The heart that is soonest awake to the flowers is always the first to be touched by the thorns.
- Thomas Moore, 1779-1852
Basic Terminology
Bipolar disorder is the medical name for manic depression. The terms may be used interchangeably. Bipolar disorder is a mental illness, but it is more appropriately described as a neurobiological brain disorder involving extremes in mood. It is one of the three major affective (mood) disorders. The other two affective disorders are unipolar disorder (depression only) and schizoaffective disorder. Most medical researchers believe that bipolar disorder is genetic.
The DSM criteria are merely guidelines, sort of like a check-off list of symptoms. Newly-diagnosed people will sometimes go to the library or bookstore to learn about bipolar disorder. They are likely to get very confused by what they read, and wonder if the psychiatrist made a mistake! This is because bipolar disorder may be quite complex in its variations, a fact that the popular literature doesn't always address. Each individual has her or his own unique form of the illness.
ome people have mild manias, called hypomanias, and others have wild manias. Some people have depressions which are deep, awful, and long-lasting. Others may have brief depressions. Still others have a sort of a "physical" depression or physical pain, with flattened or non-existent emotions. And sometimes (not always) a person with bipolar disorder may have accompanying psychotic features such as delusions and/or hallucinations.
People without bipolar disorder seem to think that hypomania and mania sound like fun. After all, most of the definitions in books say that mania is a euphoric or "high" state. It is true that mild hypomania may be fun, because it is so energizing and may lead to a period of highly productive activity. But in actuality, both mania and hypomania may also be dysphoric.
Dysphoria implies agitation, anxiety, uncontrollable rage, or self-destructive feelings. Sometimes mania and depression happen at the same time. These are called mixed states.
Finally, a person with bipolar disorder doesn't generally have an episode of depression, then an episode of mania, in equal amounts. Although it is true that "what goes up, must come down," the cycles are often unpredictable and of varying length.
Most people with bipolar disorder have extreme cycles only once every few years. Rapid cyclers go through four or more episodes of mania and depression per year. Ultra-rapid cyclers have episodes shorter than a week. Ultradian cyclers have distinct and dramatic moods shifts within a 24-hour period.
And, believe it or not, some people with bipolar disorder may have weeks, months, or years with absolutely no extreme ups and downs at all. Instead, they have normal moods like everyone else. Psychiatrists actually classify this, too! It is called euthymia.
My Own Experience
I was diagnosed with bipolar disorder in 1992, after a lifetime of struggling with depression and mania. According to the DSM-IV, I am Bipolar 1, Rapid Cycling. I also have a seasonal aspect to my illness. Every summer I cycle into Mixed States from early June through mid-August.
I have tried many medications, in varying dosages and combinations. Fortunately, I have an exceptional psychiatrist, who works with me and is there for me. There is nothing quite like a good partnership with your doctor, especially when it comes to mental illness.
The best description I have seen of what it is like for me to live with manic depression comes from Dr. Kay Redfield Jamison's book, Touched With Fire: Manic-Depressive Illness and the Artistic Temperament (The Free Press, Macmillan, New York, 1993). Dr. Jamison has bipolar disorder, and knows what she's talking about.
"The clinical reality of manic-depressive illness is far more lethal and infinitely more complex than the current psychiatric nomenclature, bipolar disorder, would suggest. Cycles of fluctuating moods and energy levels serve as a background to constantly changing thoughts, behaviors, and feelings. The illness encompasses the extremes of human experience. Thinking can range from florid psychosis, or "madness," to patterns of unusually clear, fast and creative associations, to retardation so profound that no meaningful mental activity can occur. Behavior can be frenzied, expansive, bizarre, and seductive, or it can be seclusive, sluggish, and dangerously suicidal. Moods may swing erratically between euphoria and despair or irritability and desperation. The rapid oscillations and combinations of such extremes result in an intricately textured clinical picture. Manic patients, for example, are depressed and irritable as often as they are euphoric; the highs associated with mania are generally only pleasant and productive during the earlier, milder stages." (Jamison, Touched With Fire, pages 47-48.)
Available Treatments
There is no cure for bipolar disorder, but it may be managed with medication, psychotherapy, and life-adjustment skills. Usually a combination of all three is required to avoid hospitalization and/or the eventual lure of suicide.
First-line treatments in the United States include lithium and Depakote. These are called mood stabilizers. Lithium is a naturally occurring substance (an element), and is usually the first drug tried because of its overall success rate. But despite its good press, lithium doesn't always work, and the side effects are sometimes too hard to live with.
