posted April 18, 2008 11:29 PM           

Introduction

What Are the Symptoms of Bipolar Disorder?
Suicide
What Is the Course of Bipolar Disorder?
Can Children and Adolescents Have Bipolar Disorder?
What Causes Bipolar Disorder?
How Is Bipolar Disorder Treated?
Do Other Illnesses Co-occur with Bipolar Disorder?
How Can Individuals and Families Get Help for Bipolar Disorder
What About Clinical Studies for Bipolar Disorder?
For More Information
References

Introduction

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year,1 have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person’s life.

“Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide.”

“I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do.”

Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6.
(Reprinted with permission from Alfred A. Knopf, a division of Random House, Inc.)

What Are the Symptoms of Bipolar Disorder?
Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

Increased energy, activity, and restlessness
Excessively “high,” overly good, euphoric mood
Extreme irritability
Racing thoughts and talking very fast, jumping from one idea to another
Distractibility, can’t concentrate well
Little sleep needed
Unrealistic beliefs in one’s abilities and powers
Poor judgment
Spending sprees
A lasting period of behavior that is different from usual
Increased sexual drive
Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
Provocative, intrusive, or aggressive behavior
Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

Lasting sad, anxious, or empty mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in activities once enjoyed, including sex
Decreased energy, a feeling of fatigue or of being “slowed down”
Difficulty concentrating, remembering, making decisions
Restlessness or irritability
Sleeping too much, or can’t sleep
Change in appetite and/or unintended weight loss or gain
Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

Suicide
Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

talking about feeling suicidal or wanting to die
feeling hopeless, that nothing will ever change or get better
feeling helpless, that nothing one does makes any difference
feeling like a burden to family and friends
abusing alcohol or drugs
putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one’s death)
writing a suicide note
putting oneself in harm’s way, or in situations where there is a danger of being killed
If you are feeling suicidal or know someone who is:
call a doctor, emergency room, or 911 right away to get immediate help
make sure you, or the suicidal person, are not left alone
make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm
While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.

What Is the Course of Bipolar Disorder?
Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.3

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see “How Is Bipolar Disorder Treated?”). Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared.4 But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

Can Children and Adolescents Have Bipolar Disorder?
Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.

Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day.5 Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to such symptoms.

For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.

What Causes Bipolar Disorder?
Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder—rather, many factors act together to produce the illness.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes—the microscopic “building blocks” of DNA inside all cells that influence how the body and mind work and grow—passed down through generations that may increase a person’s chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.6

In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene.7 It appears likely that many different genes act together, and in combination with other factors of the person or the person’s environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.

Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses.8,9 New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.

How Is Bipolar Disorder Treated?
Most people with bipolar disorder—even those with the most severe forms—can achieve substantial stabilization of their mood swings and related symptoms with proper treatment.10,11,12 Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.

In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.

Medications

Medications for bipolar disorder are prescribed by psychiatrists—medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.

Medications known as “mood stabilizers” usually are prescribed to help control bipolar disorder.10 Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.

Lithium,

the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.

Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.
Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.

Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20.13 Therefore, young female patients taking valproate should be monitored carefully by a physician.

Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant.14 Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.

Treatment of Bipolar Depression

Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, “mood-stabilizing” medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications.

Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants.16 Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval.17 Olanzapine may also help relieve psychotic depression.18
If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead.

Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication.
Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications and supplements taken together may cause adverse reactions.
To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.

Thyroid Function

People with bipolar disorder often have abnormal thyroid gland function.4 Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician.

People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.

Medication Side Effects
Before starting a new medication for bipolar disorder, always talk with your psychiatrist and/or pharmacist about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be sure to tell the doctor about all side effects you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your medication should not be changed or stopped without the psychiatrist’s guidance.

Psychosocial Treatments
As an addition to medication, psychosocial treatments—including certain forms of psychotherapy (or “talk” therapy)—are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas.12 A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient’s progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. NIMH researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.

Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.
Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members.

Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person’s symptoms.

Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

Other Treatments

In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.19
Herbal or natural supplements, such as St. John’s wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your doctor. There is evidence that St. John’s wort can reduce the effectiveness of certain medications.20 In addition, like prescription antidepressants, St. John’s wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.21

Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.22

A Long-Term Illness That Can Be Effectively Treated

Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes.

Do Other Illnesses Co-occur with Bipolar Disorder?

Alcohol and drug abuse are very common among people with bipolar disorder. Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar disorder and substance use disorders.23 Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.

Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder.24,25 Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment.

How Can Individuals and Families Get Help for Bipolar Disorder

Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

Help can be found at:

University—or medical school—affiliated programs
Hospital departments of psychiatry
Private psychiatric offices and clinics
Health maintenance organizations (HMOs)
Offices of family physicians, internists, and pediatricians
Public community mental health centers
People with bipolar disorder may need help to get help.

Often people with bipolar disorder do not realize how impaired they are, or they blame their problems on some cause other than mental illness.
A person with bipolar disorder may need strong encouragement from family and friends to seek treatment. Family physicians can play an important role in providing referral to a mental health professional.
Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment.
A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized against his or her wishes.
Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual.
In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse.
Like other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers.
Family members of someone with bipolar disorder often have to cope with the person’s serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors.
Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations.
What About Clinical Studies for Bipolar Disorder?
Some people with bipolar disorder receive medication and/or psychosocial therapy by volunteering to participate in clinical studies (clinical trials). Clinical studies involve the scientific investigation of illness and treatment of illness in humans. Clinical studies in mental health can yield information about the efficacy of a medication or a combination of treatments, the usefulness of a behavioral intervention or type of psychotherapy, the reliability of a diagnostic procedure, or the success of a prevention method. Clinical studies also guide scientists in learning how illness develops, progresses, lessens, and affects both mind and body. Millions of Americans diagnosed with mental illness lead healthy, productive lives because of information discovered through clinical studies. These studies are not always right for everyone, however. It is important for each individual to consider carefully the possible risks and benefits of a clinical study before making a decision to participate.

In recent years, NIMH has introduced a new generation of “real-world” clinical studies. They are called “real-world” studies for several reasons. Unlike traditional clinical trials, they offer multiple different treatments and treatment combinations. In addition, they aim to include large numbers of people with mental disorders living in communities throughout the U.S. and receiving treatment across a wide variety of settings. Individuals with more than one mental disorder, as well as those with co-occurring physical illnesses, are encouraged to consider participating in these new studies. The main goal of the real-world studies is to improve treatment strategies and outcomes for all people with these disorders. In addition to measuring improvement in illness symptoms, the studies will evaluate how treatments influence other important, real-world issues such as quality of life, ability to work, and social functioning. They also will assess the cost-effectiveness of different treatments and factors that affect how well people stay on their treatment plans.

