Mental Health: The Complexity of Bipolar Illness

“All it takes is a beautiful fake smile to hide an injured soul, and they will never notice how broken you really are.”

Robin Williams, entertainer and a person with Bipolar Illness, 1951-2014

Bipolar Disorder is characterized by alternating periods of extreme mania and extreme depression. When a person is in a manic phase they may appear to be very upbeat, often acting in a way that he or she wouldn’t normally act — overly talkative, hyperactive, sleeping less, over confident, grandiose, engaging in risky behaviors.

Conversely, when a person is in a depressed phase he or she may feel down, hopeless, worthless, restless, fatigued, and like isolating. The periods can last for varying lengths of time, and they can also be mixed, creating a chaotic combination for both the sufferer and those close to him or her.

According to statistics from The National Institute of Mental Health, Bipolar Illness continues to affect 2.6 percent of the U.S. population — some 5.7 million Americans — with a sizable majority of these individuals classified with severe.

We know that the disease runs in families, more than twothirds of people with bipolar disorder have at least one close relative with the illness. We in the mental health field have long thought that bipolar disease originates in the cerebral cortex of the brain, the largest part of the brain; that component of the brain involved with higher-level thought and action. However, according to recent research conducted, and reported by, The Scripps Research Institute (TSRI) has shown that groups of genes within the stratum — a part of the brain that coordinates many primary aspects of our behavior, such as motor and action planning, motivation, and reward perception — could be deeply involved in the disorder.

Bipolar illness is well controlled now days with prescribed mood medication and other appropriate therapies, however many individuals with the illness do not follow their medication or treatment regimen. Although individuals with bipolar disorder pose great risk for suicide, such as the tragic death of Robin Williams by suicide while in an extreme cycle of depression, the greatest risk lies in the area of substance abuse. According to statistics presented in the American Journal of Managed Care on a recent study, about 56 percent of individuals with bipolar disorder had experienced drug or alcohol addiction during their lifetime.

Approximately 46 percent had abused alcohol or were addicted to alcohol. About 41 percent had abused drugs other than alcohol, or were addicted to drugs( I might add that these statistics hold true in our State of Texas and Valley communities as well). The study, as all previous studies have indicated, alcohol is the most commonly abused substance among individuals with bipolar illness.

Most individuals with bipolar illness tend to “self medicate” by using alcohol or illicit chemical substances; to “numb” the painful symptoms of anxiety, depression and sleeplessness.

These facts have always held true for the last few decades, since first reported in the mid 1990’s, leading to the term “Dual Diagnosis,” and the beginning of the Dual Disorder Treatment movement. I was once involved in the developing and managing Dual Disorder Treatment Programs, both in residential and out-patient settings.

While employed at a Texas state center for mental illness, we received training concerning Dual Disorders from the renowned Dr. Bert Pepper; a pioneer in the Dual Disorders movement.

Within a year of development of the program, which was most successful, the State “pulled the plug” on all residential dual disorders/ substance abuse programs… stating that they were too expensive to treat, and the outcomes were not that “successful.”

We professionals, psychologists and addictionologists, who have treated the individual with a dual disorder; know from experience, and vast amount of studies, that the treatment of Mental Illness and related Substance Use Disorders must be conducted together if relief is to be afforded the individual and their families suffering from the effects.

Now, with the State Mental Health Facilities only treating the person with a specific mental illness; schizophrenia, major depression, bipolar disorder; they are referred elsewhere for Substance Use Disorder treatment; the person with a dual disorder is essentially left out in the cold with exceptions of a few organizations to treat the condition; thus the reason that the statistics have not changed over the years.

A while back the name of “Dual Disorders” was changed to “Co-occurring Disorders,” and remains apropos at the time of this writing.

According to most recent statistics gleaned from the Substance Abuse and Mental Health Services Administration (SAMHSA) there are about 8 million individuals with Co-occurring Disorders in the U.S., and the bulk of those individuals are diagnosed with Bipolar Disorder.

Many individuals with bipolar illness become quite comfortable and pleased with their illness when in the manic phase…artists, musicians, comedians, and others adapt and use their mania to their advantage. I once had a patient, let’s call him Fred, who reported that he did not want to take his medication because he would lose his productivity…he liked his mania.

He was most domineering in group therapy; most talkative, delusional, and opinionating. He was committed often to our facility as he was in danger to himself and others; coming off his medication, and causing grief with his family; staying up at nights and keeping his family awake, arguing, threatening; and in his depression phase of his illness had suicidal ideations.

He had great anxiety concerning the depressive phase of his illness, would have suicidal ideations when entering the phase, and desired to remain in his manic phase to avoid that.

Once stabilized on his medication, and his thoughts and actions were stabilized, he still felt uncomfortable…he “missed” his mania.

Yes, many individuals having Bipolar Illness often put on that “mask of normalcy;” when in reality they are struggling with their disease, along with family and friends…it is most assuredly a complex problem.

Until next time, Stay Healthy My Friends!