In 1995, the U.S. FDA approved Depakote, an anti-convulsant, for use in treating bipolar disorder. Depakote, Depacine, Depakene, Epival, Epilim, and Valproate are derivatives of a substance called valproic acid. Other anti-convulsants which are being used (but have not been FDA-approved for bipolar disorder) include carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal), topiramate (Topamax), tiagabine (Gabitril), and clonazepam (Klonopin). In addition, verapamil (Calan), a calcium-channel blocker, has been used experimentally in the treatment of manic-depressive illness. Seroquel, Risperdal, and Zyprexa (antipsychotics) have also been successfully used to treat mania.
Antidepressants may be added to mood stabilizers, especially if the individual has particular trouble with depression. However, unopposed antidepressants (use of antidepressants without also using a mood stabilizing drug) may be dangerous for a bipolar patient. It is dangerous because the person may go into a manic state very quickly, or begin rapid cycling, or their illness may worsen. Even patients who are on an antidepressant plus a mood stabilizer must carefully monitor themselves for these altered patterns.
It is often very frustrating to treat manic depression. What works for one person may not work for another. Sometimes a combination of medications is effective, including use of antipsychotics, benzodiazepines, thyroid supplements, and sleeping aids. (If a person has other medical problems which require medications, these must be balanced very carefully with those taken for manic depression.)
These varying mixtures are often referred to by patients as med cocktails or meds. And even with the best of med cocktails, the side effects of the drugs may be nearly unbearable, or there may be breakthrough episodes of mania or depression.
Suicide and Bipolar Disorder
About 1% of the world's population is thought to have some form of bipolar disorder, from mild to severe. Statistically, men and women are equally represented. Approximately 1 in 5 people with bipolar disorder eventually commit suicide (Goodwin and Jamison, Manic Depressive Illness, p. 228). This is 30 times higher than the general population! And 20-50% of people with bipolar disorder attempt suicide at least once (p. 231).
"Patients with depressive and manic-depressive illnesses are far more likely to commit suicide than individuals in any other psychiatric or medical risk group. The mortality rate is higher than it is for most types of heart disease and many types of cancer. Yet this lethality often is underemphasized, a tendency that may be traceable to the erroneous but widespread belief that suicide is volitional." (Goodwin and Jamison, Manic Depressive Illness, p. 227)
Imagine thinking about suicide daily. Imagine feeling like there is no way out of the madness of your thoughts, your bizarre emotional swings, or your life situation except to kill yourself. For a person with bipolar disorder, suicidal ideation (i.e., suicidal thoughts, plans, obsessing on death) may occur during depression, dysphoric mania, and/or mixed states.
Learning About Your Diagnosis
People with bipolar disorder are sometimes told by family and friends to "just snap out of it" or "just cheer up" or "pray to God and you will be healed." This sort of well-meaning advice can be lethal to someone who is experiencing the disturbing states of mania or depression. The implication is that if we tried harder, we would not be having all these problems. What nonsense!
Remember, mental illnesses have a biological basis, just like other illnesses. There are plenty of scientific studies which prove this. This is not a justification of the unusual behavior which happens during mania or depression, but rather an explanation of its origin.
Perhaps you have been to a doctor, and now have a prescription in your hand. The doctor says, "Take as directed. In two weeks you will feel much better." Is this true? What if you get side effects? What if nothing happens? How can you possibly survive the wait?
As difficult as this sounds, you must be your own health care advocate. Don't expect your doctor to do it for you, or your significant other, or your parents, or your friends. Take charge of your diagnosis. Speak to your doctor about your concerns. In the beginning, you may need daily or weekly contact with the doctor. Ask questions. Find answers.
You may wish to keep a journal or a mood chart. Learn to identify those things that make your episodes worse. Identify things which seem to help. Make adjustments to your daily life. Find support to help you through the rough times.
If you have been diagnosed with a mental illness such as bipolar disorder it is time to learn as much as you can, as fast as you can. There are books to read, organizations you can contact, real-world support groups, Internet mail lists and newsgroups, and Web-based chat areas. Plus, there are some excelent Web sites which you can visit on your journey of discovery.
Famous People with Bi-Polar Disorder:
Bipolar Disorder (Manic Depression)
These individuals have publicly stated that they have experienced manic depression in their lives.
