Bipolar Affective Disorder used to be called Manic Depression. It affects from 1 – 2% of the population and affects men and women equally. Average age of onset is 15 – 25 years. It is difficult to diagnose, often co-occurs with a broad assortment of physical ailments and causes great distress for sufferers and their families.
People are often confused by this illness but it’s not too difficult to understand.
How many times have you woke up in a great mood. Your feet touch the floor and you know it’s going to be an amazing day. The traffic lights change as you approach and the lettuce you buy is always sweet.
Conversely, we have all had those days…you know you’ve had them, where you wake knowing it’s a miserable day. You’re grumpy and out of sorts and hate everything. Nothing goes your way, and everything irritates you.
Bipolar affective disorder looks like this:
For the sake of a simple discussion, let’s assume that the normal range of emotion occurs between 2 and 4 on the scale above. Those great days are 4 on the scale. But those other days are on 2. Most of us fluctuate between 2.5 and 3.5. (Remember I’m using a graph to demonstrate this disorder, NOT to suggest numerical ranges for our feelings.) When people have manic episodes, their highs go above the best that we feel. On the graph, these are the points 5 and 6. When people have depression, their moods drop below those bad days into another realm.
These cycles are beyond the control of the individual going through them. Talking, directives and therapy are not solutions for this disorder. It requires medication and extreme attentiveness to the person’s health and well being. But sometimes neither of these work and the individual goes through a repeated cycle of hospitalization and release.
The length of a cycle is measured from one peak or valley, to the next Rarely a person will cycle only once in a lifetime but more likely cycle several times per year.
By the way, the graph represents balanced cycles of the illness, but some people remain manic for much longer than they are in depression or vice versa.
Bipolar affective disorder is extremely hard to diagnose. It never goes away. (At best, medication is used to control the symptoms.)
If you look at the line above, you will notice that on the way from mania (a peak) an individual’s mood or affect will settle and move through normal into depression. Ditto on the way back up. People with this disorder show long periods of time when their behavior appears normal. And is. But these times are misleading, because they are simply part of the process of the disease. Up and down, alwaus passing through normal in each cycle. But of course the time spent within that normal range is determined by the length of each cycle.
At the extreme, Mania is the cycle of the illness that usually gets the most attention. In this phase, behavior is often publicly disordered. Symptoms include extremely high energy (feeling high), little if any sleep, rapid firing speech, increased sexual drive, increased recklessness without regard for the consequences, grandiosity and major thought disturbances. It is in this stage that people may read a book faster than they can turn the pages, or take off their clothes and dance down Main Street in the middle of rush hour. This is the time they ‘realize’ that the local pawn shop is mistakenly selling real diamonds for next to nothing and they will beg, borrow or steal money to buy all of them in every pawn shop in town. They may start binge drinking, drugging and eating. Or sleeping with anyone available. They may talk extremely fast and becoming extremely cunning and sly. Extreme drinking and drug use may also happen in a manic stage. Periods of extreme creativity are also common – paintings, books and musical scores often come from these periods, although their quality can be questionable. Ironically it is this ‘high’ that patients hate to give up. They feel accomplished, productive and super-capable in the manic stage.
When the body and brain are exhausted, the individual’s mood starts to slide down into normal. Often at this time, remorse, embarrassment and humiliation are common and sometimes overwhelming. Inevitibly depression takes over and the individual is full of self loathing and hopelessness. Suicide ideation or attempts happen at the bottom of the depressive stage, which mimics depression that is more common in society.
Psychosis, hallucinations and delusions may occur at either end of the spectrum.
Also, remember I’m talking generalities and clear, delineated stages, which isn’t how it happens. But I think it helps for understanding.
Treatment includes a regimen of psychotropic medication (drugs for the brain) and stress management. A friend of mine has this illness. As long as he is absolutely rigid about his sleep, exercise, nutrition and creative practices, he can live a productive and happy life. He has three teenaged children and is actively involved in their lives. He’s happily married too. But he is very clear, his mental health comes first. But remember, we don’t know where his illness lies on the continuum of mental health and illness. And his rigidity may not help the next person with BAD.
As always, people with this illness have a chemical imbalance in their brains that drives them to behave in ways that cause them and their loved ones embarrassment, shame and loss. But the next time you see someone behaving like this, say a prayer and send kind thoughts. If they could behave differently, they would.
