On Bipolar Disorder: “You are not your illness. You have an individual story to tell. You have a name, a history, a personality. Staying yourself is part of the battle.” Julian Seifter, www.Tumblr.com

Just a few days ago, eighty-seven year old comedian Jonathan Winters died. Some of you may be too young to know him, but I’m sure you know the many gifted entertainers who were influenced by Winter’s brilliant improvisations, like that of Robin Williams, Jim Carrey, Jimmy Kimmel and Steve Martin. You may also be unaware that Mr. Winters struggled with bipolar illness his whole life. One of the most damaging manic episodes came in 1959, when Winters was reported to have climbed the mast of a moored historic ship in San Francisco while drunk and naked; he was subsequently transported to a sanatorium.” (Washington Post, Jonathan Winters, Improvisational Genius).

But, no doubt, bipolar disorder contributed to Mr. Winter’s comic genius of being able to dig ruthlessly into American archetypes as the subject matter of his routines and also to his nervous breakdowns. Friends, family and employers viewed him as wildly unpredictable and thus a professional liability, which is often the perception people have of bipolar persons. Nonetheless, like Jonathan Winters, there is a long history of entertainers (Catherine Zeta-Jones, Marilyn Monroe, Patty Duke, Robin Williams, and Carrie Fisher), entrepreneurs (Larry Flynt and Ted Turner), writers and poets (William Styron, Sylvia Plath, F. Scott Fitzgerald, Ernest Hemingway, William Blake, Walt Whitman and Ralph Waldo Emerson), composers (Rachmaninoff, Tchaikovsky and Mozart) and world leaders (Abraham Lincoln, Winston Churchill, and Napoleon Bonaparte) who have still been able to leave their creative mark on the world despite having bipolar disorder (Famous Bipolar People).

The link between creative genius and bipolar illness does exist. But, let’s not get too carried away by the exceedingly good company that you, or a family member, are keeping if you have this disease. Because, as you know too well, the periods of high creative productivity is no match for times that you have had to spend either in manic confusion or in the despair of depression; the kind of depression that makes 20% of bipolar people take their lives through suicide.  American Clinical Psychologist, Kay Redfield Jamison describes well her own emotional struggle with the disease. “There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you’re high it’s tremendous, you’ve never functioned better. But, somewhere, this changes. The ideas come too fast and are far too many. Confusion replaces clarity, memory goes, and humor and absorption are replaced by fear and concern. Everything previously moving with the grain is now against— you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind that you never knew were there. It will never end, for madness carves its own reality.” Kay Redfield Jamison, An Unquiet Mind: A Memoir of Moods and Madness

Indeed, Bipolar Disorder does carve out its own reality, if left untreated. With proper diagnosis, treatment and management, people can achieve their goals and forge a fulfilling life. Unfortunately, some bipolar people do not seek treatment, until a manic episode gets them in trouble sexually, financially, or with the law. Or, they are misdiagnosed, as the symptoms can present as a range of disorders that include clinical depression, schizoaffective disorder, and even the attention deficit and anxiety disorders. And, still some people refuse treatment altogether, to maintain their creative edge.

For sure, BPD is a challenging mental health condition. Its onset, progression, diagnosis, treatment and management of the illness is challenging to patients as well as to the professionals treating them.

The Cause

Bipolar disorder is a combination of genetic, neurochemical, and environmental factors that come together in ways to trigger the onset of the disorder. Bipolar disease runs in families. Twin studies have taught us that bipolar disorder is more genetic (nature) than a result of childrearing (nurture). Identical twins who share the same gene profile will have a 65% chance of sharing BPD. This drops to around 5% to 20% for fraternal twins. Also, if one of your parents has bipolar disorder, then you will have a 15% to 25% chance of also having the illness. Overall, studies have placed the genetic heritability of bipolar disorder at 60% to 85%.

But, how does the gene for BPD actually lead to the symptoms that makeup the illness? The gene for BPD causes a malfunction in the brain’s neurotransmitter system (nerve chemicals and messengers) that is responsible for thinking, modulation of mood, and control of behavior. The illness is generally dormant in childhood. But, tends to be activated by stress in the late teenage, young-adult years. Fluctuations in hormones, pressures to establish an adult identity, and to settle on an educational and professional path can overwhelm the brain chemistry of the person who has the gene for this disease.