· Buzz Aldrin, astronaut
· Shelley Beattie, athlete (bodybuilding, sailing), artist
· Ned Beatty, actor
· Maurice Benard, actor
· Danny Bonaduce, radio personality, actor, writer
· Robert Boorstin, writer, special assistant to Pres. Clinton, State Department
· Art Buchwald, writer, humorist
· Alohe Jean Burke (Ghafoor), musician, vocalist
· Tim Burton, artist, movie director
· Robert Campeau, financier (Canada)
· Lisa Nicole Carson, actor
· Dick Cavett, writer, media personality
· C.E. Chaffin, writer, poet
· Garnet Coleman, legislator (Texas)
· Francis Ford Coppola, director
· Patricia Cornwell, writer
· John Daly, athlete (golf)
· Ray Davies, musician
· Lenny Dee, musician
· Eric Douglas, actor
· Robert Downey, Jr., actor
· Kitty Dukakis, former First Lady of Massachusetts
· Patty Duke (Anna Duke Pearce), actor, writer
· Thomas Eagleton, lawyer, former U.S. Senator
· Margot Early, writer
· Robert Evans, film producer
· Carrie Fisher, writer, actor
· Larry Flynt, magazine publisher
· Connie Francis, actor, musician
· Stephen Fry, actor, author, comedian
· Kaye Gibbons, writer
· Kit Gingrich, Newt's Mom
· Stuart Goddard (Adam Ant), musician
· Shecky Greene, comedian, actor
· Linda Hamilton, actor
· Kristin Hersh, musician
· Jack Irons, musician
· Kay Redfield Jamison, psychologist, writer
· Daniel Johnston, musician
· Margot Kidder, actor
· Peter Nolan Lawrence, writer (England)
· Rika Lesser, writer, translator
· Bill Lichtenstein, producer (TV & radio)
· Sue Lyon, actress
· Jay Marvin, radio personality, writer
· Kevin McDonald, comedian, actor
· Kristy McNichol, actor
· Dimitri Mihalas, scientist
· Kate Millett, writer, artist
· John Mulheren, financier (U.S.)
· Robert Munsch, writer
· Ilie Nastase, athlete (tennis), politician
· Tony Orlando, musician
· Margo Orum, writer
· Nicola Pagett, actor
· Susan Panico (Susan Dime-Meenan), business executive
· Jimmie Piersall, athlete (baseball), sports announcer
· Charley Pride, musician
· Mac Rebennack (Dr. John), musician
· Jeannie C. Riley, musician
· Lynn Rivers, U.S. Congress
· Alys Robi, vocalist (Canada)
· Axl Rose, musician
· Francesco Scavullo, artist, photographer
· Lori Schiller, writer, educator
· Frances Sherwood, writer
· Scott Simmie, writer, journalist
· Earl Simmons (DMX), musician, actor
· Alonzo Spellman, athlete (football)
· Muffin Spencer-Devlin, athlete (pro golf)
· Darryl Strawberry, athlete (baseball)
· Ben Stiller, actor, comedian
· Gordon Sumner (Sting), musician, composer
· Lili Taylor, actor
· Dimitrius Underwood, athlete (football)
· Jean-Claude Van Damme, athlete (martial arts), actor
· Mark Vonnegut, doctor, writer
· Sol Wachtler, judge, writer
· Tom Waits, musician, composer
· Brian Wilson, musician, composer, arranger
· Jonathan Winters, comedian, actor, writer, artist
· Luther Wright, athlete (basketball)
Unipolar Disorder (Depression)
These individuals have publicly stated that they have experienced depression in their lives.
· Marvin Lee Aday (Meat Loaf), musician, actor
· Louie Anderson, comedian, actor
· Fiona Apple, musician
· Oksana Baiul, athlete (skating)
· Rona Barrett, entertainment reporter, author
· Halle Berry, actor
· Kjell Magne Bondevik, Prime Minister, Norway
· Marlon Brando, actor
· Willie Burton, athlete (basketball)
· Delta Burke, actor
· Barbara Bush, former First Lady (U.S.)
