New Book on Bipolar Disorder

One of the most mis-understood psychiatric disorders is Bipolar Disorder, formerly (and still sometimes) known as Manic-Depressive Disorder. It is poorly understood by the general public (more so perhaps than most disorders), and many would say that it has become a "trendy" disorder, used too frequently by psychiatrists (especially now that it has inexplicably become stylish to diagnose children with the disorder, something that was never done until very recently). It is often thought to consist merely of moodiness, or fluctuating mood. This is partly true, but the hallmark of Bipolar Disorder has less to do with the fluctuation, and often little to do with depression, and everything to do with the appearance of one or more Manic Episodes, which are periods during which a person's behavior is very dramatically altered. The affected person will be filled with energy, will often speak rapidly, and will insistently engage others in conversations about ideas that can only be described as "crazy."

There's a new book about Bipolar Disorder, by Michael Greenberg, the father of a young woman who has the disorder. The book is called Hurry Down Sunshine, and it is beautifully reviewed by Oliver Sacks. The book may very well be worth a read; the review itself certainly is. Here's a brief excerpt:

One may call it mania, madness, or psychosis... but it presents itself as energy of a primordial sort. Greenberg likens it to "being in the presence of a rare force of nature, such as a great blizzard or flood: destructive, but in its way astounding too." Such unbridled energy can resemble that of creativity or inspiration or genius—this, indeed, is what Sally feels is rushing through her—not an illness, but the apotheosis of health, the release of a deep, previously suppressed self.

These are the paradoxes that surround what Hughlings Jackson, the nineteenth-century neurologist, called "super-positive" states: they betoken disorder, imbalance in the nervous system, but their energy, their euphoria, makes them feel like supreme health. Some patients may achieve a startled insight into this, as did one patient of mine, a very old lady with neurosyphilis. Becoming more and more vivacious in her early nineties, she said to herself, "You're feeling too well, you must be ill." George Eliot, similarly, spoke of herself as feeling "dangerously well" before the onset of her migraine attacks.

Mania is a biological condition that feels like a psychological one—a state of mind. In this way it resembles the effects of various intoxications. I saw this very dramatically with some of my Awakenings patients when they began taking L-dopa, a drug which is converted in the brain to the neuro-transmitter dopamine. Leonard L., in particular, became quite manic on this: "With L-dopa in my blood," he wrote at the time, "there's nothing in the world I can't do if I want." He called dopamine "resurrectamine" and started to see himself as a messiah—he felt that the world was polluted with sin and that he had been called upon to save it. And in nineteen nonstop, almost sleepless days and nights, he typed an entire autobiography of 50,000 words. "Is it the medicine I am taking," wrote another patient, "or just my new state of mind?"

Fascinating questions. Thanks to MindHacks for this find! And I must agree with them, that Sacks is a wonderful writer and certainly knows what he is talking about AND he should know better than to imply that there is a genuine distinction between "biological" and "psychological" conditions!