There really isn’t a recognized pattern for bipolar on the TQ – or in the QEEG to the best of my knowledge. There is some indication that it may be, like other affective issues, a Tone problem. When the Autonomic Nervous System is stuck in Sympathetic mode, the client in manic; due to adrenal exhaustion after a period, the client collapses into the depressive phase.  Since there is not (to the best of my knowledge) any identified brain activation pattern for “bipolar”, and it is such a popular diagnosis, I don’t see how anyone could give you much of a rationale for not training ANY protocol with clients who happen to have picked up that label in their wanderings through the mental health system.  I would have to say, however, that I’ve seen a lot of adults diagnosed bipolar who appeared to fall into the Filtering/Control category–and responded nicely to that approach.  All that oscillates is not bipolar.

Bipolar has gone from being quite a rare diagnosis in the early 90s, when I first started training, to being quite trendy a few years ago.  I saw some data recently that in the decade from 1993 to 2003 the number of kids diagnosed as bipolar went from 20,000 to over 800,000–a 40 times increase!  A lot of people –especially kids – who were emotionally labile and angry (in the 90s they were part of the explosion in ADHD – another diagnosis that a decade earlier began suddenly to afflict many times more children) – now get dumped into the bipolar category.  This is rather unfortunate since psychiatric diagnoses have a nasty habit of sticking around throughout a person’s life on academic and medical records.  ADHD is bad enough, but bipolar disorder is a psychosis of sorts. Of course, that means that a child can be given the latest cocktail of stimulant/anti-depressant/anti-psychotic powerful psycho-active drugs, but it also means that they’ll carry that label into adulthood. Even professionals who believe the diagnostic explosion represents a “maturing” in the field of psychiatry (?!) frankly admit that no-one has any idea how many, if any, of these children will actually “have” the disorder when they become adults – kind of a strange thing to admit regarding a disorder that until 10-15 years ago was ONLY considered to be diagnosed in adults.

I asked Jay Gunkelman – a guy whose ability to read a QEEG and tell you about a person he’s never met borders on witchcraft – a few years ago about EEG and bipolar.  At that time, he didn’t see it as related to brain function so much as to excessive autonomic cycling: when the ANS tilted into sympathetic mode, there was a manic period; when there was adrenal exhaustion, you saw the depressive phase.

Here as in most other areas, I strongly believe that if you are capable of working at the level of the brain’s own activation patterns, you can safely dispense with the labels.  I don’t care if you are talking about “anxiety”, “depression”, “rage” or other diagnostic labels.  The disorder titles are essentially descriptions of symptoms – NOT an indication of what underlies the symptoms. There are probably 6-10 patterns that have been shown to occur in people who are anxious, probably about the same number in people who are depressed, etc., so the diagnosis is useless in terms of telling us how or where to train.  If you want to change a person’s ability to perform/behave/feel/learn in some stable way, then define the specific behavioral issues that client wants to change and look at the EEG for patterns (using a TQ or a QEEG or whatever brain-based assessment you choose) that have been linked in research to those behaviors/moods, etc.  Train to change those.

It’s important to be careful with bipolar clients, however.  A protocol that might have a positive effect if you use it when the client is depressed can have a very negative effect if you use it when he is shifting toward manic.

Question:  Will an assessment look significantly different if measured when the trainee is up or down in the bipolar cycle?

Answer:  Always do an assessment – you can try one when manic and one when depressed if you wish (if you can get the client in when depressed) and tell us what you find.  I have become downright cynical about the bipolar diagnosis, since it is so common and rather subjective.  A lot of the kids whom I worked with as ADHD (mood swings are a common factor in ADHD, as is risk-taking behavior), if the parents were willing to spend enough getting diagnoses would end up with a bipolar diagnosis to put on the resume.  Since more and more physicians have begun tossing anti-psychotics like Risperdol into the mix (with stimulants, anti-depressants and anti-convulsants) with even ADHD kids, I don’t see why they need to toss a heavy diagnosis like bipolar disorder onto the client’s back, but it is pretty common.