Postcards from the Funny Farm

When we go to the doctor or hire a lawyer or take a college course, we expect the people we encounter to be professionals.  As such, we assume they don’t have any mental illnesses … that is, many people assume that.  The truth is that many people in the professional world are doing their jobs while living with mental illnesses.  Bipolar is one of them.  In Kay Redfield Jamison’s book “An Unquiet Mind” she gives an anecdote where she reveals her bipolar illness to her boss at Johns Hopkins University.  He sort of blows it off and then tells her that if they got rid of every person with bipolar in the department it would leave them high and dry.  In other words, he assured her it was okay. He let her know he trusted her.

Ultimately, that should be the goal of any person at work, with family, wherever with people: to earn trust.

Many people do not know that famous song and screenwriters are bipolar.  They never hear about it because they live responsibly with their disorder.  Beyond that, we might assume they create such amazing art because of their disorder, not in spite of it.  I guess it’s a circular question.  People in society need more awareness of mentall illness in the professionals among us and less fear of what’s going on “over there.”

For bipolars, Lithium is a lifetime medication to be used daily just like toothpaste or acne cream. The difference is, you can’t miss this one. If you ask a psychiatrist how it works to quell mania, she/he will not be able to tell you exactly. They will, however, tell you that it works. We have gotten far enough along in science to know it isn’t the fault of a full moon.

There are assumptions about kindling in the brain and somehow the salt called Lithium in blood concentrations of .8 to .12 equalize that, but nothing truly measurable exists to explain what Lithium does. The bummer is that if a patient gets more than the .12 concentration it becomes toxic to the liver and kidneys. For this reason, bipolars have to get their blood taken regularly to measure the level. At the same time, if the lithium level is below .8, it is not even therapeutic.

There is a very interesting account on the history of Lithium here.

Some bipolars have to take as many as 16 capsules a day to achieve the right level. Others have to take less depending on their metabolism. Bipolars must be responsible. How many people in their 30’s to 50’s go regularly to a psychiatrist on a monthly basis? Bipolars do and I think that shows a lot of responsibility. Of course, some are in denial and try to avoid therapy. Bipolar has been called “the disease that sleeps.” Those people will have a manic episode eventually and it can destroy jobs, marriages, relationships, everhything. Bipolars that are silent about it and professionals know this risk and work hard to see that they make it to 80 years with luck managing this ferocious sleeping giant.

Bipolar is a serious illness as I have laid out in this series.  But just because it is serious doesn’t mean it can’t be managed.  Let me make something very clear though: it cannot and will not manage itself.  It is an aggressive disorder thate gets worse through a lifetime.  With medication and psychotherapy though, it can be managed.  Bipolars have made enormous contributions to art and science.  It is correct to fear the disorder but incorrect to judge those who have it.  In many cases they are more equipped to handle the world than non-bipolars because they have to watch and learn about their brains every day.  That might be a good endeavor for us all.

My hope in this series is to produce a paradigm shift in people’s attitude toward bipolar.  Remember when you were a kid and your parents said you were going somewhere really special?  Depending on your age, it could have been grandmother’s house or a flight to a 3 day stay at Disneyland.  Remember feeling your mood rise instantly beyond what is normal?  Well … that is normal.  Unfortunately for bipolars, their brain can experience this transition for no apparent reason at any random time.  You might think that it’s a good thing, how can it be bad to shoot up to a high mood right?  Well, when there are no logical reasons to be in such an elevated mood a bipolar person can succumb to all sorts of crazy activity … some of it potentially damaging, even deadly.  The brain is a fragile and delicate instrument and for those afflicted with bipolar, life is filled with all sorts of heavy duty work.

In a highly elevated mood, bipolars can experience what is called “grandiosity.”  This is one of the most malicious of all symptoms.  It has been described as a flight of ideas, the feeling one can conquer the world.  You don’t see yourself as Napoleon as a schizophrenic might, but you see yourself as like Napoleon out to conquer the world and you never feel as if you can lose.  This is one possible symptom of a manic episode.  The manic episode can last several days and I have even read of famous bipolars who experienced these for months or more.  This has an effect on blood pressure, spending, sleep habits, etc.  The manic episode has a profoundly devastating effect on relationships, jobs, family, and finances.  I read of one man who went to 20 stores over a 2 days period without sleeping to buy every Buzz Lightyear action figure.  When the episode passed, he realized he had maxed many credit cards in this manic acting out.  Bipolars in a manic state can be very offended and angry if you confront them.  Often this can lead to a straight jacket and a paddy wagon to a hospital.

