MRI of the brain during "normal", manic and depressed moods
So I’m bipolar. So what? How does this make me an expert? It doesn’t. I’m no authority on the subject whatsoever. I can only write about what my experiences have been and about what I’ve learned while searching for answers to this very complicated multifaceted mental illness.
There are several stock responses when I tell someone I’m bipolar. “Oh, my dear, I can just imagine the hell you go through.” Or, “Oh sweetie, talk to me anytime. My great-aunt/mother/brother/wife/ daughter has it. I know all about it.” Well meaning but it’s pure horse hockey. You ain’t got a clue unless you have it.
Another is: “We all get blue sometimes.” True, “we all” do just that. Someone dies, we lose our job or our kid gets sick. Or our house burns down while the firefighters stand there and do nothing. Any of these things alone is enough to depress anyone. But . . .
It is a situational depression. It is nowhere nearly as extreme in intensity or longevity. It isn’t so debilitating that you don’t want to get out of bed for weeks or months at a time. It doesn’t cause you to self-mutilate, or worse, to kill yourself. It may even last for a couple of years but not for a lifetime. And you can’t just talk yourself out of it.
Another is, “Well, gee, I have periods when I’m more energized than at other times.” Of course and that’s perfectly normal. You just got a raise, won some money, moved to that farm you’ve always wanted. Or, maybe it’s something simple like the sun shining and it’s a beautiful spring day. But . . .
This feeling of elation is thousands of miles away from the intensity and destructiveness of a manic episode. You don’t lose your judgment. You don’t make reckless decisions, spend boat loads of money you don’t have, or dance naked in a fountain, or self-medicate with drugs and alcohol.
Oh, there’s one more: “Well, I’m sure if you pray and talk to the Lord, you’ll be just fine.”
So what is this thing called manic depression anyway? What causes it? Is it contagious? Can’t you just take a pill to get rid of it? What are the symptoms?
According to the National Alliance on Mental Illness: “Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic and typically vary greatly over the course of a person’s life as well as among individuals.”
Too clinical. Too cut and dry says I. What are missing here are all the complexities of mood disorders, all the varieties which come in all sizes, shapes and even colors and the multitude of symptoms which overlap. There’s major depression. There’s manic depression. There’s schizophrenia. Each of them presents themselves differently and all of them have similarities, making diagnosis a complicated affair.
Even manic depression has variations on a theme. One is rapid cycling where moods go up and down like a roller coaster ride. The other is mixed states where mania and depression are experienced at the same time. Mixed states are bad enough. Rapid cycling is pure hell and they're both hard to control because just the tiniest dose of a medication, too much or too little, can send a person spiraling in the other direction. And there are even a few more, but that’s really getting too technical for this blog.
Scientists have been trying to find a genetic link to bipolar for decades, but so far it has eluded them. There was a huge study of the Amish about 15 years ago because they have such a high rate of bipolar and not a small amount of inbreeding. The study was a dud, unfortunately. But clinical trials continue at Columbia, John Hopkins, Duke and other major universities and centers. It is well documented that manic depression, and related mood disorders, is passed down through the generations.
A few cut and dry, but revealing, statistics from NAMI:
- Approximately 20.9 million – or 9.5 percent - of American adults over the age of 18 have some form of mood disorder.
- Manic depression affects about 5.7 million adults in America, or about 2.6 percent.
- The median age of onset is 32. (Note: children as young as six or seven are being diagnosed. More about this later).
- Ninety percent of people who commit suicide have a diagnosable mood disorder.
As mentioned earlier, bipolar is such a complex disorder that it is impossible to do it justice on a blog. What you’ve seen here and in my previous post (HERE) is a superficial look at best. But I think readers need this tiny bit of information to understand what follows.
Everything with us is an extreme. There's no such thing as smooth sailing. It’s a stormy sea with periods when a body, mind and soul can be pushed to the depths, raised up in turmoil and only occasionally have peace and calm.
Tnlib - Thank you for an informative and insightful look into the world of mental disorders. Perhaps that is not an accurate desciption; as new discoveries are made and research continues, it appears that most illnesses are actually a complex conundrum of physical and pyschological interactions.
ReplyDeleteWhile finding a genetic link would be interesting I don't see it as very helpful to those afflicted. I believe that there will be an eventual breakthrough in the workings of the brain that will help identify the chemical/electrical relationships and, by extention, will identify the anomolies in these functions that cause what we now term "mental illness." When that happens we will finally have the means to affect lasting cures.