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is seeking participants for the largest-ever, “real-world” study of treatments for bipolar disorder. To learn more about STEP-BD or other clinical studies, see Clinical Trials , visit the National Library of Medicine’s clinical trials database, or contact NIMH.

posted April 18, 2008 11:43 PM           

full article here: http://serendip.brynmawr.edu/exchange/node/1726

Biology 202
1998 Third Web Reports
On Serendip

Bipolar Disorder and the Creative Genius

One common feature in mania or hypomania is the increase in unusually creative thinking and productivity. (2, 3, 5, 7) The manic factor contributes to an increased frequency and fluency of thoughts due to the cognitive difference between normalcy and mania. (2, 5) Manic people often speak and think in rhyme or alliteration more than non-manic people. (2, 5) In addition, the lifestyles of manic-depressives in their manic phase is comparable to those of creative people. Both groups function on very little sleep, restless attitudes, and they both exhibit depth and emotion beyond the norm. (2, 5) Biologically speaking, the manic state is physically alert. That is, it can respond quickly and intellectually with a range of changes (i.e. emotional, perceptual, behavioral). (5) The manic perception of life is one without bounds. This allows for creativity because the person feels capable of anything. It is as if the walls, which inhibit the general population, do not exist in manic people, allowing them to become creative geniuses. They understand a part of art, music, and literature which normal people do not attempt. The manic state is in sharp contrast to the depressive phase of bipolar patients. In their depressed phase, patients only see gloom and boundaries. They feel helpless, and out of this helplessness comes the creativity. (5) The only way bipolar patients can survive their depressed phases, oftentimes, is to unleash their despondency through some creative work. (5, 3)

Since the states of mania and depression are so different, the adjustment between the two ends up being chaotic. Looking at some works of literature or music, it can be noticed which phase the creator was in at the time of composition. In works by Sylvia Plath, for example, the readers may take notice of the sharp contrast among chapters. Some chapters she is full of hope and life, while other chapters read loneliness and desolation. Another example can be found in Tchaikovsky's music; there is a great variation among his compositions concerning their tone, tempo, rhythm, etc. In fact, some say that most actual compositions result from this in-between period because this is the only time when the patient can physically deliver something worthwhile. (3) Because the phases are so chaotic, the ideas float during the manic and depressive states, but the final, developed products are formed during the patients' "normal" phases.

However, the problem with bipolar disorder in present time is that drug treatment often vanquishes the creativity in the patient. (5) In earlier days when drug therapy was not implemented, the creativity would be free. Yet, through the attempt for affected people to cope with day to day living, their creativity must be sacrificed. It is remarkable how these "afflicted" persons exude extraordinary creativity. Therapists and researchers are on the constant search to provide treatment for the debilitating symptoms. In the case of bipolar disorder, the world benefits from the mood swings endured by a large percentage of these patients. Though their ability to function properly is of utmost concern, since the cycling between manic and depressive phases is so traumatic and energy depleting, the unusual existence of creativity of such caliber in these people is something to conserve. As more effective drug treatment is being sought after, hopefully there will be medication that will permit the creative genius of the patients and allow them to function in society as well.

posted April 18, 2008 11:57 PM           

"Men have called me mad, but the question is not yet settled, whether madness is or is not the loftiest intelligence--whether much that is glorious--whether all that is profound--does not spring from disease of thought--from moods of mind exalted at the expense of the general intellect. Those who dream by day are cognizant of many things which escape those who dream only by night"
- Edgar Allen Poe

"Imagination is more important than knowledge"
- Albert Einstein

Is creative genius somehow woven together with "madness"? According to the dictionary, "to create" is "to bring into being or form out of nothing." Such a powerful, mysterious, and seemingly impossible act must surely be beyond the scope of scientific inquiry. No wonder creativity has for so long been "explained" as the expression of an irrational, intuitive psychic "underground" teaming with forces (perhaps divine) that are unknown and unknowable (at least to the "sane," rational mind). The ancient Greeks believed creative inspiration was achieved through altered states of mind such as "divine madness." Socrates said: "If a man comes to the door of poetry untouched by the madness of the muses, believing that technique alone will make him a good poet, he and his sane compositions never reach perfection, but are utterly eclipsed by the inspired madman" (8). Creative inspiration - particularly artistic inspiration -- has often been thought to require the sampling of dark "depths" of irrationality while maintaining at least some connection to everyday reality. This dive into underground forces "reminds one of a skin-diver with a breathing tube" wrote Arthur Koestler in his influential book, The act of creation (9).According to Koestler, "the creative act always involves a regression to earlier, more primitive levels on the mental hierarchy, while other processes continue simultaneously on the rational surface." Using similar themes, the chemist, Kekule described a visionary moment leading to his groundbreaking discovery that the benzene molecule is a ring. His creative break with the prevailing assumption that all molecules were based on two-ended strings of atoms came in a blazing flash of insight:

"I turned my chair to the fire and dozed. Again the atoms were gamboling before my eyes.... [My mental eye] could distinguish larger structures, of manifold conformation; long rows, sometimes more closely fitted together; all twining and twisting in snakelike motion. But look! What was that? One of the snakes had seized hold of its own tail, and the form whirled mockingly before my eyes. As if by a flash of lightning I awoke." (2).

Like Kekule, people recognized for their creative genius often depict moments of inspiration as an electrifying convergence of rational and irrational thought. If creativity is to be found between the rational and the irrational; between the known and the unknown; between the conventional and the innovative, then the creative mind continually runs the risk of going "too far." As Koestler has put it, "skin-divers are prone to fall victim to "the rapture of the deep" and tear their breathing tubes off" (9). Artists Ernest Hemmingway, Virginia Woolf, Charles Parker, and John Berryman would appear to have succumbed to this rapture when they entered psychiatric hospitals and eventually committed suicide (9).Further reinforcing the association of creativity with illogical, disruptive psychic forces are great numbers of influential 18th and 19th century poets, including William Blake, Lord Byron and Alfred, Lord Tennyson, who wrote about their emotional extremes of experience. For example, George Edward Woodberry wrote of poets: " Emotion is the condition of their existence; passion is the element of their being" (8).And the turbulent lives of high profile musicians and artists such as Charles Mingus, Georgia O'Keefe, Jackson Pollack, and Sylvia Plath also seem to testify to a link between creativity and psychic instability. But can a connection between mental disorder and enhanced creativity be identified by the methods of science? Is there really a connection, and if so how does it work?

