Bipolar Me

What you say says a lot about you. How you say it matters too. You can take a simple sentence and change its meaning just by how you pitch your voice and what words you emphasize.

Try it: Say the sentence, “I want you to love me.” Emphasize the “I” and you’re saying, “I, as opposed to anyone else.” Emphasize “want” and you mean “I want it, even if you don’t believe it.” If you come down hard on “love,” you mean “I want love, not friendship.” An emphasis on “me” translates to “I want you to love me, not that other person.” It works for nearly any sentence: “Please close the door.” “You have my attention.” “Why don’t you care about me?” We translate these meanings naturally and internally, without really thinking about them.

Changes in language can certainly be revealing. In fact, there are several different kinds of speech that have a role in mental illness. They can be indicative of a certain kind of mental illness or of the way that a person is feeling. They can be used in diagnosis. They can be a way to better understand what a friend or loved one is going through.

Pressured speech

Pressured speech means that words seem to just tumble out, without much thought as to what is being said. The words come quickly, packed together like little freight trains of meaning that will zoom by if you don’t pay attention. Listening to pressured speech can be both confusing and overwhelming, difficult to understand.

Pressured speech is common in bipolar disorder, especially in manic episodes. People who are experiencing mania feel a compelling, urgent need to share thoughts, ideas, comments, or emotions. They don’t wait for replies, as one would in a normal conversation. They can also speak inappropriately loudly or at inappropriate times, such as in church or during a lecture or concert. Pressured speech can last for an hour at a time or even longer.

Because they are speaking so fast, people with pressured speech may even have difficulty expressing their own thoughts. There can be a lack of a clear thought process in what the manic person is saying, as they may talk about many things that don’t connect to each other. Their speech may include jokes or rhymes, song lyrics, and such.

It does no good to ask a person with pressured speech to slow down or stop talking. They may feel like they must keep talking, as if they can’t stop.

While pressured speech is most often associated with the mania or hypomania of bipolar disorder, it can also happen with schizoaffective disorder, autism, psychosis, ADHD, or an anxiety disorder.

Flat affect/emotional blunting

Flat affect means that you’re not demonstrating much of an emotional reaction to a situation. Inside, you may feel happy, for example, but it doesn’t show on your face or in your speech. The inside and the outside don’t match.

Emotional blunting is a little different from flat affect, though. With emotional blunting, you don’t feel an emotion internally at all. You might not feel at all interested in a book or a movie that once gave you pleasure or laughter, for example. This results in flat, unemotional, dull speech patterns.

Flat affect and emotional blunting are in some ways the opposite of pressured speech. They may occur when a person is depressed, in shock, or suffering from PTSD or other conditions. It’s a symptom of some illnesses, but not an illness in itself.

Word salad

“Word salad,” also called “schizophasia,” means a confused mixture of seemingly random words and phrases. It happens as a result of a neurological disorder like dementia or a stroke, or a psychiatric condition like schizophrenia. The words can be grammatically correct or not, but they make no sense. One example of word salad would be a person saying, “That clock has a headache.” It’s a real sentence, but it has no meaning that a listener can discern. The person producing word salad may not be aware that they are not speaking coherently.

There are several ways that schizophasia can be expressed. “Graphorrhea” is word salad in writing. “Logorrhea” means excessive talking, but without the attempt at clarity of pressured speech. A “clanging” speech pattern uses rhymes or other sound associations rather than trying to construct meaning in the usual way.

As for me, a person with bipolar disorder, I have experienced emotional blunting often and pressured speech a couple of times. My hypomania tends to have other manifestations such as reckless spending. My husband can tell when I’m nearing or in a depressive episode when I speak mostly in a monotone, with single-syllable responses to most questions. But my lifelong fascination with language has made me aware of the psychological and psychiatric implications of speech. And my lifelong experience with bipolar disorder has made me keenly conscious of the way in which speech interacts with mental illness.

Seeing that I spend so much time in my blog discussing mental illness, a friend challenged me to say what “mental wellness” looks like. I’ve decided to take a crack at it.

First, I have to say that I’m not sure mental wellness really exists. Everyone (at least everyone I know) seems to have assorted neuroses and minor phobias. These are generally subclinical, though, so they don’t really count as mental illness. Anyone with them, therefore, could be defined as mentally well, I guess.

But really, who is mentally well? A lot of people – maybe most – believe they are mentally well. Not all of them are, given that many people with mental illness can be in denial. Of course, mentally well people can also be in denial about various things. They could be in denial about their own personality traits or those of their friends and loved ones. They may, for example, overlook the fact that they are quick to take offense or that Aunt Nancy is very judgmental. Those may be character traits or even character flaws, but they aren’t mental illnesses.

I have a mood disorder myself, so I’m particularly attuned to how people deal with their moods. Everyone has them. Let’s consider depression. Everyone feels depressed from time to time. (There are people who insist that they are constantly positive or at least aspire to that state, but I do believe that in their heart of hearts they occasionally feel down when no one’s looking.) The hallmark of clinical depression is how long it lasts and to whether it descends at random on a person who has no “reason” to be depressed. But how long is “too long”?

I would guess that people who are mentally well seldom experience more than a few days to a week of depression, unless they are experiencing particularly – well, depressing – circumstances, such as not getting a job or being rejected by a romantic partner.

The time limit criterion breaks down in the case of the death of a loved one. Grief takes as long as it takes, and depression is often a component of grief. My mother-in-law, for example, suffered such grief after her husband of 50+ years died that she was virtually incapacitated for months. And her depression continued for some months after that. Yet I would not say that she was mentally ill. To me, she still fit in the category of mentally well. Reactive depression is different from clinical depression.

I would say that one definition of mental wellness is the ability to cope. With most things. For the most part. Most of the time. I know that sounds wishy-washy, but the fact is that no one, mentally well or not, copes well with everything all of the time. It’s just not in human nature. I think of it this way – just as it’s said that you have a drinking problem when your drinking causes problems (financial, legal, relationship, or whatever sort of problems), you have a mental problem if your lack of coping causes you problems in the same areas. Certainly, mentally well people can get overwhelmed at times by the demands that life places on them. And some people with mental illness can cope relatively well. I like to think that I do, now that I’m reasonably stable on medication and with therapy.

I’m starting to get to the point where I say that someone who is mentally well is simply someone who is not mentally ill. But that’s not really a good answer.

I can say that mental wellness is not a matter of being “shiny, happy people.” Everyone’s life is filled with trials and darkness as well as joy and light. Everyone struggles at some time. But not everyone is mentally ill. So, the question really becomes not what is the definition of mental wellness, but what the definition of mental illness is. We have the DSM, but it’s made up of descriptions rather than true definitions. And you get into some gray areas. Are personality disorders mental illnesses? (I don’t know.) Is autism a mental illness just because it’s listed in the DSM-V? (No. Just no.)

So, to the person who challenged me to say what mental wellness is, I would ask in turn what your definition is. Does anyone else have a better idea of what mental wellness means? I’d love to hear it.