Friday, July 15, 2011

Bipolar Paper I wrote for Abnormal Psychology





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 BIPOLAR DISORDER: a DANGEROUSLY UNDERREPRESENTED EPIDEMIC

    By Jordan Adorno          

Abstract

     Bipolar Disorder is a severe mental disease that is characterized by extreme interchanges between mania and depression. In other words, people with this disorder (formerly called ‘manic depression’) are prone to various unhealthy behaviors and emotional instability. As a matter of fact, according to the National Institute of Mental Health, 5.7 million people, to be more specific, suffer from this illness, although many do not receive treatment (Bethesda, 2009). The single most substantial reason for this are the widespread stigmas about Bipolar Disorder, that it isn’t “real”, that it’s just shrinks’ latest “hoax”, that it’s just a fancy  name for people who have mood swings, that it can be willed away with “self-training” etc. Correctively speaking, however, Bipolar Disorder is a serious mental disease that according to the American Psychological Association, affects men and women in equal numbers, and has potential to be life-threatening without treatment (American Psychological Association, 2005).


Startlingly, according to Kevin Caruso, expert for Suicide Prevention, Awareness, and Support Online, between 25-50% of people with Bipolar Disorder attempt suicide in their lives (Caruso, 2009). Such a positive correlation truly dispels the misconception that Bipolar Disorder is nonexistent, and proves also that bipolar persons refusing professional assistance due to the widespread disinformation are at higher risk of suicide. Many more disturbing numbers are directly associated with Bipolar Disorder, which demonstrates the desperate need for society to understand the disorder and its natures - accurately! According to the APA’s empirical resources, Bipolar Disorder’s main points are as given: it can cause someone to spend days, weeks, maybe even months feeling indestructible, overambitious, ecstatic about their life, and then suddenly spiral them into an overwhelmingly depressed period full of self-doubt, witlessness, and lack of motivation, even to do normally enjoyable things. Basically, when an individual is in a manic or depressive state, they overall tend to exhibit the extreme degrees of either euphoria (manic) or miserableness (depressive). For instance, though a bipolar individual may seem relatively normal most of the time, a sad or tough experience can destabilize his or her mental processes by sending them into an overtaking depressive stage; likewise, a happy or self-satisfying event could trigger mania for an indeterminable duration, sending the given Bipolar individual into a “euphoria” that too often leads to self-damaging behaviors such as impulsiveness, money wasting, promiscuity, or even rash, life-changing decision making; ultimately, a lost sight on important matters is the typical endpoint at either end of the "mania" and "depression" scales.  Overall, when sufferers of Bipolar Disorder experience these manic or depressive stages, they are dangerously incapable of properly regulating their emotions (American Psychological Association, 2005). 


   Unbelievably, according to Psych Central’s Steve Bressert Ph.D., “Roughly 70% of manic episodes in bipolar disorder occur immediately before or after a depressive episode”; then, speaking on the durations of these episodes, Bressert makes very apparent, “Both the manic and depressive periods can be brief, from just a few hours to a few days, or longer, lasting up to several weeks or even months” (Bressert, 2010). Unfortunately, because of the stigma that Bipolar is a "woman" disease, society sometimes sees it as emasculating if men seek help for emotional instability. As such, the margin of men voluntarily seeking professional mental help is significantly less reported (Bressert, 2010). Since men and women are affected equally in numbers, equal concern should be felt and applied, but due to society teaching men to not express a need for emotional aid, too many Bipolar men remain untreated. Unsettlingly, the conventional Bipolar male is much more prone to becoming aggressive, violent, and even committing suicide (not to mention males are already four times likelier to successfully commit suicide at that), which is terrifying (Caruso, 2009). Needlessly said, it cannot be emphasized enough that it’s urgent that mental health stigmas come to an end - immediately!


           Prevalently, serious symptoms of Bipolar Disorder begin to manifest during adolescence or early adult life, when people are most vulnerable to the exposure of emotional intensity, rash decisions, and risky behaviors. Once symptomatic, without treatment their unorthodox behaviors will continue throughout their adulthood and may exceed to much worse degrees. In corroboration of this alarming factor, Kevin Caruso stresses, “[E]arly diagnosis and treatment of Bipolar Disorder should be considered an urgent matter” (Caruso, 2009).  What’s so curious and frustrating is that treatment for Bipolar Disorder has been available at compelling success rates for several decades, the mood stabilizer Lithium having been the namely prototype. Indeed, a series of others medications work at impeccable success rates when taken consistently, leading Caruso to recommend, “Become familiar with the symptoms, and if symptoms are present, see a medical doctor and a therapist immediately. Do not delay. Bipolar disorder is highly treatable, so get help” (Caruso, 2009). Caruso's eloquent choice of words could not stress any greater how much of an emergency Bipolar manifestation should be to a newly-afflicted, most likely very young individual.