Evidence linking the creative gift with risk of "madness"

"When a superior intellect and a psychopathic temperament coalesce," wrote psychologist William James as the twentieth century began, "we have the best possible condition for the kind of effective genius that gets into the biographical dictionaries. Such men do not remain mere critics and understanders with their intellect. Their ideas posses them, they inflict them, for better or worse, upon their companions of their age" (10).James and contemporary scientists such as psychiatrist Emil Kraepelin emphasized the positive aspects of certain psychological disorders, and speculated that other talents could combine with them to produce extraordinary creativity. But James also stressed the debilitating extremes of psychiatric illness (22).This moderate view, underscoring the need for balance in an effectively creative person, has since characterized much thinking on the subject of creativity and mental disturbance. As Sylvia Plath later said, "When you are insane, you are busy being insane - all the time... When I was crazy, that's all I was." (5). Against this background, research into the interaction between creativity and psychiatric disorders suggests that their may indeed be a vital connection between "genius" and "insanity" in some instances.

Several different approaches to investigation have been employed. (15)(19)(16).Biographical or posthumous research has for many years focused on life study investigations of past artists, scientists, and others recognized by society for their creative achievements. More recently, diagnostic and psychological studies have been conducted on living populations. Some researchers have tried to assess the mental health of people who have received social designations of creativity such as awards and prizes. The question can also be approached from the opposite direction by attempting to assess the creativity of people who have been diagnosed with mental disorders.

Two biographical studies conducted mid-century find a prevalence of mental disorders significantly higher among both artists and scientists than among the general population. These studies also identify a strong association between creativity, mental illness, and higher suicide rates within families(15). From 1927 to 1943 Dr Adele Juda, researcher at the Institute for Psychiatry of Munich, interviewed over 5,000 people, finding neurosis and personality disorder in 27% of the artists and 19% of the scientists and statesmen studied, against an expected general rate of 10-12%. (19).The highest rates of psychic disruption were seen among poets (50%) and lower rates wee found among architects (17%). (8).Juda also found that artists and scientists as well as their brothers, sisters, children and grandchildren were more likely than the general population to suffer from mental disorder or commit suicide. (15).More recently Dr. Jon Karlsson, at the Institute of Genetics in Iceland, studied mentally disturbed individuals who were identified by diagnoses recorded in hospitol registers. Karlsson found that such individuals as well as their close relatives were far more likely (two to six times more likely, depending on the diagnosis) than the population at large to achieve eminence across a wide range of intellectual and artistic endeavor, based on citations in Who's Who(15).

A concurring study has resulted from the efforts of Arnold M. Ludwig, Professor of Psychiatry at the University of Kentucky Medical School, to learn what characterizes the kind of high-end creativity that makes it into the history books. Ludwig and his associates have spent about ten years studying the biographical records of 1,000 prominent 20th-century artists, scientists, and other professionals. "As I expected," Ludwig concludes, "creative artists were by far the most likely to suffer from mental disturbance." (15). Ludwig found the lifetime rate of mental disturbances in the social, business, and investigative professions ranged from 39% to 49%, but averaged 72% among the artistic professions -- considerably higher than the estimate of 32% for the population as a whole(15).

Evidence in the biographical record appears to be supported by findings from two studies of topflight living artists. The earlier of these studies, undertaken in 1974 by University of Iowa psychiatry resident Nancy C. Andreason, found an extraordinarily high rate off affective illness among writers participating in the University of Iowa Writer's Workshop, and among their families. 13).Andreasen, a Ph.D in English literature, obtained interviews with 30 faculty members at the prestigious workshop and matched them with control subjects in nonartistic professions. She found that 80 percent of the participating writers revealed they had suffered either depression or manic-depression (an emotional disorder characterized by extreme, sometimes debilitating mood swings) compared with 30 percent of the control subjects. Two of the writers eventually took their own lives(13).

In support of Andreason's findings, a disproportionate number of living British artists and writers were found to experience mental disturbance in a 1989 study by Kay Redfield Jamison(8). Jamison, a professor of psychiatry at the Johns Hopkins University School of Medicine who has talked openly about her own manic depressive emotional instability, approached a group of 47 eminent Britons while on sabbatical at Oxford and asked them to complete exhaustive questionnaires about mood swings and creativity. Jamison's sample of cultural heavy hitters included members of the Royal Academy and contributors to the 'Oxford Book of Twentieth-Century English Verse. Jamison found 38% of these artists had been treated for affective illness including depression and bipolar disorder and 28% had gone beyond talk therapy to psychotropic medication or electroconvulsive therapy. (8).This level of psychic distress far surpasses that in the general population, where rates of bipolar illness are about 1% and major depression are 5-15%(13).

There does seem to be a clear trend observable across several studies: creative individuals, particularly artistically creative individuals, are unusually likely to be emotionally unstable. One modern study looks at this apparent link from the opposite direction, asking "are the mentally ill unusually creative? (14)(8). The study, conducted in Denmark by Psychiatrist Ruth L. Richards and psychologist Dennis R. Kinney of Harvard Medical School's McLean Hospital, found that creativity was significantly higher among the study subjects - 17 manic-depressives, 16 cyclothymics (who suffer from milder mood fluctuations) and 11 of their relatives with no psychiatric history- than among the comparison group. Rather than assessing creativity on the basis of social recognition, Richards and Kinney used the previously validated "Lifetime Creativity Scale" to assess the quantity and quality of work and avocational activities(8). Manic depressives were found to be less creative than their relatives or cyclothymics. Thus, the researchers' concluded that "creativity can be enhanced, on the average, in subjects showing milder and perhaps 'subclinical' expressions of potential bipolar liability." (6).

Looking at these results, there does appear to be a point of intersection between creativity and madness. But the data required to illuminate this connection seems very hard to obtain. How reliable are the studies?

The biographical research seems likely to be biased due to the overexposure of public figures. Individuals in the public eye face different challenges with respect to keeping their skeletons in the closet than most people do. Thus, the stigmatizing illness of a recognized creative "genius" might be more likely to be somewhere on record. Studying living artists is no easier. Selecting individuals for study on the basis of mainstream recognition or awards received may not produce a representative sampling of creative people as a whole. In fact, the studies of Andreason Jamison and Richards can all be criticized for the small size of their sample groups.

There is also a sort of "chicken-or-egg" problem as to whether creative people bring psychic instability with them to achievement or whether achievement itself creates mental turmoil. Society may tolerate displays of unconventional behavior such as eccentricity, uneasiness, excess and experimentation in people of recognized achievement. This could be the source of the behavior rather than underlying mental disorder.