· Helen Caldicott, activist, writer
· Drew Carey, actor, comedian
· Jim Carrey, actor, comedian
· Melanie Chisholm, singer
· Margaret Cho, actor, comedian
· Sandra Cisneros, writer
· Dick Clark, television personality (American Bandstand)
· John Cleese, comedian, actor, writer
· Leonard Cohen, musician, writer
· Paula Cole, actor
· Judy Collins, musician, writer
· Shawn Colvin, musician
· Jeff Conaway, actor
· Pat Conroy, writer
· Billy Corgan, musician
· Kathy Cronkite, writer
· Sheryl Crow, musician
· Bill Dana, comedian
· Rodney Dangerfield, comedian, actor
· Jonathan Davis, musician, composer
· Sandra Dee, actor
· Ellen DeGeneres, comedienne, actor
· Paolo DiCanio, athlete (soccer)
· Scott Donie, Olympic athlete (diving)
· Tony Dow, actor, producer, director
· Queen Elizabeth
· Jules Feiffer, playwright, screenwriter, cartoonist
· Tim Finn, musician, composer
· Eddie Fisher, singer
· Harrison Ford, actor
· Albert French, writer
· Sarah Ferguson, Duchess of York
· John Kenneth Galbraith, economist, educator, author
· James Garner, actor
· Paul Gascoigne, athlete (soccer)
· Kendall Gill, athlete (basketball)
· Dwight Gooden, athlete (baseball)
· Tipper Gore, activist
· Pete Harnisch, athlete (baseball)
· Mariette Hartley, actor
· Juliana Hatfield, musician
· Anthony Hopkins, actor
· Janet Jackson, musician
· Billy Joel, musician, composer
· Elton John, musician, composer
· Daniel Johns, musician
· Ashley Judd, actor
· Gelsey Kirkland, dancer
· Joey Kramer, musician
· Julie Krone, athlete (horse racing)
· Pat LaFontaine, athlete (hockey)
· Jessica Lange, actor
· Jacob Lawrence, artist
· Allie Light, director
· Rick London, cartoonist
· Greg Louganis, Olympic athlete (diving)
· Courtney Love, musician, actor
· Camryn Manheim, actor
· Martha Manning, psychologist, writer
· Dave Matthews, musician, composer
· Gary McDonald, actor (Australia)
· A.J. McLean, musician
· Robert McFarlane, former National Security Advisor (U.S.)
· Rod McKuen, writer, poet, producer
· Paul Merton, comedian (U.K.)
· Alanis Morissette, musician, composer
· S.P. Morrissey, musician
· Les Murray, poet (Australia)
· V.S. Naipaul, writer, Nobel Laureate
· Stevie Nicks, musician
· Deborah Norville, television journalist
· Sinead O'Connor, musician
· Rosie O'Donnell, actor, talk show host
· Ozzy Osbourne, musician
· Donny Osmond, musician
· Marie Osmond, musician
· Dolly Parton, musician, arranger, writer
· Charley Pell, former coach, Univ of Florida
· Teddy Pendergrass, musician
· Alma Powell, wife of Gen. Colin Powell
· Susan Powter, motivational speaker
· Freddie Prinze, Jr., actor
· Bonnie Raitt, musician
· Lou Reed, musician
· Trent Reznor, musician
· Joan Rivers, comedienne, talk show host
· Robbie Rist, actor
· Roseanne, actor, writer, comedienne
· Martin Rossiter, musician
· Winona Ryder, actor
· Yves Saint Laurent, fashion designer
· Monica Seles, athlete (tennis)
· Linda Sexton, writer
· Neil Simon, writer, playwright
· Paul Simon, composer, musician
· Lauren Slater, writer
· Jose Solano, actor
· Phil Spector, producer (music)
· Rick Springfield, musician, actor
· George Stephanopoulos, political advisor, educator
· Teresa Stratas, musician (opera)
· Darryl Strawberry, athlete (baseball)
· William Styron, writer
· James Taylor, musician
· Kate Taylor, musician
· Livingston Taylor, musician
· Tracy Thompson, writer, reporter
· Hunter Tylo, actor
· Kurt Vonnegut, writer
· Mike Wallace, journalist, TV news (CBS)
· Damon Wayans, comedian, actor, writer, director, producer
· Dar Williams, musician
· Tom Wolfe, writer
· Elizabeth Wurtzel, writer
· Boris Yeltsin, former President, Russia
Famous 20th and 21st Century People Who Had Manic Depression:
Below is a list of deceased individuals from the 20th and 21st Century who had a confirmed (not speculated) diagnosis of manic depression. The information comes from biographies, autobiographies, printed articles, interviews, documentaries, and obituaries. This is a list-in-progress.
