WHAT IS BIPOLAR DISORDER?

By: MIGHTY PURSUIT TEAM

On November 21st, 2016, police were called to Kanye West’s house, after reports of a disturbance happening. Shortly after, Kanye was taken to a psychiatric hospital and his Saint Pablo tour was effectively canceled.  He was initially admitted on the grounds of “exhaustion”, but later diagnosed with bipolar disorder after a stretch of angry and erratic behavior. Perhaps what he was experiencing that night wasn’t far off from what unfolds in a scene from 2012 Oscar-winner Silving Linings Playbook. Pat Solitano Jr, played by Bradley Cooper, causes a startling disturbance in a Philly neighborhood late at night, as he frantically searches for his wedding video. He ends up getting in a physical altercation with both his parents, before police are called on the scene. As we wrestle with what bipolar disorder is, we must do so with the understanding that these examples are not outliers. Over 5.7 million people have been diagnosed with the disorder in the United States and that only accounts for those who have publically sought treatment. Selena Gomez, Mariah Carey, Russell Brand, and Demi Lovato are among the high-profile figures that have been diagnosed with bipolar in recent years.  Quite literally, a large population either knows someone who has bipolar or personally struggles with it themselves. But despite its widespread nature, Bipolar is one of the most stigmatized mental health conditions and something people don’t quite know how to deal with. Sufferers often then have to go through the lonely experience of either being demonized or “othered” for their behavior, which only compounds the problem. But we’re of the mind that it doesn’t have to be that way.  We can drop the stigma by first educating ourselves on what Bipolar is. Then we can use this information to take necessary steps toward helping ourselves and those around us. And that’s where the conversation starts today.

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HOW BIPOLAR WORKS

Unlike mental disorders such as OCD, Bipolar disorder is not very easy to hide. At times, the symptoms of Bipolar manifest in a very public way. As Harvard Health puts it, “bipolar disorder is a mental disorder characterized by wide mood swings from high (manic) to low (depressed).” These intense highs, known as manic episodes, often don’t feel like an overtly negative experience to the sufferer. As one publication explains, “it’s common to experience feelings of heightened energy, creativity, and euphoria. If you’re experiencing a manic episode, you may talk a mile a minute, sleep very little, and be hyperactive. You may also feel like you’re all-powerful, invincible, or destined for greatness.” In fact, the way people talk about their experience with these highs is often in a glowing light. We see this in a 2018 film called Bipolar Unmasked, in which we get the first-person perspectives of those living with Bipolar. One person remarks, “I think Bipolar can be an amazingly beautiful experience,” while another adds, “Mania feels great. Things are beautiful. Things look different.” Kanye himself says he feels a “heightened connection with the universe when I’m ramping up.” Reading these comments, it can almost depict Bipolar as a desirable experience, leaving you wondering.. so what’s the problem then? Firstly, in these bouts of mania, risky decision-making can ensue. At the height of your perceived invincibility, you may find yourself running down the street naked or jumping in front of a train, while later having no recollection of these events at all. Of course, this isn’t everyone’s experience. It depends on the intensity of the manic episode. But in most situations, no matter the severity, it creates complicated social dynamics. If you don’t have Bipolar, but are around someone who is manic, their behavior can feel very overwhelming. Secondly, there’s always a hard crash that comes after the high for the person struggling with Bipolar disorder. Some comments from people in that same film: “It’s a hard, hard crash to come all the way down here.” “The world starts to lose its color.” “It’s a very dark place, it’s suffocating.” “I will look at the clock and it will be noon. And the next time I look at the clock it will be four o’clock in the afternoon and I haven’t moved.” “This is the worst place in the world.” “There’s no break from it.” “You start to disengage.. you isolate yourself.” These defining characteristics – the lows (depression) and highs (mania) – are the hallmarks of Bipolar disorder. But even as we understand that as the blanket statement that describes the disorder, not everyone’s experience is the same. That is where the types of Bipolar come in.