There is some thought that this illness can show up in children as young as six. But in this situation, the cycles are usually hourly and the mania is expressed as rage. The problem is that none of the meds used to treat adults have been approved for children.
Another friend has a little girl who put her fists through walls at seven. She had been expelled from school because when she cycled, they couldn’t protect her or the other students.
Diagnosis took a long time (in part because of the illness and in part because psyciatrists are often loath to ‘label’ someone so young). But eventually they found the right meds and she settled down, becoming a normal, sensitive, happy little girl. She was a different child. Truly an amazing turn-around.
After eighteen months, the physical side effects of the medication were more serious than the illness so she was taken off them. Within weeks she was behaving in the same old ways with one exception: this time she knew how different her behavior was and why the other kids called her crazy. And then, this gorgeous little girl actively tried to take her life not once but twice.
She is twelve now and going through adolesence while dealing with the disease which is subdued by meds but not controlled. Their home is difficult, at best. A prayer for them would be appreciated.
Credit for fact verification and additional information is available at:
http://emedicine.medscape.com/article/286342-overview
http://www.obad.ca/information_bipolar
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/
http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml
Do you know anyone with this illness? Have you seen this behavior?
Louise, this is the most straightforward explanation of bipolar disorder I’ve ever read. I’ve witnessed these cycles in a friend who would sometimes go three weeks without sleep, spend money she didn’t have, and abuse her meds. A character in my first book is bipolar, and though I did a considerable amount of research, I think I’ll use what you’ve written here (and your sources) as a guide to having another look at the character’s behavior. I’m so glad I came over and read this post!
Gerry, you made my day. Thanks so much. I’m glad it was helpful, which was my goal.
thanks for including this post in your awesome mash up
This is, as usual for your posts, just fascinating. I was in a relationship for many years with someone that suffered from this. It was just devastating. He would not take his meds and no one could rescue him.
Thank you for sharing this. I will pray today for the pre-teen that you mentioned.
Thanks Heidi. I’m glad you enjoyed. No one can rescue them. it’s sad but true.
My heart goes out to the 12 year old and her family. It’s hard enough to raise a teenager without throwing something like this into the mix.
Adolesence and mental illness are a horrid combination.
I love these posts. So informative. One question:
Have you ever read And I Don’t Want To Live This Life by Deborah Spungen? I wonder if this is what was wrong with her daughter.
I have not read this book, Catie. but from the description, it sounds possible. It certainly sounds like the behavior of my friend’s little one. Good catch.
One of my closest friend’s mother is bipolar. Because we grew up together, this is actually one mental disorder that I know quite a bit about. For my friend’s mom, she didn’t show any symptoms until after the birth of her second child, and then she had to be hospitalized for six months. Since then, her medication helps her manage, though she still has rough periods. My friend used to worry that she’d inherited it, but so far no signs.
they are lucky to have had you in their lives, Marcy, given your acceptance and understanding of people. it is not uncommon that times of great hormonal change, BAD evolves. It’s tragic to lose your mother for so long at such a young age. fingers crossed your friend doesn’t get it.
What an unfortunate acronym. That poor kid and her family. Prayers are winging out for them. An excellent post, Louise.
Yes, it is an unfortunately acronym and yes it is an awful illness. Prayeres are gratefully received for all of them.
So well articulated. My heart breaks for the little 12-year-old. I can only imagine how difficult it is to deal with this illness as an adult but as a child…it’s incomprehensible. Prayers for sure!
Love these post Louise…helping to really demystify and lessen the stigma that’s often associated with mental illness. Keep up the great work!
Thanks Natalie. I’m glad you’re finding them valuable.
A friend of mine was married to a aoman with BAD. Unfortunatsly, she refused to take meds or get any other help, and this is the main reason why the marriage didn’t last.
I can’t see how a marriage could last without meds, but unfortunately, many people don’t want to lose the high of mania. when you operate at 150% of the rest of us, it’s intoxicating.
Yes, but I didn’t know at the time why they were acting so different. Way different. It must be horrible for their families.
thanks Gerri. it is horrible for the families if they don’t take care of themselves. and yes, it is fairly common. I think most of us have seen this behavior but because we always assume individuals control their behavior, we go down a hard path. (I’m speaking generalities, of course – not you.)