· Alvin Ailey, 1931-1989, dancer, choreographer
· Louis Althusser, 1918-1990, philosopher, writer
· Clifford Beers, 1876-1943, humanitarian
· John Berryman, 1914-1972, poet
· L. Brent Bozell, d. 1997, attorney, political scientist, writer
· Jeremy Brett, 1933-1995, actor
· Neal Cassady, 1926-1968, writer
· Rosemary Clooney, 1928-2002, vocalist
· Hart Crane, 1899-1932, poet
· Lindsay Crosby, 1938-1989, actor
· Phil Graham, owner, Washington Post
· Graham Greene, 1904-1991, writer
· Peter Gregg, 1940-1980, team owner and manager, race car driver
· Moss Hart, 1904-1961, actor, director, playright
· Abbie Hoffman, 1936-1989, writer, political activist
· Phyllis Hyman, 1949-1995, musician, vocalist
· Randall Jarrell, 1914-1965, poet
· Jane Kenyon, 1940-1995, poet
· Otto Klemperer, 1885-1973, musician, conductor
· Frances Lear, 1923-1996, writer, editor, women's rights activist
· Vivien Leigh, 1913-1967, actor
· Oscar Levant, 1906-1972, pianist, composer, television personality
· Karl Paul Link, chemist, scientist
· Joshua Logan, 1909-1988, Broadway director, producer
· Robert Lowell, 1917-1977, poet
· Burgess Meredith, 1908-1997, actor, director
· Spike Milligan, 1919-2002, comic actor, writer
· Phil Ochs, 1940-1976, musician, political activist, poet
· John Ogden, 1937-1989, composer, musician
· Jaco Pastorius, 1951-1987, musician
· Pierre Peladeau, 1925-1997, entrepreneur
· Murray Pezim, 1920-1998, financier
· Theodore Roethke, 1908-1963, writer
· Delmore Schwartz, 1913-1966, poet
· Del Shannon, 1934-1990, musician
· Don Simpson, 1944-1996, movie producer
· David Strickland, 1970-1999, actor
· August Strindberg, 1849-1912, writer
· Nick Traina, 1978-1997, musician
· Townes Van Zandt, 1944-1997, musician, composer
· Joseph Vasquez, 1963-1996, writer, movie director
· Mary Jane Ward, 1905-1981, writer
· Norman Wexler, 1926-1999, screenwriter, playwright
· Virginia Woolf, 1882-1941, writer
· Bert Yancey, 1938-1994, athlete
Famous 20th and 21st Century People Who Had Depression
Below is a list of deceased individuals from the 20th and 21st Century who were treated by medications or psychotherapy for depression, or experienced depression during their lives. There is no doubt that at least some of these people would come under the "bipolar" classification today.
The information comes from biographies, autobiographies, printed articles, interviews, documentaries, and obituaries. This is a list-in-progress.
· Stuart Adamson, 1958-2001, musician
· Chris Antley, 1967-2001, athlete
· Diane Arbus, 1923-1971, photographer
· Samuel Barber, 1910-1981, classical composer
· Samuel Becket, 1906-1989, writer
· Menachem Begin, 1913-1992, Prime Minister (Israel), Nobel Laureate
· Tommy Boyce, 1939-1994, musician, composer
· Clara Bow, 1905-1965, actor
· Cheyenne Brando, 1970-1995, actor
· Richard Brautigan, d. 1984, writer
· Donald Cammell, 1934-1996, movie director, screenwriter
· Truman Capote, 1924-1984, writer
· Paddy Chayefsky, 1923-1981, writer, movie director
· Lawton Chiles, 1930-1998, senator, governor (Florida)
· Winston Churchill, 1874-1965, Prime Minister (U.K.)
· Kurt Cobain, 1967-1994, musician
· Tyrus Cobb, 1886-1961, athlete
· Calvin Coolidge, 1872-1933, U.S. president
· Dennis Crosby, 1935-1991, actor
· John Denver, 1943-1997, musician, composer, writer
· Terence Donovan, 1936-1996, photographer
· Michael Dorris, 1945-1997, writer
· James Farmer, 1920-1999, civil rights activist
· Philo T. Farnsworth, 1906-1971, inventor of electronic television
· Andre Franquin, 1924-1997, cartoonist
· Michel Foucault, 1926-1984, writer, philosopher
· Judy Garland, 1922-1969, singer, actor
· Stan Getz, 1927-1991, musician
· Arshille Gorky, 1904-1948, artist
· Philip Guston, 1913-1980, artist
· Hampton Hawes, 1928-1977, musician
· Lillian Hellman, 1905-1984, writer
· Ernest Hemingway, 1898-1961, writer
· Margaux Hemingway, 1955-1996, actor, model
· Audrey Hepburn, 1929-1993, actor
· Herman Hesse, 1877-1962, writer
· Edward Hopper, 1882-1967, artist
· Eugene Izzi, 1954-1996, writer
· William James, 1842-1910, philosopher, writer
· Lyndon Johnson, 1908-1973, U.S. president
· Franz Kafka, 1883-1924, writer
· Danny Kaye, 1913-1986, actor, comedian
· William Kurelek, 1927-1977, artist
· Primo Levi, d. 1987, chemist, writer
· Ross Lockridge, Jr., 1914-1948, writer
· Jack London, 1876-1916, writer
· Malcolm Lowry, 1909-1957, writer
· J. Anthony Lukas, 1933-1997, writer
· Salvador Luria, 1912-1991, geneticist, Nobel Laureate
· Susannah McCorkle, 1946-2001, vocalist, writer
· Peter McWilliams, 1949-2000, writer, activist
· Robert Merrill, 1924-1998, musician, lyricist
