Bipolar

Bipolar (pronounced bahy-poh-ler)

(1) Having two poles, as the earth.

(2) Of, relating to, or found at both polar regions.

(3) Characterized by opposite extremes in opinions, nature etc.

(4) In electronics, relating to a semiconductor device, such as a transistor, that exploits the electrical characteristics of contact between two substances, one with an inherent positive charge, the other with an inherent negative charge.

(5) In electric power distribution, a power transmission line having two direct-current conductors in opposite polarity.

(6) In physics, a region of magnetic flux having two distinct poles

(7) In psychiatry, of, relating to, or having bipolar disorder (a major mood disorder that is characterized by episodes of mania and depression; once known as manic-depression.

(8) In physiology, having two poles; used especially of nerve cells in which the branches project from two usually opposite points.

(9) In geopolitics, of or relating to an international system in which two states wield most of the cultural, economic, and political influence (ie two states with hegemonies exerted over their respective spheres of influence.  The companion terms are unipolar and multipolar and all are sometimes used by analogy in fields like commerce or sporting competition to reference instances of specific dominance.

1800–1810: The construct was bi- + polar.  Pole (in this context) was from the Middle French pole & pôle, from the Latin polus, from the Ancient Greek πόλος (pólos) (axis of rotation).  The –ar suffix was from Latin -āris (of, pertaining to) and was appended to nouns to create adjectives (it came increasingly to be appended to words of non-Latin origin).  The bi- prefix came directly from the Latin bi-, from Latin bis (twice) & bīnus (double), from the Proto-Italic dwi-, from the primitive Indo-European dwi- and was one of the sequence of Latin number prefixes (uni-, bi, tri etc).  In English, it can be confusing because it can used to mean either (1) two, pair, both, duo or (2) half.  In chemistry, the use meaning half has been discontinued.  In general use, the ambiguity remains, illustrated by the use when applied to measures of duration which can variously be interpreted as “once every two periods” or “twice every period”, the classic examples of which are this like biweekly, bimonthly, and biannual.  Style guides now often suggest choosing unambiguous forms such as “fortnightly” or, where no such elegant alternative exists, spelling it out explicitly (twice a month; every two years etc).  Using semi- as a prefix can work but is imprecise although acceptable if the meaning is in other ways made clear.

In English, as a clipping (a use of the prefix as a stand-alone word) of bisexual (used as both noun & adjective), the meaning was clear and effortlessly “bi” moved from LGBTQQIAAOP slang to the general vocabulary.  Potentially misleading however is bigender, a coining of LGBTQQIAAOP activists which became linguistically necessary when gender and sex were re-assigned as separate constructs.  It’s recommended it be used as the hyphenated bi-gender (to be consistent “bi-sexual” should probably also adopt the form) lest one might ponder if a bigend is LGBTQQIAAOP slang for something (and at this point one’s mind may wander) unbeknown to one.  Additionally in engineering, a big-end bearing in an internal combustion engine is the one located “big end” of the connecting rod and attached to the crankshaft.  Mechanics may use “bigender” (pronounced big-end-ah) as slang which in oral use won’t be confused with something pronounced as by-jen-dah but if transcribed, were the latter hyphenated, there’ll be no mystified mechanics.  Bipolar is a noun & adjective and bipolarization & bipolarity are nouns; the noun plural is bipolar.

Lindsay Lohan following Edvard Munch's (1863–1944) The Scream (1893).  Much art has been analysed by those seeking insight into the mental health of the artist, schizophrenia and bipolar disorder two conditions frequently identified.

The adjective bipolar dates from 1810 in the figurative sense of "of double aspect" and was by 1859 used in the literature of anatomy (having two processes from opposite poles) to refer to nerve cells while the sometimes hyphenated noun bipolarity (state of having two poles) emerged in 1834.  The earliest known instance of the now familiar use in psychiatry as a technical term to describe what was then known as manic-depressive psychosis appears to date from 1957 in a publication by German psychiatrist Karl Leonhard (1904-1988), noted in the history of the profession for his extensive (though now mostly forgotten) classification of psychotic illnesses (a nosology (the construct being nos- + -ology, from the Ancient Greek νόσος (nosos) (disease) + -λογία (-logia) (study of), the branch of medical science dealing with the classification of diseases)) although still used in structural linguistics is the system of classification of non-verbal communication.  As the term “manic-depression” ascended the linguistic treadmill (a process accelerated by the negative connotations which attached to the word because in popular literature and films manic depressives were often characterised as psychopathic murderers or other flavours or madness) “bipolar disorder” was positioned as a preferable term, the reason being that bipolar was separated from both the connotations of “manic depression” and the two elements (“manic” & “depression”), each loaded with negative associations.  Accordingly, in 1980, bipolar disorder replaced manic-depressive psychosis in the third edition (DSM-III) of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM).  According to tracking by dictionaries, it was in the mid-1990s that bipolar (in the context of mental health) gained traction in general use and, inevitably, appeared on the linguistic treadmill although even forty-odd years on there’s little to suggest it has yet reached the level of opprobrium which might prompt the DSM’s editorial board to discuss the need for a replacement although their processes can take a while, the term “mental retardation” (long regarded in the community as offensive and in some cases misleading) not replaced by term “intellectual development disorder (intellectual disability)” until the release of DSM-5-TR (text revision) in 2022.

The bipolar world in 1980.  The geopolitical architecture of the Cold War (circa 1948-circa 1990) revolved around Moscow (the Warsaw Pact) and Washington DC (NATO).

