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.

I was discussing this series with my wife and she suggested I do a post on what spouses/loved ones should look for as symptoms of bipolar disorder.  After all, this is a mental illness so the person suffering it usually will not notice the symptoms on their own.  Here are some symptoms of a bipolar manic episode:

• Racing thoughts
• Decreased need for sleep
• Grandiosity
• Irritability
• Excessive spending, usually to the point of being overdrawn or maxing credit cards for silly items. Rule of thumb: If authorize.net starts calling your house repeatedly … something bad is going on.
• Highly verbal, almost annoyingly so to others.
• Not eating enough
• overly elevated mood and/or deep depression

Based on what I have read and put together, those are key signs.  You can get a broader and more formal perspective in the DSM section on bipolar/manic depressive illness.

Okay, so now you suspect your spouse or loved one has bipolar: Now what?

Bipolar is “special” among mental illnesses in that it has something called “The Manic Episode.”  People ranging from Carrie Fisher (Princess Leia) to Robert Downey Jr. (Iron Man) have spoken publicly about their manic episode.  Carrie Fisher talked about how she stared at the full moon all night with no need for sleep.  By the way, a little trivia: Carrie Fisher’s novel “Postcards from the Edge” inspired the title of this blog.  That, and Chevy Chase’s 1988 Mental Health humorous film “Funny Farm.”Okay, trivia over.  Robert Downey talked about how the mania brought on drug use.  The fact of the matter is that anyone who suffers a manic episode is lucky to be alive.  Extreme care should be taken with a spouse or loved one who is suffering through one.  They can last for weeks and even sometimes months and they are brutal to the person and anyone who is close to them.  The good news is, there are things you can do:

1. Stay calm and in control.
2. Call the local hospital and ask if they have a psych admitting ward.  Explain the situation.
3. Take them there for admittance or get a referral.
4. If you can’t get them admitted … try to keep them fed, get them to sleep if possible, keep them calm.
5. Unfortunately, some insurances will not pay for the hospitalization unless the patient is “a danger to themself or to others.”  This is a bummer but it is the reality.  Use your best judgment.

I hope this post on what to watch for will help you notice a loved one beginning or going through a manic episode.  Get psychiatric help, this is the key to avoiding disaster.