Bipolar Episodes

The establishment subscribes to 2-3 types of bipolar episodes:

1. mania - high of euphoria, activity, grandiosity, impulsiveness, etc.
2. depression - low of activity, energy, negative thoughts, suicidal thoughts, etc.
3. mixed states - properties of both mania and depression, perhaps including psychosis

Believe it or not, there is still debate on whether the third type actually exists.  I have encountered prominent doctors at a university who subscribed only to the traditional bipolar I and II distinction in which bipolar I is thought to involve both mania and depression and bipolar II is thought to involve hypomania (baby mania) and depression.  These doctors would not discuss mixed states, but instead discuss schizoaffective disorder as the third disorder that can explain bipolar-like symptoms.

The first two types of episodes are what give bipolar its a name where the 'bi' refers to mania and depression, and the 'polar' refers to the presumed spectrum on which mania and depression sit at opposite ends.  It is fairly easy to see that the name bipolar comes from the traditional description of bipolar I and II.  The addition of mixed states is an acknowledgement that there is actually not a depression-mania spectrum for some people, and opens a diagnostic category for the people having episodic bi-polar-like symptoms that are not clearly related to schizoaffective disorder.

What are mixed states?
It is thought that they look different in everyone that experiences them.  And, one person might experience more than one type of mixed episode.  (Keep in mind that this discussion is not very scientific, as the definition of a mixed episode is still being developed.)  I like to think of it this way, and notice that my view is different from the traditional definition: mania is an episode centered around feeling good and depression is an episode centered around feeling bad.  I believe there are other feelings that can anchor an episode such as anger, or fear.  In each case, the trademark of bipolar is that these episodes take an emotion and make an extreme experience.  So that anger becomes a rage episode and fear becomes a paranoia episode.

These emotional episodes are called mixed, because they are said to have symptoms of both classical mania or depression.  For instance a rage episode might be considered energetic and may also involve suicidal thoughts.  Or a paranoid episode might be sleepless and may also involve difficulty with concentration.

Personally, I find the task of identifying both mania and depression symptoms in an episode to be difficult.  I would prefer to see descriptions of multiple types of emotion centered episodes.  But we will see where scientific discovery takes mixed episodes.  Hopefully we will see progress in the near future.

Does anyone else have thoughts about the distinction between mania, depression, and mixed episodes?