Thread by @deontologistics

So, here’s a more personal thought than I usually put on here, but I think it’s worth putting out there. I’m bipolar (type 2), and I think there’s a peculiar trade off involved in bipolar diagnosis and visibility.

Just to get the infodump out of the way: estimates put about 1-3% of people on the bipolar spectrum, though there’s regional variation in genetics and diagnostics, which makes it comparable to autism spectrum disorder as an index of neurodiversity more generally.

Also, much like ASD, understanding of BSD, both in empirical and folk psychology, has been heavily distorted by the most extreme examples of non-functionality, i.e., autistic catatonia and psychotic mania.

This means that both diagnosis and treatment have been heavily focused on the most extreme and obvious symptoms, thereby (i) underestimating the actual neurodiversity within these categories, and (ii) ignoring the symptoms that are most important to the people in question.

There is a lot more that I could say about this in both cases, but it suffices to point out the difference between BSD types 1 and 2, which was the first categorial distinction, and which even still is not sufficiently appreciated.

The key thing that differentiates a BSD diagnosis from one of episodic depression or major depressive disorder is evidence of mania. What distinguishes type 2 from type 1 is that this is (i) rarer than depression, and (ii) much less extreme, and so called ‘hypomania’.

This puts one in a diabolical bind if one needs a type 2 diagnosis: (i) one can only get effective help for the depressive symptoms if one is seen during a hypomanic episode, but (ii) as soon as one gets diagnosed, the focus often switches from depression to hypomania.

This is particularly problematic, once one realizes that people with a type 2 diagnosis spend more than half of their lives experiencing depressive symptoms, compared to a tiny fraction in hypomania: ncbi.nlm.nih.gov/m/pubmed/12890…

One of the reasons it took the medical community so long to realize this is that, just as ASD was mistakenly taken to be about communicative dysfunction, rather than information procesing, so BSD was taken to be about affective disregulation, rather than cognitive dysfunction.

To repeat: people with BSD and type 2 in particular, spend *most of their lives* experiencing progressively worse cognitive dysfunctions of various kinds, and this is largely invisible to those around them. People see mood, not cognitive function, and this is a very bad proxy.

There have been times in my life where I have wanted to scream at the top of my lungs ‘I’m not SAD, I just CAN’T THINK!’ But these were mostly times where I couldn’t think well enough to comprehend and fulfill this desire.

So here’s the trade off: getting diagnosed, or otherwise making one’s bipolar out visible invites everyone else to become an expert in your mood, and it’s dangers. And they’re liable to do so in pretty condescending and otherwise ignorant ways.

I am currently hypomanic. It’s been at least 18 months since I was in this phase, and there are various interesting reasons why this is the case. It is *obvious* to everyone around me that I am. This thread is itself an indicator.

Let me break that down: I am currently (I) generating more ideas, (ii) more motivated to communicate them, (iii) more disinhibited I’m doing so, in relation to the risks involved, and (iv) these are more likely to be driven by emotion (e.g., excitement, irritation, anger).

This thread checks all of the above. I’ve found something I’m highly emotionally sensitized to and channelled that into a cognitive output that some would no doubt describe as unwise.

But here’s the thing. Such people are more likely to talk *about* me than *to* me in such circumstances. Which extends to *telling* me things without *discussing* them with me.

If you ask me ‘Have you considered that you might be hypomanic right now?’, expect the answer to be along the lines of ‘Really? No shit’.

I’ve got a front seat to my own hypomania, and I can see more than what is *visible* to you. This can be true even though it is also true that hypomania creates cognitive failure modes akin to *blindness* of oneself by supercharging bias and capacity for rationalization.

If one takes seriously the idea that we must confront mental health issues while respecting the autonomy of those affected as much as possible, then one must endeavor to treat such people as interlocutors in discussions about their mental health.

This is not always possible, precisely because the cognitive malfunctions associated with MH conditions create corresponding discursive malfunctions. This is where the rubber meets the road in the ethics and politics of mental health. Friction is where things get difficult.

Hallucinations, delusions, negative ideation, executive dysfunction, dissociation, fugue states, etc., diminish the psychological capacities necessary for personal autonomy. This is the limit-case of ought-implies-can. Without certain sorts of can, there are no oughts at all.

Nonetheless, diminished or intermittent autonomy is still autonomy. I accept that I may lose certain sorts of authority over my body and it’s disposition at some future point. Suicide attempts are a non-trivial possibility in my future, as are full blown psychotic episodes.

I give license to those who will have to do what they need to do to prevent and or mitigate them, should they happen. But it is *me* who gives them license.

The people with the best and most nuanced understanding of selfhood that I know, are without exception people who have had to confront such realities, because they simply cannot take selfhood for granted anymore. As ever, dysfunction gives us a perspective on function.

The complex relationship between neurodiversity and neuropathology means that where things sit in the taxonomy of function is often highly contextual. One person’s dysfunction is another person’s hyperfunction, and vice versa.

The ultimate lesson that I want people to take away is that there can be such a thing as *inconvenient* hyperfunction, which is not thereby best thought of as dysfunction.

I have written this thread instead of doing things I otherwise should be doing. That’s a species of executive dysfunction. However, in context, this does not have to be an issue. That is, unless *you* make it an issue.

Sometimes, people have every right to make this sort of thing an issue. Context is determined by the people in our lives and the demands we impose on one another, and mental health is one source of such impositions.

The ethics and politics of mental health, and neurodiversity more generally, are shaped by the ideal that these impositions should be chosen, or at least optional, wherever possible. That’s the reward, and the burden of autonomy.