By Joseph Randolph

The bipolar person, in the months before she let anyone call her that out loud (and even longer before she could say it herself without flinching as if someone had just scraped metal along enamel inside her skull), spent many evenings sitting at her kitchen table with two objects arranged in front of her as if in some small, private rite: a copy of DSM-5, its cover already curling at the corners from use, and a worn paperback of Madness and Civilization that still smelled faintly of the Riga bookstore where she had bought it twelve years earlier, when she believed that history and theory offered a more interesting life than any she might lead. The manual had the blankly confident layout of a corporate device manual—thin paper, clinical fonts, bullet-pointed criteria—while the Foucault volume arrived in that dense, almost repressed French prose that her graduate advisor had once called “ornate scaffolding around a single terrifying insight,” and she moved between them with the swing of someone trying to triangulate her own life between two incompatible ways of describing pain. On the table sat her pill organizer as well, a plastic rectangle softened by repeated washing, each compartment holding half-scored ovals and chalky discs that had come into her life with names like valproate, lamotrigine, lithium carbonate, each introduced by someone with an advanced degree and a practiced tone of concern, each promising some version of stabilization, smoothing, adjustment. She could recite the relevant pages by then: Bipolar I, Bipolar II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, each presented with the same bland assurance, each accompanied by numbered lists that felt, to her, less like description and more like a liturgical call-and-response between life and reimbursement. Five of nine symptoms, two of the following, duration at least four days, disturbance in mood observable by others. She recognized herself in these lines, which enraged her. She also refused to accept that recognition as the final word.

The bipolar person had, as her therapist liked to say in a tone that attempted compassion and drifted instead toward recruitment, “a very sophisticated language around all this.” Which meant, in practice, that when asked “How did the last week feel?” she did not answer “bad” or “better” or “rough,” but within the first thirty seconds had referenced the 1952 spiral-bound DSM, the way wartime psychiatrists had treated soldiers’ despair as interference in a machine, and the subsequent expansion of diagnoses into hundreds of categories, and how this entire apparatus seemed designed to do for the soul what Taylorism had done for the factory— break it into units, measure output, punish variability. The therapist, a woman in her early thirties with a cardigan in every sympathizing shade, nodded and wrote notes and suggested, gently, that perhaps these reflections might also function as “avoidance,” a term which the bipolar person, as soon as she heard it, mentally filed among the minor exorcism words of the present era: negative thought, cognitive distortion, emotional dysregulation—a vocabulary that treated her entire interior as a malfunctioning appliance.

The bipolar person came honestly by her temperament. In childhood, long before any clinician heard her speak, she had experienced time as a kind of unstable medium through which some days cut sharply and others flowed slack. At thirteen she spent three sleepless nights designing an entire alternate curriculum for her middle school, complete with booklists, color-coded schedules, and a proposed unit on tragic drama that she felt would rescue her peers from suburb-calcified souls; she brought this sheaf of paper to the principal with a seriousness that frightened him, and his response—a gentle explanation about limited resources and district standards— landed in her chest like a verdict on reality itself. At sixteen she fell into a six-week stretch where every task, from showering to tying her shoes, felt like trying to swim through cooling syrup, and during those weeks she imagined, for the first time, a self that might simply stop. No dramatics, no note, just a decision to get off the bus at a different stop and walk to the river instead of home. That decision remained theoretical; she went home. Still, the knowledge that such an exit had presented itself remained in her like a door she had once handled.

In college, before any diagnosis, she encountered “The Depressed Person” in a seminar on contemporary fiction and read it with the strained recognition of someone who sees their own private tics paraded onstage. The whole apparatus of the story—the calls, the self-lacerating awareness of burdening friends, the monstrous expansion of self-analysis into an occupying force—felt at once cruel and exact. She loved and hated the piece for the same reason: the depressed woman’s voice in the story had no theory. It had pain, self- consciousness, and a kind of pathetic grandeur. The bipolar person wondered, eyes moving too quickly across the lines, what such a story would look like if the subject had tasted, alongside that sort of despair, the other voltage—the breathless velocity of thought at three in the morning when every idea arrives with a halo of certainty, when sentences bloom and recombine faster than her hand can write them down, when every book on her shelves seems, for one hour, a set of stepping-stones across a river toward some immense, shining coherence. That other state did not appear, in Wallace’s story. The missing half left her restless.

