Straight Talk on Bent Thinking

Straight Talk on Bent Thinking

"Straight Talk on 'Bent' Thinking"

By Steven A. Weisblatt, M.D.

Thinking difficulties are some of the most impactful symptoms of bipolar disorder, yet are also the most challenging to notice. When paying attention, focusing or concentrating requires significant effort, or if you find yourself experiencing racing, scattered or obsessive thoughts, these problems can negatively affect the way you function at work, at school and at home, by limiting your ability to use all your brain power. But unless these symptoms came upon you suddenly (which is not typical), you may not even realize that your process of thinking is “abnormal.” As these thinking difficulties often can represent mental “over-activity” due to ongoing manic symptoms, recognizing that they are present hopefully will prevent your doctor from inappropriately prescribing an antidepressant and mismanaging your care.

It’s hard enough to identify if you have thinking difficulties, much less communicate them to your doctor. It’s like this: If you fall down and suddenly can’t walk, you instantly know something’s wrong because you remember how you walked a moment before your accident. However, thinking difficulties, like mood disorders, often evolve over time, so you may not recognize that your mind is not functioning up to snuff. Therefore, just as an orthopedic patient would complain that his knee will bend only so far or her hip “clicks” when it rotates, it’s critical that you describe your thinking process accurately to your clinician. Don’t assume that your clinician automatically will ask about thinking difficulties, or will ask in a way that is clear to you. Because these symptoms can be a challenge to detect and because the medical terms are complex and sometimes misunderstood, take the initiative to observe your thinking, articulate what’s going on in your mind and ask questions.

Since for many of us—clinicians and patients alike—the right words don’t come very easily, here are some terms and definitions that may help you better understand thinking difficulties and open up an important dialogue:

Racing Thoughts:

The speed of your thinking is rapid. Often, patients describe the feeling as their mind “racing like an engine.” Or, they say, “I can’t shut my mind off.” For some, this symptom may be noticed only at bedtime, when the external stimuli of daytime activities aren’t distracting them from the experience of their internal thought process. Many patients say that they listen to the radio or the television to “drown out” their own thoughts until sleep comes.

Cluttered Thoughts:

Your thought process is such that you think of many different thoughts at the same time or in close succession. Many patients report feeling like their mind is extremely “busy” or their thoughts “chattering.” Others describe this experience as having only part of their mind present and engaged with the task at hand while another part of their mind is distracted by either related or unrelated thoughts.

Obsessive Thoughts:

The process of your thinking tends to be repetitive, ruminative, perseverative or persistent. You may have difficulty putting a thought, worry or concern out of your mind. It’s not that the subject of your thoughts is abnormal (though it can be), but that the degree of your preoccupation with the thought (or the thought’s intrusiveness) is blown out of proportion. These thoughts tend to override other thoughts and intrude, unbidden, into your awareness during unrelated activities or while thinking about unrelated things. Obsessive thoughts are difficult or impossible to dismiss, or even temporarily put them aside. The experience may be noticed particularly at bedtime.

Impaired Attention:

Your thinking is distracted. You have difficulty maintaining focus on a task or conversation, because you feel pulled away by external stimuli or your own thoughts. The experience is like sitting in a multiplex theater where the walls between theaters are removed and you are distracted from the movie on the screen directly in front of you by the movies playing to either side. Often patients report having trouble with memory, though the actual problem is that they are so distracted that they are not really making memory.

Patients with bipolar spectrum disorder frequently experience impaired attention, focus, or concentration long before ever seeking professional help. In adapting to their deficit, many children and adults choose to avoid situations where thinking is critical–like reading or engaging in a classroom environment. As a result, many patients report to their clinician that their thinking is normal—which, to them, it is!

In fact, for many bipolar patients, it is not until their illness is accurately diagnosed and adequately treated, and they start to notice the absence of any thinking difficulties, that they first realize they were experiencing “abnormal” thinking at all. For example, I have seen many patients who did not enjoy reading – or schooling that required reading—until they were properly treated.

Recognition of thinking difficulties in children is particularly challenging. Many children (and adults) can appear to be paying rapt attention, but, when asked, report that their mind is drifting to, or preoccupied with, unrelated thoughts.

Sometimes these patients are called “absent minded.” Often, in children, mood symptoms are not predominant or are not yet recognized and the clinician believes he or she is dealing purely with a distractibility problem. Sadly, this may be why many patients are frequently misdiagnosed with non-specific attention disorders like “A.D.D.” and “A.D.H.D.” and are only later in life correctly diagnosed with bipolar spectrum disorders.

It is important to note, however, that not all difficulty with attention is a symptom of a mental health problem. If you’re not interested in the topic (or the speaker) or are distracted by a pressing matter, one would not want to identify that as a thinking problem per se.

Being able to self-recognize and self-report an abnormal thinking process is so important, because it may be difficult or impossible for an outside observer—be it a family member, spouse or trained clinician—to notice it. Make sure that you bring up with your clinician (you may not be asked) any trouble you experience with thinking or attention, at both your initial and follow-up appointments. Hopefully, some of the concepts above can enlighten the discussion.

Dr. Weisblatt ( is a Former Assistant Professor of Psychiatry at S.U.N.Y. Downstate Medical Center and has private practices in New York and Pennsylvania. He has spoken and consulted widely about accurate diagnoses and effective treatments.


Is there a particular subject you would like Dr. Weisblatt to address in this column? Email him at


"Dr. Weisguy, Thank you for a decade of friendship and support"
M & M, Stroudsburg, PA

"Wherever the art of medicine is loved, there is also the love of humanity’…thank you for all you’ve done for our son…"
- L & T, Cleveland, Ohio

"Thanks a bunch!"
- S.A. , Bronx, New York

"You’re dynamite, indomitable and genuinely caring!"
- B.P. , Bronx, New York

"I just wanted to thank you for your clinical expertise and am profoundly grateful for your diagnosis. As the medications started to take effect, my world started to change: my daily activities became less stressful and relationships with employees, friends and, most importantly, my children, became more fulfilling."
- JZ, Westchester, New York

Recipient of the "Top Doctors" award
- Castle Connolly Guide, New York Metro Area

1995 John Heinz Friend of Nursing Award
- Pennsylvania Nurses Association, PA

"Thanks for all your help through the years. Heaven knows where I would be without your guidance – and don’t forget the pills!"
- B.B., Princeton, NJ

"I like having you as a doctor – I never had a doctor buy me a birthday cake before. It was very special!"
- Jules, Stamford, CT

"Your patient care has been exceptional - and your phone calls are a great morale booster!"
- Tim, Darien, CT