· Carmen Miranda, 1909-1955, dancer, actor
· Claude Monet, 1840-1926, artist
· Thelonious Monk, 1917-1982, musician
· Marilyn Monroe, 1926-1962, actor, singer
· Vaslov Nijinksy, 1889-1959, dancer, choreographer
· Richard M. Nixon, 1913-1994, U.S. president
· Laurence Olivier, 1907-1989, actor
· Eugene O'Neill, 1888-1953, writer
· Wilfred Owen, 1893-1918, poet, soldier
· Dorothy Parker, 1893-1967, writer, poet
· George S. Patton, 1885-1945, General (U.S. military)
· Walker Percy, 1916-1990, writer
· Sylvia Plath, 1932-1963, writer
· Jackson Pollock, 1912-1956, artist
· Cole Porter, 1891-1964, composer
· Freddie Prinze, 1955-1977, comedian, actor
· Norman Rockwell, 1894-1978, artist
· Eleanor Roosevelt, 1884-1962, First Lady
· Amelia Rosselli, 1930-1996, poet
· Mark Rothko, 1903-1970, artist
· Gabrielle Roy, 1909-1983, writer
· May Sarton, 1913-1995, poet, diarist, novelist
· Ronnie Scott, d. 1996, musician
· David O. Selznick, 1902-1965, film producer, director
· Anne Sexton, 1928-1974, poet
· Charles Schulz, 1922-2000, artist, cartoonist
· Dmitri Shostakovich, 1906-1975, musician
· Diana Spencer, 1961-1997, Princess of Wales
· Dusty Springfield, 1939-1999, vocalist
· Rod Steiger, 1925-2002, actor
· Gene Tierney, 1920-1991, actor
· Henri Marie Raymond de Toulouse-Lautrec, 1864-1901, artist
· Spencer Tracy, 1900-1967, actor
· Vivian Vance, 1909-1979, actor
· Tennessee Williams, 1911-1983, writer
· William Carlos Williams, 1883-1963, physician, writer, poet
· Bill Wilson, 1895-1971, co-founder of Alcoholics Anonymous
· Hugo Wolf, 1860-1903, composer
· Ed Wood, 1925-1978, movie director
· Natalie Wood, 1938-1981, actor
· Tammy Wynette, 1942-1998, musician, vocalist
· Faron Young, 1932-1996, musician
· Robert Young, 1907-1998, actor
Family History Pointers to Mental Illness (http://www.frii.com/~parrot/tree.html)
Insanity runs in my family. It practically gallops. - Cary Grant, in Arsenic and Old Lace, 1944
When you go to a psychiatrist for a first time, she may ask you a series of questions to establish a little about your background. From your answers, she may be able to determine if your problem is related to a physical injury, confined to a "life situation," or a "learned behavior," or widely spread over your family (possibly indicating a genetic basis).
The major mental illnesses, such as bipolar disorder and schizophrenia, appear to be genetic. Scientific studies are pointing to this. (Occasionally, head trauma (physical injury) may cause a person to become mentally ill, with no genetic basis. This is rare, but it happens.)
When the family is told that their loved one has an illness which may have been inherited, they just cannot believe it. They exclaim: "Nobody in our family is mentally ill!"
Undeniable Denial
There is a lot of stigma associated with mental illness. This means the family will not talk about what they know, because it is "shameful." And even after you have been diagnosed by a doctor, your family members may deny that anything is wrong with you. They may even try to talk you out of your legitimate diagnosis. They may tell you to shape up, or snap out of it!
In the "Good Old Days," people with mental illnesses were institutionalized, hidden away, or ignored and shunned. Medications didn't become widely available until the 1960s. There was little research being done, and a whole lot of scary stuff going on. The best thing was to avoid it all together. So, you get stories like: "Remember your great-Uncle Joe? He was always doing crazy things, and he drank a lot. His sister cried a lot. They were a mess!" These family stories are quite important for many reasons, including medical.
In discovering these stories, you're not trying to bad-mouth your family or dredge up hard feelings. You are looking for clues. And good clues lead to more effective treatment for you.
A Few Pointers
Here are a few things to look for in your own historical family tree, or in your immediate, biological family of origin. Hold on tight, this list will knock you over.
· alcoholism
· anxiety or panic attacks
· arthritic-like symptoms (fibromyalgia, chronic fatigue syndrome)
· behavioral addictions or compulsions
· child abuse or spousal abuse
· chronic aches and pains
· chronic digestive problems
· chronic headaches or migraines
· compulsive gambling
· compulsive shopping
· criminal activity and/or incarceration
· depression not related to life events
· drug abuse or drug addiction
· eating disorders (bulimia, binging, anorexia)
· eccentric behavior
· explosive anger/prolonged anger
· hyperactivity
· hypersensitivity to light, noise, touch, crowds, etc.
