By Sarah Knutson
Counterpoint Winter 2018 • Commentary • Page 21
My current diagnosis is “Bipolar I Disorder.” In a few years, that likely won’t exist. I might even be able to sue my clinician for not assessing – or ruling out – known biological markers of stress that overlap with conventional diagnostic features.
For a variety of complicated reasons, some of us develop an overactive stress baseline (sympathetic/fight-or-flight response) early on in life.
Across numerous species, major early-life stressors produce both kids and adults with elevated levels of glucocorticoids and hyperactivity of the sympathetic nervous system. Basal glucocorticoid levels are elevated – the stress response is always somewhat activated – and there is delayed recovery back to baseline after a stressor.
Studies have shown how early-life stress permanently blunts the ability of the brain to rein in glucocorticoid secretion.
A simple way of thinking about this is that a lot of us start our lives in “high idle” mode. The engine is always a little too revved and running a bit fast for its own good.
Plus, it’s harder than usual to calm it down. This puts added wear and tear on the system, and that begins to show over the years.
Human beings are incredibly diverse in our life circumstances, experiences, interests and gifts.
Each of us constructs a response to the challenges we face based on what we have to work with (personally, socially, environmentally) at the time.
With time and repetition, some responses start to come more naturally than others. They start to feel like the essence of “me.”
That’s the beauty and diversity of life. It potentially gives us a lot to learn from each other.
So what’s going on with “mania”?
As it turns out, the human stress response (sympathetic/fight-flight) doesn’t get turned on only by fear, like if I’m being chased by a bear. It also turns on if I am the bear and chasing you.
The human stress/survival response developed to help us survive – both as individuals and as a species. Our survival is not just about getting away from threats as fast as we can. Survival also requires us to be alert and on the ball for potential opportunities.
It’s not enough to just know there’s an opportunity. A lot of opportunities are there for only a moment. Like classic cat and mouse, you have to gear up and go after it before it gets away.
Think of bargain shopping at Walmart on Black Friday. I have to be able to mobilize really quickly if I’m going to snatch up that hot deal on a big-screen TV.
Fortunately, the survival response is there for me. It’s all over the stuff that matters to human beings the most, thereby enabling me to out-hustle or out-wrestle the next guy who is all over the same Walmart bargain that I am.
Physiology of “mania”: symptom by symptom
So now let’s take a look at so-called “mania.” We’ll go through the criteria for a manic episode symptom by symptom so you can see how the stress response is potentially operating here.
DSM 5 Criteria for Manic Episode, Criteria A:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
To really see what’s going on, let’s go back to that Walmart bargain and take a look at what is happening physically and mentally.
First of all, an opportunity like this doesn’t come every day.
In all likelihood, I’m gonna get something I desperately want at a price I can finally afford.
But there’s a catch: I get the bargain if and only if the item I want is still on the shelf – which requires me to activate like crazy to beat out the next guy.
So, is my mood expansive or elevated? You bet. It’s the chance of a year, and I might get it.
Am I going to get potentially irritated? Well, if anything cuts me off or gets in my way, you bet.
Is my energy increased? You bet. I have to make a dash for it. Am I goal-directed? You bet. That’s the whole purpose.
Does it last a week? Probably not, because it’s a one-day sale.
But it could. Like if I had to compete with the other customers in a survivor show for the chance to get the best deal, and that competition went on for a week or a month.
And, just the same as if I was in a war zone and had to stay in high alert, my body would likely rise to the occasion for as long as I needed it to in order to protect my interests as much as possible.
Before we move on to Criteria B, you have to understand a bit more about the fight-or-flight response and how it actually affects us. When I’m chasing the opportunity of a lifetime, this is what my body does:
- Adrenaline surges. My heart pounds, lungs pump and blood pressure amps in service of getting as much fuel and oxygen to my muscles as possible.
- My fists clench, my legs get ready to run, I’m primed and ready to pounce.
- My digestion shuts down.
- Higher-order thinking (judgment) gets put on hold. That takes energy that my muscles need to move me. It also takes wayyyyy too long. I can’t afford to get bogged down in details.
- With judgment out of the way, out come the fast reflexes and old habits. The autonomic system takes over behind the scenes and starts calling the plays. Whatever it is that I do best and know best – whatever comes most naturally – is what that system goes with.
- Next come the tunnel vision and the tunnel hearing to shut out all the outside distractions, allowing me to hyper-focus and totally zoom in on my vision of what I want to happen.
- I feel no pain. Literally. Endorphins, my body’s natural opioids, are in full gear now, again making sure that nothing distracts me from the task at hand.