Then there is the depression.  Just like on a globe there is a South pole and a North pole that are diametrically opposed, so the moods of a bipolar are polarized.  If you remember having a dog or pet die, you remember sinking moods.  Some drops in mood are inevitable in normal brains.  In biopolars they attack viciously with no regard for reason.  For bipolars, ones mood will drop from being manic to being in the utter depths of despair.  I know many people reading this understand depression.  We call this “unipolar.”  The psyche and mood of a person stays down too long and that produces debilitating issues for the depressed person.  For the bipolar person it can be multiple times worse due to all the damage one has done while manic.  Depending on how severe the episode, the bipolar may not even remember the insane theings she/he did while manic.  In a depressed state she/he is ill-equipped to pick up the pieces and get their mood back to normal.

It is like the mood thermostat is broken.  You might set it on “calm” but it fluctuates out of control without any mercy whatsoever.  The brain of a bipolar lacks the natural ability to adjust moods.  Thank goodness for bipolars, there is a wonder drug called Lithium that we will discuss in a future post.  Lithium acts as a repairman who can make the thermostat work a heck of a lot better than without.  As I discuss how Lithium works, I think you will be shocked and amazed to hear about the stigma that keeps many individuals and families from taking this drug.  The same way a Cat5e patch cable connects a computer to a network, si Lithium enables the bipolar to function in society. I’ll explain how it was discovered as a drug for bipolars and why anyone diagnosed with bipolar should talk to their psychiatrist about getting it if they haven’t already.  Lithium is the thermostat fixer for bipolar.  There is hope, thanks to Lithium.

Before discussing the abstract art that we call bipolar, we have to look at diagnosis and what is required.  It seems like more and more news stories about rapists, murderers, garden variety psychopaths, and the like contain a tag at the end of something like:

“This story is truly a tragedy, such and such was being treated for bipolar before they went bad.”

You must have a heart for the bipolars out there who are living productive, often high-level professional albeit silent lives.  They are still dealing with the unbearable highs and lows (which we will discuss in a later post) and they also have to maintain in such a way as to never let anyone expect they have the specter.  After all, the evening news is no friend to bipolars.  They extend the stigma along with ill-informed people, the media, and Hollywood.  It puts an albatross around the neck of anyone who finds out they might have it. Many bipolars say it makes them want to search for the best flight deals out of town.

Even bloggers can spread false stigma about bipolar.  I remember reading one guy’s blog (I won’t link or mention it).  He would write everyday how the walls were breathing and making him angry and other outlandish truly psychotic things.  He would justify it by saying he was bipolar.  I wrote him a note saying his symptoms seemed more schizophrenic than and he said he had read a book and diagnosed himself as bipolar without ever seeing a psychiatrist.  Ah, the downside of the internet.

The number one enemy of people with bipolar is people who self-diagnose themselves as bipolar.

To be clinically diagnosed bipolar, according to the DSM, several quite explicit and profound symptoms must be present over time.  I read one doctor that said true diagnosis can take about 10 years.

The reason this is important is because we all have moods.  Just because someone has mood swings does NOT make her/him bipolar.  Often irresponsible people tell everyone they are bipolar before getting a medical diagnosis.  They do this for mixed reasons.  Bipolar unfortunately has become a “catch all” for people with issues.

Even if a responsible person feels moments of extreme highs and lows and goes to the doctor to get diagnosed, the doctor may be wrong.  Bipolars have to sort through feelings, facts, and the data day to day.  They have to become experts on their disorder because even the doctors can’t know for sure until time has passed and behavior observed.

Do you know someone who claims to be bipolar?  Have you seen a movie or news show that equated moodiness with bipolar?  Remember diagnosis is the key. If they aren’t seeing a psychiatrist regularly (either in real life or on the show) it is likely they are not truly the texbook bipolar.  Rather, they are part of a stereotype.  There is a lot more than mood to bipolar as you will learn in this series. Take this list linked below for example. It is famous people who have been clinically diagnosed as having bipolar.  Recognize any of them?

Remember seeing any of them frothing at the mouth or filmed in a straight-jacket?  Hardly.  Most of them are/were world changers and that’s one thing science can associate with bipolars.  I’ll bet you never heard that in the media!  Consider the silent bipolars when you hear and see the loud ones on your television screen.  Based on what I have researched and experienced regarding bipolar, I think society needs a real paradigm shift toward the truth about it.

Wiki partial list of Famous people with Bipolar