tripolar disorderFor a long time I have been trying to figure out how to convey to the people I work with the view of mental health professionals that a certain type of depression is really a kind of mania, called “mixed mania.”

From an “objective” standpoint, this makes a lot of sense. A mixed state generates lots of energy and agitation.  Viewed from outside, a mixed state is very different from the lethargy and slow speech of a “typical” depression.

From a subjective perspective, meaning the perspective of the person who’s experiencing the mood, the idea makes no sense at all. A mixed state feels very similar to a severe depression and feels not at all like the euphoric state of a typical mania.

Yesterday, while in the shower, it occurred to me that the problem was that we have this word called “bipolar” and we are essentially trying to shoe-horn people’s subjective experience into a two-state model when, in fact, there are three (and sometimes more) states, each of which is very different and distinct.

The reason we think of mixed states in this way is that it helps us as practitioners make sense of a complicated phenomenon, and it helps us when we are thinking about treatments. Treating a mixed state like a typical depression (for instance adding an antidepressant or some other “upper”) would be like pouring gasoline on a fire.

What are the three states of tripolar disorder?

  1. The first is a lethargic (slowed down) and obsessional kind of depression. In this state, the person feels like staying in bed a lot, looks slowed down and shows very little emotion. It’s very hard to make any decisions, any choice is thought through over and over again.
  2. The second state is the “classic” manic state: generally, very positive and optimistic with lots of energy and ideas, talking a lot and e-mailing or texting people and perhaps more interest in romance and sexuality.
  3. Finally, there is the “mixed” state. This is often a very unpleasant experience. It is associated with lots of negative thoughts and judgments and a great deal of internal agitation as well as irritability. It may be a relatively stable state, or it may involve rapid fluctuations of mood from depression to agitation and perhaps even classic mania. In other words, it’s a turbulent, negative, critical and agitated state.


Afterword: I thought this was a pretty neat post and creative idea… but of course, like many such ideas, it is not really new at all. I checked out the Urban Dictionary and found this definition of tripolar disorder. And discovered that there is actually an album of the same name by an Australian band called Sick Puppies. There is a website under construction that claims that tripolar is something that people with bipolar have who also suffer from borderline personality (not true in my experience, although people with severe tripolar can certainly get very disturbed in a way that might look like borderline personality).