Category: Bipolar disorder

Bipolar Disorder in Men

I was asked to share my thoughts on the topic of Bipolar Disorder in Men by the wonderful International Bipolar Foundation. They provide education, advocacy and support for those living with Bipolar Disorder….here’s the piece I contributed.

As a psychiatrist living with bipolar disorder, I have been both a care receiver and a care giver. Over the span of my career, I have treated many men with bipolar disorder having the luxury of viewing them through the lens of being both a clinician and a patient. Though men and women have the same lifetime prevalence of bipolar disorder, it has been my experience that the expression and co-morbidities differ notably between the genders. To begin with, allow me to review some basic facts.  It appears that men have an earlier age of onset of bipolar disorder than do women.  Men are likely to exhibit their first symptoms at age 22, on average, with women typically having an onset three years later.  The literature, affirmed by my own experience, suggests that men are more likely to have their initial mood swing be mania while in women it is more likely to be depression.  Some studies suggest that men have a greater number of manic episodes over the course of their illness than do women and these manias are associated with more intense levels of aggression in men.  As well, depressive episodes in men are more frequently associated with irritability than is the case with women.  Of note, men with bipolar disorder are much more likely to have co-occurring substance use disorder than women.  Some have suggested (I agree) that it can be more difficult to diagnose early onset mania in men because some of the typical manic symptoms (aggression, over-confidence and boldness, for example) are traits that we often associate with masculinity. 

signpost with man and woman written

Gender Stereotypes

Our cultural gender stereotypes play a large role in how men react to having a psychiatric illness.  There is great stigma attached to having a mental health condition, especially for men, in my opinion.  Males in our society are encouraged to be invulnerable, self-sufficient, in control and emotionally level-headed.  Expressions of affect are frowned upon and judged as being “weak”.   We expect our men to be stoic and “strong” and harshly judge those who fall short of this unrealistic and unhealthy expectation.  It is no surprise then that men are more likely to deny their illness than are women.  I shunned treatment for far too long even though I was a psychiatrist and knew my diagnosis.  Those with untreated bipolar disorder suffer needlessly and the higher rate of suicide amongst men is heartbreaking.

Reasons for Hope

Though these statistics are sobering, there is much to feel hopeful about.  It is clear that men respond just as well to treatment (medication, therapy and group support) as do women.  Exercise, healthy eating habits and good sleep habits are the three pillars of self-care that many with bipolar disorder regularly incorporate into their daily lives.  Millions of men across the globe have stepped forward and are receiving the care that they need.  We hear with regularity from those in the national spotlight (celebrities and sports figures, for example) who come out of the mental health “closet” and publicly acknowledge that they have bipolar disorder. My own experience is reason for others to be hopeful.  I shunned psychiatric treatment for far too long for fear of being judged and because of the stigma against mental illness in the medical community.  When I have shared my diagnosis at conferences and with colleagues, family and friends, I have been stunned at the response, receiving more affirmation and hugs than I could have ever imagined possible.  My own harsh self-judgements evaporated as I have been fully embraced.  Mine is a story like countless others.


I believe that all those who share their journeys reap unexpected benefits.  For me, there has been something even more important.  I now embrace having bipolar disorder.  It has allowed me to connect with others in genuine, heart-felt ways and to be part of a wider group of kindred spirits.  There is nothing quite so powerful and freeing as authenticity.  Being true to who we are requires fortitude and courage. In my work over the years, I have seen time and time again that men are much more likely to accept their diagnosis if they view doing so as an act of courage.  Which it is.  So, I would offer this advice to my fellow male travelers: when you are ready, tell your story.  We change the culture of silence one conversation at a time.  Have the audacity to be part of this long overdue dialogue.  You will engender the respect of others in ways that you hadn’t thought possible.  When you do, you will see a man staring back at you from a mirror filled with humanity, authenticity and pride.

A YouTube Conversation

A Conversation about Bipolar Wellness

Yesterday, I had the pleasure of being interviewed by the International Bipolar Foundation ( It was a wonderful conversation, with a listening audience, about living with Bipolar Disorder and how to best maintain wellness. It was broadcast live on You Tube, Facebook and their website.  

The listeners asked lots of great questions about their own journeys.  I shared my story of what it has been like to be a physician living with Bipolar Disorder, touching on issues of stigma in the clinician community, faith and treatment. We discussed how best to ensure emotional and mental health, the value of being authentic and faith.

What impressed me about the audience was their commitment to remaining well.  They struggle mightily against great odds, at times, and make impressive efforts to take care of themselves in impressive ways.  As I spoke, I realized once again that we are a community of kindred spirits traveling the pathway of a mood-challenged life together.  I received so much more from them than I gave. It once again confirmed to me that we are in this together.  None of us are alone.

Here’s the conversation:

Visit the International Bipolar Foundation ( Or visit their facebook page.

