Up Close With Dr. E

Puncturing the myths about Bipolar Disorder

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In the process of creating a Hollywood movie, the director will take the life of an ordinary person — a man, woman or child — and then expose them to a great challenge, quest or life-threatening situation. As we, the viewers, watch the hero struggle, the tension of the movie builds as one key question begs to be answered: will the hero survive or be destroyed?

Two Hollywood movies, both having survived the test of time, capture this fundamental struggle between good and evil. These two movies are “Dr. Jekyll and Mr. Hyde” and “The Werewolf.” Unlike vampire movies, where a human, once bitten and turned into a vampire, leads a highly predictable life, the Jekyll, Hyde and Werewolf movies create drama through the process of transformation. After being bitten, or after drinking a special potion, a cycle of transformation begins: human to monster to human to monster to ...

Imagine living in a family where your mother or father suddenly transformed into a totally different person. You would learn, as a child, how to live with fear. Fear produced by unpredictability. Children who are raised in families where a parent cycles from one mood state to another, survive by becoming “little detectives.” By picking up clues that a parent is about to shift into a different person, the child detects danger and protects themselves by hiding.

Today’s column is about a psychiatric illness which shares these features with Jekyll-Hyde or the Werewolf: Transformation, unpredictability and fear. This disorder, once called Manic Depressive Illness, is now called Bipolar Disorder. It is one of the most misunderstood disorders. Myths, false beliefs and yes, superstitions about BD, abound. The purpose of today’s column is to puncture the myths about BD, by using the lance of scientific findings.

Bipolar Disorder is a disabling condition where an episodic, or cycling presentation occurs. The person with BD will cycle between a depressive phase and a mania phase. The depressive part is similar to clinical depression: sadness, poor sleep, feelings of worthlessness, poor concentration, fatigue, loss of pleasure and impaired ability to work. The mania phase includes these symptoms: erratic sleep or not requiring sleep, increased energy, increased sexual interest, poor judgment, racing thoughts, reckless and aggressive behavior and buying sprees.

Here are the seven most common myths about BD:

1. BD is a rare condition. False. Because BD has subtypes it can present in many different ways, which are often missed. Subtypes of BD are: Bipolar I — one episode of full blown mania (there does not have to be a depression stage). Bipolar II — Instead of mania, a less severe “hypomanic” episode occurs along with a depressive phase. Rapid Cycler — at least four episodes occurring in one year. When subtypes are identified, BD occurs in about 3% of adult populations.

2. BD does not occur in children or adolescents. False. While it is true that BD usually is first seen in adults, children can also have BD. The term, “early onset BD” is used when a child is diagnosed.

3. BD does not produce suffering. False. Because BD is often missed or incorrectly diagnosed, there is a long gap in time between onset of symptoms and treatment. This failure to detect the illness increases the destructive power of the disorder, making it one of the most disabling conditions in the world. Undetected BD destroys relationships, marriages, jobs and one of every five untreated BD patients commit suicide.

4. BD is caused by sinful behavior such as substance abuse. False. BD is a genetically transmitted illness which can be precipitated by stressful life events. Undiagnosed BD patients use alcohol or other drugs to self-medicate.

5. BD can’t be effectively treated. False. Modern BD treatments are effective in helping patients stabilize their lives.

6. BD patients only need medications. False. Comprehensive treatment programs focus on all aspects of a patient’s life and medication only treatments are now considered to be outdated.

7. BD patients go off their medication because they miss the high of the manic phase. False. While it is true that some seek the manic high, the vast majority know the destructive power of their illness. The reality of BP is that the depression phase is much more prevalent and lasts longer than the manic phase.

Bipolar Disorder, one of the most misunderstood psychiatric conditions, is now being identified and successfully treated.

Sources: “A Primer of Drug Action, Julien, 2008.”

 

Dr. Richard Elghammer contributes his column each week to the Journal Review.

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