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What do Stephen Fry, Vincent Van Gogh, Ludwig Beethoven, Lily Allen, Ada Lovelace, Abraham Lincoln and Patricia Cornwell have in common? They all produced great works? Well, some of them. Are they all hugely creative? Most of them. They all made a big difference to the world? A lot of them.
They all suffered to one degree or another from a condition called bipolar disorder, or manic-depressive illness. So if you’re visiting this page because you’re worried you might have bipolar disorder or someone you know might have it, you’re in the company of greats.
People of all ages and genders can experience a bipolar disorder, though they are less common in children. Bipolar disorders mostly manifest themselves between the 15 and 19 years of age and are unlikely to develop past the age of 40.
Everybody experiences ups and downs in their lives and 1 in 4 will suffer from a mental health disorder at some point in their lives. Estimates of the prevalence of bipolar disorders vary but it’s probably around 1 in 100 adults.
For some, bipolar disorders happen a few times in their lives, for others, it is a constant, chronic condition.
Bipolar disorder is a relatively new definition of what has long been regarded as just part of the human condition. The Ancient Greeks regarded what we now call bipolar as a “divine” state, Plato describing two distinct forms of mania, one being the result of bodily causes, the other “divine or inspired”, featuring eroticism, musicality, artistic urges and all manner of inspiration. Manics were regarded as having “divine inspiration”, or a direct connection with the gods. This was not a condition that was envied by many who understood it, but it was respected.
This mania and inspiration were balanced, in his view, by melancholia, or states of profound lows, longings and introspective suffering. There is a logic to this balance, one that was discussed in history but has become more understood in the last twenty years.
Hippocrates, the founder of medicine as we know it, also described these manias as conditions of the brain, so the Greeks clearly had a good, human understanding of what these unusual fluctuations in moods, feelings, and thoughts brought. They also appreciated that “extraordinary men in philosophy, politics or the arts are melancholics”. The connection between deep lows and creative highs was a part of an extraordinary mind.
We know that humans have been suffering from, and benefitting from, bipolar “disorder” for at least three thousand years. Many of the greatest intellectuals and artists of history have been prone to mania and melancholia, and from those that we have reliable testimony from, we know that some consider the lows as necessary or essential to the creative highs. The two complement each other, to some with the condition at least. Others would trade it away in an instant.
The experience of bipolar disorder is unique to each person with the condition. Some people experience quick swings, entering a state of mania or depression in a matter of minutes, for others the swing is more inexorable and slow, coming on in hours or even days.
Generally, bipolar disorders are characterised by the experience of a high state, or a manic phase; and a low state, or depressive phase. These can vary in severity from mild ups and downs to the individual needing hospitalization due to the dangerous behavior they are exhibiting to themselves or others.
An up phase, or mania, can be the most extraordinary release of energy for the individual. Many people feel uncontrollable urges to create: to write, draw, paint, sing or dance. Others talk incessantly, clean, exercise or work intensely. It varies from individual to individual. The mania can last for a few hours or days, even weeks at a time, and are accompanied by (variously): a lowered need for sleep, grandiosity, and egocentrism, talking to excess, an uncontrollable flow of thoughts, easy distraction, a raised libido, increased the level of work and pleasure seeking with little or no regard to the consequences.
For a modern diagnosis of mania in bipolar disorder (according to the ICD-10), three of the above symptoms must be present for at least a week and be characterised as “profound mood disturbances”. For many people with bipolar, the experience can vary massively, with different symptoms manifesting themselves in different phases and in different conditions.
For the depressive episodes, the individual needs to be experiencing at least 5 of the symptoms described below for a successful diagnosis:
Low or depressed moods, lack of interest or enjoyment in most activities, lack of sleep or too much sleep, lethargy, fatigue, introspective guilt, lack of concentration, indecision, weight loss, weight gain, changes to appetite, suicide ideation, and planning.
Hardly a condition to be envied, looking at that list of symptoms. Bipolar is a blight to many of the people who suffer from it. Not everybody is creative, some people just become irritable in the up phase and are unable to concentrate on anything for long enough to create anything.
Diagnosis of bipolar affective disorder is difficult. Due to the wide range of symptoms and the unique nature of everybody’s conditions, there is no hard and fast rule for what bipolar is and what it is not, and there is no way of concretely defining it.
The diagnosis of bipolar disorders should only be undertaken by a qualified psychiatrist.
A standard mental status examination will look at what is present in that individual’s life, how they’re coping with any symptoms, what they’re thinking, their mood and how they present themselves. Whether they are present violent, self-destructive or suicidal behaviors are taken into account, alongside their perception of themselves and others, how well they are able to solve tasks, their insight, and their state of physical health.
