Bipolar Disorder – Opposite Directions
For a long time bipolar disorder was called manic depression. Mania and depression are the two “poles” of bipolar disorder, and they are mood shifts in exactly opposite directions. Each of these two physical brain states affect a person’s behavior and life in specific ways. As one might assume, these effects are mostly the opposite of each other.
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Bipolar Disorder – Life on a Roller-Coaster
Here’s why we say that bipolar disorder is like life on a roller coaster. Through his/her life the person with bipolar disorder might go through years of great success, big wins, perhaps in a state of hypomania. Hypomania is a type of manic-like mental state that is not real and full mania. Hypomania often does not have the loss of judgment that comes with mania. But, at some point this hypomania might slide into full mania and the person will not notice. With mania, judgement starts to slip badly and success will likely go down the drain. But then, alternating with these “up” years are other years of depression, of doubt, of struggle, of doing poorly.
Alternating Life Styles with Bipolar Disorder
People with bipolar disorder can become billionaires and yet die poor. They can be rich and world famous, liked and loved, yet end life by suicide at a young an age. (As an illustration in literature, do a search for the 1897 poem “Richard Cory” by Edwin Arlington Robinson. Paul Simon turned the poem into a song, “Richard Cory“, that Simon and Garfunkel recorded. It’s on their 2nd album, “Sounds of Silence”.)
There Are Effects that are the Same for Mania and Depression
Both mania and the severe depression that is bipolar depression can land a person in a doctor’s office and maybe in the hospital. Both mental states need to be treated with medicine and medical care. There is no therapy that, by itself, works for mania or for bipolar depression. Both can and do destroy relationships, families, friendships, businesses, and lives. More and more medicines are being developed and approved to treat bipolar disorder, both the mania and the depression.
Bipolar Disorder is a Common Disorder
At least 1 out of every 100 people have bipolar disorder, and the percentage could be as high as 3 out of every 100. Doing the arithmetic, that calculates to 75 million to 225 million people worldwide. These are not small numbers. There are many people with bipolar disorder.
Once Bipolar Disorder Starts It Lasts a Lifetime
Bipolar disorder is the way a person’s brain is built. It’s a lifelong illness. Mania follows depression and depression comes after mania. There might or might not be a time of normal mood in between the mania and depression, as the individual swings from one mood extreme to the other. Typically, the episodes of mania are shorter than the depressions. The mania might last a few weeks or months. Then comes a few months or years of depression. But the episodes of mania are driven times, times of high energy, extremes of emotion, and behavioral chaos. An huge amount of damage can be done in one brief episode of mania. While the episodes of depression might appear less of a problem they are just as dangerous and, at times, are fatal (suicide).
The Cause Is Not Known
No clear and single cause for bipolar disorder has been found. There are risk factors that add up to make the likelihood of a person having bipolar disorder higher. A family history of bipolar disorder or schizophrenia, for example, and adverse life events at any age.
Bipolar Disorder is a Physical Brain Condition
As Professor Emil Kraepelin explained to the world in 1921, bipolar disorder is a physical, medical condition. It is not a “mental” condition, that is, it is not a condition that can be helped without full-on medical treatment, including medication. The brain of people with bipolar disorder is different from the brain of a person without bipolar disorder. Medicine is needed to “normalize” the brain.
The Up Pole – Mania
Mania is not straightforward. It can be up, energetic, optimistic, self-assured. Or, it can also be irritable, angry, and high-energy hostile. Some people, when manic, switch between the two happy and angry.
When manic and feeling good, a person feels too good. It’s hard for most people to understand the concept of feeling too good. When manic, an individual feels that nothing can go wrong. Even in really bad situations, it’s all going to be okay. Since nothing can go wrong, they take risks they shouldn’t take. They just don’t see the risk. There are big energy surges and are too active. Non-stop talking is another problem, their thoughts and comments hopping from one topic to another faster than people around them can keep up, faster than people around them can think. But if helpful people try to slow them down, manic people can easily get irritable and really, really nasty angry.
One reason the manic person feels that nothing can go wrong is that they’re overly optimistic. They can feel super capable or even powerful. As a result, they might take big risks with money, or with sex, or with relationships. It can get ugly.
As mentioned above, there is a milder form of mania that people with bipolar disorder can have, called hypomania. They feel just really good. They can be highly productive and function well. The mildly manic individual usually does not think there is anything wrong, and while they stay hypomanic, maybe there is nothing wrong. And people around the individual who do not know him or her might not see anything wrong. But people who know him well can see the change. It’s a warning, like a bright yellow flashing warning light. Caution, a full manic episode might be on the way!
The Down Pole – Depression
People with bipolar depression are, well, depressed, but in this case, really depressed. An ordinary sad mood is familiar to everyone. This bipolar depressed mood is not only worse, it’s just plain different, a completely different type of mood. It’s a medical condition that is an extreme form of gloom and pessimism. They have little energy and don’t do much. They can’t sleep or sleep too much, are not hungry or eat too much. Nothing is fun or enjoyable. They can’t think clearly, can’t concentrate, and are forgetful. They’re tired and slow, feeling just worried, anxious, and empty. At the worst, they can know for certain that life is not worth living and attempt suicide. At times, sadly, they succeed.
You Also Need a Guide – Therapy
The roller coaster of bipolar disorder is a scary jungle. It takes years for the person with bipolar disorder to understand what is happening to them. As with most medical conditions, medicines can’t solve everything. Call it education, call it psychotherapy, call is a “bipolar disorder user’s group”, but whatever the name, it’s a person who knows the territory and can be a guide. A guide for how to live better with the bipolar disorder.
Did You Know That… Richard Dreyfuss has bipolar disorder?
Richard Dreyfuss, Academy Award winning actor (Jaws, Close Encounters of the Third Kind) has become a public advocate encouraging people to recognize that they might have bipolar disorder and, if so, to get medical care for it. He has said that bipolar disorder with bad anxiety has been with him most of his life, starting in his early teens. He would feel energetic and great. Too great. (Yes, it is possible to feel too good.) Then the switch from hypomania or mania to depression would come, with severe anxiety and depression. Through his career, according to his accounting of the situations, some movie performances were different than others depending on his mood state at the time. These mood swings were medically severe. During one episode of major depression his wife divorced him and took their three children. He now takes medication and is in therapy.
And Now for a Bit of Medical History…
As with so many other medical conditions, the ancient Greek physicians seemed to know of bipolar disorder. They observed and wrote descriptions of dramatic changes in energy levels and in moods in some individuals. The element lithium, now known to be a highly effective treatment for bipolar disorder, might even have been one of the salts in the Greek bath salts used to calm mania. The first “modern” linking of mania with depression was in the 1600s in a book by Theophilus Bonet. He called bipolar disorder manico-melancholicus. About 200 years later, in 1851, the French psychiatrist Jean-Pierre Falret wrote an article calling bipolar disorder circular insanity, or “la folie circulaire,” with subjects switching between deep depression and high manic excitement. The physician that contributed the most to our current understanding of bipolar disorder was the German psychiatrist Emil Kraeplin, who recognized it as a medical illness with a biological cause. He published “Manic Depressive Insanity and Paranoia” in 1921.
National Institutes of Health, National Institute of Mental Health
National Library of Medicine (United States), MedlinePlus