Miguel Amador Abnormal Psychology Professor Cleveland April 13, 2004 Bipolar Illness Bipolar illness, also called manic depression, is misdiagnosed on the average of two out of three times; unfortunately it is an illness that kills one in four afflicted persons. Major psychiatric disorders such as bipolar illness make up half of the leading causes of disease related disability in the United States (web). Bipolar illness is a major psychological disorder characterized by episodes of mania, depression, or mixed moods. One or the other phase may be predominant at any given time; one phase may appear alternately with the other, or both phases may be present simultaneously. Causes of this illness involve biologic, psychological interpersonal, social and cultural factors (Mosby 193).

It is a life-long illness, which requires life-long treatment. Lithium, a mood stabilizer, is usually one of the first prescribed medications. Sometimes psychotherapy is helpful when combined with the drug treatment. A regular routine is also helpful in letting a bipolar individual lead a more productive lifestyle. The reason that bipolar illness is misdiagnosed so often is because the person commonly focuses on the depressive symptoms rather than the manic symptoms, which occur also.

The individual is either ashamed or afraid to tell the doctor about the manic side of the illness. Bipolar illness affects approximately ten percent of the population. There is no one cause for this illness. Some theories about what causes it are: genetics, stressful life events, and chemical imbalances (web). Psychologists and neuro biologists argue whether ego damaging experiences and self-deprecating thoughts or biological processes cause the depression. The mind does not exist with out the brain.

Considerable evidence indicates that regardless of the initial triggers the common pathways to depression involve biochemical changes in the brain. Geneticists have provided some concrete proof of a biological connection; manic depression frequently runs in families (Scientific American 42). It is not a discriminating illness; it affects all races and social classes. It has been said that Michelangelo would have produced three times the works we have today if he had been properly diagnosed and medically treated for manic depression.

In 1982, Patty Duke was diagnosed as manic-depressive. She was relieved to finally have an answer to her alternating bouts of rage and despondency (Hales 42). Bipolar disorder has many effects on the families lives as well. They range from emotional to social issues; they deal with changes in family members and the structure of the family. The family must learn how to deal with the very real threat of suicide.

After the diagnosis, many families may have a series of mixed emotions such as anger or extreme guilt. They may also feel ashamed or anxious. Sometimes they worry about having caused their loved one to become bipolar because of being short-tempered or because they had been un-supportive. In the past, a lot of blame was (erroneously) placed on the parents for producing a mentally ill child. In severe cases of recurrent manic depressive illness, the individual may never again be quite the same person the family had known prior to the diagnoses of the illness. The family then goes through a sort of mourning process.

They may grieve over the lost hopes and dreams. The families sometimes feel shame because of the unfulfilled expectations, and also with the stigma of mental illness. One of the reasons that mental illness carries such a stigma is because it is often associated with decreased productivity (less nowadays). The value of productivity has been the mainstay of North America. Anxiety is often present because the family members grow to anticipate the a change in mood or a return of symptoms.

Families find it stressful to plan any activities or events for fear of the affected person causing a scene or problem at the event. Families can greatly benefit from becoming active in a manic depressive support group. The word manic means mania. Characteristics of mania include: increased energy and activity, restlessness, racing thoughts and rapid speech, excessive euphoria, extreme irritability and, decreased sleep requirement, uncharacteristically poor judgement, increased sexual drive, denial that anything is wrong, and risk behavior. Depression is characterized by: persistent sad, anxious or empty mood, feelings of hopelessness, helplessness, worthlessness, pessimism, guilt, loss of pleasure or interest in ordinary activities including sex, decreased energy, feelings of fatigue, difficulty remembering, concentrating and making decisions, changes in appetite, and thoughts of suicide (web). Mental illness is a hidden disease many times.

It is something that happens to your neighbor, your co-worker, and yourself; and you may not even know it. There are currently many medications on the marked to help these individuals. There are anti-psychotic drugs such as and. These two medications may be combined with lithium, or taken in place of it. For some bipolar individuals lithium alone does not work.

