Hey Bartender, can I get a splash of depression with my mania?
On the rocks.
Mixed is (sigh) just another confusing term. I see two ways in which we use this word and the DSM appears to have broken it into Mixed Episode and Mixed Features. I will only rant about mixed features for now and the other I will save for later (Fun!)
The DSM has all these rules for what is mixed and who gets to have it and all that. They’ve been changing it around. DSM5.org says…
“In DSM-IV, a diagnosis of mixed episode required an individual to simultaneously meet all criteria for an episode of major depression and an episode of mania. During its review of the latest research, the DSM-5 Mood Disorders Work Group recognized that individuals rarely meet full criteria for both epi- sode types at the same time. In order to be diagnosed with the new specifier in the case of major de- pression, the new DSM-5 specifier will require the presence of at least three manic/hypomanic symp- toms that don’t overlap with symptoms of major depression. In the case of mania or hypomania, the specifier will require the presence of at least three symptoms of depression in concert with the episode of mania/hypomania.”
They have also given us a “mixed-features specifier” that is only supposed to be attached to rule following episodes of depression, mania, and good old hypomania.
But yay! The term mixed and its friends, mixed features, rapid cycling, ultra rapid cycling, etc are a sort of an acknowledgment of all the jagged pieces of Bipolar. Which is nice. Ish.
Now you get to have a real label for your swirling Bipolar pieces that don’t fit anywhere else. (As long as you meet those rules. There are rules about what exactly mixed features can be. I can’t copy the whole article in here. If you want to read more rules click the link. Rules exhaust me.)
I like “mixed features” though (the term! not the experience!) That is a fun and helpful word to tack on to various things if you want to be a rule breaker. Kind of like a Bipolar version of that joke where you just add “in bed” or “that’s what she said” to the end of everything.
You know like….
I have been mildly dysthymic for 8 months…….with mixed features!
I don’t meet all the criteria for being hypomanic but I am pushing the ceiling of my “baseline” with my happiness……with mixed features!
I only had four days of severe depression (so it doesn’t really count)……with mixed features!
I am completely stable……….with mixed features!
Because, here is the thing….
While I am sure that there are probably some Bipolars out there with nice clean DSMable Bipolar (Actually, I lied. That is kind of hard for me to believe) I know a lot of us sort of live life all mixed up. As far as I can tell that is called Bipolar. Most of us have messy Bipolar. Up down all around over under all over the place in the middle out in space.
And that is the biggest mindfuck because you can be walking along baseline just minding your own business and then SPLOOSH step in a huge mud puddle of negative anxiety ridden depression. Mixed is a great word we can stamp onto the mysterious crapfest that is a lot of Bipolar.
It is just Another WORD. A group of letters that somebody came up with a long time ago that evolved into the word it is today that means something in the dictionary that didn’t have anything to do with psychology until a little while ago when some doctors thought “Hey what should we call this confusing thing? Um…How about mixed?”
Bipolar is such an inaccurate word for what it really is anyway. I actually think maybe “Mixedpolar” would be a better more descriptive name for our disorder.
I don’t know though. It doesn’t sound as sexy.