Mania and The Shining

Jack’s madness

I know exactly how Jack Nicholson felt in The Shining.  As he descends into madness, his primitive, base impulses become unleashed.  Whether he wishes this to occur or not is irrelevant.  His unraveling happens without his consent.  As we watch, we know that insanity is his destiny, no matter what.  There is no off switch for this.

Picture of Jack Nicholson in the Shining depicting madness

My mania

Bipolar mania and hypomania kidnap the brain.  I never knew it was coming but when I was in the middle of it, no amount of will or wishing or prayer could stop the inevitable from happening.  I was on fire, taken over by a flood of neurotransmitters that transported me to places I hadn’t asked to go.  When my brain was hijacked in this way, I had thoughts I’d never have in my right mind and was propelled into actions that my sane self would never do.  I became a super surfer, careening along the surface of a tidal wave moving at terrible speed. My sleep was disrupted but I didn’t care because I had boundless energy.  I was overly chatty with strangers and mistakenly believed that I could write novels and plays.  I spent money recklessly and I was the smartest guy in the room.  

It was like being taken against my will to a place I no longer knew.  Jack didn’t ask for his downward spiral and I never asked for my upward ones.  His course was a one way ticket downward but bipolar disorder has cyclical escalations with repeated episodes of insanity interspersed with periods of normalcy.

This might sound like it’s a lot of fun but it wasn’t.  During these times, I was irritable, agitated, anxious and argumentative.  Each time one of my elevated periods burned out, my awareness of how I had behaved and the degree to which I had lost my mind were laid bare and lead to crushing guilt.  Eventually, hypomania brought me to my knees.  

My turning point

After years of worsening mood cycles, I was finally standing in front of the bathroom door, like Jack, with an axe, unable to hold back my primal urges. My visceral id was intent on propelling me through that door no matter what. Unfortunately for me, what lay on the other side was a lot worse than a frightened Shelly Duvall. In my elevated state, I was catapulted forward and suddenly my life was at risk. It was this traumatic event that finally forced me into psychiatric care. I realized that I was either going to put down that axe and get treatment or I was going to destroy all that I held dear. There could be no more fractured doors in my future. There could be no more Mania and The Shining.

I am at my best

When Jack does begin to break through the bathroom door, he maniacally peers through the hole he just created. At that moment, he was at his worst and now years later and well treated, I am at my best. We all have primitive beasts inside but mine have been tucked away for years. The only shining I now see ahead of me are the bright lights of all the healthy days yet to come.

Do you have a story of mania? I’d like to hear from you

Bipolar identity: Jekyll or Hyde

Before i was mood stabilized

Before I was stabilized on medications for bipolar disorder, I was very confused about my identity. I was a “moody” guy with good days and bad ones, had periods where I was productive and other times, not so much. I had episodes when I expressed a lot of energy and other times, I felt dragged down. But everyone was like this, I told myself. I was just a moody guy. I didn’t question it. After all, why ask whether it’s dark out at night or light during the day? It just is.

Picture of Dr Jekyll and Mr Hyde in the 1931 Movie

When I finally admitted that I had bipolar disorder and was mood stabilized, I saw my true identity on the inside as even keeled but that I had neurotransmitters that kidnapped my genuine self, pushing me downward into an abyss or hoisting me up to irrational highs. It was a relief to know that I was, at my core, “normal” like Dr. Jekyll but it was awful to know that I could be transformed into the deranged Mr. Hyde whenever my “sickness” expressed itself.

The medications

The experience of having one’s true personhood abducted by their brain is common in those who have bipolar disorder. Our neuro-chemicals cause us to question who we really are. Just as bad, though, the medications we take add to our identity-confusion. Over the years, many of my patients with bipolar disorder have told me that the pharmacopoeia I was prescribing was robbing them of themselves. The pills were causing them to be less fun-loving and their true creative self; their lives weren’t as rich and vital as they were without treatment. Despite my best intentions to help them, I was a perpetrator of their distress. I understood them. I had walked their walk.

Humans must have a clear sense of who we are, defined by our values, ethics, core beliefs and behaviors. Having such clarity anchors us in our world. We can’t have satisfying relationships or meaningful vocations when we don’t know who we are. It’s simply impossible to have a shifting sense of self and live a stable, happy life.

Mood stability

After years of mood stability, I was finally certain about the difference between medication side effects and the genuine, authentic me. I felt good: bipolar was a healthy aspect of my identity. I was fully integrated with a solid sense of self and this provided me with a comfort that I never had experienced before. Perhaps in the future I will have a hypomanic or depressive episode and Mr. Hyde will reappear. When I become stable after that period ends, though, I will know that I am neither Dr. Jekyll nor Hr. Hyde. I am both. I am now a doctor living well who happens to have a mental health condition. It’s as simple as that. Full acceptance of all aspects of my authentic self allows me to have inner peace. I am now whole.

Are you Jekyll, Hyde, neither, both?