Her first formal entrance into the medical script came three years after she finished her doctorate, when her department chair suggested, with the courtesy of someone who desired both her survival and her continued production of course evaluations above 4.5, that she might speak to someone about “all this volatility.” The volatility in question consisted of: one semester where she produced three articles, rewrote an entire syllabus two weeks before term, and still arrived early to every class armed with diagrams and carefully printed quotations, and another semester where she canceled four classes within the first month, forgot two meetings with undergraduates, and responded to emails in short bursts, twice at four in the morning and then not for days. The chair, himself a man of gentle moods and reliable timetables, framed his concern in institutional terms. “You’re brilliant,” he said, which annoyed her because it made the rest of his sentence feel purchased, “and we want you here a long time. We just need to make sure you can, you know, sustain this.” Sustain: a bureaucratic synonym for endurance that contained, for him, teaching loads and committee work, and for her, the question of whether a human life could accommodate both the pace of institutional obligations and the pitch of feeling that gave her any reason to care about those obligations in the first place.

The first psychiatrist she saw occupied an office three blocks from campus, in a building whose elevator always smelled of stale coffee and winter coats. He had a framed degree from Columbia on the wall, and a print of some washed-out landscape, and a set of gestures honed over years: the half-lean forward to signal empathy, the small sweep of the hand that invited her to continue, the nod that absorbed without agreement. He asked her to describe “what happens,” and she began, inevitably, with a miniature history of classification: Kraepelin, manic-depressive insanity as a matter of cycles rather than visions, the shift from rupture to pattern, the way factory time and actuarial tables had infiltrated the definition of sanity so thoroughly that any person whose moods refused to march in lockstep with institutional time would find themselves with a code. He listened, to his credit, longer than many would have. Then he said, with a professional mildness that enraged and impressed her, “It sounds like you have episodes where your mood and energy rise beyond your baseline—less sleep, more speech, more ideas—and then periods where everything slows and feels empty. Does that feel accurate?” She hated the simplicity and admitted that it did. He wrote something in her chart, the keyboard clicking faintly, and she felt, with a sinking inside that she would later recognize as pure superstition, that each keystroke carved a small rune into her future.

The bipolar person, as she left that office with a starter dose of a mood stabilizer in her bag, understood fully what had just occurred. She had entered as a person with a complex history of reading, teaching, craving, despairing, writing, longing, staying alive by way of argument and book and field and friend. She left as someone whose interior could now be documented in three characters and a decimal point. F31.81. Bipolar II Disorder, most recent episode depressed. She knew, because she had read the ICD tables in their dry, implacable type, that insurance companies and hospital clerks around the world used this code to do their own kind of theology: to decide who deserved coverage, who might receive which drug, how long a stay on a ward should last. She also knew that without such a code she would pay in full for every appointment and each pill. The code functioned simultaneously as leash, passport, curse, and blessing. She found this knowledge intolerable.

At the same time, the first nights on the new medication brought a quietness she had not experienced since adolescence. Not serenity; nothing so grand. More like the removal of a constant high-frequency whine she had only ever noticed by its absence. Thoughts still came, but without that insistent forward lean that demanded immediate speech or action. Sleep arrived within an hour of turning off the lamp. She woke rested. For several weeks she felt, unwillingly, grateful. Then she realized that the same drug had blunted the other kind of night—the wide, crackling hours when she used to feel ideas moving through her like a weather front, when she could read for six hours in a row and still feel alert, when paragraphs seemed to write themselves in her notebook while the rest of the city darkened. That loss grieved her in ways she found difficult to explain without sounding perverse, especially to those who had watched her crash and weep and invent elaborate exit strategies during the other phase. To them, and to her therapist, the math seemed clear: fewer tears, fewer missed classes, no new plans involving rivers or pills. The cost—some lost pages, some sleepless euphoria—seemed, from their perspective, acceptable. She heard their reasoning and, on paper, agreed. Yet beneath that agreement her mind kept insisting on a different equation, one that refused to rank safety above all other values.

