
- Vol 38, Issue 4
- Volume 04
Finding Love Among the Highs and Lows of Ultradian Bipolar Disorder
“As soon as Lexi reaches home, she abruptly sinks into depression and curls up in a fetal position, almost catatonic in her bed.”
REEL INSIGHTS
When Amazon Prime decided to base a television series on selected stories from the “Modern Love” column of The New York Times, I was excited. I had been an avid reader of the column, in which individuals reflect on the intricate nature of human relationships. The episode that struck me most was “Take Me As I Am, Whoever I Am,”
In the series, Terri is played by Anne Hathaway. The Oscar-winning actress takes the viewer through the roller coaster of bipolar highs and lows. The episode begins with Lexi (Hathaway) during a manic high at a supermarket. She sports loud makeup, sequins, and bright clothes. She is instantly drawn to a man named Jeff and lands herself a date with him that week. The action segues into a flash-mob dance reminiscent of a scene in the movie La La Land.
As might be expected, the high does not last. As soon as Lexi reaches home, she abruptly sinks into depression and curls up in a fetal position, almost catatonic in her bed. While she does manage to wake herself up for the date, she appears slow, dysphoric, withdrawn, and unkempt, making Jeff wonder if she has a twin.
A few mornings later, Lexi wakes up—euphoric again—to the sound of birds chirping, and she calls Jeff for another date. However, by the time he arrives that night, she has flipped again, going from dancing around her apartment to sobbing uncontrollably on the bathroom floor. When Jeff walks away, she decides things need to change. She needs to give everyone a chance to know the real Lexi.
The episode illustrated how stigma often prevents individuals from getting the psychiatric help they need. Particularly unusual was the portrayal of a high-functioning lawyer with ultra-ultra rapid cycling (ultradian) bipolar disorder, an uncommon illness for even psychiatrists to see and diagnose. Lexi had almost no baseline or a euthymic phase.
As a portrayal of bipolar disorder, the episode has both strong and weak points. Hathaway’s portrayal of Lexi’s depression makes you feel empathetic. Crumpled on her bathroom floor in tears, hopeless and terrified, Lexi is a realistic portrayal of many patients’ experiences. Lexi’s mania, however, looks as glamorous as a Hollywood movie. She is super-productive and euphoric, with no impairment or mixed symptoms. Unfortunately, many patients will not be able to relate.
Pluses and minuses aside, it is heartening to think that viewers will see and empathize with Lexi’s struggles. Ultradian bipolar disorder can be difficult to recognize, even for psychiatrists, and it can be a controversial
Despite its rarity, ultradian has been on psychiatrists’ radar for decades, and good treatment options are available. Robert M. Post, MD, and colleagues first described
In the episode’s final scene, Lexi finally opens up about her condition to a coworker. It is a powerful moment in which she likens the cathartic experience to an elephant lifting its foot off her chest. After a trial of several medications and electroconvulsive therapy, Lexi finds a new stability. She is ready to begin a new chapter in her life.
Cheney’s column and the episode both end with
An earlier version of this article was posted ahead of print on March 9, 2021, with the following title:
Dr Sinha is chief resident physician of psychiatry at the University of Missouri–Columbia.
References
1. Jones D. Modern Love: coming out as bipolar in Modern Love and reliving it on TV. The New York Times. October 18, 2019. Accessed February 15, 2021.
2. Bauer M, Beaulieu S, Dunner DL, Lafer B, Kupka R. Rapid cycling bipolar disorder—diagnostic concepts. Bipolar Disord. 2008;10(1 Pt 2):153-162. doi:10.1111/j.1399-5618.2007.00560.x
3. Kramlinger KG, Post RM. Ultra-rapid and ultradian cycling in bipolar affective illness. Br J Psychiatry. 1996;168(3):314-323. doi:10.1192/bjp.168.3.314
4. The Carlat Psychiatry Podcast. Word of the day: ultradian cycling. Carlat Publishing. July 4, 2020. Accessed February 15, 2021.
5. Cheney T. Modern Love: take me as I am, whoever I am. The New York Times. January 13, 2008. Accessed February 15, 2021.
Articles in this issue
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Sedation: The Ups and Downs of a Side Effectover 4 years ago
Addressing Obesity in Patients Taking Antipsychoticsover 4 years ago
Finding Solutions While Managing Problemsover 4 years ago
Race, Ethnicity, and Chronic Painover 4 years ago
Phenomenology, Power, Polarization, and Psychosisover 4 years ago
In Memoriam: Eulogies for Beloved PsychiatristsNewsletter
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