Further complications arise from the need to define and measure creativity and mental illness. There is hardly consensus as to the nature of creativity and the appropriate way to assess it. And under or over-diagnosis of mental disturbance can also confuse the picture. Giving dead artists and scientists retroactive diagnoses is surely very tricky. The reliability of letters or memoirs must be limited because they are written from a single, biased viewpoint. Also, historical context and existing social customs will have influenced which behaviors are focused on for comment and in what light. For example, the long tradition of "inspiration as divine" will have colored the perceptions of biographers, friends, family, and researchers who might expect some "madness" in their creative companions. Of course, the biases of individual researchers will be brought to the diagnosis of living populations as well. Psychiatrist Frank Johnson of the University of California at San Francisco warns that the modern version of divine inspiration in the medical literature "makes madness the condition for writing poetry or doing philosophy." (13). Thus, Arnold Ludwig believes biographers, because they spend years getting to know their subjects, have a better perspective than clinicians asking standardized questions. "A questionnaire has built-in theoretical or diagnostic assumptions," Ludwig notes, "and after all, what you get in a clinical interview is autobiography, and that's the most inaccurate record of all." (13).

Nevertheless, there does seem to be concurrence across several studies that mental disturbance and creativity overlap in some way. It appears that a large number of accomplished creative individuals, especially artists - far more than could be expected by chance - have experienced emotional disturbances. These disturbances appear to be categorized most often today as bipolar disorder or major depression. This is enough to suggest some correlation may indeed exist. "Of course our studies have methodological problems," Kay Jamison says, "But they all point to the same association. So you have to ask yourself: Is there a trend? Is the trend in the same direction? And if the answer is yes, then you at least have to entertain the possibility that the studies are right." (13). This in no way supports simplistic notions of the "mad genius." It seems clear from the research that that most emotionally unstable people are not extraordinarily creative, and most extraordinarily creative people are not emotionally unstable. But partial correlation does not mean there is no correlation. The next question is, how might states such as mania or depression contribute to creative accomplishment?

How can emotional turmoil enhance creativity?

... his raptures were,
All air, and fire, which made his verses clear,
For that fine madness still he did retain,
Which rightly should posses a poet's brain
-- Michael Drayton

Many researchers have compared the characteristics of milder forms of mania (hypomania) to creative thought. Acutely tuned senses, restlessness, intensity of focus, reduced inhibition, grandiosity, thought diversity, and the ability to associate divergent ideas and thoughts rapidly are all hallmarks of both the creative and mildly manic (or "hypomanic") individual. Harvard neurologist G. Robert DeLong, associates hypomania with "unusual intensity of focus." Long found that children with early signs of manic-depression have unusually rich imaginations and can become absorbed in fantasies or in creative tasks for hours on end. These children produce impressive feats of memory and highly detailed drawings (14). In a different vein, Psychologist Ralph Tarter of the University of Pittsburgh says a "fundamental breakdown in inhibitory mechanisms" characterizes many psychologically disturbed states, including mania, and can also be stimulated by alcohol or drugs. The resulting freedom from inhibition "leads to farfetched connections, and -- as is true in many artists -- easier access to unconscious material. Manic thinking flows freely, and includes many loose and novel associations" (14). Kay Jamison describes two features central to both creative and hypomanic thought. First, thought is fluid, rapid, and flexible. In addition, there is heightened ability to merge ideas and thoughts that have no conventional connection. (8).

Fluid, quick, and divergent thinking is seen by psychologists such as J.P. Guilford to be important in producing new, original, and "creative" ideas. (15). In divergent thinking, Guilford says, "there is much searching about or going off in different directions." Such thinking is not goal bound, but is free to strike out in new directions, rejecting old conclusions. Rapidity of thought itself spurs creativity. "Because of the more rapid flow of ideas," Psychologist Eugene Bleuler explains, "and especially because of the falling off of inhibitions, artistic activities are facilitated even though something worth while is produced only in very mild cases and when the patient is otherwise talented in this direction. The heightened senses naturally have the effect of furthering this." (21). Observing an incredible outpouring of uncensored mental activity by his manic friend Lord Byron, Sir Walter Scott said: "The wheels of a machine to play rapidly must not fit with the utmost exactness else the attrition diminish the Impetus." (8). But the sheer volume or density of ideas spewing from a manic person's mind increases the likelihood that at least some of those ideas will be creative ones.

Research demonstrates that manic people also have increased ability to form new and different associations between words. In word association tests, the number of "statistically common" responses to tested words fell by one-third and the number of "original" responses increased three-fold amongst manic people(20). According to Jamison, this qualitative change in mental processing "may well facilitate the formation of unique ideas and associations." Nancy Andreason found that both manic people and a sample of established writers show a conceptual style of "overinclusiveness" that tends to "blur, broaden, or shift conceptual boundaries." (8).

Dr Oliver Sacks, professor of Neurology at the Albert Einstien Memeorial Centre, New York, has commented on the extravagant powers of association and fancy of hypomanic people. In an inaugural speech at the opening of the Centre for the Mind in Canberra, Sacks described similar flights of fancy in people with Tourettes Syndrome (a neurological condition of sudden violent, unexpected movements, thoughts, images and verbalizations). "Asociation is often very rapid, very unexpected, very facile; streams of visual puns and resemblances may pour out of the person, and verbal puns and resemblances. Sometimes can be like a sort of public dream. There can be an extraordinary fantasmagoric quality of rich fancy." (3). For Sacks this richness of fantasy must be exploited "to go deep and create in a way which involves something much, much deeper, and more personal" if true creativity is to occur. Otherwise the one remains "trapped on the surface of fancy."

Genuine, concept-driven creativity comes from "the depths of the mind and the depths of the personality and the depths of the unconscious; and not just on the surface," Sacks believes. (3). He compares "surface" facility or ingenuity to the abilities of autistic prodigies who are able to rapidly render elaborate, detailed drawings and paintings of architectural scenes glimpsed for only a few seconds. These prodigies and their drawings don't develop. Sacks describes such a 5 year old prodigy:"I had the feeling that the whole visible world flowed through Stephen like a river, without making sense, without being appropriated, without becoming part of him in the least; that though he might retain everything he saw in a sense, it was retained as something external, unintegrated, never built on, never connected or revised, never influencing or influenced by anything else." (3). To truly create, as to truly percieve, requires synthesis, says Sacks. Perception involves 30 or 40 different brain systems working seamlessly to show us the visual world. From this synthesis, sense or meaning emerges. In the same way, Sacks describes creation as a sort of global synthesis of many fragments including perception, imagination, feeling and memory. Thus, there is always a person at the centre. Creation is deeply personal. We may engage consciously with an idea or problem, bringing all of our expertices to bear, and then when we are unable to wrest a solution from it, we let go of it, frustrated. But all of our conscious efforts, all of our collected knowledge and experience, continue to "incubate" at some sublevel of consciousness with our emotions and dreams and the multitudinous parts of our being. In what Sacks calls this "creative unconscious" or "creative reverie," "there must be innumerable fragments, ideas, impressions, feelings which are playing together, dancing, colliding, meeting, seperating," always with some organizing principle coagulating the ideas to form a whole. (3).Then, perhaps when we least expect it, we have an "aha" or "eureka" moment.

