Bipolar Disorder

bipolar man

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 prominent anxiety has been with him most of his life, starting in his early teens.  He would feel energetic and great.  Too great.  Then the switch would come to anxiety and depression.  Through his career some movie performances were different than others depending on his mood state at the time.  During one episode of major depression his wife divorced him and took their three children.  He now takes medication and pursues therapy.

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A Bit of 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, known now 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.

Bipolar Disorder Is Worse Than a Life Roller-Coaster

It used to be called manic depression, the two “poles” of bipolar disorder.  Each of these two brain states have concomitant effects on the person’s life.  As one might assume, the effects are mostly opposite of each other.  Through his life the person might go through years of big wins, as hypomania and success slide into full mania, when his judgement starts to slip.  But then alternating with these “up” years are other years of depression, of doubt, of struggle, of not doing well.  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 it into a song 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 bipolar depression can land a person in a psychiatrist’s office if not in an inpatient psychiatric hospital.  Both require medication to control the condition.  There is no psychotherapy that, by itself, works for mania or for bipolar depression.  Both can and do destroy relationships, families, friendships, businesses, and lives.  More and more medications are being developed and approved that 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 It Starts It Lasts a Lifetime

Bipolar disorder is a lifelong illness.  It is how one’s brain is constructed.  Mania follows depression and depression comes after mania.  There might or might not be a time of normal mood in between (called euthymia), as the individual swings from one mood extreme to the other.  Typically, the episodes of mania are shorter than the depressions.  Maybe a few weeks or months of mania.  Then a few months or years of depression.  But the episodes of mania are times of high energy, extreme emotional chaos.  An unbelievable amount of damage can be done in one brief episode of mania.  While the episodes of depression might appear less chaotic they are just as dangerous and, at times, are fatal.

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.  Medication helps to “normalize” the brain’s pathophysiology.

The Up Pole

Mania is not straightforward.  Mania can be up, energetic, optimistic, self-assured.  Mania can also be irritable, irascible, angry, and energetically hostile.  Some people, when manic, switch between the two.

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 okay.  Since nothing can go wrong, they take risks they shouldn’t take.  They just don’t see the risk.  They have energy surges and are too active.  They might talk non-stop, their thoughts and conversations 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 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.

Mild Mania

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 might not see anything wrong.  But people who know him well can see the change.  It’s a warning, like a bright yellow flashing light.  Caution, a full manic episode might be on the way!

The Down Pole

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 qualitatively different, a completely different animal.  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.

 Helpful links:

National Institutes of Health, National Institute of Mental Health

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

National Library of Medicine (United States), Medline Plus

https://medlineplus.gov/bipolardisorder.html

The Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

American Psychiatric Association

https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders

National Alliance on Mental Illness

https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder