Do 4% of Americans Really Have ‘Soft Bipolar’ Disorder?

I’ve been seeing an increasing number of stories and studies lately on ‘soft bipolar disorder,’ or bipolar II, which is—in the crudest terms—basically a less serious version of classic bipolar disorder, or bipolar I. According to a University of Texas survey, approximately nine million Americans, or 4% of the population, have this disease.

My curiosity piqued, I checked a book out of the library recently called Less Than Crazy: Living Fully With Bipolar II by Karla Dougherty. The writing is … not stellar (it’s like a publishing rule, I think, that self-help books must use cheesy metaphors at least three times per chapter). But overall, the book provides a good base for understanding bipolar II, how it differs from regular bipolar disorder, and why it (allegedly) goes undiagnosed or gets misdiagnosed as plain old depression or anxiety disorder all too often. I have thoughts on this (of course), but before we get to those, I’ll give you a quick, objective rundown on the basics of bipolar II as it’s commonly understood in psychiatry.

Classic bipolar disorder—what used to be known as manic depression—is characterized by extreme highs and lows. During a manic phase, someone with this disorder might spend ludicrous amounts of money, not need to sleep at all, become hyper-sexual, or even become delusional (they might also, for a period of time, be capable of excessive productivity). During their lows, they might suffer from extreme, unable-to-get-out-of-bed type depression, and many attempt suicide. [A really interesting book about living with bipolar I is Marya Hornbacher's Madness: A Bipolar Life.]

In contrast, people with bipolar II experience more subtle manic symptoms. They might have periods of light mania, called ‘hypomania,’ marked by increased energy, optimism and drive. Their manic phases might manifest not in delusions or totally out-of-control behavior but as anxiety or a more minor exuberance. Their depression might not be as severe (though it could be), and could differ from standard depression in various ways. People with untreated bipolar II are—in general—more able to function throughout these cycles, holding down jobs and maintaining relationships and all that. Their quality of life might be impaired, but they’re less likely to have complete depressive or psychotic breakdowns. According to Dougherty, more than half of people with bipolar II also have some sort of anxiety disorder; they’re also more likely to ‘rapid cycle’ (have several periods of alternating depression and mania or hypomania per year) than those with bipolar I.

Despite the fact that bipolar II is sometimes referred to as ‘soft bipolar,’ ‘baby bipolar’ or ‘bipolar lite,’ the latest official psychiatric manual (the DSM-IV) considers it a distinct disease from bipolar I. Still, many people, including many doctors, place it as part of the ‘bipolar spectrum,’ which actually includes six different types of bipolar disorder (including depression with mood swings that don’t quite approach mania or hypomania, called cyclothymia, and a preponderance of mania with just a little bit of depression).

Fair warning: My objectivity ends here. It seems there is an increasing focus in psychiatry or in the media these days on mental illness ‘spectrums.’ Where once we just had autism, we now have Asperger’s and autism spectrum disorders. In Delivered From Distraction, a book on ADHD, authors Edward M Hallowell and John J Ratey stress that having an attention deficit isn’t really a disorder; we all just have different brains, and some people’s brains are more suited to focusing than others (that’s a really rough summary).

I go back and forth on whether this seems like a good or bad development. On the one hand, I think that from a diagnostic perspective, a de-stigmatizing perspective and just a reality-of-the-situation perspective, it’s good that we begin to look at more mental health problems not as black or white (Crazy or Not Crazy). Economist/philospher Tyler Cowen (and a lot of others, but he’s the first I read) calls this sort of thing ‘neurodiversity.’ As neuroscience is helping to reveal, we all have different brain quirks—so who is this mythical ‘normal-brained’ who defines the norm (and disorders), anyway?

But—and I know I’m a cynic—it also worries me that this could open the floodgates to the medicalization of a lot more very normal differences in the way we experience moods or process emotions. Reading Dougherty’s book, I can identify: Yes! Wow! I’ve had ups like this! I’ve had downs like this! Then I stop and think for a second and wonder: who hasn’t? A lot of the stories she tells are of folks whose parents described them as ‘just moody’ or ‘hypersensitive’ when they were children, who were later diagnosed as bipolar II. But how do we say what the proper amount of moodiness or sensitivity is?

I don’t want to begrudge anyone their chosen solutions—if medication for bipolar disorder is helping sensitive, moody individuals stabilize and live better lives, awesome! I really believe that in this day and age, no one should have to live with a brain chemistry that makes them miserable. But there are also a lot of sinister forces that could be at play in these things (like the whole pharmaceutical industrial complex).

I was discussing all this with my boyfriend, and found his response interesting: If we were just more sympathetic to human emotion and difference generally, maybe we wouldn’t need to medicalize so much of everything … What are your thoughts?