BIPOLAR TYPES

We mentioned earlier that Bipolar can be hard to hide and that largely depends on the type of Bipolar someone has.  According to the National Institute of Mental Health, there are three types of bipolar disorder:
  • Bipolar I - the most intense form of Bipolar, which has the most extreme highs and lows. Manic episodes (hypermania) usually last at least seven days and often require hospital care. Depressive episodes can last over two weeks.
  • Bipolar II - a more moderate form of Bipolar, with briefer periods of elation (hypomania), alongside long periods of depression.
  • Cyclothymic Disorder - the mildest form of Bipolar, which has alternating bouts of hypomania and depression for at least two years.
 While all three forms vary in severity and duration, they share the same commonalities.  The NIMH adds that each type “involves(s) clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.” At first glance, this can all appear like medical jargon, but we must recognize how drastically this can shape one’s experience, in addition to what it’s like to walk alongside someone with Bipolar. But at the same time, some people don’t fit neatly into each of these boxes and accounting for the nuance of Bipolar is critical.

PERSONALIZING BIPOLAR

In a separate interview with Jimmy Kimmel, Kanye says that he doesn’t experience extreme bouts of depression, only the euphoric state that comes with mania.  Of course, as we mentioned, this doesn’t fit neatly into any of the three types of Bipolar, yet he was still diagnosed and struggles with the condition. It’s also important to remember that what triggers manic and depressive episodes can vary greatly, depending on the individual. We cannot assume just because we have bipolar or someone we know does, it is all going to manifest the same exact way. Consider the words of a Reddit user, who says comments on his work performance often trigger mania within him:  “I had my one year evaluation meeting at work today and I got hollowing reviews. I can’t even lie, words of affirmation is my #1 love language/way to get me manic…I just have a really big head right now and I need to chill a bit. It may actually take some time post-diagnosis to figure out what specifically triggers your Bipolar, but some universal commonalities include negative (or positive) life events, seasonal changes and adverse reactions to drugs and/or alcohol. At the height of a manic episode you could also start to lose sense of reality, depending on the severity. Some sufferers may start trying to verify what’s real. David Harbour, who plays Jim Hopper in Stranger Things, was diagnosed bipolar in his mid-20s. When it comes to his triggers he says, “every time he has a [manic] episode, it’s always coupled with spirituality… generally people are like I need to meditate more and get into yoga.. [and for me] it’s like I need to eat a cheeseburger and hang out.” Logically, this may not make sense to the average person, but it highlights the importance of understanding how episodes can manifest on the individual level.

DIAGNOSING BIPOLAR

Not only is there a stigma around mental illness that exists cross-culturally, but there’s also a stigma around diagnoses.  People don’t like to be labeled.

But in our view, a diagnosis is a gift that can add years to your life. Why wouldn’t you want to understand how your mind works? If you had high blood pressure and were about to have a heart attack, wouldn’t you want to know?

Here’s what singer Selena Gomez had to say in an interview with Elle, as she reflected back on her bipolar diagnosis: "I felt a huge weight lifted off me when I found out…I could take a deep breath and go, 'Okay, that explains so much.”  She later told Good Morning America, “It was really freeing to have the information… It made me really happy because I started to have a relationship with myself.” As we mentioned earlier, Bipolar disorder is somewhat easier to diagnose than other disorders like OCD, because of the nature of the symptoms and experience. Regardless, in assessing your own mental health situation, resist the urge to diagnose yourself.  Our role is also to simply inform you, not diagnose you. If at this point in the blog, you have a better understanding of Bipolar, then we’ve accomplished our goal.  But you still must go see a specialist to assess your situation. And if you do get diagnosed, you may experience the freedom that Selena talks about – to no longer sit in the dark, wondering why it seems like your brain works differently. Yes, the journey will still be hard, but the good news about Bipolar disorder is that there are many actions we can take towards treating it. This is where we’ll go next.