But, even more instrumental to the progression of the disease process is what happens to the brain upon its onset. Essentially, the first bipolar episode sensitizes the brain’s chemicals and nerve messengers to subtle stresses coming from within and outside the person. Think of the first onset, like a wood log that is hard to light on its own. But, once you position twigs around it, the log lights easily. This is what happens to the brain after the first onset of a bipolar episode. Stress repositions chemical messengers (twigs) around the gene for bipolar illness (the log) that makes it highly likely that the next time the person is stressed the gene will get expressed in brain activity. Over time, the brain becomes increasingly sensitive to stress so that even the mildest change can activate a manic-depressive episode. It’s like with each stressful episode, more and more twigs get added to the fire. This is called the kindling effect, and it is the reason why BPD is so hard to manage.

There are two types of bipolar disorder that are distinguished by type, frequency, and intensity of the manic and depressive episodes.

Bipolar I Disorder

One of the defining features of Bipolar I disorder is a manic episode that does not have to be preceded by depression. The manic episode consists of extreme changes in energy level, activity, sleep, and behavior that accompany a dramatic shift in mood. Symptoms include an inflated sense of one’s capabilities, little need for sleep, pressure to talk, flight of ideas and racing thoughts, rapid shifts in attention, hyperactivity, impulsivity, and destructive action. There is also an increase in goal-directed behavior (social and occupational) and involvement in activities that have a high risk for harmful consequences to the person (buying sprees, sexual acting-out, foolish business investments, drug and alcohol use, explosive emotionally and irritable, and scrapes with the law) Symptoms of Bipolar Disorder, National Institute of Mental Health.

Bipolar II Disorder

In contrast, Bipolar II is characterized as the presence or history of one or more major depressive episodes and at least one hypomania episode, without  precedence of a manic episode. Hypomania has similar features to mania only in a much lesser degree and lasting only a few hours at a time. Because their symptoms are milder, it’s easier for the affected person to deny that they may have bipolar disease, especially because their hypomania seems normal to them. It’s a welcome relief from their usual depression (Bipolar II People Masquerade As Just Happy, New York Times).

Like bipolar I persons, they are usually  intelligent, artistic, and emotionally sensitive people. But, it is their history of depression, rather than a manic episode, that usually gets them to seek treatment. Nonetheless, they can suffer just as much as people with the type I version of the disease and can engage in the same types of self-destructive behaviors that worsen their illness.

Clinicians themselves have difficulty differentiating between bipolar I and II disorders. Since the types of patients, lengths of episodes, and age of onset are very similar. However, the real difference between the two is the difference in mania (bipolar I) versus hypomania (bipolar II).

The following questions about BPD come from people who follow me on my Facebook page for Psychology in Everyday Life. I want to share these questions and my responses with you, as you may have the same questions.

1. Can you cure bipolar disorder? Bipolar illness, like diabetes or epilepsy is managed rather than cured. It is a high-maintenance disorder. To manage it well, you have to take prescribed medication, reduce your stress, eat a nutritious diet, and refrain from using too much alcohol and drugs. Unfortunately, these treatment and health habits can be a challenge for people who have this disease. 30% to 60% of persons with BPD also struggle with alcoholism or substance abuse, as a way to self-medicate rapid changes in mood (National Institute of Alcoholism and Alcohol Abuse). This is why following a treatment regimen is critical to avoiding behaviors that activate mood swings.

2. Is it possible for bipolar people to live normal lives?  Yes, most certainly, you can, if diagnosed and treated properly. I have treated many people in the past who are bipolar. Once they got treatment, they completed their educations, were able to have stable, healthy relationships, married, and have successful careers.

I treated a young woman who struggled with long periods of dark depression, in which she wished to sleep and never wake up, just to end her pain and suffering. She was very intelligent and talented, but was unable to get up in the morning, let alone finish her education. Psychiatrists first put her on antidepressant medication, which made her feel a little better. But, the telltale sign that there was something more going on than just depression was the destructive acting-out she did when she felt better. She went from one lover to the next and shopped until she, and her finances, dropped. After being put on Lithium, she was able to finish school, establish a career, and eventually marry her lover of many years. Without the right treatment, her biology would never have had permitted her to live a normal life.