- It gets even better. The fact that I’m pursuing a highly meaningful personal goal is giving me massive hits of dopamine, which is essentially endogenous cocaine. In other words, I’m getting encouraged and reinforced by my body’s own reward system.
During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity. Am I feeling pretty powerful here? You bet. My muscles are pumped. I’m feeling no pain. I’m getting massive internal rewards. Endogenous cocaine is telling me I’m doing great. Any outside feedback that could discourage me is being shut out.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). Let’s be honest. Is there any chance in hell my body is going to let me sleep in these circumstances?
- More talkative than usual or pressure to keep talking. Yep, for sure. If I care about you or you care about me, you bet I’m talking. I want you to know about it. I’m also going to make sure you have all the information you need to help this plan succeed.
- Flights of ideas or subjective experience that thoughts are racing. You bet. There’s so much to figure out and so many angles to anticipate. All possibilities must be considered.
- Distractability (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. Frankly, I might never feel this good again. I’m on a roll and I better take advantage of this energy while it’s here. I need to make sure that I get everything I can possibly get while the universe is being this generous to me and making me feel this amazingly great. Yes, I know you might think you have important things to say to me. But that can wait. This is a once-in-a-lifetime opportunity.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity). Yep. This is here for sure.
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). Exactly. This is where the survival response is really so deadly.
The whole purpose of the survival response is to facilitate quick action and fast resolution. So it’s basically telling me that everything is urgent and to run, run, run. Because, after all, this is the opportunity of a lifetime.
In these circumstances, my better judgment really doesn’t have a chance. It’s under-resourced at the same time that my body is primed for action and my old habits are given a free reign.
There’s also very little chance of any outside feedback getting past the firewall that is being patrolled by the high-intensity tunnel vision/tunnel hearing hyper-focus system that is keen to insure that 100 percent of my attention is focused on pursuing this reward.
So that about does it. Dispensed with all the symptoms of so-called genetic, chemically imbalanced “mania” armed only with the little ole garden-variety human stress response that happens for millions of Americans every Thanksgiving.
If you’ve been following me so far and relating it to your own experience, then quite possibly you’re beginning to see how all of this might come together to create the “perfect storm” that gets labelled a “manic episode.”
But what about that inevitable crash that comes after the so-called “mania”? Where does that come from?
The survival response runs on borrowed time and energy. It requires sacrifice from all sorts of other bodily systems.
At the time, I have no idea this is happening. The adrenaline, the power surge, the dopamine hits, the pain killers, the hyper-focus frame of mind all converge to keep me chasing short-term gains.
Once I come back to earth, however, it’s payback time. There’s a boatload of refueling, replenishing and damage repair that has to be done – at the very least in my own body, quite possibly in my life as well.
Let’s talk biomarkers
Hopefully by now you can see how most if not all of the so-called “bipolar” symptoms connect to the human stress (survival) response.
The even better news is that there is a way to test to see if this is what’s happening. There are numerous biomarkers for these kinds of stress states: blood pressure, blood sugar and oxygen levels, blood and saliva tests for hormones (e.g., adrenaline, glucocorticoids), skin conductivity tests, muscle tension or twitching, frequency of movement, whether fine motor or large motor movements are more prevalent, pupil dilation, whether visual perception is biased toward detail or gross impressions, brain scans to see what neural pathways are “hot” or “cold” … the list goes on.
Why this matters
Let’s suppose you tell me that the wreckage I create in a “bipolar” state of mind is due to a genetic or disease condition that renders my brain structurally defective.
If that’s the case, then any hope I have of effective treatment is logically the purview of brain scientists, doctors and surgeons. My major role is to pray that they figure out a cure and soon.
On the other hand, suppose that what’s really driving my so-called ‘mania’ is that my stress/survival response is firing wildly.
Then the solution is a lot more within the realm of something I can work with. Yes, I have some learning to do. I need to understand the basics of how the survival system operates. I need to learn what turns it on – and even more importantly, what turns it off.
But if I have that basic knowledge (which the average person can be taught in a few hours), then I have a tremendous amount I can work with through my own observation and trial and error.
This article is condensation of the first section of a longer piece by Knutson that got 6,000 hits in a week on Mad in America. The full piece can be accessed at
The second section – learning to address what turns the survival system on and off – will be printed in the next issue of Counterpoint.
Sarah Knutson is an ex-lawyer, ex-therapist, survivor-activist from Plainfield. They are an organizer/blogger for Peerly Human (peerlyhuman.blogspot.com) and the Wellness & Recovery Human Rights Campaign. Sarah organizes free, peer-run, peer-funded opportunities for ordinary people to offer, receive, share and experience the radically transformative power of unconditional personhood and our own authentic, vulnerable humanity.