Friday, March 13, 2015

Mental Health Disorder in Focus - Biplar Disorder: Part I







Before I get to the next post on how brains create reality and the implications thereof, I want to introduce bipolar disorder because I am going to use it to illustrate a great deal of how realities get formed and distorted in our minds. 


Bipolar is a multi-faceted, very confusing and difficult disorder to understand. I'll start off with a quote from Yale professor Jon Lieff. Jon is an email acquaintance of mine (although infrequent, our exchanges always have very high quality). Jon's science/neuroscience blog, Searching for the Mind is considered (and was named) one of the best sources for learning neuroscience on the Internet (and it is among some very heady and distinguished company, let me tell you). He is a fantastic source of bleeding edge and intricate knowledge of how brains work and why. He's been very kind in answering questions of mine and (occasionally) reading posts from this blog.

This is what Jon told me when I wrote asking him about bipolar disorder:

There are literally thousands of neuroscientists trying to understand the neuroscience of bipolar disease*. At this point in history it is too complex for our present tools (my emphasis). Everything is speculation.

[* - I quibble with and take issue with the the term "disease", but I'll leave that for another time]

So before anyone gets any idea that they have any kind of understanding what bipolar is or isn't, bear in mind that bleeding edge neuroscience can't even explain it. I have to mention this because I get advice all the time that runs along the lines of "Oh, I worked with someone with bipolar, I know all about it …" or “Oh, I've read about that, I know all about it...”. And they proceed to tell me what they "think" (and I use that term very loosely) what I should "do" (ahem).

But let me start out with the image at the top of the page. This is one of the most common images associated with bipolar and it's unfortunately very misleading. It's misleading because it gives rise to and perpetuates the most common myth about bipolar disorder - that it means something along the lines of "being happy one day and sad the next".

Bipolar is NOT about being happy one day and sad the next, or peppy one day and down the next day nor simply about emotions at all. If that were the case, nearly everyone would be "bipolar" or experience "bipolar" in their lives. Changing emotional states are certainly involved but they are just a very small aspect of the condition. So that's myth number one to disabuse yourself of.

Bipolar is also very widely mis-diagnosed or over diagnosed. It's sort of the "mental illness de jour" these days, especially among the celebrity/artist/performer/creative set and can be used as sort of a catch all excuse for bad behaviour. Or for anyone who's "moody". It's also grossly over-diagnosed, as are almost all mental health conditions, because the psychiatric and pharmaceutical industries make a lot of money off of "treating" people with life long supplies of drug cocktails. The mass over-diagnosis of bipolar is something I will address in a future chapter when we examine the “bipolar boom” (a term coined by Robert Whitaker in his book Anotomy of an Epidemic) of recent decades.

Bipolar disorder is, as mentioned, very, very complex and a great number of things are involved or possibly involved but for this first post dealing specifically with bipolar disorder, I'll start with some basics and - over time - flesh things out from there.

There are three basic states involved in bipolar - the manic state, the depressive state and "mixed states".

My view of bipolar is closer to the classic manic depressive definition. Manic depression used to be the term used until diagnostic criteria started getting carried away. Classic manic depression would look something like:  relatively brief periods of mania followed by long periods of depressive states. The former can last from about a week up to a year but the average is probably around ten days to two weeks. Depressive states can last for weeks, months or years.

Now one thing to clear up right away in understanding the severity of bipolar is the question of "depression". I have huge issues with the semantics of this term. It is so broadly used and applied to so many clinically different conditions that the term "depression" is virtually meaningless.

One - and here's a big dirty secret revealed - is that the kind of depression most people go through is not a "mental illness". It is, in fact, a perfectly normal reaction to some sort of life crisis or difficulty. In the vast majority of cases it's closer to bereavement or grieving (think the feelings you have following the break up of a serious relationship, the passing of a loved one or beloved pet and that sort of thing). Many other people will go through episodes of very difficult sadness and low moods because ... well, life is shitty at that time. This too is perfectly natural. Some people panic themselves into a mental health tizzy for a wide number of reasons (a kind of nocebo effect that I get into in great detail in a later chapter). No question it can feel very dark and difficult (mostly because it's misunderstood and mishandled by "professionals" or friends and family) but it is a temporary state that - generally - passes as naturally as it came. (all of this is grist that I grind in future posts).

But while the depressive state of bipolar disorder bears a lot of similarities to more common experiences of depressive episodes, I'll outline (again, as we go along and explore it later) how and why it is different and in many cases much worse. So let's look at the states of bipolar in a little more detail. 