There are many side effects that can occur while taking these medications, but the benefits, in general, outweigh the risks. A person experiencing or suffering from severe mania or psychotic depression may hear "voices" in their heads. These medications can help prevent these episodes from happening. There currently is great progress being made in the diagnosis and treatment of bipolar illness. A part of the manic state may include a feeling that everyone around them are moving slower; they are more likely to speed while driving because they wish that they were already at their destination, or simply because the scenery isn't moving as fast as their brain thinks it should. It may also include a feeling that their mind is racing constantly.

Bipolar individuals do not get normal signals send from their bodies to their brains. They could stay up all night and have plenty of energy the next day; their body doesn't send the brain the signal of the extent of their fatigue. They could wake up hungry and find the thought of food sickening. Sometimes this is used as a weight loss technique. It is dangerous and very hard on the internal organs and the nervous system (online) Matt Dilley, a manic depressive man, describes a manic state as "being in your own world; people can talk to you and you don't even hear them." He was also diagnosed as having adult attention deficit disorder.

He was in therapy for two and a half years and was on about 30 different medications before the doctors correctly diagnosed him as manic-depressive and with adult ADD. Finally, after the correct diagnosis they put him on lithium and ritalin. He says that the medications didn't make him feel any better so he decided that he wanted to try stopping the medications all together. He has not had an episode in over two years, and he is convinced that most of the problems that he was having were psychosomatic (the reason you feel bad is because the doctors are telling you that you do feel bad). Toby, another manic-depressive man was diagnosed about three years ago. He is currently prescribed lithium, to help correct or control the chemical imbalances in his brain.

He is also currently taking for feelings of paranoia. Some of the side effects, he says, are weight gain, excessive thirst, blurred vision and extreme fatigue. The medications seem to help him, to an extent, to lead a some what "normal" lifestyle. In retrospect, he believes that he has been bipolar all his life, however, his doctor thinks that it may have been drug induced. He had regularly indulged in smoking marijuana and taking LSD. The drug abuse eventually lead to his first real break down.

His parents were divorced, and since he and his mother weren't getting along, they both decided that it would be for the best if he moved to Florida to live with his father. Leaving behind his family and friends caused an episode of severe depression. He had taken LSD prior to getting on the plane for Florida, and he was convinced that he was on a plane ride to hell. He had to be restrained on the plane and tranquilized. During his first week in Florida, he had his breakdown. His father had him admitted, against his will, into a psychiatric / drug rehabilitation center.

From this hospital, he constantly called his mother, begging her to let him come back home. He promised her that he would be good, he would be the best son that she could ever ask for. She eventually gave in and let him come back home to live. It took a long time for him to calm down or stabilize after moving back, but after moving out on his own he was better able to proceed with his life. During one depressive episode he felt like he should end his life. The voices in his head told him to kill himself.

The voices teased him, telling him he was a failure. He couldn't live with the voices anymore, so he took an over dose of medication. He said that he could literally feel himself dying. The feeling started in his feet and was traveling up toward his heart. Before the sensation reached his heart, where he believes that he would have died, he called 911 and his mother for help. He was taken to the hospital where his stomach had to be pumped out.

He didn't die. He was lucky. In his dating life he has run into many problems. One of the problems was that the women that he had been with were not faithful to him, which today still causes him problems. Sometimes the women couldn't deal with the emotional roller coaster he was on, and sometimes things just didn't work out. Most recently, he was engaged to a woman who was willing to accept him good days and bad, who loved him unconditionally.

She planned on spending her every tomorrow with him, until he threatened to kill her. He was convinced that she was cheating on him and she could not make him believe her. The third time that he threatened to kill her, he woke her out of a sound sleep, looked her in the eye and said," If I find out you are cheating on me, I will kill you. I am already crazy so I can just plead insanity." This was it for her, she broke off the engagement and never has seen him again.

