Wednesday, June 07, 2006

Bi-polar Disorder: Not everyone has it, actually

Bipolar Disorder, Manic-Depressive Illness

The diagnosis of the year.

Never before have so many patients told me they think their partner, brother, sister, mother, in-law, uncle, first cousin once removed, just about everyone or anyone they know is for sure bi-polar.

It's good that there's so much awareness of the disorder, perhaps due to the media, especially talk shows that cater to the therapy-craving public, sensationalizing mental illness. But I feel there has to be more clarification, a little polish here, for the benefit of those who never had the chance to go to grad school.

The bi in bipolar refers to the two poles of the disorder, ends of a continuum. Symptoms of these end-points range from manic, as in spending much more than one has to spend, driving too fast, craving sex all the time and not being 17, to depressive, often wishing you could dig yourself out of a deep, dark, pit and sleeping most of the day and night. Having features of only mania or only depression, one is uni-polar, not bi-polar.

I know that Reymundo Sanchez, the Latin King who wrote My Bloody Life and The Unmaking of a Latin King 'fesses up to the disorder at the end of his books (it won't spoil them knowing this) which speaks to the necessity for public education and early diagnosis. Several high profile people have owned having Bipolar Disorder.

We use the word disorder, fyi, not disease. Disease has been out of favor for at least 25 years. Now we say, bipolar, as opposed to manic-depressive, too. These terms are less-stigmatizing, is the thinking. Not everyone feels this way, certainly not Kay Redfield Jamison, who prefers Manic-Depressive Illness. A must-see is this psychiatrist's story, her personal journey, in the video below.

Biographies and public disclosures from famous personalities who suffered from this difficult emotional life include*:

Lionel Aldridge
Hans Christian Andersen, writer
Ned Beatty, actor
Robert Boorstin, writer, assistant to Pres. Clinton,
Arthur Benson, writer
E F Benson, writer
William Blake (1757-1827), poet
Ralph Blakelock, artist
Napoleon Bonaparte (1769-1821), general
Tadeusz Borowski
Art Buchwald, writer, humorist
Tim Burton, artist, movie director
Robert Campeau, financier (Canada)
Drew Carey, actor
Jim Carrey, actor
Dick Cavett, writer, media personality
C.E. Chaffin, writer, poet
Agatha Christie, mystery writer
Winston Churchill, 1874-1965- British Prm Mnstr
John Clare, poet
Rosemary Clooney, singer
Garnet Coleman, legislator (Texas)
Francis Ford Coppola, director
Patricia Cornwell, writer
Richard Dadd
John Daly, athlete (golf)
John Davidson, poet
Edward Dayes, artist
Ray Davies, musician
Emily Dickinson
Kitty Dukakis, former First Lady of Massachusetts
Patty Duke (Anna Duke Pearce), actor, writer
Thomas Eagleton, lawyer, former U.S. Senator
T S Eliot, poet
Ralph Waldo Emerson, essayist
Robert Evans, film producer
Carrie Fisher, writer, actor
Edward FitzGerald
Robert Frost
F Scott Fitzgerald, author
Larry Flynt, magazine publisher
Connie Francis, actor, musician
Sigmund Freud, physician
Cary Grant, actor
Kaye Gibbons, writer
Shecky Greene, comedian, actor
Linda Hamilton, actor
Kristin Hersh, musician
Victor Hugo, poet
Jack London, author
Robert Lowell, poet
Marilyn Monroe, actress
Mozart, composer
Jay Marvin, radio personality, writer
Cara Kahn, mtv's 'real world'
Kevin McDonald, comedian, actor
Kristy McNichol, actor
Dimitri Mihalas, scientist
Kate Millett, writer, artist
Buzz Aldrin, astronaut
Spike Milligan, comic actor, writer
John Mulheren, financier (U.S.)
Robert Munsch, writer
Napoleon, general
Ilie Nastase, athlete (tennis), politician
Isaac Newton, scientist
Margo Orum, writer
Nicola Pagett, actor
J C Penney
Plato, philosopher, according to Aristotle
Edgar Allen Poe, author
Jimmie Piersall, athlete, sports announcer
Charley Pride, musician
Mac Rebennack (Dr. John), musician
Jeannie C. Riley, musician
Phil Graham, owner, Washington Post
Graham Greene, writer
Peter Gregg, team owner and manager, race car driver
Abbie Hoffman, writer, political activist
Lynn Rivers, U.S. Congress
Francesco Scavullo, artist, photographer
Lori Schiller, writer, educator
Frances Sherwood, writer
Scott Simmie, writer, journalist
Alonzo Spellman, athlete (football)
Muffin Spencer-Devlin, athlete (pro golf)
Gordon Sumner (Sting), musician, composer
St Francis
St John
St Theresa
Rod Steiger, film maker
Robert Louis Stevenson
Liz Taylor, actor
J.M.W. Turner
Mark Twain, author
Alfred, Lord Tennyson, poet
Ted Turner, entrepreneur, media giant
Jean-Claude Van Damme, athlete, actor
Vincent van Gogh
Mark Vonnegut, doctor, writer
Sol Wachtler, judge, writer
Tom Waits, musician, composer
Walt Whitman, poet
Tennessee Williams, author
Brian Wilson, musician (Beach Boys), composer, arranger
Jonathan Winters, comedian, actor, writer, artist
Luther Wright, athlete (basketball)
Margot Kidder, actor
Robert E Lee, soldier
Bill Liechtenstein, producer (TV & radio)
Abraham Lincoln (1809-1865), US President
Daniel Johnston, musician
Samuel Johnson, poet
Burgess Meredith, 1908-1997, actor, director
Kay Redfield Jamison, psychologist, writer

