(Note: This essay is not a scientific document. The opinions
expressed come from a layman, not a trained psychotherapist. Differing opinions abound. It is the intent of this essay to create
awareness and perhaps stimulate reading and researching on this topic.
At one time called “Manic
Depressive,” the mental illness is now known as “Bipolar Disorder.” The bipolar denotes the extreme spectrums,
manic and depressive. There is still
much to be learned about this affliction. There is continued research taking
place.)
Physical
health is something tangible. Mental wellbeing
is more allusive. If you have an injury
or an illness like cancer or diabetes, everyone understands those things, and
the repercussions. Those are tangible,
measurable and not subject to speculation. If you break a leg or suffer a head injury,
no one accuses you of making it up, or that the injury is “in your head.” There
is evidence something has gone wrong.
Change
the subject to mental illness, and suddenly things become less concrete. Things become murky when the mind is the
subject. However, the reality is that
mental illness is very real, and every bit as harmful as any physical ailment. The problem is understanding what it is and
knowing that it is a fact not a fiction.
Even if the symptoms may appear to be assets, the opposite is the case
with bipolar disorder.
The
reason this subject fascinates me stems from interactions that are very recent.
I will elaborate in a different article.
Intellectually
it is easy to understand mental health when obvious. If someone is schizophrenic and exhibits
markedly different behaviors from the norm, that is not a subject for
debate. However, when mental illness becomes
subtle and less discernable, the danger is all the more prevalent because few
of us are attuned to knowing what an illness is as opposed to something less severe.
Even those directly impacted may not be aware.
The
problem stems from differentiating a “quirk” or a “difference” from something more
severe. Recognizing a mental disorder is
more problematic in a world where things move quickly and people interact often
via texting, emails and social media as opposed to long time actual person to
person contact. Behaviors can be concealed
online that would otherwise be easy to notice. The internet can be a great
tool. It can also act as a huge front. It can be a mask that covers more than
it reveals.
Added
to the complexity of knowing what a mental illness looks like, it can be
difficult for those afflicted to understand what is taking place. Not all mental illnesses lead to deviant
behavior that is easy to detect. In
fact, one side effect to at least one mental illness is actually increased
productivity with little need for sleep. Bipolar is one such mental illness.
In a
manic state, the person with bipolar can be active, almost too active. Starting projects, sometimes never finishing
them, it is entirely possible for someone with this mental illness to go unnoticed. No one would equate boundless energy with something
being askew. Certainly productivity is
a desirable trait. But, when it reaches
manic levels, if even beneficial for all involved, with such a rapid rise, there
is bound to a rapid fall. Whatever goes up, must come down in this world.
With bi
polar people, rapid ascents and just as rapid falls are the norm. One may be able to sustain the “high” for a
while, but it is certainly not lasting.
When the resulting fall happens, the descent can lead to deep
depressions, even suicidal thoughts. If sever enough can lead to suicide.
People with bipolar disorder are at great risk for suicide if they are not getting treatment. The National
Mental Health Association reports that 30%-70% of suicide victims have suffered
from a form of depression. Men commit almost 75% of suicides, even though twice
as many women attempt it. From http://www.webmd.com/bipolar-disorder/bipolar-disorder-suicide
The
cycle of manic phases alternating with depressions can go on for hours, days, weeks
or months. Sometimes the cycle can go on
for a day with oscillating feelings of highs and lows with great intensity. With rapid cycling, the feeling has been
described like that of a roller coaster ride. Only there is no gradual climb up, just a
quick ascent.
If you
can imaging feeling on top of the world, euphoric, and then feeling epic
sadness, doom and suicidal thoughts, only to stop and feel high again, then you
see how difficult this can be. The
process is emotionally draining.
If one can gradually come out of a
strong emotion, you do not have the sharp adjustment. However, when your moods go from zero to
sixty, the strain is noticeable. It can
turn into physical problems. For those
living with bipolar, this becomes almost a second nature, and is assumed to be
the norm because many with bipolar have no idea that everyone is not going
through manic highs and lows without rhyme or reason. It becomes the norm to
live with anxiety, depression and electrifying highs that produce destructive consequences. Compounding the problem, friends may not see
a down or even know what it is. They may see a manic moment as someone feeling
good. The concealment can be startling because mental health and establishing norm
is never stated.
The definition of what defines an
acceptable level of anxiety and depression is hard to place for many. For bipolar people the assumption that
everyone feels what they feel. As long
as one can function, bipolar can be ignored and simply written off as “just
life’s ups and downs,” and no more than that.
Because of
its irregular patterns, bipolar disorder is often hard to diagnose. Although
the illness can occur at any point in life, more than one-half of all cases
begin between ages 15-25.