3. Should you avoid stress if you have this disorder? It’s not possible to completely avoid stress. But, you can learn how to manage stress better, through psychotherapy, sound diet, and by engaging in behaviors that strengthen rather than weaken you. Alcohol and drug use are a no-no with this disease. Also, it’s vital that you bring supportive, healthy people into your life, so that you are not traumatized by relationship. When you accept that you don’t have the biology to stand such traumas to your psyche and body, you will begin to choose better.

4. Can you treat bipolar disorder without medication? If a person has a true bipolar I disorder, they have to be treated with some medication. But, eating properly helps to manage the disorder. A diet that high in the omega fatty acids stabilizes neuronal firing, which reduces the brain’s sensitivity to stress (A Dietary Treatment for Bipolar Disorder, Psychology Today). This suggests that extremes in diet, like eating protein alone (depresses the brain) or eating too many carbohydrates or sugar (over excites the brain) can bring about fluctuations of mood. A balanced diet is best, to keep mood swings at bay.

5. Which medications treat bipolar I disorder? Bipolar disorder is treated with mood stabilizers, along with antidepressants, and psychotics if needed. Lithium (a cell salt) is one of the oldest mood stabilizers, but, it’s still one of the most effective medications for manic-depression. More recently, psychiatrists have begun to treat mood destabilization with anticonvulsant medications (Depakote, Lamictal, Topamax, Tegretol and Trileptal) that are typically used in epilepsy. They reduce brain excitation that desensitizes the brain to stress and the mood swings that come with it. But, like most of the powerful psychiatric medications, there are side effects, like cognitive slowing, forgetfulness and brain fog. Sometimes, antipsychotic medications are used to reduce psychosis that can come with extreme states of mania or deep states of depression. These include Zyprexa, Geodon, Risperdal, Abilify, and Clorazil. Also, antidepressant medications, like Prozac, Paxil and Zoloft treat depression in bipolar disorder (National Institute of Health on BPD). Remember, these are all powerful medications, the combination of which can often cause more side effects than benefits. The goal is to feel better not to become a zombie. I have treated people who first came to me so doped up with medications that they could barely remember the door out of my office. I recommend that you do a lot of self-study on your own, so that you can work with your doctors to find the best treatment regimen that works for you. If your doctor resists your participation in this effort, I say, shop for another doctor!

6. Who do I see to make the diagnosis? Psychiatrists and clinical psychologists are most qualified to diagnose bipolar disorders. They have extensive education and training in diagnosis and treatment of mental health disorders. Even if you see a clinical psychologist first, you still have to see a psychiatrist to confirm the diagnosis and to prescribe medication. In addition to medication, you should also get some psychotherapy, to help you to manage the disorder and to learn to cope better with stress. I have worked very harmoniously with psychiatrists through the years managing my patients who needed prescribed medications. Many times patients ask me if I can call their primary care physician and tell them which medication to prescribe. They want to avoid the higher price of a psychiatric visit and also to waste no time in getting treated. Of course, I say no, because prescribing medication falls outside of my education and degree. But, even more than this is the welfare of the patient. Remember, especially with bipolar disorder, it’s critical that you see professionals skilled to make a proper diagnosis so that you get the right treatment. It’s not smart to cut corners, when it comes to your mental health.

7. How can I be sure that my family member really has bipolar disorder?  To be sure, I would get two separate evaluations from psychiatrists or a psychiatrist and a psychologist. They are best trained to make this diagnosis. But, remember, this disorder is difficult to diagnose for the many reasons I mention here, today. Thus, you have to give the professional a chance to help you, which means you may have to try a few medications before you find one that helps. Also, there’s a rule of thumb when it comes to medication. If the medication stops the bipolar symptoms that are troubling you, then most likely you have a bipolar disorder.

It’s not easy to accept that you have to live with a mental health problem for life, especially bipolar disorder. You have to remember that it’s a diagnosis that tells you what is wrong and what you need to do to treat and manage it. But, it is in no way a prison sentence. Indeed, as Julian Seifter says well, just because you have an illness doesn’t mean that it takes away from who you are. “You have an individual story to tell. You have a name, a history, and a personality.

Thus, if you think you may have this disorder, get the help that you need to make the proper diagnosis. Push through your embarrassment or fear of discovering that you may be bipolar. The only thing worth fearing is the lack of knowledge and resource to help you to live the best life possible.

I hope you liked my post today. If so, please let me know by selecting the Like icon that follows. You can also Tweet or Google+1 today’s post to let your friends know about it. Take good care of yourself. Warmly Deborah.