When my ex-husband had a bipolar manic episode, I was hurt by the way he was acting and speaking to me. Before he went into the mental hospital, I thought I had done or said something wrong that made him insecure or unable to relax. When he left to walk off the mania, going for hours and walking for miles, he often told me that he did not want to hurt me, so he had to leave. What is a wife to believe, under such circumstances?

In many ways, he was showing me his love through his depression. His first concern was not to hurt me or his son (early college years). Mental illness is not easily understood. I researched psychology as much as I could to understand my ex's diagnosis of bipolar disorder with manic features.

Our society has an intense prejudice against mental illness and shows no compassion to the mentally ill or to their families. In most cases, the laws hurt both -- ironically the laws were passed to supposedly "protect" the mentally ill against abuse of their right to freedom by their families. What happens is that those who should be in the mental hospitals never get there before a family member gets hurt in the process of waiting to figure out what to do. Or else the person who is ill commits suicide. Sometimes, the only legal resort is to put them in jail -- although with the current laws, that is increasingly more difficult to do. None of the above options is an acceptable answer to the issues of mental health.

I offer here the criteria for how depressive disorders are diagnosed, as published by the American Psychiatric Association in the "Diagnostic and Statistical Manual of Mental Disorders, 4th ed." (Washington DC: American Psychiatric Press, Inc., 1994). This manual is known in the field as the DSM-IV. I have read the definitions in the APA's massive book, updated every decade (hence, the number 4, because it has been 40 years that they have published and revised this manual). Medications used in the treatment of the various disorders are described in detail, as well. For my site, I have copied the definitions as found in Psychology Net (link above). This information is also posted in a bipolar support group site, Trillian's pages at Healthy Place (link above).

My suggestion is for everyone who has any type of psychological problem to stop judging themselves (and others who may be mentally ill) and visit a support group site to understand the various ways human beings can be mentally ill. You will be surprised. While researching my own family problems, I recently read a discription of someone I did not believe had a mental illness, until I read a detailed discription of this personality in a psychology website! I now have a different understanding of that person -- and hopefully, more compassion. (This person does not think he/she has a mental problem, by the way, and was insulted when I suggested it, yelling at me that I had one, not them!)

Please remember that the following are only guidelines for the non-professional to determine whether or not a professional is needed to diagnose a person acting in a depressive manner. You might think they have a mental problem, but you might not know what it is. It is dangerous if an individual with a depressive disorder is also experiencing a manic episode. There is more than one type of manic episodes, and there are other types of manic depressions which have different symptoms.

Family members, casual observers, police personnel, and teachers can only observe the symptoms and describe what they see. These people are non-professionals who are NOT qualified to diagnose. It is a professional psychologist or psychiatrist who can make a diagnosis of any type of psychological problem. Non-professionals can only offer a lay-person's opinion and observation. To accuse someone of mental illness can compound a mentally ill person's problem. Diagnosis, in any case, is not an accusation, but a compassionate invitation to heal via treatment. Unless an observer is well-educated enough on the subject to have that compassion, they can easily revert to verbal abuse, instead of directing a confused, unaware individual out of their depressive disorder and into real healing.

DSM IV Definition:

Major Depressive Episode:

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Manic Episode:

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others,
not merely subjective feelings of restlessness or being slowed down)
6. flight of ideas or subjective experience that thoughts are racing
7. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
8. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
9. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The symptoms do not meet criteria for a Mixed Episode

D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Mixed Episode:

A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C.The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

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Unfortunately, with the prejudices of the modern world, yes, it does. Not everyone whom you might believe is "mentally ill" really is -- they just might be a progressive, forward thinking person who is terminally FRUSTRATED with modern thought (like me!). Above all, give these friends and family members love -- healing is impossible without it.