A side
effect, other than being highly productive or creative, is that relationships
and employment suffer. Bipolar can cause
such extremes, like restlessness, boredom, lack of interest, even a hyper hard
to manage sex drive that can wreck relationships, families and lives.
People
close to bipolar individuals may see it, but not know exactly what it is. Even in the post Freud world, mental illness
is still stigmatized. It is often seen that
mental illness comes in the form of those totally unable to function. Bipolar
people can function, but they sometimes function at such a level that they
undermine themselves.
Another
trademark of the bipolar disorder are feelings of superiority, a sense of being
special and a highly elevated sense of self-worth. In that state, consequences for actions diminish,
and there is a feeling of good overall well being. In
that state of delusional bliss, bi polar people often over estimate what they
can do, sometimes with disastrous outcomes.
If
feeling good is great, the sense of being better is then matched by feelings of
worthlessness. Rather than remaining at
a high place of self esteem, one is lowered to the point where suicide
becomes a viable option. Unlike the downs and lows most endure and
cope with, bipolar disorder is marked by its intensity, impact on self esteem ,
overly high ups ,to dangerous low lows. Thoughts of death, doom, the sense of
the future being fraught with doom, and a generally negative view of the world
and everyone in it is not uncommon.
Armed
with knowledge, understanding and even attending support groups and visiting
centers for mental health wellness, the strain can be more than most can
handle. Dealing with someone whose moods
and attitudes that run from joyful to sorrow without rhyme or reason can be
confounding. The volatile state of bipolar is like a bomb ready
to blow at any time without notice or cause.
Bipolar
can even stump those who have had it.
The idea that one can simply “move on” and simply “get over it” prevails. I am not certain of the chemistry of the
brain and how thoughts are managed, but it is not a difficult conclusion to
reach that there is a biological component to bipolar disorder.
According
to research, bipolar can run in families.
If there is a history of mental illness in a family, it is more likely
that the illness may occur. However,
that may not always be the case. It is
simply the likelihood is higher.
Two independent family studies have produced
evidence that bipolar and panic disorders may share genetic mechanisms (1, 2). The salient phenotype may thus be a trait common
to both disorders. Panic attacks and rapid cycling states with fast polarity
shifts both involve abrupt fluctuations in affective state (when anxiety is
counted as an affect). There is tentative evidence of an association of both
with a gene involved in catecholamine metabolism (3, 4). If there were a genetic trait for rapid
affective shifts, one would predict familial aggregation of panic and bipolar
rapid switching.
From The American Journal of Psychi September
01, 2003
Association of Rapid Mood Switching With Panic
Disorder and Familial Panic Risk in Familial Bipolar Disorder
Dean F. MacKinnon, M.D.; Peter P. Zandi, Ph.D.; Elliot S.
Gershon, M.D.; John I. Nurnberger, M.D., Ph.D.; J. Raymond DePaulo, M.D.
Am J Psychiatry 2003;160:1696-1698. 10.1176/appi.ajp.160.9.1696
The influence
of environment, genetics, neurological configurations, chemical interaction and
stressors defining how bipolar expresses itself. How and why they work together is one of the mysteries of this condition. No one has concrete answers to the why and
how of bipolar condition. The
conclusions that research has drawn is that the disorder is real, and that it
can be controlled with a combination of the correct combo of medications and
therapy.
I
cannot addresses this from a scientific perspective, but it appears that those
who follow a regime of responsible pharmaceutical use under the direction of a psychiatrist
combined with therapy can lead to positive outcomes. Figuring out the right program in both areas
is not an easy path.
Bipolar
medications, for many this involves mood stabilizers, can be real hit or miss
area. Ironically anti-depressants can in bipolar cause an amplification of the
illness and be infective.
Mar.
30, 2007 — For depressed people with bipolar
disorder who are taking a mood stabilizer, adding an antidepressant medication
is no more effective than a placebo (sugar pill), according to results
published online in the New England Journal of Medicine. The results are part
of the large-scale, multi-site Systematic Treatment Enhancement Program for
Bipolar Disorder (STEP-BD), a $26.8 million clinical trial funded by the
National Institutes of Health's National Institute of Mental Health (NIMH).
Anti-Depressants, Mood Stabilizers: What Works Best For
Bipolar Disorder?
ScienceDaily. Retrieved
February 15, 2013, from http://www.sciencedaily.com/releases/2007/03/070329075342.htm
What works for one person may cause
bad side effects. Figuring out what works, and minimizing the after effects and
monitoring long term use are critical.
If one
drug stops becoming effective, the practice is obviously to move to a new
drug. Some seem to work long term, and
others short term. The combination of
the right cocktail is not as easy as it seems.