· kleptomania
· mood swings
· past history of psychiatric treatment
· pedophilia
· reactiveness/destructiveness
· religious addictions or religious compulsions
· seasonal depressions
· self mutilation (i.e. cutting, head-banging, scratching)
· sleep disorders
· suicides or suicide threats
· talking continually, talking fast
· Tourette's disorder
· unusual reactions to prescription medications
· withdrawal or agoraphobic behaviors
Whew. Did you make it through all that?
Having these things within your family doesn't always mean the family member has a case of undiagnosed bipolar disorder or some other mental illness. Think of things listed, above, more like possible pointers. For instance, the prevalence of abuse in a family could mean undiagnosed mental illness, or, the abuser may simply be acting out, based on other unresolved issues in his or her life. Sometimes it is a combination of both.
Physical Signs
And, don't ignore the physical ailments mentioned above, especially if they are combined with questionable behavior. Sometimes people with a certain combination of physical disorders may also have a co-existing history of bipolar disorder or some other mental illness.
For example, some of the physical symptoms listed above-such as migraines and digestive problems-are often considered to be part of theaffective spectrum. That is, people with affective disorders (bipolar, unipolar, and schizoaffective disorders) often have these accompanying physical problems at a higher rate than the general population.
Please note: Some physical disorders may "mimic" bipolar disorder or other mental illnesses. Also, medications taken for things like allergies or pain may alter behavior via their side effects. Many different angles must be considered. If you think that your diagnosis is a mistake, take the time to visit another doctor and get a second opinion.
If You Think a Family Member is Mentally Ill
If you suspect that a family member may be mentally ill and needs help, do not try to walk the path alone. It is so very easy to be overwhelmed by the whole situation. Be sure to take care of yourself, and seek out those who can help you sort through options.
There are resources out there, some on the Net, with ideas for you. Perhaps the first thing to do is talk to your family doctor. She may be able to refer you (or your family member) to a psychiatrist. Or, check out "Mental Health Resources" in the Yellow Pages of your phone book. Local organizations may have brochures on various topics relating to mental illness.
http://www.frii.com/~parrot/affect.html
A "spectrum" is a grouping of possible other medical problems which may accompany a specific, diagnosed illness.
The Affective Spectrum
Some people who have bipolar disorder (manic depression) or unipolar disorder (depression-only) have co-existing conditions such as migraines, attention deficit disorder, fibromyalgia, eating disorders, etc. What's going on?
Background
In medical terms, a "spectrum" is a grouping of possible other medical problems which may accompany a specific, diagnosed illness. Many illnesses have spectrums associated with them. In order to qualify as part of a spectrum for an illness, these other conditions must present themselves at a statistically higher rate than would normally be expected.
J. Hudson and H. Pope--two researchers at McLean Hospital, Massachusetts, a prominent psychiatric hospital--decided to find out which other medical problems appeared in people diagnosed with bipolar, unipolar, and schizoaffective disorders. These would make up the "spectrum" for affective disorders.
The Current Listing
The following have been identified (so far) as part of the medical spectrum which may accompany affective disorders.
· attention deficit disorder (ADD & ADHD)
· body dysmorphic disorder
· cataplexy
· eating disorders (bulimia, anorexia, binging)
· fibromyalgia (includes chronic fatigue)
· impulse-control disorders
· irritable bowel syndrome
· kleptomania
· migraine/severe headache
· narcolepsy
· obsessive-compulsive disorder
· panic disorder
· Tourette's disorder
The following may also be a part of the spectrum accompanying affective disorders.
· anxiety disorders
· autism
· chronic pain
· intermittent explosive disorder
· pathological gambling
· pyromania
· personality disorders
· post traumatic stress disorder
· substance abuse and addiction (includes alcoholism)
· trichotillomania
Also, there are now studies linking heart disease and depression.
How This All Works (An Example)
Of these, the migraine and bipolar/unipolar connection has been observed the longest. So, let's use migraine and bipolar disorder as an example, to explain the theory:
Example:
· Many people have migraines and severe headaches.
· Very few of these people are diagnosed with bipolar disorder.
· Just because you have migraines, doesn't mean you have a mental illness.
· For some (still unknown) reason, people with bipolar disorder get migraines and headaches more often than the general population.
· Sometimes, the medication which the person takes for bipolar disorder will also help his/her migraines.
· Perhaps, say the researchers, there is some physiological reason for this occurrence.