The creation is born as a living whole. If it comes from the deepest parts it is alive, with essential integrity. Oliver Sacks believes this is what composer Ernst Toch meant when he said, "a composition must grow organically, like a tree. There must be no seams, no gaps, no foreign matter. The sap of the tree must pass through the whole body of it, reach every branch and twig and leaf of it; it must grow, grow, grow, instead of being patched, patched, patched".

If creation does come from "the depths of the mind and the depths of the personality and the depths of the unconscious," it may be that the introspective, ruminative state of depression can enhance this journey. "One goes down into the well and nothing protects one from the assault of the truth," Virginia Woolf has said (8). Research has shown that people in mildly depressed states are more "realistic" than people in "normal" states of mind(12). Observations and beliefs produced during mild depression are closer to "reality" than those produced in "normal" states of mind. That this naked confrontation with reality should be accompanied with such a large dose of pain supports T.S. Eliots' observation that "human kind cannot bear much reality." (8). The exquisitely sensitive temperament, such as that of the cyclothymic, responds to the ordinary and the universal pain in life's experience to produce what Jamison calls a "heightened sense of vulnerability and awareness" as well as pain." (8). Robert Lowell described "seeing too much and feeling it/with one skin-layer missing." (24) What Andreason calls the "extremely fine tuned" nervous system of artists as well as manic depressives (14) may be extraordinarily responsive to what is happening in both the external and the internal, personal realm. Thus the creative person who suffers from manic-depression also has what Jamison calls "a built-in editing process" for the excesses that are sometime expressed during manic episodes. Mild depression can actually put into perspective what had seemed, in a manic-state, to be brilliant. In this state, one is better suited to sort out the brilliant or creative from the hodge-podge of ideas spewed from the manic mind.

It is widely accepted that insight gained through intense, extreme, even painful experiences can add depth and meaning to creative work. Poet Anne Sexton explained how she used pain in her work: "I, myself, alternate between hiding behind my own hands, protecting myself anyway possible, and this other, this seeing ouching other. I guess I mean that creative people must not avoid the pain that they get dealt.... Hurt must be examined like a plague." (8). An honest encounter with pain can result in healing and growth. The healing properties of art are widely acknowledged across many cultures. Creative people can use their personal pain to help others find wholeness.

Arnold M. Ludwig notes that extraordinary achievements do not arise from emotional contentment. Psychic tension, unease, and pain can be a stimulus to growth, change, and innovation. Ludwig suggests that mental disturbances may indirectly facilitate creation by "maintaining a state of unease that serves as a source of creative tension ... Creators with emotional conflicts try to resolve them through creative expression" (5). But Ludwig stresses that emotionally stable creators can generate their own sense of unease in the creative process, seeking out problems to solve. "At these times," says Ludwig, "they can often work effectively without tiring for long periods and experience creative "highs" that resemble hypomania."(5).

The relative vagueness Ludwig's notion of "creative unease" seems to characterize current attempts to explain how emotional disturbance can enhance the process of creation. Much of the thinking on the subject is simply appealing and seems intuitively correct. Given that there does seem to be a point of intersection between creativity and psychic turmoil, the mechanism remains to be pinned down. However, it does seem that characteristics of mania, depression, and perhaps other disorders such as Tourettes, can, and perhaps do, aid the development and expression of creative thought and action. It seems at least as clear that psychic instability is not a necessary condition for creation. "There are 10,000 ways to get to originality," reminds Kay Jamison, "Some people just have incredible imaginations. That doesn't mean they have a mental disorder"(20). Incredible or not, imagination plays in all of us. "Now, obviously the Cricks and the PoincarŽs and the Mozarts are very few and far between," says Oliver Sacks, "This sort of huge creativity, paradigm breaking or whatever you want to call it is very rare. But I think a genuine creativity and imaginativeness is present in all of us. I think it's an inherent quality of the human mind ... and one which is irrespective of intelligence."(3)

What does all of this mean for treatment?

"I want to keep those sufferings," said expressionist artist Edvard Munch. When told he could end his cycle of psychiatric hospitalizations with available treatment, he replied that emotional torments "are part of me and my art. They are indistinguishable from me, and it would destroy my art." (11). As Jamison points out, many creative people are reluctant to be transformed by psychiatric treatment into "normal, well-adjusted, dampened, and bloodless souls" no longer moved to create. And their fears may not be unfounded. Current psychotropic drug therapies can offer some relief from the painful, destructive features of mania and depression. But according to Jamison, there is a price to pay -- these drugs can "dampen a person's general intellect and limit his or her emotional and perceptual range." (8). As a result, many people with mood disorders stop taking these medications. The tragic consequences include emotional extremes that intensify over time and can lead to psychosis or death. These consequences should not be romanticized.

Clearly our existence as a human community would be diminished without the "genius" responsible for scientific breakthrough and for what we respond to as great musical, literary, and visual works of art. If this genius sometimes grows up in suffering, it seems that the pain of a few is of benefit to all of us. If we appreciate the gifts these creative people have given us, they deserve our understanding and careful consideration. Any treatment of such disorders should seek to find a balance that preserves crucial human emotions and experiences while alleviating destructive extremes.

WWW Sources
1) Famous People with Bipolar Disorders, List drawn from Kay Jamison's Touched With Fire; Manic-Depressive Illness and the Artistic Temperament
2) Precis of "THE CREATIVE MIND: MYTHS AND MECHANISMS", Explores what creativity is -by Margaret A. Boden, School of Cognitive and Computing Sciences, University of Sussex, England

3) Dr Oliver Sacks Inaugural lecture at the Centre for Mind , Dr Oliver Sacks, Professor of Neurology, Albert Einstein Memorial Centre, New York. Lecture deals with the nature of creativity with lots of interesting examples from Dr Sacks own research.