In
concert with drugs are therapies. From
my vantage point, the best outcomes are the result of therapy, the proper
medications and realizing that this could be a long term maintenance health
issue.
Currently,
there is no cure for bipolar disorder.
There are claims that it can be controlled, even cured after a certain
period of therapy and medication, however I remain skeptical about any program
for a mental health issue of this severity that claim one can be totally cured
and free of either therapy or prescription medications long term. The reality for the vast majority is
maintenance, diligence in following a psychiatrist’s direction, a qualified therapist, a good
support system of friends and family, a healthy life style, avoidance of alcohol
and all recreational drugs, and group therapy, are the better directions.
Agreement
on a healthy life style and prescription meds are all good positive directions
that anyone can see as positive essential steps. Group therapy, or support groups may or may
not work for everyone. They may be
needed periodically, or they may not be what everyone needs. However, the concept of being in a supportive
environment with others experiencing mental health issues can be invaluable in
dealing with the illness. The
experiences of others with medications, concerns, problem solving and dealing
with mental health illness can make it better than simply trying to do this in
isolation. However, everyone is different.
For
those involved in mental health care, one problem, along with the disorder
itself, is that of friends, family and others understanding what this all
means. There is the point of view that
one simply has to “get over it.” The notion that bipolar is something you can
control by sheer will is not the case.
Bipolar is a powerful mental illness. One of the problems in treating it
is realizing you have it in the first place. So it is very understandable that
others may not understand, or be in complete denial, that bipolar condition is real.
Even
those versed in the basics of psychotherapy may think that at some point one
needs to break away and be healthy minus therapy and medications. That may be true for those with life issues
or dealing with a specific issue not related to biological factors or a history
of long term mental illness. The concept of visiting a therapist, taking a
sedative and then ending it could be a solution for some people. The severity
of their condition may merit that. One
can be mentally balanced and still need mental health care. That is making the
assumption that the person involved did not have a life threatening and or
quality of life threatening illness.
Bipolar
is one of those mental illnesses that simply does not vanish. You may at some point need fewer visits and
few group sessions, but the reality is that you have to manage this mental
illness or a relapse into an ever worse mental state is possible. Without proper care, bipolar can be a devastating
disorder.
One
possible reason for the reluctance to accept that a mental illness is real, or rather
one has one because of weakness of character, is that mental health issues are
such an unknown and that they may lead others to question their own mental
health wellness. When confronted with
someone dealing with an illness that impacts behavior, attitudes, choices and
personality in a negative way, it raises the question, “could that be me?” Denial of mental health concerns by some
could be a way of denying it is real for themselves. It explains the vociferous
denial of the condition in some areas.
What
makes lack of understanding so dangerous is that these attitudes prevent people from seeking
help who need it most. There is even a notion
in some sectors mental health is a weakness, and seeking professional help is
pointless. The avoidance of psychiatric
help is not confined to that community.
Thankfully, some people are
coming out to make it easier for others to seek help. The impact of celebrated people letting their
stories be told can be empowering.
Whenever
legislation is raised regarding mental health, it invariable takes a back seat
to physical medical care. The issues are
linked, and to deny one is to overlook the other. Physical health is tied to emotional states
that are stable, or at least, the very least, able to navigate life’s
difficulties with methods that are effective, safe and not harmful. To ignore mental health is to condemn those
affected to a life time of difficulties, potentially death. Mental health that is not addressed can be lethal.
In some
circles mental health issues simply do not exist. They are invisible because we
live in a society that makes recognizing them difficult. Discerning between a slight attitude change due
to a life encounter is vastly different from a chronic state of fluctuating
moods, odd powerful desires, disinterest in pleasurable things, a hedonistic
approach to life tagged to delusions of grandeur tied to low self esteem. This
is not to minimize anyone’s issues, but one maybe treatable and the other a
life time struggle to control. It is
differentiating between normal stresses and normal reactions versus the ups and
downs of bipolar disorder that can be triggered at any time without apparent
cause.
Imagine,
if you will, walking down the street and feeling up beat and good. Then
envision a bus driving by that triggers a very strong memory. On the spot, you
start uncontrollably sobbing feeling like your life is coming to an end and you
are a failure. Now picture yourself at
home 60 minutes later with dry eyes feeling up beat and positive. Those are not the normal reactions of most
people. Or, imaging feeling loss and
sadness that goes on for days and weeks punctuated by joy here and there. Those
are the emotional mood swings of bipolar. Over time, the stress of living like
this and dealing with the world from an emotional space that is fragile marked
by a lack of understanding of self, and you have the makings of an emotional
melt down. Decision making, handling finances,
relating to others, even feeling alive can die.
The good
side, there is at least hope. Bipolar does not have to end your life or
creative side. In fact when controlled, it at the very least makes one
interesting.
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