Mania:

Mania is really a tough state to understand. A great number and variety of things may go on. In a small percentage of cases great creativity can be (emphasis on can be) involved and experienced. Some people become violent. It is widely associated with all kinds of bad behaviour (hence many actively seeking a diagnosis of bipolar to explain away bad behaviour ... I am always skeptical of these cases). But let's look at some of the clinical criteria used to assess a diagnosis of bipolar. 

In no particular order, we have:

  • extreme euphoria (get used to the word "extreme")
  • very impaired judgement and/or insight into one's own behaviour
  • extreme sexuality and high/obsessive sex drive
  • extreme and seemingly inexhaustible levels of energy
  • extremely high and unrealistic levels of positiveness, hopes and optimism
  • inability to sleep (Note: this is not at all the same as the kind of restless/anxious insomnia many people experience. When I say can't sleep, I mean being in the grips of bouncing off the walls energy and extreme levels of mental alertness and having no need or desire to sleep whatsoever)
  • obsessive drives and high motivation to act on one's thoughts and "visions"
  • behaviour like runaway spending and/or extremely poor financial judgement, discretion and management
  • extreme levels of "I can do anything" confidence and beliefs
  • extreme, perhaps delusional levels of optimism
  • a feeling of being on top of the world, the world is my oyster and can conquer anything
  • nothing but the most positive thoughts and self-dialogue
  • "Superman" like feelings. Like literally the belief that one can fly or cover great distances through the air. (hard to believe but this actually happens in some cases and there are cases of people in the grips of mania who jumped to their deaths because they literally believed they could fly)
  • severe delusions and/or delusional thinking
  • great clarity of thought (which may or may not be delusional ... a thorny aspect to pick through)

All of these are extremely (that word again but seriously, it cannot be used enough in describing various states of bipolar) powerful and gripping. The power of these is well, well beyond the ability of most people to imagine and are well beyond what almost anyone has experienced.


For a proper diagnosis of mania, one does not have to have experienced all these criteria in one episode. I believe (if memory serves) it requires (or used to when strict diagnostic criteria was closely adhered to) seven to ten of these conditions to be present for a minimum of four days running. How all that "plays out" in any one individual is going to vary about as much as there are personalities and personal differences (if you start to add all that up you can begin to grasp the complexity of the disorder).

A key thing I personally believe should be factored in is how much a manic episode disrupts a person's normal life. As well, how much all these behaviours/states depart from a person's normal personality. There are people who experience many of these things but aren't so put in the grip of them that they stop going to work or otherwise greatly alter their normal lifestyle. In true mania, one will completely be in the grips of and be obsessively driven by these things and their life will be greatly disrupted.

Some personal thoughts:

A young psychologist who was working with me, genuinely curious to better understand what mania feels like, once asked me what it was like. What I told her, and I'm paraphrasing from memory here, was this:

Mania is like the best drug anyone could ever make. It is beyond the best feeling in the world. You feel like you can do anything, be anything, think anything, solve anything. You have sexual energy a porn star would die for. Doubts, fears, any negative feelings whatsoever evaporate. You become God's gift to humanity. If such a drug could be made you could charge $1,000 a pop for it and people would gladly pay and line up for blocks for it. There is nothing like it on earth. Nothing.”

Until, of course, it stops.



Depressive States:

Boy, where to begin. Well, the easiest thing is to simply look at the mania list of symptoms and then try to imagine (and this is very, very hard to imagine indeed for the average person who's never experienced anything like that) the polar and extreme opposite of all those states.

Again, in no particular order, we have:

  • extremely low energy levels (to the point of literally being incapable of getting out of bed, taking a shower, preparing meals and so on)
  • extremely (again, get used to the word "extreme") low desire, drives and motivation
  • complete loss of interest in sex
  • extremely negative views of oneself
  • extremely negative and destructive "self-talk"
  • extremely persistent and intrusive thoughts and visions of self-harm and/or suicide
  • literally crushing levels of guilt and self hatred
  • extreme hopelessness
  • an obsession with the "dark side" of life and humanity
  • extremely negative views of the world and future
  • extremely impaired insight
  • and just an indescribable level of literal inner darkness

All these too are extremely powerful and quite beyond the ability of anyone to "control" without massive amounts of intervention, help, training, awareness (and yes, perhaps short term drug therapy).