In those periods when her mood rose anyway, despite the pills (which happened whenever she convinced herself she could manage on a slightly lower dose and then actually reduced it, half-consciously, by letting the little tablets sit un- swallowed on her nightstand), the bipolar person experienced time as a strange bounty. Hours unfolded with an internal light, without the familiar drag of boredom or dread. She graded papers at one in the morning and genuinely cared about commas. She outlined three articles and began two. She wrote long emails to friends about the metaphysics of diagnosis, the history of penitential manuals, the way medieval theologians had handled acedia—spiritual torpor—as both sin and sorrow. Those emails embarrassed her later, when she reread them in the grey slump that followed and saw, with sick clarity, how every sentence strained toward some grand statement about the soul. In the moment, though, she felt a sense of almost sacred urgency: if she did not write this now, some crucial alignment between inner and outer reality would be missed forever. Hypomania, for her, arrived less as wild risk-taking than as an excess of coherence. Everything seemed to fit together too well. Spinoza’s monism, the penitential handbooks, Joyce’s composition habits, the DSM’s criteria tables, her own students’ midterm essays, a late-night documentary about factory bells in nineteenth-century Manchester—all of it arranged itself into patterns so clear that she wanted to call everyone she loved and explain. The problem, of course, was that almost nobody wanted three hours of explanation at two-thirty in the morning.

Her friends endured, for a time. The “support system,” as the therapist liked to call them, consisted of four people: a fellow professor who loved her and feared for her, an ex- girlfriend with whom she retained a difficult tenderness, a younger brother in another city, and an older poet who had once sent her a postcard that read, in its entirety, “You will survive this century. Love, JTM.” The bipolar person, during her high-voltage seasons, would rotate through this list in long, late calls. She needed confession, but not the kind the therapist offered. She wanted witnesses who might understand that her pain, and her flights, had context beyond neurotransmitters. So she told them, again and again, about the DSM as billing instrument, about E.P. Thompson and the imposition of clock time, about how she sometimes imagined a parallel universe in which mania received treatment as a kind of lay prophecy, handled with ritual containment and community care instead of forced sedation and permanent classification. Her friends listened with varying degrees of patience. The fellow professor took notes and sent her articles in return. The ex-girlfriend alternated between furious love and exhaustion, sometimes saying, “I believe you, but I also need you to sleep.” The brother cracked jokes and refused, with a stubborn kindness, to treat her as broken. The older poet, when she called him, usually stayed silent for long stretches and then, at some point, said something like, “You know they will always prefer a manageable crisis to a dangerous vision, right?” which both comforted and inflamed her.

These calls acquired, over time, a secondary register. Beneath the surface drama—her monologues, their responses—the bipolar person began to track something else: the fatigue in their voices, the pauses before they picked up, the moment when someone sighed and said, “Hey, can we talk tomorrow? I’m at work.” She recognized that she was using their lives as staging grounds for her need to narrate. This recognition did not prevent the next call. It did, however, provide material for her self-contempt in the opposing mood. During the down phases, she lay on her couch staring at the un-dusted spines of her books and replayed each conversation with the clinical cruelty she usually reserved for close reading. Here she had interrupted. There she had deployed Kierkegaard’s despair as armor against their attempts to ask how she felt. In that email she had used the phrase “neurochemical theology” as if coining clever terminology could redeem the fact that she had, hours earlier, seriously considered driving her car into a concrete barrier simply to see whether anything on earth could interrupt the grind of her thoughts.