TREATING BIPOLAR

Since Bipolar is a mood disorder, the medical world often points to mood-stabilizing medications as the most effective treatments. Perhaps the most well-known medication is Lithium, which was originally approved by the FDA over 50 years ago to treat Bipolar. One researcher from the University of Toronto says that with the exception of ECH, “lithium is the single most effective treatment in psychiatry.” But despite the praise, mood stabilizers can’t be looked at as a universal solution for Bipolar disorder. You could equate Lithium (in addition to other mood stabilizers like valproic acid, divalproex sodium, carbamazepine and lamotrigine) more to a band-aid than a cure. Why? Well, as we read in a recent Harvard Medical School article, “Little progress has been made in finding better therapies, in part because scientists don’t fully understand how the condition arises or exactly how lithium improves symptoms when it does work.”  Similar to SSRIs for OCD, not knowing why the medication works in the first place makes some uncomfortable with taking it in the first place. Not to mention the prospects of facing nasty side-effects that are often a given with mood stabilizers. People often report that life feels “dimmed” when on mood stabilizers. Harbour, the Stranger Things star, says of being an actor on medication “you think you’re not the artist you could be [when you’re on medication]… [so it’s like] let’s open this baby up.” Another user on Reddit says that Lithium “made me feel dead inside and fearful of a life filled with absolutely nothing,” while another proclaims, “I love lithium. It took a few months for me to get to a high enough blood level so I did not see results right away. My doctor’s motto is "start low and go slow." But it's been over a year now and I am doing well.” Some of the common side-effects of mood stabilizers are tremors, weight gain, and headaches in addition to the psychological effects mentioned above.  But regardless of the downsides to going on mood stabilizers, you can’t dismiss the body of evidence that shows they have helped save lives, especially when it comes to suicide.  Still, if you’re looking for alternative or complementary treatments, you’d be delighted to hear there are a few highly effective options. Psychotherapy, in particular CBT (Cognitive Behavioral Therapy), has made a major impact in treating Bipolar. And since routine is a big variable, making lifestyle changes and engaging in ISRT (Interpersonal Social Rhythm Therapy) is key towards management and recovery.

CBT (Cognitive Behavioral Therapy)

Harvard defines CBT as, “A highly effective psychotherapy [that] focuses on how our thoughts, beliefs, and attitudes can affect our feelings and behavior.” It’s based on the idea that much of reality is shaped by our thoughts and feelings, not externally facing circumstances or variables, like people, situations or events. The benefits of CBT help us better cope with circumstances, even if the externally facing variables don’t change. This is incredibly important, especially considering the depressive downturns and the social implications that come with Bipolar disorder. Proponents of CBT are quick to point out that CBT is not merely about positive thinking, but rather realistic thinking. How do we interpret the events that happen within reality, both negative and positive? As one psychologist put it “The goal with cognitive therapy is to make sure someone has an accurate assessment of the situation. Some situations are genuinely awful, and a negative belief about them makes sense. Some situations are truly good, so a positive thought is accurate.” Of course, central to the idea of CBT would then be how you make sense of the world. How do we define what’s accurate, genuinely awful or truly good? How do we make sense of suffering, our experiences and the ways people have hurt us? Clearly, it can’t just be based on feel-good emotions.  Dr. John Gottman, one of the most influential psychologists in the world, details in his book The Science of Trust how women have told him some of the best sex they experienced was directly after physical abuse. We see this exact scenario play out with Nicole Kidman’s character in the critically acclaimed show Big Little Lies. But as we witness in the show, it’s doubtful any psychologist would encourage women to lean into their positive emotions in this scenario and view these experiences as “truly good”.  Objectively speaking, in any culture, there’s something deeply troubling about physical abuse. CBT works best when we align ourselves with objective truth and understand how the world actually works. Thousands of years before the modern roots of CBT, Jesus gave us a foundational paradigm for how to view our experiences.
  1. There is a Creator who designed a beautiful world, but humans only have a limited lens into the nature of reality.
  2. Since the beginning of time, something (clearly) has gone horribly wrong, springing about everything from wars and disease to death, mental health issues, and racism.
  3. Humans are flawed and play an active role in hurting each other, infected by a condition Jesus labeled חטא (sin), which in its simplest form, means to miss the mark. Think in terms of archery, to which we are essentially missing the bull’s eye on the Creator's original design to love God and love each other.
  4. Jesus claimed to be the primary means himself in which all things are being restored to their original condition, inviting us to follow his way of life
  5. In the present day, we live in a time period of the “now” (present healing, reconciliation and beauty) and “the not yet” (future and final healing and reconciliation).
 Knowingly or unknowingly, aspects of this paradigm have undoubtedly influenced modern-day psychology and our approach to CBT. For a therapist to even guide a patient into an “accurate assessment” of the situation, requires them staking claims to what’s “genuinely awful” and “truly good”. It requires an acknowledgement that things aren’t as they should be (or as they were in the beginning) and that humans do play an active role in hurting one another. It requires walking their patient through how to cope in the midst of suffering, to live between the healing available “now” and the hope of the “not yet”. And hereby is the importance of aligning ourselves with how the world (objectively) works when practicing CBT.  When it comes to treating Bipolar disorder, putting CBT into motion might involve helping the patient navigate guilt and shame after a manic episode, helping them see the situation rightly and practice self-forgiveness. It may also help the individual get a proper lens towards viewing depressive episodes and avoid falling into a trap of cognitive distortions. Jesus and his followers knew that suffering (dealt rightly) can produce perseverance, which in-turn will make us complete as human beings. Why is it that we always enjoy the underdog story? Why is it that the most compelling narratives in film are often the tragedies that turn into triumphs? It’s because this simple truth is woven into the fabric of our existence. Time and time again we learn that to get the best results out of CBT, we have to get an accurate assessment of the situation. As we’ve observed, we do so by aligning ourselves with how the world actually works and let everything else flow out of objective truth. To which Jesus says this to his followers: “Therefore everyone who hears these words of mine and puts them into practice is like a wise man who built his house on the rock. The rain came down, the streams rose, and the winds blew and beat against that house; yet it did not fall, because it had its foundation on the rock.”

