's hard to keep up, but in a way I'm glad I missed it. Those sort of things always make me cringe. Thanks for explaining the disorder, it was fascinating. I don't think it excuses anything though. I know people with full blown bipolar disorder (not sure if I or II) and they behave themselves online, though then again they are medicated. :D What do you think? I'd love to know!

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  16. Lisa, here you go: I think there's a huge difference between explaining behavior and excusing it. This man is not psychotic--he's in touch with reality. His choices are his own, and appear to be within his control.

    In general, I hear this a lot--it frustrates people when mental illness is offered as a full or partial explanation for someone's behavior, because it feels like an excuse, like the individual shouldn't be held responsible for their behavior somehow. I disagree. I think it's essential to understand as many of the factors that contribute to human behavior as possible (or else it would be impossible to be helpful), all the while dealing with the very real consequences of that behavior. No excuses, just understanding each person's individual struggles, seeing them as they are, and dealing with what's there instead of shaming/blaming/dismissing.

    In other words--I agree with you :)

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  17. I hadn't heard of this guy's rant yet. I must be living in a box or something.

    Cycolthymia is really interesting for me because I didn't know it existed until way after my psych rotation (but then again, that was a long time ago).

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  18. Matt, that's pretty much the feeling in a nutshell, probably. You can feel it vibrating off of him.

    And for a person familiar with this disorder through past work, including having a family member who's Bi-Polar, I get it...SO get it.

    Thanks for this post, Sarah! Way to take it to another level (above the bashing).

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  19. Yes, I'd read it when he first posted it via an agents link on Twitter. I would have to say that about 1/4 the way through, my spider senses were thinking bipolar (not that I knew anything really given that I don't KNOW this man at all.) But his descriptions do sound more profound than cyclothymic disorder. And yes, it completely colored my view of what I was reading. I worry that here is a man who was in the middle of a professional opportunity that I can only assume was very important to him at one point in his life, important enough to pursue and to achieve anyway. But now, possibly because of a psychological condition, his bridges to the publishing world are a blazing inferno of lost connections.

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  20. This is fascinating! Reading your posts always makes me want to return to school and take more psych classes. :)

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  21. it seems to me he lost momentum with all the waiting he experienced int he industry. and I get that. there's a lot of things about this industry that could make someone's "low" even lower. I also think his rant is about way more than his disorder or his highs and lows, but he mentions them for a specific reasons or another. interesting letter, interesting guy.

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  22. Whoa! 'This' and 'this' were very interesting.(I didn't watch the whole YouTube video, though, 'cause his hypomanic symptoms (?) made me itchy!) Fascinating, thanks.

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  23. I hadn't seen this before. I won't judge about the presence of pathology, but clearly this is someone hurting and trying to reason through his pain.

    It fascinates me that several of the patients I've seen ultimately diagnosed with cyclothymia or bipolar disorder are very highly functioning individuals with stressful jobs.

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  24. I don't know who this is and wouldn't want to comment without reading or seeing the video, but I have to be honest, knowledge of a disorder might make me wonder if that disorder is affecting his behaviour. I'm sorry if that's wrong, but it would occur to me.

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  25. I always seem to miss these controversial happenings. Is that a good thing? I hadn't heard of cyclothymia before. Thanks for teaching me something new!

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  26. Holy cow, you are an encyclopedia of usefulness!

    What a great blog, what a great blogpost. I'll definitely be back for more--oh and hi Sarah! *waves* Here's a wedge of cheese (the non-calorie type).

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  27. Wow Sarah. This was really cool. And ironic, too, because I just barely saw the original video today. I didn't notice the mention of the disorder, but I was sort of multi-tasking at the time (what? the video was 18 min long! I don't have that long to listen AND watch a guy rant!). I don't think it changes how I viewed the video. But it does help explain why I thought the guy reminded me so much of Tom Cruise. ;)

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  28. As I read your post I thought, How did I miss this? But now that I've read the comments, I see I wasn't alone. It's sad that his points were lost in speculation about his condition.

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  29. I know people who suffer from bi-polar disorders. Very tragic. I didn't realize there were lighter versions, so this post was very helpful.

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  30. Thanks for the information. I do medical transcription part time and often type for a psychologist, so the terms are familiar to me but my understanding of them was vague. You've corrected that. Thanks!

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  31. There's such a gray area here...it's a tough call. Nice post!

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  32. I stumbled across this page while researching Cyclothymia for my own informative website.

    I've now watched the YouTube footage (or 'this' as you refer to it) and was impressed with Sebastian's performance and his ability to speak for 18+ minutes without much pause for thought or direction. He obviously feels strongly about the potential injustices within the publishing world and has every right to express his opinions, which I thought he did with passion and 'soul'.

    As for his Cyclothymic disorder, those of you who have just made aware of this disorder may also be interested to learn how many legendry figures such as Michelangelo, Isaac Newton, Winston Churchill, Jimi Hendrix, Florence Nightingale, Charles Darwin, Beethoven, all suffered with the same condition. (visit www.cyclothymic.me.uk for the full list). Along with many other people (past and present) they are celebrated for their creativity, achievement and indeed genius, (often attributed to bipolar spectrum variants) but very few people would be aware or even able to conceive of the debilitating turmoil they would have struggled with privately.

    As a person with Cyclothymia myself I can identify with Sebastian's apparent rapid speech and clarity of thought known as hypomania. People in this state are considered more perceptive than the average person and are the ones most likely to effect significant bureaucratic and political changes in the world, while the rest it would appear are happy to settle for obligatory conformity in the hope of eventual 'acceptance'.

    I'm Sure Sebastian will find his own way, and achieve all the success and a level respect he deserves.

    Steve Henson

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  33. Apologies for adding my previous post as a 'reply' instead of a 'comment'

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