The bipolar person, in her depressive intervals, did not so much lose language as turn it against herself. All the conceptual apparatus she loved—the genealogies of diagnosis, the theology of suffering, the poetics of affliction—continued to function, but in service of indictment. She did not say, “I am sick.” She said, “I have internalized an entire bureaucratic cosmology that treats my volatility as error,” in a tone dripping with contempt for her own susceptibility. She hated the part of herself that had swallowed the code and answered to it. She hated, as well, those who seemed content within the code. The therapist, who had never read Lamentations or Trakl or Byron or Augustine or Hildegard or Dante or Blake or John of the Cross and who spoke of “coping skills” with an earnestness that made the bipolar person want to throw a chair, seemed in those moments like an emissary of a world that believed survival and meaning to be the same thing. The psychiatrist became, in her sulks, a priest of an idol she despised: Homeostasis. Balanced budgets of mood. All spikes shaved. All lows padded. Every appointment became a minor rite in which wildness was confessed and then medicated away—an emblem of the quiet tragedy of a culture that treats spiritual amplitude as a malfunction and then deputizes clinicians to shepherd people back toward median life.

And yet: even in the depth of those states, the bipolar person did not fully reject the institutions managing her. She had, after all, experienced firsthand what unmedicated swings did to her life. She had not forgotten the semester where she forgot to pay rent and opened her door to a polite but firm notice. She could conjure, at will, the look on her brother’s face when she once called him from a motel outside town and explained, in cheerful detail, a plan to quit her job, sell her belongings, and follow some abstract “line of inquiry” across the continent. The fear she saw in his eyes then (he had driven two hours in the dark to collect her) haunted her more than any diagnosis. She took the pills again after that. She recommitted to appointments. She taught her classes, even when each sentence required an act of will. The bipolar person knew that the psychiatric system, however clumsy and conceptually shrunken, kept her alive. She also believed that the same system, in its framing, misdescribed her life so thoroughly that living on its terms felt like a betrayal of something essential.

She articulated this, once, as clearly as she could, during a late session when exhaustion had scraped away most of her usual irony. The therapist had asked, again, “What does the diagnosis mean to you?” in a tone that suggested a workbook exercise. The bipolar person stared at a patch of chipped paint on the office wall and said, very slowly, “It means that when I feel an upsurge in energy and think faster and speak faster and experience the world as if someone turned up the saturation on the colors and the volume on the music, that state counts, in this room and in your book, as a prodrome—” she paused, because she enjoyed the expression on the therapist’s face when she used medical jargon correctly—“a warning sign of disaster. It means that my most intense experiences of clarity now arrive already guilty. It means that my creative process has become a symptom. It means that when I write for twelve hours and feel, for once, aligned with my own mind, a part of me is also watching the clock, counting how many days I can sustain this before you increase my dose. It means that I no longer trust my own exhilaration.” She stopped. The therapist, to her credit, did not rush to reassure her. She sat very still for a moment and then said, softly, “That sounds like a tremendous loss.” The bipolar person swallowed, surprised by the word choice. Loss felt closer to truth than disorder.

In her more lucid moments, the bipolar person could admit that the floor of the world had shifted. Industrial time, as she had once lectured her students, had reorganized not only factory shifts but bodies, marriages, entire calendars. The psychiatric manuals and criteria lists appeared, in that light, less as conspiracies than as continuity: new instruments to ensure that citizens remained aligned with schedules that served machines and markets. She did not think the psychiatrist in his office, or the therapist with her cardigans, woke up intending to patrol this alignment. They simply lived inside it. The coercion occurred at the level of structure. You cannot recognize as holy a mood that makes you miss work. You cannot fund a healthcare system around states that refuse reliable measurement. She understood all this. She still wanted, with a stubbornness that embarrassed her, some other way of naming what she lived.

