Bipolar disorder, or manic depressive, is a mood disorder fluctuating between states of extreme highs and major lows from the societal norm. It is a chronic illness associated with mood swings that can be severe and incapacitating, as compared to most other individuals. Many with the disorder attend school, work, and live a productive life, but courage, dedication, and the help of medications and psychotherapy help to make it possible. Sadly, some patients stop taking their prescribed medication(s), or choose not to at all, when they feel better because they think it’s no longer needed.
Mood swings can cause attention spans to dwindle, the person leaving projects unfinished and plans undone. The disorder differs from person to person, with some expressing mania for a few days, then depression hits for months. Others go months or years without experiencing a mood shift at all. A mixed state is even possible, where both manic and depressive episodes are present at the same time.
Studies from the National Institute of Mental Health have shown those with the disorder may even have enhanced creativity and empathetic skills (Mental Health Education & Information, 2016). Different variations of bipolar disorder exist, including disorder type I & type II, hypomania, and rapid cycling. Psychosis can occur in both manic and depressive episodes.
Mania and hypomania are known as the ‘high’ moods where mania is the more severe form of the two. Manifestations during a manic episode are definitive from how the person normally acts and create obtrusive, and sometimes destructive, behavior.
According to the DSM-5, the time frame for a manic episode lasting more than 1 week coincides with Bipolar type 1 (DSM-5, 2013 pg 162). Symptoms include increased mental/ physical energy, a decreased need for sleep, grandiose thinking brought on by inflation of self-esteem or self-importance, rapid or exaggerated speech, and racing thoughts where internal ideas rollercoaster through the mind without control. Some may be incapable of making logical decisions in this state and engage in an unhealthy activity, such as excessive purchasing/ gambling, or using illegal substances. These symptoms can be bothersome, causing conflicts at work or in personal life, and in severe cases, can lead to the person being hospitalized. This is the realm of Bipolar Disorder type 1, where the patient experiences more euphoric states than depressive ones. The DSM-5 states hypomania includes the same features as a manic episode but is usually not as severe or has a long duration. Hypomanic features lasting four consecutive days could indicate possible bipolar disorder, but a few symptoms expressed are not reliable enough for a clear diagnosis. More information would need to be gathered along with further elevation. (DSM-5, 2013, pp162). Major Depression is at the opposite end of the bipolar spectrum, characterized by five or more symptom markers that have been bothersome for two weeks straight. When a person’s mood seems filled with desperation and gloom for most of the day or every day, this could be the first red flag of depression (DSM-5, 2013, pp163). These feelings must not be induced by another medical ailment or from the physiological means of substances. Common physical symptoms associated with major depression are wavering eating habits and consumption, weight loss not achieved through dieting or weight gain, restlessness, and fatigue. It’s been reported that pain at times will not respond to treatment. Psychological issues present loss of interest in things that once gave pleasure, interrupted sleep patterns, feelings of inadequacy, concentration, and memory problems, along with reduced attention spans (DSM-5, 2013, pp164). At times, a person may not be able to face societal demands and withdrawal from the world and create disturbances in life. Christian Nordqvist under Timothy J. Legg, Ph.D. editing, describes the darker side of depression creating suicidal tendencies and thoughts of death (What Should You Know About Bipolar Disorder). In severe cases, a depressive person may act on their thoughts, potentially ending their life. Bipolar disorder type 2 dwells here, often dipping into the lower tiers of the disorder and occasionally reaching the manic highs.
In accordance with the DSM-5 (2013), the prevalence for 12 months, also known as someone who had the condition during a certain period, for bipolar disorder type 2 on a world-wide scale affects 0.3% of the population, and the United States 12-month prevalence stands at 0.8%. The DSM-5 credits the DSM-4 with ‘bipolar I, bipolar II, and bipolar disorder not otherwise specified yield a combined prevalence rate of 1.8% in U.S. and non-U.S. community samples’ (DSM-5, 2013, pp168). The prevalence rate in children is harder to establish, but those twelve and older have a higher score at 2.7%. Journal of Medical Genetics elaborates further, determining the lifetime prevalence of the bipolar disorder is around 0.5-1.5% and onsets around age 21 and both sexes are equally affected. It’s usually diagnosable between ages 15 to 25 but can be triggered at any age (Genetics of Bipolar Disorder). It is currently diagnosed at 5.6 million Americans having the disease, or 2.6% of the population. Morbidity rates are high with approximately 15% of people committing suicide (DSM-5, 2013, pp169).