And if that sounds horrible, let me introduce you to -


Mixed States:

Mixed states are completely beyond almost anyone's ability to comprehend and imagine. Even most highly experienced clinicians cannot fully grasp it. As the name suggests, it is a combination of aspects of manic and depressed states. Except it's none of the "fun" part of mania and all of the worst aspects of depressive states. It's all the dark and negative elements of depressive states except unlike the lack of energy and drive and motivation in depressive states, the person will have nuclear levels of energy and motivation to act on all those horrible, negative and distorted thoughts.

One in five cases of severe life long bipolar will end in suicide. It is widely believed and accepted that the vast majority of these will take place during mixed states. Bipolar has a reputation for violent behaviour. That violent behaviour will take place during mixed states. Mixed states are very, very, very bad news.

As much as I've experienced these states, they are beyond my ability to describe them. Very, very difficult to survive them.


Various other "fun" stuff:

  • various forms of psychosis or psychotic states - I'll have to cover this in more detail another time. This is virtually impossible to describe. Think hallucinations, voices, commands to perform harmful acts and all kinds of fun stuff like that. Extremely powerful and horrifying stuff, let me assure you. And quite beyond the experience of all but a small handful of people.
  • People with bipolar will often suffer from or experience other mental health conditions such as ADHD, Borderline Personality Disorder, Major Anxiety Disorder and a host of other fun things to try and deal with aside from all of the above.
  • there is no known cure for bipolar
  • drugs, despite what is commonly believed, do not "cure" bipolar but instead may lead to a worsening of conditions and other severe side effects (long, long topic that I will cover elsewhere) though they do “knock down” many of the drives and can give an impression of stability
  • the "illness aspect" of bipolar will worsen with each cycle through manic and depressive states and/or mixed states


So that's kind of a clinical overview. Let me leave off with a few final thoughts. 

None of these are simple "moods". We are talking massive, massive and long term changes in literally how the brain operates and takes in and processes sensory information. Huge changes in brain regions, neurochemistry and other neurobiology are involved. Over the long term, there will be actual structural changes to the brain and brain damage. There will be changes down to the cellular level and - believe it or not - the DNA level. The differences in these states are so vast that they each literally change how one views the world and acts according. One becomes, almost literally, a different person in each of these states.

These states can change in long, slow waves (the classic is one manic state and one depressive state a year). Or they can switch back and forth like a light switch (so called "rapid cycling", a truly, truly horrible and horrifying experience to go through, something I would not wish on my worst enemy).

Advanced state bipolar is considered one of the two most severe, destructive and difficult to deal with neuropsychiatric disorders on earth along with schizophrenia. I'd argue that it's worse than schizophrenia because of the wildly varying mental states (schizophrenia is certainly no fun but at least it's a consistent state).

I have, and have had for some time, the most advanced and severe form of bipolar. There is very little in the upper echelons of psychiatric experiences that I haven't lived with or experienced.

There are other aspects and behavioural changes quite different from what I've outlined here that can lead to a diagnosis of bipolar that I'll also try to explore as we go along. 

 A few further thoughts:

Bipolar disorder can decimate a person's ability to live a normal life, hold steady jobs, have steady relationships or even fit in with society at all. Personally I have never been able to keep a job long term or stay in a relationship. It can destroy you financially. It can destroy any concept you have of yourself as a human being.

Emphasis for each on "can", however. For most of my life I had no idea what was happening and thought it was just my "colourful personality". It is my view that it can be managed but the sooner in life the better. Once you're at an advanced stage and age such as myself, it gets increasingly difficult (I'll also outline the reasons for this in later chapters).

But my personal state is not what I want to focus on. I have learned - through personal experience and enormous amounts of research - that there are ways to "Tame the Polar Bears". That is what motivates me to keep going, what motivates me to write this blog. There will be numerous chapters teaching how to tame the poplar bears (1) but I always point to my Positive Difference Making Fundamentals as a place to start.  

It is also my belief that bipolar needn't become a permanent life long condition if one learns early enough to recognize and manage triggers and stress (two things that will be a huge focus of this blog in managing any mental health condition). 

There will be lots, lots more on bipolar and exploring all aspects of it so please stay tuned! (2)


(1) The "polar bears" are my term for the polar opposite states of bipolar disorder.

(2) I have a lot on the go writing and research wise so please be patient in waiting for future posts specifically dealing with bipolar. It may take some months before I get to them all.  

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