Psychiatric Reference for writers: bipolar disorder.

The kiss of euphoria, the agony of a blackened soul: bipolar disorder

Consider these two quotations.

“Bipolar robs you of that which is you. It can take from you the very core of your being and replace it with something that is completely opposite of who and what you truly are. Because my bipolar went untreated for so long, I spent many years looking in the mirror and seeing a person I did not recognize or understand. Not only did bipolar rob me of my sanity, but it robbed me of my ability to see beyond the space it dictated me to look. I no longer could tell reality from fantasy, and I walked in a world no longer my own.”

Alyssa Reyans, Letters from a Bipolar Mother

“Creativity is closely associated with bipolar disorder. This condition is unique . Many famous historical figures and artists have had this. Yet they have led a full life and contributed so much to the society and world at large. See, you have a gift. People with bipolar disorder are very very sensitive. Much more than ordinary people. They are able to experience emotions in a very deep and intense way. It gives them a very different perspective of the world. It is not that they lose touch with reality. But the feelings of extreme intensity are manifested in creative things. They pour their emotions into either writing or whatever field they have chosen” (pg 181)”

Preeti Shenoy, Life is What You Make It


As these excerpts suggest, bipolar disorder is a sickness of extremes.  People with this illness have intense cyclical mood swings.  What rages as an energetic, brightened soul this month sinks into a creature of agony the next.  It’s not surprising that many artists, writers, and musicians struggle with bipolar disorder — when the highs aren’t catastrophic, they act muse and guide and mentor.


Bipolar Disorder, a definition

The official definition of this disorder could be “a disturbance in mood severe enough to interfere with the sufferer’s life.” These emotions are unique to the individual and can actually include different types of “highs” and “lows” in the same person, but in general, mood states are defined as follows:

What isn’t bipolar? 

The question should read “what’s normal?” Most people have natural fluctuations in their mood; sometimes glum, sometimes overjoyed.  These mood states don’t last long – a few days at most – and they’re rarely severe enough to cause problems.  Often a change of environment, improved coping skills, time for reflection, or a good person to talk to is all that’s needed to make things better.  If you need a definition of normal, that’s about as close as you’re going to bet.

Bipolar depression is characterized by sadness, loss of hope and interest in life, helplessness, excessive feelings of guilt, eating/sleeping too much or too little, problems thinking, low energy, and self-esteem problems.  These symptoms last a minimum of two weeks.  Left untreated, the episode can last years.  Severe depression can lead to strange thoughts and hallucinations (usually distressing experiences, like derogatory voices or pathological guilt over something the sufferer didn’t do).

“Bipolar habitus.” Sufferers of bipolar depression tend to sleep and eat excessively, while depressed individuals without bipolar disorder tend to suffer from insomnia and diminished appetite.  Old psychiatric texts often describe the typical bipolar “body” as pair-shaped, a consequence of overeating when depressed.   Bipolar depression is also linked to interpersonal sensitivity than its non-bipolar counterpart.

Mania and hypomania both present with euphoria or agitation, talking non-stop, excessive energy and pleasure-seeking, multi-tasking poorly, hypersexuality, poor decisions and choices (like overspending money, hyper-sexuality), problems with concentration, and diminished need for sleep.  Mania lasts longer than hypomania and is more disruptive.  Severe mania can lead to abnormal thinking and hallucinations (for example, sufferers might believe they have special powers and/or hear God speaking to them).

Mixed episodes is a term used to describe mood states that have both depressive and manic symptoms.


Types of bipolar disorder.

Recent nomenclature divides bipolar into four classes, though some clinicians think of the third “type” (cyclothymia) as a separate illness.  The reason for categorizing bipolar types is related to different disease patterns, prognosis, and to a large degree treatment strategies.

Type 1: Individuals are described as Type 1 bipolar if they have experienced mania. That is, if the patient has never experienced frank mania, he or she cannot be diagnosed with Type 1 bipolar.

Type 2: Someone who has experienced hypomania and clinical depression (but not mania) is considered Type 2 bipolar.  This subset tend to experience more depressive episodes than Type 1.

Type 3: The third type, called cyclothymia, is marked by episodes of mild depression and hypomania (i.e. not serious enough to meet criteria for a “real” episode) that interfere with the sufferer’s quality of life.

Bipolar disorder, not otherwise specified (NOS): The final category includes those cyclic mood disorders or bipolar-like conditions that don’t fit into the first three categories.  An individual who experiences hypomania but never depression would be considered bipolar NOS.


Treatment.

When it comes to bipolar, a multi-pronged approach is best.  This almost always includes medication.  Other “prongs” include psychotherapy, stress management, stable environment, consistent sleep schedule, and psychosocial support.

Medications: Treatment of bipolar disorder almost always includes medications: antipsychotics, mood-stabilizers, and when necessary, antidepressants.  Most people with this illness require medications.   This is a particularly difficult disorder to treat, in that the individual’s metabolism seems to change according to the type of episode.  For example, higher doses of medication are needed in the treatment of mania than other mood states.

Lithium.  There was little treatment for bipolar disorder until the emergence of Lithium, which even today has been shown to be extremely effective in stabilizing this disorder.  It is the only psychiatric medication show to reduce suicide rate in individuals with bipolar disorder.

Psychotherapy:  Interpersonal and Social rhythm therapy is a school of psychotherapy used specifically for bipolar disorder. Cognitive behavioral and supportive therapy can also be helpful, as well as group therapy and support groups.  While therapy is helpful, few individuals with bipolar disorder respond to talk therapy alone.

Lifestyle: The interesting thing is that bipolar disorder seems to be caused in part by a faulty internal clock.   The goal, then, is to establish an effective external clock.  This includes keeping a strict routine (scheduled socialization, exercise, etc) and taking medications to normalize sleep patterns as much as possible.  Individuals with this disorder must also avoid behaviors that destabilize the internal clock, like rotating shiftwork (anything that interferes with consistent sleep hours), frequent changes of environments, and substance abuse.


“The creative curse:” famous people with bipolar disorder

Mania and hypomania can awaken the muse and set life a-flying.  When it isn’t destructive it’s extremely productive.  No doubt there’s some link between mood disorders and creativity, especially a mood disorder like bipolar disorder.  It’s no surprise then that many prominent artists, musicians, and writers have this disorder.  Click on the link below for the Wikipedia article, “List of people with bipolar disorder,” and you’ll see what I mean.

https://en.wikipedia.org/wiki/List_of_people_with_bipolar_disorder

That’s bipolar disorder in a nutshell.  Thanks for reading.


Alex Natalian, Psychiatrist and Author

Alex Natalian is a penname for psychiatrist KRR.

 

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