Bipolar disorder was actually introduced to the DSM when the multi-axial system (Axis I to Axis V) was created:

Axis I: Clinical Disorders (including bipolar disorder)

Axis II: Personality Disorders and Mental Retardation

Axis III: General Medical Conditions

Axis IV: Psychosocial and Environmental Problems (stressors)

Axis V: Global Assessment of Functioning

This structure was modified with the release in 2000 of DSM-IV-TR which, within the axis system, divided diagnoses and symptoms into sections or "decision trees," including which symptoms must be included for a diagnosis and which must not be present.  The sectional approach was carried over to the DSM-5 (2013) when the axis system was abandoned, replaced by 20 chapters containing categories of related disorders of which “Bipolar and Related Disorders” is one, others including Anxiety disorders, Obsessive-compulsive and related disorders, Depressive disorders, Feeding and eating disorders and Personality disorders.  Within its category, bipolar disorder was subject to some refinements, including those reflected in other areas (such as objectum sexuality) that attempted to reduce the medicalization of behaviour that although statistically aberrant, was part of the normal human condition.  Childhood bipolar disorder for example, although long well-defined and accepted as a diagnosis, was effectively rolled into a new category of depressive disorders called disruptive mood dysregulation disorder (DMDD), reflecting the concern that the diagnosis of pediatric bipolar disorder was being inconsistently and overly applied to behaviour better understood as variations of childhood irritability.  Possibly too, the editors may have been influenced by work in labelling theory which suggested the early appearance in an individual’s medical history of conditions such as depression or bipolar disorder could have life-long consequences.

In the DSM-5, the diagnostic sub-categories of bipolar disorder were extended to seven:

(1) Bipolar I disorder

(2) Bipolar II disorder

(3) Cyclothymic disorder

(4) Substance/medication-induced bipolar and related disorder

(5) Bipolar and related disorder due to another medical condition

(6) Other specified bipolar and related disorder

(7) Unspecified bipolar and related disorder

Other changes included (1) the elimination of “mixed episode”.  Instead, a manic, hypomanic, or depressive episode can be specified as “with mixed features” a specifier with its own DSM definition. (2) The bipolar II diagnosis in the DSM-IV excluded a history of mixed episodes and this exclusion has been removed, something many long advocated. (3) There was a standardization of the text.  The word “abnormally” was not included in the DSM-IV criterion A for a hypomanic episode, while it was in criterion A for a manic episode; in DSM-5 the same language is used for both, the full criteria for the two distinct types of episodes thus closer together. (4) Each type of bipolar disorder gained specifiers (such as “with mixed features”, “with anxious distress” & “with rapid cycling”) which serve further to clarify the illness.

The DSM-5-TR was released in 2022 and among the changes were amendments to the section covering disorder.  Criterion B in bipolar I disorder was refined to make explicit that a manic episode can't be “superimposed on” (ie bolted-onto to run simultaneously with) an existing diagnosis of schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified psychotic disorder.  A similar procedural clarification was made to criterion C for bipolar II.  The specifiers indicating the severity of a manic episode were also updated.  Under DSM-5, the bipolar severity specifiers were mild, moderate, and severe which certainly made sense when labeling depressive episodes but when of clinical significance, that was less helpful when categorizing manic episodes because, in the nomenclature of the DSM, “mild” indicated “no impairment in functioning” whereas manic episodes inherently impaired function.  The specifiers for manic episodes accordingly were updated in the DSM-5-TR to (1) Mild (the manic episode meets the minimum symptom criteria), (2) Moderate (the manic episode causes a very significant increase in impairment and (3) Severe (the patient needs nearly continual supervision to prevent harm from being done to themselves and/or others).

2:365 by Kim Rask & Missy Douglas (2014), Ucki Ood, pp 400 (ISBN-100615950620).  A collection of 365 works painted in 2013 as a document of bipolar disorder.

First diagnosed with bipolar disorder at 19 while a student of art at Cambridge, Dr Missy Douglas (b 1977) in 2013 undertook for that year, each day to paint a canvas which would express her feelings at that moment.  To ensure the works reflected her condition rather than the effects of medication, during this year she went un-medicated, hoping the paintings would more accurately reflect the highs and lows of bipolarity.  When going to sleep each evening, Dr Douglas had no idea how she would feel the next morning, some days ecstatic, some days depressed.  Although the change in name to bipolar was probably helpful, Dr Douglas' experiment does illustrate why “manic depression” was so evocative of the condition.  Interestingly, on not one day was a painting not completed, not does the set include a blank canvas or one simply black or rendered otherwise monochromatically.  What this indicates would be something to ponder but is perhaps indicative of how a spectrum condition can manifest, Dr Douglas presumably a high-functioning bipolar.  For a BBC piece, Dr Douglas provided brief notes for six of the works:

Day 5: “I was really anxious, angry and feeling trapped.”

Day 177: “I was really in a dark place here. I was completely in a depressive phase.”

Day 236: “I was burying feelings and my emotions were all over the place.  Very turbulent.”

Day 242: “I was at the height of mania here, but there was a massive wave of white depression heading towards me.”

Day 314: “Mania.  I was buzzing and everything was technicolor and beautiful.  I was flying and felt invincible."

Day 359: “Christmas Day 2013.  I was feeling very depressed yet I completely compartmentalised and concealed it.  The twinkly forced jollity hid the sadness.”