Karen Hart did not sleep for two weeks, except for the occasional nap. She barely ate, because going without food made her feel "superhuman.''
Hart, then a junior at MIT, was juggling course work with a heavy load of activities; she was an actor, a set designer, and technical director for the school musical. She had no problem doing it all.
"I would be lonely because I felt that everyone else could reach the same level as me, this level of transcending humanity . . . [but] they just weren't there yet. And so I was stuck by myself here,'' the 22-year-old said recently.
Hart's high-energy act was more than just youthful enthusiasm: It was an emerging pattern of mental illness called bipolar disorder that affects 10 million Americans.
The late nights, flexible schedule, and socialization of college can often trigger a person's first episode, with more than 50 percent of all cases starting between the ages of 15 and 25, according to the National Alliance on Mental Illness.
Colleges in New England are now offering a variety of services for afflicted students, including therapy, support groups, and referrals. But students with the disorder, medical experts, and advocates believe the help is not enough. They say that these young people can feel a deep stigma if others find out about their disorder and that few of the students' peers have a real understanding of their affliction.
"A lot of people with bipolar disorder can finish college over time,'' said Andrew Nierenberg, director of the Bipolar Clinic and Research Program at Massachusetts General Hospital. "But on average they're employed below their level of education, and compared to their matched peers they make a lot less money.''
It begins with recognizing the illness. Bipolar disorder, also known as manic-depressive disorder, is characterized by episodes of elevated mood, euphoria, and irritability, contrasted with periods of deep depression.
It affects men and women equally.
A number of students also face a critical dilemma: stay on their medicines to try to gain stability or skip the drugs and their side effects, which include significant weight gain and what some describe as a sense of numbness.
Hart said that for a two-week period she was in a "mixed state,'' feeling depressed and manic at the same time. Occasionally, she broke down and everything would go black. And as the set designer for the musical, she was working with power tools and kept fighting the urge to hurt herself, she said.
"That was the first time in my life where I think I actually got seriously suicidal,'' said Hart, of Pennsylvania.
Approximately 25 to 56 percent of people with the disorder try to commit suicide at least once in their lives, Nierenberg said.
A study published in the 2006 Journal of Affective Disorders, the most recent available study of its kind, compared 60 adults with bipolar disorder to 60 demographically matched adults without the affliction. Despite very similar IQ levels, 47 percent of the healthy adults received a college degree, whereas only 16 percent of the adults with bipolar disorder completed college.
Jessica Feldish, 22 and also from Pennsylvania, is a junior at Northeastern University with the disorder. She said that in a typical month she feels normal for only a week and a half. The rest of the time she is either depressed or manic.
"My depression makes me feel isolated and alone and dead inside,'' she said. "And my mania makes me feel too alive, too excited, and it's scary.''
At Northeastern, students with bipolar disorder are eligible for long-term therapy at the school's health center.
Also, Active Minds, a mental health advocacy organization geared to college students, has chapters on campuses in New England, including the Massachusetts Institute of Technology, Boston University, and Simmons College. The University of Massachusetts Amherst has an Active Minds chapter, as well as a bipolar disorder support group.
"For the most part, colleges have been putting a lot of resources into mental health services and have identified this as an important issue,'' said Harry Rockland-Miller, director of the Center for Counseling and Psychological Health at UMass Amherst.
Nassir Ghaemi, director of the Mood Disorders Program at Tufts Medical Center, describes the depressive periods of bipolar disorder as "a slowing down of one's thoughts and moods'' that lasts an average of two months. Mania is when an individual's mental capabilities are increased, he said.
Those in a manic state may not need to sleep, and they may engage in risky behavior such as reckless driving, extramarital affairs, and excessive spending.
Sarah Savage, 19, who is bipolar and attends Simmons College, had periods of depression during her high school years in Maine, but it was not until college that she experienced her first manic episode. Although she is usually careful with money, she went on a two-week spending spree, she said, buying an excessive amount of clothes and jewelry, spending $50 on a hair brush and $400 on DVDs.
This year, Simmons formed an Active Minds chapter, and Savage saw her quality of life improve.
Although the exact cause of the disorder is unknown, scientists believe it to be genetic, Ghaemi said.
Treatment options are limited and work only some of the time. Nierenberg, at Mass. General, said the last time researchers developed a drug specific to the disorder was 60 years ago, and that was lithium.
Feldish recently decided to go off her medicines. She said that last summer she gained 20 pounds from the drugs, and "I felt so listless and depressed and numb.''
Instead, she is taking a more holistic approach and does acupuncture, yoga, massage therapy, and other relaxation techniques.
Despite the challenges of bipolar disorder, Feldish has done well at Northeastern. An environmental studies major, she has had several prominent internships, is active in campus groups like the Progressive Student Alliance and the Social Justice Council, plays water polo, and is a waitress.
But she still feels the pain of bipolar disorder.
"I am very bitter about it,'' she said. "It's one extra thing I have to deal with that other people don't. And my life is harder because of it.''
As much as those with bipolar disorder can resent their condition, some students see a way to put their manic phase to good use.
Patrick Maudlin, 24, a classically trained pianist from Arizona who attended Berklee College of Music, said that being bipolar gives him a creative boost.
When he first became manic, he said, he started hearing new types of music in his head and found that his piano skills had drastically improved.
"I was blown away with myself,'' he said. "I used to really like that I had'' bipolar disorder, he said. "I don't want to have it anymore, but I don't want to lose the gifts that I have.''
Maudlin was eventually expelled from Berklee after a dispute with the school's president.
For Hart, manic episodes helped fuel her academic success, she said.
"I knew how to use it to be superproductive, and productivity was really an addiction for me at that point,'' she said. "I loved the feeling of getting things done.''
Her disorder spiraled out of control, she said, to the point that she had to take time off from school.
And although life has been a lot better these days, Hart said it is the stigma of mental illness that follows her.
"A lot of people don't understand mental illness still, and in a lot of ways people never will, and never will be able to,'' she said.
Katherine Landergan can be reached at firstname.lastname@example.org.