She's Just Being Bipolar

Clearly, there's still a stigma. 

Most people with families, or extended families, have at least one member that has "abnormal" behavior. In reference to one of my extended family members, her children will usually excuse or complain about her behavior with "Oh, she's being bipolar again." Within the family, we all know that it's their polite way of calling their mother a bitch. However, neither words are particularly polite, and bipolar shouldn't be synonymous with bitch.  The DSM currently identitfies bipolar disorder as one of two types of a manic-depressive mood disorder, characterized by mood shifts of deep depression quickly fleeting into dangerous, rash bouts of hyper-euphoria (or hyper-mania). Hyper mania can best be described as the "polar" opposite of a deep depression, and often results in risky behaviors and feats, over spending, and dangerous encounters with violence, sex, drugs, or alcohol. A secondary type of Bipolar Disorder (Bipolar II Disorder) manifests mania as a hypomania, which is marked by a lesser amount of impairment, less dangerous or less likely to require hospitalization for treatment. Less severe diagnosis can be made for those exhibiting these traits, but without exhibiting the overconfident attitude often associated with Bipolar I. 

Just add mania!

Since Richard Burtons The Anatomy of Melancholia, published in 1650, this disorder has been recognized as a depressive disorder, and Burton has been credited as "the father of depression as a mental illness." Since 1650, Bipolar Disorder has been grouped with Skitzophrenia (later separated), and in the early 1900's was referred to as Manic-Depressive Psychosis. In 1950, an article was published detailing the genetics of the disorder, and in the 1960's many who were diagnosed as Manic-Depressive were institutionalized, but without financial assistance as the government did not recognize Bipolar Disorder (a name coined in 1980) as an illness until 1979, when laws were put into place to assist those living with the disorder, and the DSM-III included the disorder and its definition. 

Today, Bipolar is recognized as a legitimate disorder, often linked to family members suffering the same symptoms, but the treatments vary, and none are a magic pill. Allen Frances, an editor of the last released DSM, blames himself and his colleagues for making it an easier diagnosis to get, and theoretically, more people are being misdiagnosed and put on the wrong drugs. By adding multiple definitions, and broadening the definition, more people are getting access to help, but as the diagnosis rates double, drug companies are raking in profits through their intensive anti-psychotic and mood stabilizing drugs campaign. "If diagnosis can lead to overdiagnosis and overtreatment, that will happen. So you need to be very, very cautious in making changes that may open the for for a flood of fad diagnosis." According to Frances, the next edition of the DSM proposes more diagnoses that are also broadened in definition, which could lead to another wave of diagnosis fads and new drugs. 

I've heard of sleep shopping on Ambien, but that's another story...

We've also seen a rise in depression and diagnosis within young college students, with a ten percent rise in depression-related diagnosis in the last ten years. As NPR's Patti Neighmond discusses in Depression on the Rise In College Students, attributes the increase to better treatment of younger high-school students, for whom special education and medication were prescribed at a younger age to help them get through K-12 education. "These are youngsters many of whom in the past wouldn't have even finished high school," according to Dr. Katherine Nordal of the American Psychological Association. "Special education serves in high school mean that more students with emotional difficulties and special needs are going to college," alongside their unassisted peers. There's clearly arguments both for, and against these diagnosis of young people with depressive issues. The drugs, therapy and identity of Bipolar are a benefit for those who need the help, but over diagnosis puts a strain on budget and attention for those who do need it, and masks an underlying issue for misdiagnosis. The risks of side effects, as seen in Generation RX, such as an increase in suicidal feelings and withdrawal from life, as well as effects listed today for drugs like Celexa, sometimes prescribed for depression in Bipolar patients, can be debilitating. Panic attacks, decreased sex drive, anxiety, difficulty sleeping, chest palpitations, seizures, coma, heart burn, vomiting, allergic reactions, weight gain, and dry eyes are all listed, to summarize a full 8x11" list of side effects. 

"There's no room for demons when you're self-possessed." Carrie Fisher

But the popularity and media discussion of the disorder continues. Once a taboo subject, even celebrities are outing themselves as having been diagnosed. Carrie Fisher, best known as Princess Leia from Star Wars, has detailed in her autobiography Wishful Drinking, and publicly acknowledges her struggle with Bipolar Disorder. Her book gives humorous insight to her own inner turmoil behind the face of one of the most famous pop icons in the last fifty years. In an interview she describes her battle with drug abuse and failed relationships as she struggled for years to come to terms with, and treat her diagnosis. "I was unable to stop. I would get stuck in traffic and would get so upset that I would take the phone and hit the wheel with it. I knew this wasn't right." She says in her interview with BPhope (bipolar hope). "I thought, 'I'm a drug addict. Fine. That's an explanation for this kind of out-of-control way that I am, so please just give me a break,'" she says. '"I'm going to be a drug addict here, an alcoholic, let me do that.' But after a year, I got worse." Fisher went to rehab in 1997 for treatment, and in 2000 spoke publicly for the first time about the illness she'd been struggling with for more than fifteen years. Now properly medicated and in therapy, she has since gone on to become an advocate for people who struggle with bipolar disorder, and to many a role model for the humor she weaves into her tales of wild days and recovery. 

Living the Dream?