ISRT & Lifestyle

Since Bipolar is primarily about your mood, implementing lifestyle remedies will go a long way towards avoiding manic states and depressive episodes. It will require you being in-tune with yourself on a daily basis, assessing the various external forces that could be triggersome. Which goes to say, one of the most effective therapies to treat Bipolar Disorder is ISRT (Interpersonal and Social Rhythm Therapy). Since changes in routine can trigger episodes in those that are vulnerable, the therapy focuses on your social and biological routines. A few things that often get highlighted are changes in your schedule, social conflicts, stress and interrupted sleep patterns. Some people often are able to directly link one or more of these variables to the trigger of an episode. Building an ISRT often happens in a few phases. When working with a therapist, they’ll help you develop a social rhythm metric to help track your daily routine. This includes consistency in the time you go to bed, eat dinner, first interact with other people and go to work.  Esteemed in modern-day psychology, ISRT is also a treatment that bears similarities to what followers of Jesus have been doing for millennia. Creating a rule (or rhythm) of life has always been essential towards the spiritual, emotional and physical well-being of Jesus followers. Author John Mark Comer adds that, “a rule of life is a schedule and set of practices and relational rhythms that help us create space in our busy world for us to be with Jesus, become like Jesus, and do what Jesus did.”  Naturally built into the practice of a rule of life are rhythms of rest and work, healthy relational dynamics and regulating sleep patterns. When it comes to management and recovery of Bipolar disorder, you will have to decide what’s best for yourself. Therapists are quick to point out that lifestyle treatments are not replacements for medication and you have to weigh whether you want to take medication in the first place.

CAUSES OF BIPOLAR

At this point, the burning question you still may have about bipolar is... what causes it in the first place? In a previous blog, we covered the six underlying causes of mental illness, which are:
  1. Genetics
  2. Environmental
  3. Digital
  4. Circumstantial
  5. Ideological
  6. Existential
 When it comes to examining Bipolar specifically, there are a lot of theories as to the causes, but little concrete evidence that allows us to boil it down to a singular cause. However, many of the underlying causes to mental illness apply to Bipolar at a higher level. Some have proposed there are issues related to regulating dopamine and neurotransmitters in the brain. On the circumstantial front, researchers from around the world have also been investigating the link between childhood trauma and Bipolar disorder. Perhaps most substantially, researchers from Harvard Medical School and MIT experienced a scientific breakthrough in 2022 by pinpointing a gene called AKAP11 as a strong risk factor for both bipolar disorder and schizophrenia.

