Metaphorical models - Bipolar Disorders

The Loose Switch Metaphor

Having bipolar disorder is like having a loose emotional switch. Flick the switch up and mood becomes elevated, flick down and mood becomes depressed. The switch tends to flick from north pole to south, or between black and white, without any shades of grey. It is as if there is an absence or a diminution of any inhibitory process to prevent the emotional momentum from building in a particular direction.

(Mood stabiliser) medication is like using glue to stiffen the switch, discouraging the switch from flicking to one pole, and discouraging mood instability.

The Feet-need -to-be-brought -down-to-Earth metaphor

Losing touch with reality is common when in the manic phase and to a lesser extent when in the depressive phase if severe. Even when manic, the subject is often distressed by mood instability, interpersonal friction, paranoia, sleep disturbance, lowered frustration tolerance, racing thoughts, disorganisation and unproductive overactivity. They may be aware that they are functioning differently to their normal state. Often the bipolar sufferer will be aware they are "riding too high in the clouds" and need to be brought back down to Earth.

(Anti-manic e.g. "mood stabiliser", "atypical antipsychotic") medication may assist the sufferer to be brought down to Earth more gently than will otherwise be the case if they should wait, in which case they may well come plunging down and crashing (i.e. phase change into depression). This is because manic episodes are not uncommonly followed by depressive phase changes. Treating the manic phase may prevent depressive episodes, especially when mood stabilisers are used prophylactically, for relapse prevention. If the manic phase can be prevented, so then can the depressive phase that often follows, even without antidepressant medication.

The Excessive Creativity (or Too-much -is-not-necessarily -a-good-thing) metaphor

Bipolar genes may well be related to capacity for achievement and creativity, attraction of the opposite sex, leadership qualities (e.g. increasing group stability), risk taking & exploration. These qualities are clearly positive human attributes that may have evolved for the benefit of the species, and have therefore been retained by Natural Selection. (The increased risk to developing) bipolar disorder may result from an excess number or particular combination of the genes that code for these attributes. In other words, "more is not always better". The tendency towards bipolarity may result from excessive positive, normally adaptive, capacities.

Mood stabilising medications may temper these capacities. The fact that it usually takes some weeks before obtaining maximal benefit from these medications is likely to relate to the time span for the process of these medications activating certain genes, protein synthesis and end-organ effects of these proteins. Medications may dampen the expressivity of genes that are pushing and driving the mood too far in one direction. Alternatively, they may strengthen what is usually an inadequate inhibition of the escalating mood state, by activating genes and proteins that permit inhibition of elevated mood.

The Rollacoaster Metaphor

Having bipolar disorder is like being trapped on a runaway Rollacoaster ... without brakes or a steering wheel. The track swings high and low and the sufferer is taken along for the ride.

Medication is like adding brakes to the front carriage, slowing the train down enough to permit the rider to take some of the cars off the tracks to spread them amongst other paths.