4) Manic-Depressive Illness and Creativity: Does some fine madness plague great artists? , Scientific American article Several studies now show that creativity and mood disorders are linked. By Kay Redfield Jamison professor of psychiatry at the Johns Hopkins University School of Medicine. She wrote "Touched with Fire: Manic-Depressive Illness and the Artistic Temperament" and co-authored the medical text "Manic-Depressive Illness." Jamison is a member of the National Advisory Council for Human Genome Research and clinical director of the Dana Consortium on the Genetic Basis of Manic-Depressive Illness.

5) Mental Disturbance and Creative Achievement - Arnold M. Ludwig , -- biographical study of prominent 20th century people finds high achievers in social, business, and science professions have higher rates of mental disturbance than the population as a whole. The Harvard Mental Health Letter, March 1996

6) "That Fine Madness" Discover Magazine, , by Jo Ann C. Gutin October 1996 v17 n10 p74 (9) Current trend of ascribing creative benefits to manic depression, or bipolar disease, has extended to diagnosing artists posthumously, and has angered sufferers of the cruel disorder.

7) The Systems View of Life , (includes discussion of how creativity is built into all living systems) By Fritjof Capra, theoretical high-energy physicist and author. Capra received his Ph.D. on the gravitational collapse of neutron stars from the University of Vienna in 1966 where he studied with Werner Heisenberg. He does research at the Lawrence Berkeley Laboratory and lectures at the University of California, Berkeley

8) To order the book: Touched with Fire: Manic Depressive Illness and the Artistic tempermen- by Kay Redfield Jamison

9) To order the book: The Act of Creation by Arthur Koestler , To order the book: The Act of Creation by Arthur Koestler (New York: Dell. 1971). Koestler examines the idea that we are at our most creative when rational thought is suspended--for example, in dreams and trancelike states. Koestler looks at the parallel creative processes involved in the sciences, humor and the arts, concluding that they are inextricably linked. Arthur Koestler was a twentieth century novelist, political activist, and a social philosopher. Much of his work was out of step with mainstream views of his contemporaries. Today his original ideas are appreciated by some as brilliant, as his work on creativity.

10) William James, The Varieties of Religious Experience: A study in Human Nature , (1902; reprint, Middlesex England: Penguin, 1982)

11) Edvard Munch, Expressionist artist

12) Sackheim, Self-deception, self-esteem, and depression: The adaptive value of lying to oneself , in Empirical Studies of Psychoanalytic Theories, ed. J. Masling (Hillsdale, N.J.: Analytic Press, 1983), vol. 1.

13) "That Fine Madness" - by Jo Ann C. Gutin Discover Magazine , October 1996 v17 n10 p74 (9) Current trend of ascribing creative benefits to manic depression, or bipolar disease, has extended to diagnosing artists posthumously, and has angered sufferers of the cruel disorder.

14) CREATIVITY AND THE TROUBLED MIND - PSYCHOLOGY TODAY , April, 1987-- by Constance Holden

15) Divergent thinking - J.P. Guilford , Guilford 's divergent production operation identifies a number of different types of creative abilities.

16) The Gift of Saturn: Creativity and Psychopathology -- Antonio Preti , Antonio Preti, MD; Paola Miotto, MD CMG, Psychiatry branch via Costantinopoli 42, 09129 Cagliari, Italy

17) Circadian Rhythms Factor in Rapid- Cycling Bipolar Disorder by Ellen Leibenluft , M.D. Psychiatric Times May 1996 Vol. XIII Issue 5

18) Creativity and unpredictability -- Margaret Boden

posted April 19, 2008 12:12 AM           

Like many mental illnesses, the commentary surrounding bipolar disorder is saturated with myths--it's hard to tell what's true and what's not. Below you'll find the real story, from our Expert Patient John McManamy.

1. Everyone has their ups and downs, so mine aren’t that serious.

Yes, everyone has good days and bad days, but when these ups and downs seriously interfere with your ability to work, relate to others and function effectively, it is advisable to seek out a psychiatrist.

2. Bipolar disorder is a mood disorder.

Half true. Bipolar disorder certainly affects mood, but it also affects cognition and the ability to perform mental tasks. Some days we can out-think Stephen Hawking. Other days we make Forrest Gump look like an intellectual. !!!

3. Yes, but bipolar disorder is still a mood disorder.

Granted, but for most of us it is also part of a package deal that may include anxiety, substance and alcohol abuse and sleep disorders. Also, researchers are finding smoking guns linking the illness to heart disease, migraines and other physical ailments.

4. Bipolar disorder is characterized by mood swings ranging from severely depressed to wildly manic.

Not necessarily. Most people with bipolar disorder are depressed far more often than they are manic. Often, the manias are so subtle that they are overlooked by both patient and psychiatrist, resulting in misdiagnosis. People with bipolar disorder can also enter long periods of remission.

5. Mania is like being on top of the world—if you could only put it in a bottle and sell it.

You wouldn’t want to with most manias. True, some forms of mild mania are characterized by feelings of elation, but other types have road rage features built in. More severe mania turns up the heat, resulting in different kinds of out-of-control behavior that can ruin your career, relationships and reputation.

6. Bipolar disorder is caused by a chemical imbalance of the brain.

This is the simpler explanation—what you tell your family and friends. What you need to know is our genes, biology and life experience make us extremely sensitive to stress. Various stressors, such as personal relationships and financial worries, have the potential to trigger a mood episode if not effectively nipped in the bud.

7. Medications are all you need to combat bipolar disorder.

False. While medications are the foundation of treatment for bipolar disorder, recovery is problematic without a good lifestyle regimen (diet, exercise and sleep), effective coping skills and a support network. People with bipolar disorder also benefit from various forms of talking therapy and religious/spiritual practice.

8. Medications don’t work for me.

For some people this may be true, but we all need to give our meds a chance. Treatment guidelines anticipate initial failures, and while no two guidelines are in agreement they are all based on the premise that eventually you will find a medication or combination of medications that will help you.

9. Lower quality of life and sluggish cognition are fair trade-offs for reducing mood symptoms.

False, big time. In the initial phase of treatment, meds overkill may be justified to bring your illness under control. But full recovery is based on improving your overall health and ability to function, not just eliminating mood symptoms. Over time, the side effects of medication tend to go away, so patience is advised. You may choose to live with minor side effects such as mild hand tremors. But if major side effects persist, you should work with your psychiatrist in adjusting doses or switching to different meds. The onus is on you to alert your psychiatrist to major side effects and to insist he or she take appropriate action.

10. Once you’ve been diagnosed with bipolar disorder, you can forget about leading a normal life.

False. Living with bipolar disorder is a challenge, and you may have to change your expectations, but you should never give up on living a rewarding and productive life.