Look at all those lovely, dancing lights on the MRI; who wouldn't imagine preferring them to the the alternatives. The imaging that offers the best new hope for diagnosis and treatment of bipolar disorder also serves as visual metaphor for the allure of hypomania...and, if only, that was the reliable end-state for the bipolar brain. If only.
ReplyDeleteThank you, Rocky. I believe that if a gene can be isolated, it'll lead to more understanding of the brain's role in psychiatric disorders and hopefully to better treatment. Trust me, nothing would make me happier. But I don't think we'll ever find a "cure". But I could be wrong and that would also make me happy.
ReplyDeleteNance: The first time I read about this was in Kay Jamison's An Unquiet Mind. As she said, it lights up like a Christmas tree during a manic episode. Supports Rocky's theory about the physical and psychological interactions. To me, you can make out a frown on the brain in the bottom middle MRI.
In the middle row (hypomanic state), the bright red areas seem to be near the occipital regions. In my imagination, perhaps this is what Van Gogh's brain may have looked like. Yes, one can be envious to have this ability. On the other hand, how much he suffered to leave behind those amazing art treasures.
ReplyDeleteMy sister has this. It's been hell for me. Thanks for the links ... there's really this sense of powerlessness. I can tell when she's cycling, when she's in an "up" mode, because that's when I get all sorts of communications about things I'm supposed to be doing to make her life better, and then when she's a little too "up" I'm accused of not doing those things because I'm selfish, greedy, lazy, stupid, whatever, and then on the downward spiral there's the occasional "normal" communication and then she checks out for weeks on end, won't return phone calls, etc. and that's how I know she's on the down cycle. Lather, rinse, repeat.
ReplyDeleteI think "bi-polar" is different for everyone and manifests differently for every patient. I'm not sure I even believe in the diagnosis anymore, I think it's more of a catch-all phrase and everyone experiences it differently.
I'm glad you seem to be managing your condition. My sister is in denial and only treats part of her condition, which is ... difficult.
SoBe: Because of the differences in our brain chemistrys, it's absolutely different for each of us. It's also why one medication cocktail might work for us but not for someone else. And because our brain chemistry changes, we often have to try some other med at some point. A vicious cycle - just like the damn disease
ReplyDeleteA lot of people think it's a catch-all diagnosis but I really don't think so. There are just so many variables, many of them overlapping, many of them the same. There's the big umbrella, Bipolar. Under that you have Bipolar 1, Bipolar II, and Cyclothymia. I think the reason people think it is a catch-all is because they don't realize the huge body of work that has gone into the study of it and the amazing amount of progress that has been made, thanks in large measure to things like MRIs.
I'm sorry your sister is in such denial. She'd be a much happier person, and do doubt lead a more productive life, if she'd take the bull by the horn and deal with it.
You - and others - should drop by my blog and read TAO's comment. I think it's about his third one down. It is very profound and moving.
Excellent post, tnlib,
ReplyDeleteHave long thought that Samuel Taylor Coleridge wrote well when he described depression in "Dejection: An Ode" Stanza 2:
A grief without a pang, void, dark, and drear,
A stifled, drowsy, unimpassioned grief,
Which finds no natural outlet, no relief,
In word, or sigh, or tear—
Indeed! They used to call it "anhedonia" for just the quality that he captures in those lines, I think.
Anyhow, there have been some claims in recent years that the medications prescribed for bipolar disorder, while they may help in a crisis, tend to make the cycles worsen and to make them occur more and more rapidly, which is disturbing to say the least, if it's true. But perhaps more on that anon -- it's a difficult subject that requires referencing and reflection on my part.
Dino: I'm not familiar with Cooleridge's ode - thanks for putting it up.
ReplyDeleteThrough abject ignorance the media spreads more myths about mood disorders and meds than it does about Palin's inanities. I am definately going to hit on those big bad meds in my last post. But I'll just say here that I know from experiance that those druggies have made my life a lot more tolerable.
Yeah, im the definition of Bipolar... ive experianced it all... and if your not full blown bipolar than you just dont know crap... anyway, check out my music.. then tell me if you agree that im "crazy" or "ill"... www.wix.com/chetacheez/world or goto YouTube.com and search "Cheta Cheez". Good article.
ReplyDelete