Bipolar does not seem to have a singular cause but rather could be a combination of mixed factors interacting with each other. Some studies founded on the National Institute of Health and Medicine theorize genetics can play a role in determining the likelihood of developing the disorder, especially when a family member already has the condition. This does not mean, however, that those with a family history of bipolar will develop it, but the predisposition is there (‘Bipolar Disorder’). It’s a possibility that environmental influences could trigger the genetic code and activate a severe mood swing in someone, even if noticeable symptoms were not there. It is currently diagnosed at 5.6 million Americans having the disease, or 2.6% of the population, and equally affects women and men. Found in a National Institute of Mental Health article, Lauren B. Alloy and Lyn Y. Abramson tested the Behavioral Approach System (BAS) theory, which aims to explain ‘the role of sensitivity to rewards and goals [and how it] plays in bipolar disorder’ (The Role of the Behavioral Approach System (BAS) in Bipolar Spectrum Disorders 2010, ). Behaviorists believe bipolar disorder is caused by a reward and failure system, with frequent fluctuations in BAS scores could be indicators of manic and depressive symptoms alike. Operant conditioning and modeling are used. For example, when goals are successfully earned, or rewards are involved, their BAS becomes hypersensitive and activates, which is thought to trigger a hypomanic or manic episode. The person could experience symptoms such as ‘goal-directed behavior, decreased need for sleep, and euphoria’ (The Role of the Behavioral Approach System (BAS) in Bipolar Spectrum Disorders, 2010).
Definitive losses and failure of accomplishment create depressive behavior that includes lack of energy, sadness, and hopelessness, along with the behavioral approach shutting down. Cognitive theorists believe bipolar disorder is caused by ‘faulty thought patterns’ and give them psychological skills to help control mood swings as described by Mack Lemouse in his article for Health Guidance (Cognitive Therapy for Bipolar Disorder). Cognitive views are used in conjunction with Behavioral to create Cognitive Behavioral Therapy, a type of psychotherapy to guide bipolar symptoms. It directly challenges the person to face their fears or change their way of thinking and overcome issues.
Treatment can mean many different forms of therapy, with prescribed medications and psychological, or talk, therapy being the most common forms. Prescription drugs such as mood stabilizers, anti-psychotics, and anti-convulsant medications are administered to bipolar patients to manage episodes of mania and depression. Lithium carbonate is the most common mood stabilizer given and is usually the most effective at combating swings. Some medicines do come with possible side effects, but some do not outweigh the cost of stability. The Journal of Medical Genetics claims mood stabilizers such as lithium and various anticonvulsants reduce phases of mania and depression (Journal). If left untreated, symptoms can be problematic and trying, but effective treatment can promote wellness in months as opposed to years. Although treatment is useful for mood swings and depression, the person is still prone to these issues while in a stable condition. Maintaining a close relationship with their doctor can help ease and make symptoms manageable.
Talk therapy has the most beneficial rates for working on issues. CBT, or Cognitive Behavioral Therapy, is designed to help those with bipolar grow an understanding of their disorder, learn to take control of it, and challenge self-defeating thoughts and behaviors (Cognitive Therapy for Bipolar Disorder). A specific example of cognitive therapy is cognitive restructuring. The therapist helps the student identify self-defeating thoughts that can be modified into self-enhancing thoughts. The process is referred to as A – B -C. The “A” stands for “activating event” the experience that provokes the thought. The “B” stands for “belief” which is the self-defeating belief the client may have about the activating event. The “C” stands for “emotional consequences”, referring to the feelings that arise from the self-defeating belief. The therapist then helps the client focus on the belief aspect of the process in order to help him or she develops an alternative self-enhancing and true though that they then practice. A regular routine is also beneficial for patients hoping to remain stable. Everyday health article Living Well with Bipolar Disorder offers lifestyle choices one could do to limit severe conditions (Jen Laskey, 2014). Things like getting enough sleep, exercise, mood trackers, and eating right can boost mood and lower chances of triggering an episode.
Actress Carrie Fisher, best known as Princess Leia from the Star Wars franchise, was diagnosed with bipolar disorder at the age of 24. She accredits a five-year denial of the diagnosis but attributes it to her then battle with cocaine addiction (Carrie Fisher’s Honesty About Bipolar Disorder, Addiction Helped Fight Stigma,2011 ). An overdose leads Fisher to seek sobriety and mental health. Fisher was one of the most vocal people in Hollywood about mental disorders and helped shed light on a once darkened stigma. It is possible there was a chance the illness ran her family with speculation of her grandmother and father also having the disorder, her article she wrote on dailymail.com (Star Wars actress Carrie Fisher reveals her bizarre friendship with Elizabeth Taylor, the woman who stole her father from her mother). After her parents’ divorce at two and gradually realizing with age why they weren’t together (her famous father left her famous mother for the mother’s friend), Fisher turned to drugs and alcohol to cope in her teens, bipolar symptoms beginning in her early teens. Symptoms for her included maniac episodes, boughs of depression, bothersome mood swings, and racing thoughts. In her twenties, she was finally diagnosed with the disorder but did not take it seriously until a few years later (Star Wars actress Carrie Fisher reveals her bizarre friendship with Elizabeth Taylor, the woman who stole her father from her mother)). It wasn’t until 1985 when she voluntarily entered a rehab center after nearly overdosing on drugs to get help for her addiction and mental health. Finding the right psychiatrist made all the difference, and she was able to find a medication and therapy routine to manage it. She has even received ECT, or electro-convulsant therapy, to help treat symptoms of bipolar. Carrie Fisher was an activist and mental health rights champion up to her death in December 2016 from cardiac arrest. Her loss is felt not only through fandoms but for those who had the same battles and could relate to her openness and witty humor, trying to make light in mental darkness.