There must be thousands more. I'm always suspicious when a powerful actor gains a lot of weight that this poor soul is on lithium, a wonderful discovery that has helped millions, but tends to increase the appetite, preferable to the destructive impact of mania and depression to oneself, family, and friends. No one likes it, or wants to take it in a manic state. Mania is addictive, becomes an addiction to the substances in one's own brain.

Yet, with such distinguished company, who wouldn't want to have this disorder? I know a physician who taught medical school who outright admitted to it, when I was a young person, in his first lecture. So is it romantic? Cool? Do we want this?

Not exactly. It isn't a romantic disorder; it's a difficult one that can wreak havoc on a person's life, especially if one’s presentation reaches the extreme poles of either depression or mania. One in five are vulnerable to suicide.

The good news is that the medications we have now are amazing and have made life not only tolerable, but often pretty darn good, although finding the right cocktail can be trying. Psycho-education, which this blog aspires to, enables individual, families and friends to cope when it's known that someone is suffering from Bipolar Disorder.

There are two kinds, and I'll focus on Bipolar I in this post. Bipolar II is primarily depression with manic episodes few and far between.

It helps to look at the illness as a very fluid, changing cluster of symptoms that range from one pole to another on a continuum. Pretend the continuum is a baton, the thing they twirl in marching bands. At one end of the baton is depression, and at the other is mania. The ends are extreme and flag the disorder.

The depressive end of the continuum is so vegetative, so depressed, that a person sleeps most of the day and still doesn’t feel good. Everything is an effort, everything hopeless, despairing. Thinking a chore, reading impossible, the memory effusive. The manic end of the baton is hyper-attentive, so awake, so incredibly, alive, that one feels omnipotent. (This is a place akin to that in which some have religious identifications with deities, but it isn't the only condition that can manifest itself this way).

The manic pole is characterized with no empathy. People at both ends of the baton are likely to be completely out of touch with the feelings of others, and this is especially evident at the manic pole. Under mania people need no sleep, we’re not talking like, they get 3-4 hours a night, they get none. They can get very testy, too, irritable, even shoot people without reason, certainly bark at them and abuse them.

So, this is not a good disorder, okay? It is not a romantic condition. Lucky for all of us, it is treatable. Unfortunately, when mania does not present as irritability, when it presents as ecstasy and omnipotence, the rest of us may suffer to the individual’s lack of empathy, but the patient is feeling no pain, does not want treatment, and will be non-compliant about medication.

Anyway, although symptoms and behaviors at the two poles are extreme, there's a wide continuum of emotional life between them. The baton, by the way, can get pretty long in higher functioning individuals with the disorder.

In our hyper-caffeinated world, I have to say that it is my personal feeling that many people who think they have this illness don't. Cut out your caffeine and alcohol consumption for a month and then look at your symptoms before you look at the symptoms of the disorder and say, "Hey, that's me!"

The catch is, of course, Cut out your caffeine and alcohol consumption. Who wants to do that? Just a thought, something to consider.