· "Migraine" is thus included as part of the spectrum for affective disorders.
http://www.frii.com/~parrot/weblinks.html
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Last updated: 28 November 2001
Web Resources
There are many excellent Web sites which provide information and support for people with manic depression and other mental illnesses. Since there are too many to list, I have chosen a few which have good, basic information.
Basic Information about Bipolar Disorder
*http:www.pendulum.org: This excellent site, maintained by daedalus, is loaded with information on bipolar disorder. It is the official Web site for Pendulum, the email discussion list which was established in 1993.
*http://nimh.nih.gov/publicat/bipolarmenu.cfm The National Institute of Mental Health's listing of bipolar information. The brochure at the top of the page (click on Full Text) gives a good overview of bipolar disorder.
*http://www.psycom.net/depression.central.html is Dr. Ivan Goldberg's Web site. Dr. Goldberg, a renown psychopharmacologist (specialist in psychiatric drugs), has always been a great support for folks with unipolar and bipolar disorders. His site loads up fast (for all Web browsers). The site contains lots of good information, including easy-to-read FAQs about lithium, anticonvulsants, and antidepressants and lots of good links.
Support Organizations
*http:www.pendulum.org/support: You can sign up for the Pendulum email support list through the Web site. This particular Pendulum page also has a variety of other support organizations listed.
*http://members.iinet.net.au/~fractal1/fcontnts.htm: A wonderful Australian site, with an email support list.
*http:www.bpso.org: BPSO stands for Bipolar Person's Significant Others. BPSO is a "private mail list for those in a loving, intimate, or nurturing relationship with someone with bipolar disorder." The purpose of the Web site is to provide information and support for those who have to deal with bipolar disorder in their lives, even though they do not have the illness themselves. You may join BPSO (the email list) via the Web site.
*http://www.ndmda.org: NDMDA provides information and fellowship for those with affective disorders. There are "chapters" all over the United States, and now in other countries, too.
*http://www.nami.org: A support organization for people with mental illness and their families. The site provides good, general information, plus resources for many kinds of mental illness. Highly recommended as a place to start for info on mental illnesses, medications, and research-in-progress. Very useful info for families of persons with mental illness.
Information on Children with Bipolar Disorder
There is a wonderful book out called The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder, by Demitri and Janice Papolos. You can find the book at online bookstores, and at your local bookstore, too. The Papoloses have a Web site which includes articles and links. Go to http://www.bipolarchild.com.
Also, be sure to check out:
*http://www.bpkids.org This is a good resource for parents and helpers of children of bipolar disorder. You can find email support lists and real world support groups here, too.
Research Organizations
*http://www.wpic.pitt.edu/stanley: The goal of this organization is to promote the development of comprehensive and innovative treatment for manic depression. The Stanley Center tracks current clinical trials, keeps a Bipolar Registry for scientific studies, and publishes a newsletter. They post abstracts from their international conferences.
*http://www.ncbi.nlm.nih.gov/PubMed: Here is a place where you can do scientific literature searches, using key words. Read about recent studies and trials of new medications.
Suicide
*http://www.save.org: This is a very complete site about the topic of suicide. If you are thinking about it, or wonder about it, or have had a loss in your family, this is a good place to go. The SA\VE pages are full of great links to other sites, too.
*http://www.afsp.org: Excellent information for survivors, family members, educators. Excellent links section.
Other Things You Should Know
*http://www.schizophrenia.com. Although this site was created with the intent of informing about schizophrenia, I have found it to be filled with great information which also applies to bipolar disorder and other mental illnesses. The "Information for Family and Friends" section is very useful.
*http://www.ect.org: The most comprehensive site about electro-convulsive therapy (or ECT) on the Web. Shocked! was created to inform and educate about this controversial treatment.
General Information on Mental Health
*http://www.nmha.org/infoctr/factsheets/index.cfm: This link takes you to the NMHA fact sheet list. Each fact sheet provides basic information about a particular topic relating to mental health. These are good, introductory explanations.
*http://www.mentalhealth.com: Promotes improved understanding, diagnosis, and treatment of mental illness throughout the world. Addresses mental disorders, diagnostic criteria, treatments, research, articles, publications, and software.
*http://mentalhelp.net has lots of interesting information! It is one of the longest running Web sites on mental health, psychology, and psychiatry. Always something new here.
*http://psychcentral.com: Dr. Grohol is a psychologist who has an intense interest in on-line means of communication about mental health topics. His Web site is very comprehensive. He often includes news articles that I haven't seen elsewhere.
*http://www.mentalhealth.org, from the Center for Mental Health Services, U.S. Department of Health and Human Services, is a one-stop source of information and resources on prevention, treatment, and rehabilitation services for mental illnesses.