Trevor, a mechanic who worked in his father’s machine shop, was happily married but childless. He began acting quite strangely shortly after his brother had a son. He started to stay up late at night, working alone in his garage. He told his wife, Eunice, that he had invented a motor that could run on propane only, and he thought Ford would buy his invention. He became more and more talkative, with monologues far into the night that Eunice found exhausting. If she protested, he became irate, saying she didn’t appreciate him. Then he withdrew all their savings from the bank, for a reason he refused to explain. Uncharacteristically, he berated Eunice for interfering in his life. He was physically much bigger, towering over her and shaking his fist at her.
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Eunice called her father-in-law, who talked quietly to Trevor. Trevor then broke into tears, rocking back and forth and lamenting what a failure he was.
Trevor’s father told Eunice that Trevor’s aunt had suffered from bipolar I, also known as manic-depressive illness. They took Trevor to the local hospital and he agreed to be admitted. After he had calmed down, he said he had felt great, as if his ideas were brilliant. He needed little sleep and his thoughts raced. He said that he had never felt so wonderful in his life, but that he also felt he was on a roller coaster that he couldn’t get off.
Bipolar illness appears to be less common than depressive disorders, affecting only 2 per cent of the population at any given time. However, this figure is probably an underesti¬mate, as people who have bipolar illness are frequently not aware of being ill, even if their close relatives know. The illness is chronic and recurrent, interfering with the person’s ability to lead a productive and satisfying life. Fortunately, treatment can be very effective.
Many highly creative people have been affected with bipolar disorder. Winston Churchill could be amazingly productive when hypomanic, but totally incapacitated when his ‘black dogs’ of depression took over. (Hypomania refers to an elated mood and excessive energy that are out of keeping with the circumstances but do not involve delusions or hallucinations.) The illness could be traced back four or more generations in Churchill’s family. His father, Randolph, was notorious for excessive behaviours, sometimes brilliant, sometimes silly. His ancestor the first Duke of Marlborough, who waged wars in the time of Queen Anne, could be a brilliant strategist, and then become inactive for long periods.
Kate Millett, a prolific feminist writer, describes her bouts of bipolar illness in The Loony-Win Trip. She talks about the stigma, the embarrassment, and her attempts to find the help she needed. At one point, on a holiday far from friends and help, she was unceremoniously committed to the chronic ward of an Irish mental hospital.
Kay Redfield Jamison is a professor of psychiatry at Johns Hopkins University in Maryland, USA. Early in her career she suffered severe bouts of mania and depression. She has helped to reduce the stigma of the illness by talking publicly about her experiences and writing about them. A brave account of her illness can be found in her book An Unquiet Mind.
Everyone’s moods fluctuate over time, usually in response to good or bad events. Once the upsetting or exciting events are over, our mood returns to a level neither too sad nor too excited. If you suffer from bipolar illness, however, your moods are greatly exaggerated. You swing widely between elation and despair. You may not be aware of how dispro¬portionate your responses are to the events that triggered them; they make perfect sense to you. Sometimes there are no particular triggering events, but you read profound meaning into minor coincidences. When you enter a manic phase, your mood starts to rise and your elation and energy become so excessive that, often within a few days, you lose control and judgment. You seem to have lost the ability to come down to a base line or ‘normal’ level of mood. Then your mood reverses, just as excessively. A woman who has suffered from bipolar disorder since her teens used to leave her doctor a phone message saying, ‘I started into a depres¬sion at two-thirty Wednesday afternoon.’ Although the doctor was sceptical of her precision at first, her predictions turned out to be surprisingly accurate.
Bipolar illness begins at an earlier age than depressive illness – usually in the late teens – and is often confused with schizophrenia in adolescents, because the manic phases can appear quite bizarre, with delusions and hallucinations.
The illness seems to be starting at younger and younger ages. Sometimes young children diagnosed as having atten¬tion deficit and hyperactivity disorder are found to be in the early stages of a bipolar illness. Bipolar disorder occurs in all ethnic and cultural communities.
Bipolar disorders cause major disruptions in family functioning. Separation and divorce are common. Denial is pervasive; people deny problems, sadness, the pain of loss, and the need for others when they are in a manic phase. In a depressed phase, they are incapacitated and unable to function.