She searched, as any scholar would, in older books. Late at night, when the pills had dulled the frantic edges but left her restless, she read Job aloud in her living room, voice cracking on the parts where God answers from the whirlwind and offers no explanation, only a catalog of strange creatures and vast phenomena. She read the Psalms, the ones that end without consolation. She reread Hölderlin’s late fragments, their scrambled word order and luminous despair. She read Simone Weil on affliction as an experience that strips the self of every consolation, and Bachelard on the interior as a set of rooms, stairways, corners. These texts made no attempt to sort moods into steady states. They treated sorrow and exaltation as events that deserved awe. They did not prescribe. They did not promise. They simply held.

Some nights she imagined a small room—a cabinet, as she once called it in a note to herself—lined with shelves where moods might sit like jars, each with its own label, descriptive rather than diagnostic: “August evening, running through the park, sudden conviction of rightness”; “February afternoon, grading papers, awareness that nothing in the world will ever suffice”; “June night, seminar table, sensation that every student’s face holds a separate universe”; “early morning, shower, desire to vanish.” In this cabinet, moods came and went. None required coding. None possessed supremacy. Some harmed. Some created. Many did both. The person walking among them would need discernment and company and perhaps some medicine, sometimes, but she would not need to rename herself after her worst or most dangerous state. She would not, in other words, walk through the world as “the bipolar person.” She would be a person with many moods, some of which modern systems found inconvenient.

The actual world, of course, declined to adopt this cabinet. The bipolar person woke each weekday, took her medication with coffee, answered emails, met students, wrote when she could, attended her appointments, tried, with varying success, to refrain from middle-of-the-night monologues. She continued to think about DSM committees, Goffman’s institutional micrology, Weber’s iron-cage rationalization, Simmel’s metropolitan nerves, Veblen’s theatre of consumption, Woolf’s tidal interiority, Dostoevsky’s fevered reckonings, Melville’s scholastic monologues, all of it. She continued to live. When she felt the first bright surge that usually signaled a rising week—the way thoughts seemed to knit more quickly, the way colors in the grocery aisle appeared almost unbearable in their intensity—she experienced, now, a difficult mixture of anticipation and dread. She knew the forms already filled out in her name. She knew the code. She also knew, with the certainty of someone who has lived under several regimes of description, that no manual would ever capture the fact that on one of those rising nights she had held a student’s hand in an emergency room while the girl trembled and said she wanted to disappear, and the bipolar person had felt, in that fluorescent light, a profound and unspeakable alignment: two human lives, both tired of performing predictability for systems that did not deserve it, both still clinging, somehow, to the possibility of meaning.

If asked, years from now, by some diligent researcher writing a book on the “lived experience of bipolar disorder,” to explain how she had understood herself under that name, the bipolar person imagined she would answer in two registers at once. In the first, she would offer the required data: onset in adolescence, family history inconclusive, sleep irregular, response to lithium partial, to lamotrigine better, one hospitalization avoided by the timely intervention of a brother with a car. In the second, she would say something like: “I lived in a century that treated variable mood as a hazard to schedules, and so my temperament became a disorder. I survived with help from pills, friends, and books. I remember every exalted night as clearly as every desolate morning. I refuse to call the former mere symptoms.” And perhaps, if the researcher’s recorder still ran and patience held, she would add, “I once read a story called ‘The Depressed Person’ that made despair feel like a sealed room. My life took place in many rooms, some locked, some flung open at three in the morning with the windows rattling. Your forms will require me to list episodes. My answer will require more time.”

Author bio: Joseph Randolph is a multidisciplinary artist and professor from the Midwest. He is the author of Vacua Vita (philosophy) and Sum: A Lyric Parody (poetry), and his debut novel Genius & Irrelevance is currently under review. His writing has appeared or is forthcoming in Action, Spectacle, The Penn Review, Night Picnic, and elsewhere, and he received second place in the 2025 Bath Flash Fiction Award. His music is available on streaming platforms, and his paintings can be found on Instagram @jtrndph.