Bipolar, a mood disorder

Kay Redfield Jamison, Ph.D., who has a diagnosis of mental illness, includes this personal account in her book, Manic-Depressive Illness, NY: Oxford University Press. The following is an excerpt:

“There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you’re high it’s tremendous. The ideas and feelings are like shooting stars,  and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to seduce and captivate others a felt certainty……..But, somewhere, this changes. Everything previously moving with the grain is now against - you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind.

“Credit cards, bounced checks to cover, explanations due at work, apologies to make, intermittent memories of vague men (what did I do?), friendships gone or drained, a ruined marriage.”

The NAMI Family-to-Family Education Program, 2014 lists the following characteristics of a manic episode. The mood is abnormally elevated, expansive, euphoric (high) and/or irritable.  There is decreased need for sleep, insomnia, staying up all night. There could be an increase in goal-directed activity which can include excessive planning of an activity.

Another symptom includes increase in pleasurable activities that risk painful consequences such as excessive spending, sexual recklessness, foolish business investments.

Also there is inflated self-esteem or grandiosity, more talkative than normal or pressure to keep talking, rapid thoughts or “flight of ideas,” distractibility, short attention span, difficulty concentrating. Hypomania can exhibit in the same way but there is not a marked impairment in functioning.

Some 3 million Americans live with some form of Bipolar Disorder.  If your relative is one of these people, there are important things to know.  This mood disorder, formerly called manic-depressive illness, can be profoundly debilitating; the devastating plunge from mania to major depression is terrible to experience. For some, periods of stability do occur between episodes; they and their families are lulled into believing the illness has vanished and will not strike again. However, the time between episodes tends to decrease as the person gets older, creating a life-long challenge of managing the illness, and finding strategies that will sustain periods of stability.

Bipolar I is diagnosed when an individual has had one or more episodes of full-blown mania, usually – but not necessarily accompanied by one or more Major Depressive Episodes. This illness can be a “fooler.” It is not unusual for people to have several depressive episodes (and a diagnosis of Major Depressive Disorder) before a full manic attack occurs. In addition, many people with this illness will be diagnosed with Major Depressive Disorder because they do not recognize (or report) prior episodes of mania. This is why consultation with the family is absolutely essential to insure a proper diagnosis. If the ill family member will not consent for you to speak to the doctor, send the doctor a registered letter with your account of what has been going on.

Lack of sleep is one of the most common triggers of mania. It is a good idea to educate your ill family member about this feature of the illness. If a manic attack is caught early, it is often possible to head off a full-blown episode with proper medication.

Once the manic episode is fully underway, family members will find it very difficult to get their ill relative into treatment. Denial and lack of insight are the norm rather than the exception in this severe part of the illness. It may be necessary to call law enforcement for help in getting your family member to the emergency room. Crises Intervention Training has educated law enforcement to recognize and deal with people in a manic episode. They know your family member needs treatment, not jail.