No, it’s not just a bad day. It’s not even just a horrible day. It’s another one of those days when you pick up a razor and slash a diary of just how bad you feel into your flesh.
Seeing is believing:
…and the opposite is true; those who do not suffer from this mental illness cannot even begin to imagine the terrifying heights to which you can fly; the almost supernatural endurance sustained during a manic period. You can survive on two or three hours a sleep a day, for weeks on end. It’s as though a whirling dervish has possessed your very being and there is no stopping the mad reel. Even more frightening is the knowledge that you are going to crash, sooner or later. There is no avoiding that finale.
You never hit bottom. There is no bottom, just endless sinking into nothingness; a fall through the basement floor of despair. It is not uncommon for a depressive to simply stop living in any meaningful way. She does not get up, she does not wash her hair, she does not cook or clean or even talk. It can go on for months, there is only the keening; a high-pitched wail turning into a scream. If you call, she won’t answer the phone. If you go to her house, she locks the door and hides.
Is it real?
Doctors have been studying this issue for many years, and though they believe it is a true mental disorder, they have been hard-pressed to find physical evidence to prove it. Recently, they have turned to Brain Imaging to find anomalies in the way the brains of manic-depressives work. By studying the neurotransmitters (messengers between brain cells) they are beginning to see differences in the functioning of manic-depressives when compared to a normally-functioning brain. There is some proof that bipolarism is partly genetic in nature, as it tends to run in families. But researchers believe it is more of an interaction between many genes as opposed to a single gene acting on its own, along with environmental causes which may include emotional trauma. Since it is a relatively new field of research, there is hope that soon a link will be found between the genetic make-up of manic-depressives and and inherited genes.
Diagnosis is difficult, due to the fact that many of the symptoms mimic those of other mental illnesses. One of the methods used to determine whether the patient is bipolar is to rule out other psychological disorders. It is also hindered by the fact that many doctors either do not believe it is an actual illness, or do not recognize the symptoms.
Signs and symptoms of manic-depression
Often beginning in childhood, this disorder begins with what is termed ‘hypo-mania’. This consists of rapid and exaggerated mood swings, irritability and impulsive behavior. If left untreated it tends to worsen over time, developing into full-blown manic-depression. There are different degrees of bipolarism. Bipolar I is characterised by at least one episode of mania, with or without the depressive aspect. Bipolar II diagnosis requires at least one manic episode, accompanied by a depressive episode. Cyclothymic disorder consists of recurring hypo-manic and depressive episodes, not necessarily separated; it is possible to be manic and depressive at the same time. In this case, there must be four or more major depressive incidents that impair the patient’s functioning on some level. Rapid cycling manic-depression manifests as at least four major manic episodes a year, with major depressive episodes in between.
Other signs to watch for are self-mutilation or talk of suicide. Although it is more likely for bipolars to commit suicide in the early stages of the illness, it is always a possibility, and signs should be taken seriously. Cutting is a form of self-mutilation common to manic-depressives; usually it is done in places on the body that do not show, such as the thighs. If done on the arms, they tend to wear long sleeves to conceal the wounds. They often do not feel the pain at all, and it is an expression of self-loathing and despair.
Once diagnosed with bipolarism, medication is usually recommended. The most common medication to treat this disorder in the beginning is lithium. Advanced cases often require the use of anti-seizure medication and anti-depressants to combat severe depressive incidents. In severe cases Electroshock Therapy (EST) is used. No one knows quite why it works, but it jolts the brain and seems to be effective in restoring some balance to the lives of manic-depressives.
Psychotherapy should be used hand-in-hand with medication. It is important for the patient to understand the triggers that cause episodes, and to find ways to cope with the stressors in their lives. Manic-depressives usually have very disorganized personalities and hold onto false beliefs, regardless of evidence to the contrary. It is baffling to their families and friends, because they never know what to expect; they can go from outrageous and promiscuous behavior to complete withdrawal in no time at all, and often those closest to them give up and despair of ever figuring out the best approach.
It may well be that time holds the only answer to the questions posed about this mental disorder. For those of you with bipolars in your life, the most important thing you can do is have patience; and never downplay the agony in their lives. One of the most frustrating facts for bipolars is that there is no visible sign of their illness, and so many people refuse to acknowledge that there is anything seriously wrong.