As bipolar can affect any of these conditions, assessing where they are for the patient at the time and then how they change with the onset or alleviation of symptoms is instructive to the practitioner attempting diagnosis.
The symptoms of bipolar are shared with many other conditions, and can be the result of other illnesses or the medication used to treat those illnesses, as well as drug and alcohol use. A full battery of blood, urine and stool tests might be ordered to try and factor out any possible outside or disease related cause. Conditions such as hyperthyroidism can have a very similar effect to bipolar disorder, so needs to be ruled out.
Once the individual has undergone these tests, the practitioner will have a clearer idea of whether it is indeed a condition of the brain that is resulting in the bipolar like symptoms, or whether it is the result of other factors that might be controlled in a different manner.
Because a bipolar disorder is often accompanied by other disorders such as anxiety and/or eating disorders or substance abuse, it can be hard to separate the conditions and give a solid diagnosis.
A magnetic resonance imaging (MRI) test and/or an electroencephalography (ECG) test might be ordered to establish the recurrent patterns of the individual’s brain pathology. This means the brain is scanned to see what is going on, essentially.
The symptoms of bipolar might also be as a result of a lesion, aneurysm or tumour in the brain, so eliminating these from the possible causes is helpful on two counts. It allows the patient to undergo treatment (if any is available, the brain is a hard thing to treat) for any pathology found in the tests, and allows the doctors on the case to be able to eliminate a variety of possible causes.
In addition to these benefits, increasing amounts of MRI and ECG data is being accumulated and is starting to allow researchers to diagnose mental health conditions by looking at the brain directly.
This involves 1 or more episodes of mania or mixed episodes of mania and depression, possibly including a severe depressive episode. Bipolar 1 Disorder is not a result of any substance misuse or illness.
Bipolar 2 has at least one severe depressive phases and at least one hypomanic phase (a less severe form of mania). This is a condition that is easier to live with but can still disrupt a person’s quality of life substantially.
Characterized as periods of hypomania and a low level of depression that is constantly in flux, this is a long-term and fairly mild bipolar disorder that can have periods of no symptoms for up to two months. This is differentiated from depression by the periods of mild mania, or hypomania, that occasionally develop.
Bipolar disorders are unique to every sufferer, so many are not easily fit into a neat category. This can be the manifestation of some symptoms but not others, or differences in severity and the period of the mood swings. Hypomanic episodes without the depressive phases would be categorized as NOS.
While bipolar disorders are rarer amongst prepubescent children, most often developing in mid to late teens, they do occur in young children. A bipolar disorder can often be mistaken or misdiagnosed as attention deficit hyperactivity disorder, another catch-all for a wide range of atypical behaviors.
Bipolar disorders can be recognized in a child by the extremity of their emotional states. Children get sad and emotional with distressing regularity as it is, a child with a bipolar disorder would exhibit longer periods of emotional difficulties and very hard to control behavior than usual.
The periods of mania or depression can be not as long as those in adults but from a child’s perspective, they can be very long periods of mania or depression. A check of the child’s thyroid functioning and family history will help with a diagnosis.
Unfortunately, the condition of being a child or teenager results in most of the symptoms of a bipolar disorder, so they can often be missed before adulthood, meaning the child has missed out on years of potentially effective treatment.
The evidence is emerging that the people who suffer from bipolar disorders have significant differences in their brain physiology. As all mental phenomena are the result of the brain’s wiring and configuration, this shouldn’t be a surprise to anybody, but to find evidence for it is encouraging. When conditions like this can be adequately described in terms of brain structure, researchers and physicians will be a great deal closer to offering effective treatments to those who seek them.
The parts of the brain that are looking different in bipolar sufferer’s brains to “normal” people’s brains are those related to, unsurprisingly, the parts of the brain that create the mental phenomena affected by the condition.
These include the amygdala, the hippocampus, and the cingulate gyrus. All parts of regulating moods, emotions, memory, and thoughts. While the initial studies are promising, showing clear differences from the average brains, and some commonality between them, there is much, much more research to do before a singular pathology (if there ever is one) is established for bipolar disorders.
MRI studies are still very small (mostly due to the cost of undertaking them) and not very reliable, so the data that are gathered now isn’t necessarily reliable, but these are early days, so watch this space for more developments.
Most bipolar disorder experts agree that a likely cause of bipolar disorder is a series of chemical “imbalances” in the brain.