Great post, Louise. I actually know a number of people who live with bipolar disorder. It’s a hard disease to understand because many people who know the individual know that he/she is capable of “normal behavior,” so when that person is manic or depressed, they blame the individual. Hopefully posts like this will help the general population understand this difficult illness better.
What advice do you have for people managing the illness in terms of establishing routines and maintaining productivity across cycles? I’ve heard that having a routine (like your friend that you mentioned) helps make the illness easier to manage.
My friend is so disciplined he makes me ill. But here’s his regimen:
1. Takes his meds on time, every time, no exception
2. He’s rigid about his sleep. there are no exceptions. Bedtime is at a certain time and that’s it. Lack of sleep or disturbed sleep, for him, is the single greatest risk for relapse.
3. Exercise: to sleep properly he must be tired physically, so he bikes to and from work (an hour each way) and then runs marathons to be sure he’s exhausted enough.
4. Diet: he eats a balanced, nutritious food plan with few deviations. If he has a bit of candy today, then he doesn’t touch it for a few weeks or a month.
5. No stimulants or downers, so not even a single glass of beer or wine. It has a greater effect on him than others, in his opinion, so he rigidly avoids it.
6. No medication unless prescribed by his doctor who supervises his BAD
7. Has a rich and varied spiritual life, including church, prayer and meditation. He and his wife are of 2 different faiths and the participates in both churches, in the choir or on the board.
8. He mines his creativity, as a guitar player and songwriter. He plays in a garage band for fun.
9. He works full time
0. He is absolutely honest about his illness, talking about his story to anyone who will listen.
There are 2 things I believe about him: first, he is incredibly lucky to have figured this all out before the internet and before he did too much damage (beyond killing his first marriage) and I think his illness responds well to his routine – not everyone’s will do the same.
Second, I couldn’t be married to him because he’s always on the go, doing somehting somewhere somehow. Exercise, church, volunteering, playing music etc etc etc. He’s never home. I regularly tell his wife she’s a saing for she’s a single mom in some ways. But because they have great communication and he really knows himself, they make it work. My hat’s off to them.
hmmm 9 simple steps. I wonder what my life would be like if I followed them?
My grandmother had bipolar disorder, and when she was in the manic stage, she could conquer the world. Her energy would be high, she’d be out and running errands and planning stuff, and even when she settled into something ‘normal’ she’d still be functional and active. But when she hit the low points… she’d forget to take her medication, she’d stay in her apartment all day in her pyjamas, and there were several very close calls. I never understood it when I was younger, but as I got older I began to realize the patterns. Unfortunately some people in our family never really understood, and they thought that if she ‘tried hard enough’ she could be better. (such comments made me want to smack the commenter!)
Yes, me too. Because of the ‘normal’ periods, people don’t understand that this behavior is not a choice. so much ignorance and it always causes so many problems. Good for you for understanding.
So interesting. I had a neighbor that put me through hell. I had no idea she had this condition at the time. If I only knew, I wouldn’t have blamed myself for her outbursts.
Oh Susie, I’m so sorry you blamed yourself. People with this disorder can be nice one day and then the next….whoa!!! Glad you learned something and won’t go down that path again.
Louise, this is a great post. Very informative and well written. I am familiar with BAD and depression and it takes a lot for people to realize this isn’t something a person can just ‘snap out of’. The chemical imbalance that the person has no control over is exactly right. I will say prayers for your friends and their daughter.
Thanks Stacey – you are exactly right. We wouldn’t expect someone to control the growth of cancerous cells and yet we expect them to control the chemicals in their brain, so they behave in a certain way. It’s a difficult disease to be around, for many people, but all the people I know with it, would gladly change it, if they could.
I was in a meeting last week where one of the gentlemen was exhibiting this kind of manic behavior. He admitted that he was ‘in a manic time’. It made for a difficult meeting but my associate and I agreed to just listen and give this man our time. I think the blessing went both ways as this reminded me that life is about relationships, not always following an agenda.
I do wonder what I could say the next time we talk with him to help ease some of the uncomfortableness about his behavior if that we’re to come up?
Thank you for your article! It is extremely helpful and interesting.
Tammy, I would ask him to explain ‘his manic time’ and to give you his perspective on his behavior and situation. Ask him is there’s something you can do for him, but don’t get caught in trying to rescue or save him – he has to manage this on his own. People who have any self-awareness can usually provide information. If that doesn’t work, then I’d be holding him to timelines and items on the agenda, as much as possible.