Diagnosis requires careful assessment and a history, and it won't matter all that much if a person's had a Single Episode, or a Most Recent Episode Unspecified, for example. If you or someone you know has this disorder you should get help and let a professional fine-tune your basic diagnosis.

Labeling someone is unctuous, undesirable, and there is a movement against it within the psychiatric community, certainly the social work community. But if someone has Bipolar I Disorder, the first step really isn’t to talk about feelings or to treat the family. It is medical intervention, meaning medication.

Then there's much more to do, even when an individual is on the right meds, for there are triggers, it seems. We used think people cycle, still do. But stress hurries the cycle along, "triggers" both manic and depressive episodes, complicating the natural cycling of emotions along the baton. Anger, especially, (discussed as expressed emotion, in the literature) is toxic.

This makes a case, of course, for psychotherapy, family therapy, and behavioral therapy. Beware if someone you know has a major disorder and is only taking meds.

Copyright 2006, TherapyDoc

*See Actors and Actresses with Bipolar Disorder and Bipolar Disorder and Public Personalities, this list is direct from their websites, perhaps not even true, my disclaimer. If you read through the list, however, you might think, Maybe so! This explains the genius!

But just to keep you honest, the disorder is confused with others, and the assessment is complicated. The most readable of the books on the subject (okay, I confess, I haven't read them all) An Unquiet Mind, by Kaye Redfield Jamison (Johns Hopkins School of Medicine).

Here she is:

Here are a few of the differential diagnoses, compliments of Depression Alliance.
Mood Disorder Due to a General Medical Condition.
Substance-Induced Mood Disorder.
Major Depressive Disorder.
Dysthymic Disorder.
Bipolar II Disorder.
Cyclothymic Disorder.
Schizoaffective Disorder.
Delusional Disorder


Just Me said...


I have Bipolar I, severe mixed rapid cycling. I am finally more or less controlled on an extremely hefty med cocktail and with the help of an incredible pair of doctors.

But for most of the time I've had this and before that, when I refused to have it, I heard everyone claim bipolar. And that never seemed right. Then when I was diagnosed and went through years of absolute misery trying to find meds, I never was given a fair chance because everyone knew someone with bipolar and "all it took for him to be better was ______" and I needed to do that too. People assumed they knew so much about me. I was allergic to Abilify and wound up in the ER. Someone this turned into everyone at work thinking I was psychotic and admitted. I came back and had people telling me all about their relatives' psychotic episodes. Now, it's not like I've not had psychotic features, but I do not need to know every story on earth, nor has everyone had that particular horror. What people don't get is that psychosis or mania are not fun. Mixed episodes are torture beyond all description, but nobody knows about those. For me the best definition of psychosis was the 2 1/2 years that I could not shower without terror that someone would get me, and this was increased by the water keeping me from hearing normally to refute it. So for all that time I alternated showers and sponge baths and lived with embarrassment that I didn't shower daily.

Also, the caffeine thing? After 6 years (and wow, I just realized I totally missed my diagnosis anniverary for the first time last month), I agreed to try two things. I went on Seroquel, which I'd resisted because I'd not liked what I saw in my patients (I'm a therapist), and I gave up every drop of caffeine. Not just for the length of the episode, forever. And I stabilized and have stayed that way. I do get caffeine through chocolate and the trace amounts in decaf drinks, but that's rare. I miss cold fountain Coke, but not enough to lose my life.

therapydoc said...

Ah, chocolate. Your welcome.

Cheryl said...

Thanks for linking to this TD. You know, I've never sat and contemplated this before really, but for once I am glad I am a generally irritable person. I'm an irritable maniac AND and irritable depressive (I got screwed). Frankly quite often now I just hate myself because I don't have to be irritable like I am. I very well know there are things I can do that I do not do for various reasons... My shrink is generally able to talk me into something on the list because of that. But if I was euphoric... I don't even want to think about that.

I definately WOULD NOT glorify this. There's nothing romantic about annoying yourself and absolutely everyone around you ALL THE TIME. It's a strain.

Debbie said...

British actor Stephen Fry did a great documentary on Bipolar disorder for the BBC a couple years ago. He talks a lot about his experiences before and after his diagnosis and how it impacted his acting career and personal life. Worth checking out.

catatonickid said...

Yeah, there's a 'you try living with it' factor in going truly out of you mind.

That speech, though. Brilliant. And brave.