When the building blocks of the brain, the neurons talk to each other, they do so by sending electrical impulses. These impulses are altered and triggered by neurotransmitters, chemicals that act as signals in the brain. When too much or too little of these are present, the neurons don’t fire in their usual way, resulting in a series of unusual signals.
This is what researchers believe is happening with bipolar, that patterns of unusual behaviors are caused by unusual quantities of these chemical signallers altering the overall behavior of the brain, and therefore the individual.
While the chemical imbalances argument is relatively convincing, there is the added dimension of the basic underlying wiring of the brains of bipolar sufferers being different. This means that their brains respond in a different manner to the same stimuli as an average brain. A difference in the wiring of the neurons in certain parts of the brain, alongside a broad chemical difference, gives more of a complete picture of how bipolar can manifest itself from brain conditions.
There is no single gene that causes bipolar, but as it is a condition of the body, it will have a genetic basis. Whether this is a set of genes responding to an infection (a possibility) and resulting in the differences that characterize bipolar, or whether certain genes in certain combinations and in certain conditions result in bipolar conditions, the basis has to have a genetic element. What they are is not currently understood. With 20,000 genes and 90+ billion neurons, each with an average of 10,000 connections, drawing any conclusions about genetic causes of brain physiology is extremely difficult.
There is some evidence to show that bipolar conditions are heritable, or they can be passed from generation to generation through genes. Having a family member with a bipolar disorder increases an individual’s risk of developing the condition themselves. This lends credence to the genetic factor theory.
While the onset of mania or depression can happen at any time, there are factors that can trigger them. Stress, trauma and life-changing events are common triggers. Those events can cause the onset of symptoms is interesting: it shows that the relationship between the healthy functioning of the brain and a healthy mind are one and the same.
When treating a bipolar disorder, the active phase of the condition is the one needing treatment. Generally, drugs can be effective if used in the right phase of the condition.
Patients in a manic phase can be prescribed benzodiazepines; lithium; antipsychotics such as loxapine and haloperidol, quetiapine, chlorpromazine, fluoxetine and lurasidone; and dopamine agonsists such as pramipexole. More natural treatments include CBD, which has shown promise as an effective treatment for depression.
While these drugs can reduce the severity of a manic episode and the potential accompanying psychosis, when taken for a short or extended period of time, these drugs (especially lithium) have extremely serious side effects that can have even fatal consequences.
Psychotherapy can be effective in decreasing the frequency of relapses, increasing the ability of the patient to cope with their condition and lead a good life, and generally improving the quality of life.
Therapies like CBT have some evidence for their efficacy but aren’t conclusive over the long term. There is hope for people with bipolar disorders, many people respond very well to drugs and/or psychotherapy, giving them the mental space they need to find ways of dealing with their changing psychological conditions and live a successful life.
For most people, their bipolar disorder won’t disturb their lives too much, and, like the Ancient Greeks, they will come to understand and appreciate the changing nature of their moods and feelings, accepting the mania and depressive phases as an integral part of their experience within the world.
Others will find the life they always want impossible to lead, some committing suicide, others ending up in prison or a psychiatric ward as a result of their uncontrollable condition. While there is increasing understanding of the condition’s causes, science is still a very long way from offering a comprehensive cure or treatment.
A great deal of the great art, music, literature, and science has been produced by people with a bipolar disorder, and for some the creative phase of their condition is invaluable. Most people with a bipolar disorder won’t achieve fame or fortune, but the richness the condition can bring, as well as the unique perspective, meaning they can lead at least an interesting life. That’s as good as it can get for many.
We’ll finish with a couple of quotes from two well-known people with bipolar conditions:
“There’s no doubt that I do have extremes of mood that are greater than just about anybody else I know. The psychiatrist in the hospital recommended I take a long break. I came here to America and for months I saw a therapist and walked up and down this beach. My mind was full of questions. Am I now mad? How have I got this illness, could it have been prevented, can I be cured of it? Since then, I have discovered just how serious it is to have bipolarity or manic depression as it’s also called. Four million others in the UK have it and many of them end up killing themselves.”
“One of the things that baffles me (and there are quite a few) is how there can be so much lingering stigma with regards to mental illness, specifically bipolar disorder. In my opinion, living with manic depression takes a tremendous amount of balls. Not unlike a tour of Afghanistan (though the bombs and bullets, in this case, come from the inside). At times, being bipolar can be an all-consuming challenge, requiring a lot of stamina and even more courage, so if you’re living with this illness and functioning at all, it’s something to be proud of, not ashamed of.
They should issue medals along with the steady stream of medication.”