diagnosis put me in a category of the population called bipolar. In my mind, I was a lunatic, freak, psycho, crack-up, and mental case. I had officially stigmatized myself, long before anyone else had the chance.
I invited my parents to dinner to tell them the news, and they had a ton of questions. “Are you sure your doctor is right? Where did it come from? What's going to happen to you? Is it genetic?” They struggled with the stigma of having a son with bipolar, and, even worse, they worried that it might run in the family – we might have more like me!
Family and friends didn’t come rushing to my side to support me in my battle. In 1993, the mere mention of bipolar disorder frightened people; someone with bipolar was “crazy.” And because my insidious illness wasn’t tangible, like diabetes or MS, it was easier for people to blame it on me. At a time when I was most in need of support from my friends and family, stigma pushed them away.
Most people thought I had the skills and strength to “kick” my bipolar disorder and get better on my own because the symptoms didn’t show up on my body as a wound. Many people thought it was a figment of my imagination, that I was lazy or just seeking attention, and I started believing these ideas. But when symptoms surfaced, I was reminded that I really was suffering from bipolar disorder.
When medication didn’t quell the mania, I opted for the last resort – electroshock therapy. That decision in itself pretty much confirmed that I was officially mentally ill. It was too much for some of my friends to handle, and they simply disappeared. Nobody seemed to want a friend who was now a psychiatric patient and, after electroshock, a “certifiable zombie.”
Stigma prevents many us from seeking help and isolates us when we’re most in need of supportive friends and family. Even in my recovery today, when I speak openly about my diagnosis, I’m keenly aware that many people are uncomfortable and afraid. Stigma is a form of discrimination, and debunking the myths about bipolar disorder and disseminating the truths are critical to educating the public and creating a social environment that’s more conducive to mental health and recovery.
Chapter 2
Finding the Cause: The Brain and Body Science of Bipolar Disorder
In This Chapter
▶ Examining genetic vulnerabilities
▶ Investigating other possible contributing factors
▶ Understanding the brain and the way it functions and dysfunctions
▶ Looking at how medications can help
As with all mental illnesses, at this point in time, doctors diagnose bipolar disorder by observation only – identifying patterns of change in how a person is feeling and behaving. Medical science has no brain scans or blood tests that can conclusively make the diagnosis, and research now shows that the chances of eventually developing one simple screening test are next to nothing. In fact, it seems likely that what’s referred to as bipolar disorder isn’t just one disorder but rather many different disorders of brain and body function that share similar emotional and behavioral patterns.
These underlying disorders develop from complex combinations of genetic and nongenetic factors that the scientific community is only just beginning to understand. Importantly, the growing science of bipolar disorder can help eliminate the commonly held myth that it’s some type of weakness or defect in moral character. Make no mistake – bipolar disorder is a real physical illness or illnesses.
Another fact that’s also becoming clear is that although the brain is the site of many of the problems found in bipolar disorder, bipolar also affects the rest of the body in important ways. And the environment’s interactions with brain and body play critical roles in the development and evolution of bipolar disorder.
In this chapter, we explore the biological basis of bipolar disorder, looking at factors inside and outside the human body that may contribute to its onset and progression with the goal of understanding what is currently known about what causes bipolar disorder and what is yet to be uncovered by science.
Digging Up Bipolar’s Genetic Roots
Now that scientists are able to map human genes fairly easily and inexpensively, genetic research is exploding. Understanding the genetics of an illness doesn’t just shed light on causes but also seeks to identify specific biological processes that contribute to the illness, which in turn helps to develop more effective treatments. But before even jumping into a search for genes, scientists need to know if they have any reason to suspect that genetics are partly to blame. Studies of families, particularly studies of twin siblings, have been the gold standard of this research. These genetic studies reveal the following:
✔ The identical twin of a person with bipolar I disorder has about a 50 percent risk of developing the disorder. Because identical twins share all their genes, this finding means genetics accounts for some, but not all, of the chance of developing bipolar disorder. (If the genetics were fully responsible and one identical twin had bipolar I, then the other twin would have a 100 percent chance of developing the disorder.)
✔ If someone has an immediate family member with bipolar I disorder, the person has about a 10 percent chance of developing the disorder, which is much higher than the 1 to 2 percent chance of having the disorder if for an individual with no family history of bipolar.
✔ The familial risks of bipolar II and cyclothymia – so called bipolar spectrum disorders – are less clear in the research. First-degree family members (parents, siblings, or offspring) of people with bipolar disorder are more likely to have other disorders as well, such as unipolar depression, schizophrenia, autism disorder, anxiety disorders, substance abuse, attention deficit hyperactivity disorder (ADHD), and personality disorders.
Putting together all the family and twin studies, researchers say that heritability – how much of bipolar disorder is due to genetics – accounts for between 60 and 70 percent of the risk of getting the illness.
A history of bipolar disorder in an immediate family member is important to know, because it increases your risk of getting the disorder. However, families of people with bipolar disorder have higher rates of many other psychiatric conditions, as well. When considering your risk for bipolar disorder, a look at all major psychiatric disorders in close family members can help identify some genetic susceptibility to bipolar disorder. If you ask relatives whether anyone in your family has had bipolar disorder, they may not know the answer. Older relatives may have been misdiagnosed as having schizophrenia or may have never been diagnosed but had a history of self-treating with alcohol or drugs. Or a relative may have been considered eccentric, but for whatever reason was never diagnosed.
To obtain better answers, try rephrasing the question:
✔ Has anyone in the family had alcohol or substance abuse problems? Many people with bipolar disorder self-medicate with alcohol and drugs, which does significantly more harm than good but may provide temporary relief from the psychological pain. Some research also suggests that bipolar disorder and substance abuse may share some genetic risk factors.
✔ Have any family members been diagnosed with schizophrenia? In the not-so-distant past, doctors commonly misdiagnosed bipolar disorder as schizophrenia. Schizophrenia is more common in the relatives of people with bipolar disorder, likely because of some shared genetic risks.
✔ Has any family member been treated for any other mental illness? If a family member has received treatment for depression, psychosis, or other mental illnesses, he may not have received the correct diagnosis. Also, relatives of people with bipolar disorder are more likely to have many other types of mental illness, which may be partly genetic and may be due to other mechanisms.
✔ Has anyone in the family had to go away for a while to an institution, sanatorium, or rehab center? Families sometimes cover up memories of relatives who had to be hospitalized for mental