Read more stories by John McManamy.

posted April 19, 2008 12:21 AM           

"Although fewer people (11% vs. 22%) view mental illness as an emotional shortcoming than previously, the latest results suggest that many Americans don't realize manic depression, like heart disease or diabetes, is a physical illness requiring medical treatment. In fact, a majority of those surveyed believe people can prevent mood disorders, such as manic depression, by adopting "self-help" techniques, including positive thinking. Additionally, only 35 percent would consult a mental health professional themselves or for someone else experiencing symptoms of manic-depression.

These results are especially disturbing because, if left untreated, manic-depressive illness can have a devastating impact, robbing a person of his or her job, friends or family and leading to reckless behavior, including excessive spending and promiscuity. Manic depression affects more than three million Americans, but only one-third of those affected receive proper treatment.

"We must recognize manic depression is a medical illness, not a character weakness," says Lydia Lewis, Executive Director, National DMDA. "Also, we need to make people realize it is a potentially fatal illness. In fact, if left untreated or mistreated, more than 15 percent of those afflicted will take their lives."

____________________________________________
Myth
Suicide is not a problem in the United
States. Only a small number of people
take their own lives.

posted May 01, 2008 02:21 AM           

quote:

---

Many Empaths suffer from anxiety due to an overload of incoming stimuli and intuitive information. Some suffer from depression due to being overwhelmed with all the "storms" going on inside. It is not uncommon for an Empath to tell me that he or she has been diagnosed as "bipolar/manic-depressive." Now, that does not mean that if you were diagnosed as bipolar that you are automatically an Empath - it just means there is a possibility that we are quick to put medical labels on things without fully investigating them.

The interesting questions that arise are: Are Empaths more susceptible to mental illness? OR Is the mental illness/distress the result of being an unbonded Empath? Which comes first? This research still goes on. I have met plenty of well adjusted Empaths - yet will still find that they seek some sort of comfort somewhere, either in mild medication or counseling, something to soothe those internal storms.

---

posted May 01, 2008 01:08 PM           

Finding ways to embrace this and make it work in our lives is probably the best thing to do?

posted March 12, 2009 03:54 AM           

Even though this was posted a while back, I appreciate the information as my partner was diagnosed with bipolar disorder and obsessive compulsive disorder in August 08. Currently, he has stopped treatment has experienced brain zaps due to withdrawls. It's pretty alarming.

posted March 20, 2009 11:37 PM           

now, today i'm labeled that i DO have BP

posted March 20, 2009 11:39 PM           

doesnt mean much to me.

posted March 21, 2009 01:34 PM           

Question...Have you ever had an eeg done??

In the past, I have been diagnosed with almost every mental disorder you can imagine!

On anti something for 20+ years!

Recently, very recently after a major hospitol visit, a supposed TIA. I changed primarys and she ordered an eeg. As it turns out, I do have not any of the mental/medical disorders I've been diagnosed with! I have a seizure disorder! Some of the meds I was taking were actually causing more distress.

Might want to check out an eeg if you never had one!

Love and light
Mary

posted March 21, 2009 08:35 PM           

Tell Jay and Carl I said hello! I'm hanging in here! somehow!

Look forward to catching up with you and seeing you around here (though i'm somewhat of an irregular poster now)

posted March 22, 2009 06:43 PM         

sorry you are going through this one 26t...i have a bias against psychiatry in general - though i know they help some people, most drugs designed to control your brain are in my estimation VERY risky.my father was pretty definitely BP and my sister suffers from depression, but he was too early to be diagnosed and SHE HAS BEEN BETTER SINCE SHE GOT OFF HER MEDS. just two people, not a study, mind you!

have you read any of bruce lipton's books on "the new biology"? he is a scientist with a creative outlook on genetics and the influence of the mind on our health amongst other things....

posted March 22, 2009 08:18 PM           

Doesnt surprise me your sister is better w/o meds. I dont think they are for me either and wont try them for many reasons. One of my friends (who is BP) is on meds that work for her and told me her doc said that 'youre all guinea pigs and are just lucky if something works for you'. My gut tells me I dont need them or shouldnt take them.

Yeah! I got Bruce Lipton's book Biology of Belief on CD a couple years ago when it came out. I'll have to see if I can find it and take another listen. I like what he had to say.

quote:

---

personally i think if we treasured our "eccentrics" like the english do we would have less suffering/mental "disease", and more creativity

---

posted April 02, 2009 02:17 AM           

And thank you LTT for the stuff on empaths.

As I scrolled down this thread,
these two things jumped out at me:

quote:

---

Signs and symptoms of mania (or a manic episode) include:

Increased energy, activity, and restlessness
Excessively “high,” overly good, euphoric mood
Extreme irritability
Racing thoughts and talking very fast, jumping from one idea to another
Distractibility, can’t concentrate well
Little sleep needed
Unrealistic beliefs in one’s abilities and powers
Poor judgment
Spending sprees
A lasting period of behavior that is different from usual
Increased sexual drive
Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
Provocative, intrusive, or aggressive behavior
Denial that anything is wrong

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Uhhhhhhh..... YEAH.

quote:

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Many Empaths suffer from anxiety due to an overload of incoming stimuli and intuitive information. Some suffer from depression due to being overwhelmed with all the "storms" going on inside. It is not uncommon for an Empath to tell me that he or she has been diagnosed as "bipolar/manic-depressive." Now, that does not mean that if you were diagnosed as bipolar that you are automatically an Empath - it just means there is a possibility that we are quick to put medical labels on things without fully investigating them.
The interesting questions that arise are: Are Empaths more susceptible to mental illness? OR Is the mental illness/distress the result of being an unbonded Empath? Which comes first? This research still goes on. I have met plenty of well adjusted Empaths - yet will still find that they seek some sort of comfort somewhere, either in mild medication or counseling, something to soothe those internal storms.

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I swear to God, I'm an empath.

posted April 02, 2009 02:34 AM           

Whoa, after typing that, I was searching,
and I found this -- check the last sentence:

quote:

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Bipolar Type 1 is what most people think of when they hear the terms "bipolar" or "manic depressive." Moods alternate between normal, depressed, and manic. The key word here is mania, which can simplistically be thought of as the opposite of depression. According to the DSM-IV, mania is "a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week," during which time at least three of the following symptoms have persisted: inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual or pressure to keep talking, flight of ideas or racing thoughts, distractibility, increase in goal-directed activity (but usually without complete follow-through), unrestrained spending sprees, sexual promiscuity.