But just because we might have the "Bipolar gene", doesn't necessarily mean that it will be activated, which is where causes 2-6 come in.

The environment, particularly what we are putting in our body, likely plays a role in activating these genes and/or bringing the on-set of Bipolar. Harvard Medical School recently remarked: “For many years, the medical field did not fully acknowledge the connection between mood and food. The burgeoning field of nutritional psychiatry is [now] finding there are many consequences and correlations between not only what you eat, how you feel, and how you ultimately behave, but also the kinds of bacteria that live in your gut.” Emeran Meyer covered this heavily in his 2016 book The Mind-Gut Connection, adding: “We have made little progress in treating chronic pain conditions, brain-gut disorders such as irritable bowel syndrome (IBS) or mental illnesses… are we failing because our models for understanding the human body are outdated? The mind-body connection is far from a myth; it is a biological fact, and an essential link to understand when it comes to our whole body health.” Dr. Raphael Kellman, author of the Microbiome Diet, adds: “Many patients with bipolar disorder have gastrointestinal illnesses such as irritable bowel syndrome (IBS), and research suggests this may be linked to dysfunction within the gut microbiome.” As we mentioned above, if scientists continue to theorize that Bipolar is linked to regulating neurotransmitters in the brain, we cannot ignore the fact that 95% of the body’s serotonin receptors are located in the gut. But in the end, for as much as we speculate we must acknowledge that we’re still in the early innings of fully understanding Bipolar disorder, in addition to many other mental illnesses. We can gauge which theories hold the highest probability, but most importantly we have to learn how to cope with Bipolar in the here and now.

LONG-TERM OUTLOOK OF BIPOLAR

So where does this leave us? The numbers suggest that about 5.7 million adults (2.6% of the adult population) have been officially diagnosed with Bipolar in the United States. But because this is only including those that are diagnosed, it’s likely that many more people are affected than the numbers reveal. It’s impossible to know. In a previous blog, we covered the eye opening statistics surrounding mental health around the globe. Specifically in the United States, there are significant concerns around the lack of government funding towards mental health, accessible mental healthcare, affordable mental healthcare and quality mental healthcare. It’s been widely-documented that the healthcare system is essentially set up to be a continuous loop of reactiveness and symptom-management, both for physical and mental illness.  We must ask the troubling questions – why does the government fund what they do? Why are controversial drugs being given a stamp of approval? Is there genuine concern about helping and healing people? Or is something else the motivating factor? In 2021, a group of Yale professors penned an op-ed in the Washington Post entitled, “The FDA is in desperate need of soul-searching”, in which they outline how the FDA has fallen into bed with Big Pharma. It’s a common occurrence for FDA officials to swap roles with those on the boards of Big Pharma companies, such as Biogen. These are clear injustices and red flags that exist within the current operating system.  So if this is the case, where do we find our hope on the long-term outlook of Bipolar? Is it in medication? Is it in finding a great therapist? Or navigating the complicated and conflicting governmental factors to achieve success? These are all certainly parts of the equation, important and complementary aspects of our healing journey. But in our view, the starting point of healing begins with taking a step back and considering how what you believe about the world affects your mental health We covered in our blog on the root causes of mental illness, but we all live our lives by an ideology, which is a “a system of beliefs that we carry which shapes the way we interact with the world around us.” Whether we realize it or not, what we believe about the nature of reality, about God and about ourselves heavily influences the way we approach our Bipolar journey. In this regard, we’re big proponents of the way of Jesus as the most compelling way to make sense of the world. The way of Jesus proposes that healing is a holistic journey, made up of spirit, mind and body, with everything intertwined like a web. The way of Jesus helps settle the existential questions of the heart, like the meaning of life, our role in the world and the purpose of suffering, making healing a far less lonely journey as we get to walk side-by-side with the one who made us. Yes, there may be no cure for Bipolar, but settling our set of beliefs and then engaging with tools like medication and ISRT has statistically shown to be a huge catalyst towards healing for many.  This doesn’t mean the process won’t be painful. Healing often requires hard work.  But the tools are at our disposal for our tomorrow to be much better than our today.

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