What is bipolar? / Types of Bipolar

Bipolar recovery requires finding out about causes, but first we may need some understanding of the psychiatric bipolar categorisation in use today.

Receiving medications for bipolar disorder is a serious thing, with patients on average dying 20 years earlier than the general population. However, with no medical tests for bipolar, it has only ever been a way of saying, “Something is wrong with your moods but we do not know what is causing it.”


With such a wide meaning then:

Bipolar is about categorization rather than diagnosis. Diagnosis means identifying causes, so technically speaking no one can ever be diagnosed as bipolar because bipolar categorization is reserved for people where the cause is not being identified. Bipolar categorization is about labeling.


There are four main categories of bipolar:


1)      Bipolar 1: This is the label given to people who admit to having low energy moods and have been seen to have some extremely high energy moods, whether associated with positive or negative feelings. This is equivalent to the old Manic Depression, other than; the highs in bipolar often being unpleasant with negative feelings or a confusing mix of positive and negative feelings, rather than the traditional manic depressive’s high which was considered to be a kind of ‘happy’ time for the person experiencing it. When the bipolar label first became available to psychiatry in 1980 this was the only type of bipolar.  Although the numbers with this label continue to grow it still accounts for less than 2%* of the adult population.


2)      Bipolar 2: This relatively new label is probably the fastest growing in the UK and may already have been applied to nearly 10%* of the adult population. It is used for people who admit to having low energy yet have never been seen to have extremely high energy moods. It tends to be given to people who previously would have been described as depressed as well as to people who suffer from fatigue syndromes where mood changes seem to be their main problem.


3)      The next less severe bipolar option is called cyclothymia, rather than bipolar 3. It again informs us, “Something is wrong with your moods but we do not know what is causing it.”


4)      Bipolar 4: This can be used when there is no dispute about a prescribed drug or ‘street’ drug triggering the damaging high energy moods. (It is unlikely to be used if the trigger is thought to be ‘a legal high’, nicotine or caffeine.)


At first a label can help us find support, however, bipolar labels stay on our (UK) health records for life, often preventing professionals from looking for or tackling the causes of our troubles.


In many ways the exact label is not so important. The part that needs to be tackled is the cause or causes. Only by getting to grips with what causes us to be seeing a psychiatrist can we start to make a lasting recovery, otherwise we will continue to have to manage/cope with moods we do not want to be having.


I am hoping I can help readers to find and tackle the causes of their disordered moods.


Roger A. Smith


31st January 2014


*In the UK it is difficult to know exactly how many people are affected as many people are not told what is in their medical notes. I would like to hear from anyone who can provide up to date estimates of numbers affected.



*Is there a cure for bipolar disorder? - update 1

"Most experts will tell you that there is no cure for bipolar disorder, but I do not see this as a reason not to be looking for one. My research over the last 7 years indicates the first step for a bipolar person is to realise they can get massively better if they view their recovery as a long term project. Having accepted this, medication is almost always needed but the patient needs to work with professionals to get the the most appropriate medicines, (the first combination is rarely the right one) for a particular stage of their lives. Further recovery comes from understanding your own mind and body, so that you know what causes the mood swings. Of course, believing this can be done all by your own efforts (paddling) is not realistic, so the most crucial step towards a cure is the realisation that we are not alone and there are loads of people out there wanting to share their ideas (sailing) making remarkable (miracle?) recoveries possible. When people with bipolar live ordinary or even extraordinary lives unhampered by the disorder then is this not a cure?"

Roger Smith 3rd July 2005 (The morning after "Live 8")


*Is there a cure for bipolar disorder? - update 2

"The idea of cure or full recovery comes up frequently on workshops. In many ways these ideas are not meaningful with respect to mood disorder, as the ability to have more intense feelings is part of the way we are and is not necessarily all negative. We need to accept that we react differently to many stressors. We can then make lifestyle changes in order to cope well and thrive without needing to be too concerned about having a mental health 'label'."

Roger Smith 3rd July 2009 (Four years later on the morning prior to Andy Murray's first Wimbledon semi-final)


Bipolar recovery