David looked down at his hastily scrawled "to do" list. First he needed to buy 613 tickets for the Mega Millions. He knew that he would win, because he was using the number Hashem had used specifically as a guide for him to follow. Next, he had to buy 18 hamsters and gerbils, 36 cats and birds, and 72 pedigree dogs to open a specialized pet store for the Jewish community. He already had his eye on a storefront in the center of Avenue J in Brooklyn. He knew that the money in his account would not suffice, but he was sure everybody would be quite ecstatic to join this venture. He glanced at his watch…3 am….but who could sleep?…his mind was racing.

The next morning David's parents looked up as he bounded down the stairs, stopping by the breakfast table to say hello before going to college. They paused to take in his appearance, as they wondered what had happened to the person their son used to be. For the last few years they had gotten used to periods of sadness, where David did not want to do much, and stayed by himself. During those times he had complained that he wasn't hungry, and always wanted to sleep. They hadn't worried too much, because he always kept his grades up, and eventually snapped out of it. When it got particularly bad, they took him to a psychiatrist. "Depression" was the diagnosis, and the medicine always worked. They even brought him for therapy for a few sessions, until he felt better and did not want to go anymore. Besides, he had not had problems for many years. He had probably grown out of it anyway. Still…lately he looked unkempt, this morning his yarmulke was askew on his head. His eyes were bloodshot, and he seemed restless. But he must have slept…his energy seemed boundless. Although he was in a hurry, he was polite as they exchanged the usual pleasantries, and he laughed happily at his mother's joke. But when she offered him food, he declined saying that he was too busy to eat, although he reluctantly took the banana his mother pushed into his palm. She watched through the window as he jumped down the steps, and ran down the street, throwing the food into the closet garbage can.

As David swung onto the bus, he was lost in thought. When somebody jostled him he became extremely angry, shoved the person back, and began shouting. His neighbor watched with evident surprise, as she had never seen him this irritable, barely able to keep himself in control. She hung back warily, and did not approach him. As he left the bus she could see him muttering to himself.

Universally, independent of culture, ethnicity or country, bipolar disorder occurs equally in both sexes. Depression and mania can occur separately or in cycles of varying lengths in the same individuals. Symptoms of bipolar disorder can occur anytime, although most patients become symptomatic in young adulthood. These disorders span all races and socioeconomic status. Bipolar disorder appears to be a result of dysregulation of chemicals in the brain called neurotransmitters. There also appears to be a genetic component that is inherited in a complex fashion, as seen by its strong, but not absolute, tendency to run in families. Contrary to popular belief, mental illness is not associated with bad parenting.

As illustrated above, mania is associated with racing thoughts, inflated self-esteem, decreased need for sleep, irritability, distractibility, great physical and mental activity, and over-involvement in pleasurable behavior. Depression can precede it. Patients tend to enjoy the initial manic state, because they become very productive, can accomplish a lot, and enjoy their euphoria. Because of this, bipolar patients, especially teenagers, will resist taking medications. However, when bipolar illness goes unchecked, people can become paranoid and psychotic, with grandiose delusions leading to odd and self-destructive acts. Sometimes, patients will be able to hide their symptoms in the initial stages. However, symptoms of rapid speech, grandiosity, and unnaturally increased energy are usually detectable to an objective observer.

Fortunately, therapy is very useful in helping a patient cope with stressors unique to having this illness, and medication has come a long way in controlling symptoms. Bipolar disorder is not a death sentence. Many of the most influential and creative people that we have all learned about in school had bipolar disorder. However, the greatest success is associated with early recognition, and treatment.