Fisher's situation, though high profile, is not unique. A google search pulls up thousands of sites for drug addiction in relation to Bipolar, and Addiction Search states that "drug addiction, substance abuse, and bipolar disorder are often a trio." Ten years ago, there were roughly "4 million adults that met the criteria for bother serious mental illness and drug addiction." The site continues to elaborate: Most undiagnosed bipolar individuals are self medicating with drugs and alcohol without realizing it. If there are four million people both drug addicted and undiagnosed as bipolar, in theory the correct medication for bipolar could aid both a mental recovery, and a recovery from drug addiction. Unfortunately, it's hard enough to intervene in an issue of drug addiction or perceived mental illness, and a combination of both seems to have an even higher potential for the ultimate price. It seems to be easy for society to blame an individual for their own problems with things like drug addiction, and homelessness. However, according to the National Coalition for the Homeless, in 2009 20 to 25% of the homeless population in the United States suffer from some form of severe mental illness, though the National Institute of Mental Health estimates only 6% of Americans qualify as severely mentally ill. A mental illness being a personal problem quickly becomes a "public problem" as we see the streets of Burnside covered with literal piles of people without home, and if these statistics are to be believed, 1 in 4 of those "junkies" or "bums" could be homeless as a result of their mental illness. According to the National Mental Health Association, supported housing programs are very effective for people with mental illnesses, which includes treatment for mental and physical health, employment and education opportunities, support, training, and outreach programs. With the right kind of support, a diagnosis can be life saving for many people with or without homes, if the funding is available for these programs. For an otherwise normal individual, this is a mental issue that comes with a stigma of crazy, out of control, depressed, suicidal, unpredictable, and sick until the illness is treated, and controlled with medication, therapy, and time. For a homeless man in his 40's, it is seen a side effect of his "chosen" drug addiction, and "choice" to be homeless, not a cause. 

In conclusion, Bipolar Disorder has been linked to genetic family, but there is no blood test or brain scan that can identify the illness. Psychiatrists and physicians as well as researchers and drug companies continue to search, define, and diagnose this mood disorder in children as well as adults, and we continue to see a rise in the over prescription of drugs. Unfortunately, we can only treat the symptoms, as there is no known cause or trigger, nor is there a cure. But our treatment of those suffering can change, as can our perception. My mother always used to tell us when we would see homeless people wandering or sleeping on the street, that there were a lot of smart people out there, they were just very, very sick with no one to care for them. In Portland, organizations like Street Roots, the men and women often seen outside of Powell's or the Crystal Ballroom, sell their own newspapers put together by homeless people in Portland in order to support people living in poverty, and to help house homeless individuals find a new start. It's easy to walk by someone panhandling and think they're likely going to buy drug or alcohol because they "allowed" an addiction to destroy their lives, or chose an addiction over building a "successful" life. But if we look at Bipolar, a mental struggle, as a cause for self medication, leading to  lifestyle we've assumed they've chosen, it seems to create an idea of an individual person struggling, and not just another homeless man with a sign, addicted to drugs. Being bipolar is a struggle, a struggle that cannot be ignored or wished away. But with help, a struggle can be managed. 

We keep waiting. 

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Credits:

"A Brief History of Bipolar Disorder." Caregiver.com. Web. 25 Mar 2012. <http://caregiver.com/channels/bipolar/articles/brief_history.htm>.

"AllPsych Online." Psychiatric Disorders: Bipolar Disorder. Heffner Media Group, n.d. Web. 25 Mar 2012. <http://allpsych.com/disorders/mood/bipolar.html>.

"Mental Illness and Homelessness." Bringing America Home. National Coalition for the Homeless, 2009. Web. 25 Mar 2012. <http://www.nationalhomeless.org/factsheets/Mental_Illness.pdf>.

Monson, Kristi, and Arthur Schoenstadt. "Celexa Side Effects." eMedTv: Health Information Brought To Life. Clinaero, Inc. , 23 Feb 2009. Web. 25 Mar 2012. <ttp://depression.emedtv.com/celexa/celexa-side-effects.html>.

Neighmond, Patti. "Depression On The Rise In College Students." NPR. NPR and Public Broadcasting, 17 Jan 2011. Web. 25 Mar 2012. <http://www.npr.org/2011/01/17/132934543/depression-on-the-rise-in-college-students?sc=tw&cc=share>.

Spiegel, Alix. "What's a Mental Disorder? Even Experts Can't Agree." NPR. NPR and Public Broadcasting, 10 Dec 2010. Web. 25 Mar 2012. <http://www.npr.org/2010/12/29/132407384/whats-a-mental-disorder-even-experts-cant-agree?sc=tw&cc=share>.

Staba, D.. "Hollywood Kid Carrie Fisher and Her Best Awful." bpHope.com. bpMagazine, 2004. Web. 25 Mar 2012. <http://www.bphope.com/Item.aspx/280/hollywood-kid-carrie-fisher-and-her-best-awful->.

EXTRA: 

Check out Street Roots if you're interested in learning more about the project!

Famous People with Bipolar Disorder 

Pictures:

Bluntcard.com

someecards.com

Cyanide and Happiness

Carrie Fisher

Carrie Fisher Wishful Drinking

Alcohol Research

Gesture 

Change

Ambien

Jen Lancaster on Ambien