He is sorry that he lost her, but he can't trust any woman other than his mother. Kay Redfield Jamison says in her book, "An Unquiet Mind", "Before you can conquer a beast, you must first make it beautiful" (5). She is a PHD in psychology and is a MD. She is a woman that was willing to risk her career as a doctor to write a book about her life as a manic-depressive individual.

She wanted to know all of the illness' real and imagined powers; she had to know all of its moods and disguises. She thought that she should be able to handle her increasingly violent mood swings on her own, so for the first ten years of her illness, she did not seek any kind of treatment. She also found out that: The major clinical problem in treating manic-depressive illness is not that there are not effective medications -- there are -- but that the patients so often refuse to take them. Worse yet, because of a lack of information, poor medical advice, stigma, or fear of personal and professional reprisals, they do not seek treatment at all. Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often err odes the desire and will to live... An illness that is unique in conferring advantage and pleasure, yet one that brings in its was almost unendurable suffering and, not infrequently, suicide (6).

There are four classified types of bipolar disorder. Bipolar I, II, III, and. Bipolar I is the one we hear about most often; although it is not the most common form of the illness. While in a manic state, persons do outrageous things; they feel invincible and believe that they can conquer the world. Their energy is misdirected; they spend money irresponsibly, drive recklessly, and can become sexually promiscuous. In a psychotic manic state, the person becomes extremely impulsive, impatient, having a total lack of judgement.

Bipolar II is a milder form of the illness. Sometimes they are wrongly diagnosed as neurotic or having a personality disorder. They often have recurrent depressive episodes followed by a euphoric period that can last from two to ten days. Bipolar III is usually caused by medication.

Manic episodes are often preceded by a drug or electro convulsive treatment. Anti-depressants are sometimes mistakenly prescribed because the person was thought to be clinically depressed. Cyclothymes have only mild highs and lows, lasting only a few days or weeks at a time. They might start something with a lot of enthusiasm and never finish it.

The most extreme are called rapid cycles. Their moods change so quickly that they literally collide with each other within the same day or week. Many people are rapid cycles from the beginning and others, over time, develop into that form of the illness. It is unknown what causes rapid cycling; however, three theories have been proposed: kindling (sensitization), biologic rhythm disturbances (bus's) and hypothyroidism. The kindling theory says that the episodes of rapid cycling are induced by actual or anticipated events. BRD's are where the individuals biological rhythms are abnormal and can account for the sleep disturbances.

Hypothyroidism is based on the idea that there is an inadequate amount of the thyroid hormone in the brain (online). When looking at the costs of bipolar illness, there are three major aspects to consider. The first is the loss of life. When untreated, it is associated with a life expectancy decrease of up to nine years. The number of untreated patients who commit suicide may be as high as 19 percent.

With proper medical treatment however, that number largely reduces the suicide risk and increases the life expectancy by seven years. One doctor believes that treatment could be greatly improved if it were not for the fact that almost three 0 quarters of bipolar patients who remain undiagnosed, or who are misdiagnosed for the first five to ten years of their illness. Second, according to federal statistics, untreated bipolar patients can lose up to 14 years of work productivity, and estimated cost of 30 million dollars annually. Finally the total cost for bipolar illness in the United States was estimated to be about 45. 2 billion dollars, which is about two-thirds the cost of AIDS, and about half the cost of cancer. Most of that total comes from inpatient hospital care, other institutional or residential treatments, followed buy the costs relating to crime, substance abuse, out-patient treatment and medications (Murray 349).

A bipolar individual is more likely to attempt or commit suicide. According to Scientific American, as many as 15% of manic-depressives commit suicide each year. The actual number is probably higher because the families can't collect life insurance and other benefits if the cause of death isn't accidental. I think that these people must feel like they are a prisoner of their own mind, a mind that they can't even trust.

There is no cure for this illness, however, with counseling, proper medical treatment and medication, in addition to, unconditional love, support, and patience from loved ones, these people do have a chance to lead a somewhat "normal" lifestyle.