In their seminal book, Manic-Depressive Illness, written by Frederick K. Goodwin, M.D., and Kay Redfield Jamison, Ph.D., they write, "Research on mood symptoms in mania demonstrates that most patients are depressed, labile (liable to emotional change), or expansive as often as they are euphoric; they are irritable even more often."
In a section entitled Learning to Discriminate Moods, they write: "Problems in learning to discriminate normal from abnormal moods are common throughout the psychotherapy of bipolar patients...Many common emotions range across several mood states...For example, irritability and anger can be a part of normal human existence or alternately can be symptoms of both depression and hypomania."
They may explain why irritability is a symptom of depression and hypomania (in this 939-page book; I have the first edition), but it's too difficult for me to go to all the different sections where it's listed to try and distill it. However, they do quote Emile Kraepelin, M.D., who defined the term "manic-depressive psychosis" in the 1920s in Germany, and he does write about irritability and rage in hypomania.
"Mood is predominantly exalted and cheerful, influenced by the feeling of heightened capacity for work. The patient is in imperturbable good temper, sure of success, "courageous," feels happy and merry, not rarely overflowingly so...If irritability, anger, and rage are such prevalent symptoms of bipolarity, then why aren't they more prominently discussed in bipolar literature? And more importantly, why aren't we taught specific skills for identifying this behavior and changing it?
"On the other hand there often exists a great emotional irritability. The patient is dissatisfied, intolerant, fault-finding...he becomes pretentious, positive, regardless, impertinent and even rough, when he comes up against opposition to his wishes and inclinations; trifling external occasions may bring about extremely violent outbursts of rage."
When doctors write about specific behavioral symptoms as part of bipolarity, but also write, "Bipolar mood disorder is the result of a chemical imbalance," to me it suggests we aren't responsible for our own behavior, nor can we change it. But, in my experience that isn't true.
What do you think? Do you experience bipolar irritability, anger, and rage? What skills has your doctor taught you to identify it and control it?
(to be continued)