Picture it: The year is 2007, I graduated from Modesto High School at 17 with a 3.4GPA, and in October I received my cosmetology license. November brought a much needed and deserved break when I decided to stay with family in beautiful Oregon for 2 weeks. 2 days were left in my vacation when we received a call that my grandmother would be going into hospital the next day for open-heart surgery. I was distraught, overcome with panic and fear I would lose the woman that raised me. That night, I insisted my aunt and I board the next train home. The entire trip plagued me with the overwhelming, spinning of negative thoughts, constant nausea, and sleep deprivation. We finally arrived at Doctor’s and she had made it through the surgery just fine. With my grandmother in the hospital and later in recovery, the head of household responsibilities fell to me. At eighteen, I oversaw our finances and such until my grandmother was able to come back. In January when she returned, and the sudden adult responsibility was off my shoulders, my behavior began to change. No longer was I easygoing but I began to withdrawal from my family and friends. Little issues that would normally not bother me set me off into rages, tears, and inconsolability. What finally made me realize something was utterly wrong came in the form of a blow upon my grandmother in February over a simple art easel. All she asked was for me to move it and I blacked out and later remember exploding on her out of nowhere. We both were shocked since that was not typically how I behaved, nor thought was acceptable to do, and I couldn’t remember what had happened. In a daze, I apologized and told her I’d be getting the bus to Doctor’s Behavioral Health Center, that I needed to figure out why I was doing what I was.
I waited for 2 hours in observation before someone finally spoke with me. There the diagnosis of major depressive disorder was made, but I knew further investigation needed to be made. I felt there was more going on, so a trip to my primary care’s psychiatrist was done. Both a psychiatrist and psychologist diagnosed me with Bipolar Disorder type 2. An antidepressant and anticonvulsant were prescribed for me, but I felt the medications did not effectively help as they could. Topamax is an anticonvulsant commonly prescribed to help with some effects of bipolar, but made me feel worse mentally, made me shake, and did not help at all. Fluoxetine was taken to help my depression but was responsible for increased manic episodes due to a mood stabilizer not taken with. Later at 21 during a counseling session, I changed medication for a third time to Lamictal and diagnosed with rapid cycling bipolar, since symptoms were still present even with medication. Lamictal is also an anticonvulsant thought to help the more extreme mood swings bipolar people have, and it worked at least for a few years. Rapid cycling with Bipolar type 2, as explained by the DSM- 5, is where the person experiences one or more depressive episodes with at least one hypomanic trigger, with four or more episodes occurring in a twelve-month period (DSM-5, pp). Most feel a mixed state of depression but also have restlessness and manic tendencies. At 24 I switched to Lithium carbonates, a mood stabilizer made more common in the 1950s to treat some mental illnesses. Edward Shorter writes for the US National Library of Medicine on the National Institute of Mental Health website on Lithium’s history to treat manic symptoms (“The History of Lithium Therapy.”) I also was diagnosed with Generalized Anxiety Disorder and fibromyalgia, chronic widespread pain from head to toe triggered by a car accident at 21 that left me with several disks herniated/ squished and protruding in my lower back. Since then, I have gone through some therapy sessions over the years but manage to take care of the illness on my own with the use of mood trackers, music, and family/ friend support.
Carrie Fisher gave a perfect description of how bipolar disorder affects someone. In her book and one-woman show, Wishful Drinking wrote, ‘One of the things that baffle me […] is how there can be so much lingering stigma with regards to mental illness, specifically bipolar disorder. In my opinion, living with manic depression takes a tremendous amount of balls. Not unlike a tour of Afghanistan (though the bombs and bullets, in this case, come from the inside). At times, being bipolar can be an all-consuming challenge, requiring a lot of stamina and even more courage, so if you’re living with this illness and functioning at all, it’s something to be proud of, not ashamed of. They should issue medals along with the steady stream of medication.”