Frequently, untreated mania segues into psychosis marked by paranoia or extreme grandiosity (e.g. the person may believe that s/he is Jesus Christ) and results in hospitalizaton. If left untreated, depressive and manic episodes will come closer and closer together over time, and there will be fewer periods of normal functioning.
http://www.suite101.com/article.cfm/depression_women/102011/1

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Yeah. Thats it. Its Rapid Cycling.

More from that article,
which outlines several varieties
of Bi-Polar Disorder:

quote:

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The second bipolar variant is Bipolar Type 2, characterized by severe depressions alternating with hypomanic episodes. Hypomania is not as severe as mania, and the mood must be irritable or elevated for at least 4 days to qualify for a diagnosis of hypomania. During this time, the person sleeps less, eats less, and feels very creative (though, as with mania, there is usually not much follow-through). The person experiences a lot of chaos in her personal and professional relationships. People often see her as being very unpredictable, though very intelligent. A hypomanic episode is usually followed by a severe depression, and this is usually when the person seeks help.

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and

quote:

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CYCLOTHYMIA

Some experts think that Cylcothymia is a third type of bipolar disorder, and I tend to agree with their position. The DSM-IV describes Cyclothymic Disorder, or Cyclothymia as episodes of hypomania alternating with episodes of dysthymia over a period of at least two years. Clinically, this looks like a less severe form of Bipolar Type 2.

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Another blurb on Cyclothymia:

quote:

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THE CYCLOTHYMIA WORKBOOK
Cyclothymia Was First Identified in 1877,
Affects as Many as 3 Million Americans,
and It Wreaks Havoc on the Well-Being,
Relationships, and Careers of those Who Have It

Yet, you’ve probably never heard of it. Cyclothymia is a mood disorder that’s characterized by mood swings intense enough to overwhelm someone’s life but not extreme enough to be considered symptoms of bipolar disorder. Sufferers cycle between episodes of depression and hypomania, a low-grade form of mania. They are rarely free of symptoms for more than two months at a time, and their “moodiness” often costs them relationships, jobs, and peace of mind. Research tells us that up to 50 percent of those diagnosed with cyclothymia will develop full-blown bipolar disorder, and until 1980 it was classified as a personality disorder instead of a mood disorder. Although it is recognized as a scientifically valid diagnosis, clinicians are still inclined to misdiagnose it. This is due to several factors, among them the fact that people with cyclothymia may not know they have a treatable condition, so they often don’t seek help in the first place. Also, it is common for cyclothymia to be misdiagnosed as a major depressive disorder because the “up” phases of the disorder may be perceived as normal behavior rather than the episodes of hypomania.
http://www.newharbinger.com/client/client_pages/storyideas_CYCLO.cfm

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posted April 02, 2009 02:43 AM           

What Is Rapid Cycling Bipolar Disorder?

Rapid cycling is a pattern of symptoms in bipolar disorder. In rapid cycling, a person with bipolar disorder experiences four or more episodes of mania or depression in one year.

Who Gets Rapid Cycling Bipolar Disorder?

Virtually anyone can develop rapid cycling bipolar disorder. About 2.5% of the U.S. population suffers from some form of bipolar disorder -- almost 6 million people.

About 10% to 20% of people with bipolar disorder have rapid cycling. People with bipolar II disorder are more likely to experience rapid cycling.

Most people are in their late teens or early 20s when symptoms first start. Nearly everyone with bipolar II disorder develops it before age 50. People with an immediate family member with bipolar disorder are at higher risk.

What Are the Symptoms of Rapid Cycling Bipolar Disorder?

People with rapid cycling bipolar disorder have the symptoms of bipolar disorder:

At least one episode of mania in their lifetime.
Episodes of depression [major depressive disorder], which are often recurrent.
Mania is a period of abnormally elevated mood, usually accompanied by erratic behavior lasting at least seven days at a time. Hypomania is an elevated mood not reaching full-on mania. The usual duration is four to seven days.

A few people with rapid cycling bipolar disorder alternate between periods of hypomania and major depressive disorder. Far more commonly, though, depression dominates the picture. Repeated periods of depression are punctuated by infrequent, shorter periods of elevated mood.

How Is Rapid Cycling Bipolar Disorder Diagnosed?

Bipolar disorder is diagnosed after someone experiences a hypomanic or manic episode. Rapid cycling bipolar disorder is diagnosed after four episodes of depression, mania, or hypomania occur within one year.

Rapid cycling bipolar disorder can be difficult to diagnose. Rapid cycling may seem to make bipolar disorder more obvious, but because most people with rapid cycling bipolar disorder spend far more time depressed than manic or hypomanic, they are often misdiagnosed with "just" depression.

For example, in one study of people with bipolar II disorder, the amount of time spent depressed was more than 35 times the amount of time spent hypomanic. Also, people often don't take note of their own hypomanic symptoms, mistaking them for a period of unusually good mood.

How Is Rapid Cycling Bipolar Disorder Treated?

Because symptoms of depression dominate in most people with rapid cycling bipolar disorder, treatment is usually aimed toward relieving depression.

Antidepressants such as Prozac, Paxil, and Zoloft can reduce depression in rapid cycling bipolar disorder. However, taking antidepressants alone can actually increase the degree of rapid cycling, and also trigger manic episodes.

For this reason, mood stabilizers must be taken with antidepressants. Mood stabilizers include antiseizure medicines (like divalproex or lamotrigine), and antipsychotics (such as olanzapine or risperidone). Lithium is specifically not indicated in rapid cycling bipolar disorder.

Mood stabilizers are also the treatment for manic or hypomanic symptoms.

Treatment with mood stabilizers is usually continued even when a person is symptom-free. This helps prevent rapid cycling. Antidepressants are generally tapered as soon as depression is under control. Many people need to take two or more medicines daily to control rapid cycling bipolar disorder.

What Are the Risks of Rapid Cycling Bipolar Disorder?

The most serious risk of rapid cycling bipolar disorder is suicide. People with bipolar disorder are 10 to 20 times more likely to commit suicide than people without bipolar disorder. Tragically, 8% to 20% of people with bipolar disorder eventually lose their lives to suicide.

People with rapid cycling bipolar disorder are probably at even higher risk for suicide than those with "regular" bipolar disorder. They are hospitalized more often, and their symptoms are usually more difficult to control long term.

Treatment reduces the likelihood of serious depression and suicide. Lithium in particular, taken long term, reduces the risk.

People with bipolar disorder are also at higher risk for substance abuse. Nearly 60% of people with bipolar disorder abuse drugs or alcohol. Substance abuse is associated with more severe or poorly controlled bipolar disorder.

posted April 05, 2009 02:45 AM           

http://www.youtube.com/watch?v=P7Xwdvb6FXM&feature=response_watch