Calming the Bipolar Waves: From a Psychiatrist’s Point of View

Author: Thiago Genaro


Have you ever been to Rio de Janeiro? Rio reminds me of tropical natural beauty, carnival and parties. When I think of Rio, the statue of Christ the Redeemer, Sugarloaf Mountain, sailboats in Botafogo Cove, and incredible beaches come to my mind. In this coastal setting, the sidewalks in Copacabana have a life of their own. Formed by black and white stones taken from Portugal to Brazil at the beginning of the 20th century, the original geometry of the layout drew waves perpendicular to the sea line. In the 70s, the sidewalks were modified by Brazilian artist Burle Marx so that the waves drawn on them were parallel to the sea. Tune and balance on the Copacabana waterfront.

Tune and balance are what I seek when managing patients with bipolar disorder. The idea with treatment is to make mood episodes less frequent and lighter. Recently, I started caring for a triathlete patient. She arrived with a previous diagnosis of “depression with anxiety” since adolescence, without much response to antidepressants. We started talking and clearly there were criteria for diagnosing bipolar disorder.

I explained to them the defining criteria for a mixed episode and hypomania and she asked me an interesting question:

“So then these symptoms of reduced sleep and greater irritability are not episodes of anxiety?”

We talked about the mood polarizations that occur throughout the bipolar patient’s life, psychotherapy, and healthy habits; as well as beginning medication. After a few months of treatment, the patient noticed an improvement in their symptoms. Primarily, a decrease in episodes of mood polarization. We talked about the practical result of this: a calmer day-to-day life with more inner peace, and a more stable and harmonious married life.

The patient’s metaphor was excellent:

“My biggest challenge in triathlon is the swimming part. It’s not easy to swim 2km in the sea, especially when the waves are big. Things flow better when the sea is calmer and has ripples. That seems to be what happened to me months after starting treatment for bipolar disorder. I no longer face emotional tsunamis, but rather ripples”

The Copacabana waterfront, with its sidewalks in harmony with the sea, is an invitation to reflect on emotional waves.


Thiago Genaro is a psychiatrist in São Paulo, Brazil. He is part of the clinical staff of Conexa Saúde, Hapvida, MentalMe, Hospital Nipo-Brasileiro and Hospital Israelita Albert Einstein.
The content of the International Bipolar Foundation blogs is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician and never disregard professional medical advice because of something you have read in any IBPF content.
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