In corroboration, the APA states that about 99 % of psychological disorders are treatable, explaining, “Through therapy, people can learn coping techniques and problem solving skills to deal with depression and other mental health disorders” (American Psychological Association, 2005). Perhaps if our society didn't rampantly spread stigmatic ignorance regarding mental disease, the suicide rate of Bipolar individuals wouldn’t be egregiously high. So, to compel individuals down the route of seeking psychiatric assistance, a range of available resources importantly attempt, in and across the mainstream world, to educate on Bipolar Disorder. For example, preliminary facts about the disease, as well as directions on identifying the easily viewable symptoms, are commonly contained in fairly well-distributed pamphlets (such as at doctor's offices), television commercials and documentary specials, large online databases on mental illness (such as the APA's tremendous resource of empirical information), and countless books; respectively, all these resourceful methods of research provide long-proven explanations that specifically detail how biology and genetics, NOT environment, are the true roots at uncontrollable cause of the disorder. (And as such, each resource's advice on being aware of family history, not autobiographical events, help remove misplaced self-responsibility, and therefore make Bipolar sufferers less abashed about getting professional help.) 


And of course, uniformly the world's credible psychiatric practitioners offer widespread availability to their medical treatments that, if consistently regimented, can absolve Bipolar Disorder's everyday repercussions. In light of these publicized pontifications, it's thus strictly sad that, at least in the broadest general sense, there’s arguably still more substantial misunderstanding about Bipolar among the public than there is properly informed understanding. To succeed at the above goals to help Bipolar persons and their support systems, appreciating the firm distinctions during the adolescent period in life, when Bipolar symptoms are usually first triggered, precisely those that distinguish between a normal teenager and an emotionally impeded, abnormal teenager (of what is and isn’t of great alarm hence), is absolutely crucial. Many mental health deniers use adolescent mentality, PMS, and normal life difficulties to say Bipolar is a made-up disease. The contention has exacerbated into a social debate about whether Bipolar Disorder’s more often misdiagnosed or more often unreported and consequentially under-treated. Although exact numbers are of course unknown, the statistics we have surely remain but an under-representation of the true deviant numbers. Obviously it's only prudent to remember social rejection of psychiatry, rejection of diagnosis and treatment for Bipolar Disorder hence, retains to have an unnervingly high negative impact on the stats and numbers from the start (i.e. ‘Everyone has an illness nowadays’). But all biases aside, in truth the manic and depressive stages of Bipolar Disorder contradictorily disassociate from normal adolescent and young adult behaviors quite distinguishably. As said by the National Institutes of Health, “Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide [...] But bipolar disorder can be treated, and people with this illness can lead full and productive lives” (Bethesda, 2009). These treatments include daily dosages of mood stabilizers which psychiatrists can usually safely prescribe in relative immediacy, such as the mentioned prototype originally called "the miracle drug" - Lithium of course, Depakote, Lamictal, Seroquel, Wellbutrin, and so forth (on a long list of flexible options). Consistent cognitive-therapy sessions are also effective in combination with one's medication routine. Most of all though, it must be made inexplicable that these options are ALL preferable to sinking beneath the misconceived stigmas about Bipolar and refusing professional consultation for mental ailments (Bethesda, 2009).


http://www.nimh.nih.gov/statistics/images/NCS-R_BiopolarDisorder-Chart2-360.jpg
From the beginning, admittedly, belief in the existence of a Bipolar “cure” is fallacious, for no single treatment method has accelerated to such status. With that in mind, many refuters look down upon patients who are willing to take medication for the rest of their lives. Though so popular a statement, it is totally foolhardy, like saying someone with diabetes should be looked down upon for staying on their medications.  Credibly, the National Institute of Health (and all other credible sources in the psychiatric field) posits succinctly, “Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time”; then, to account for people’s misunderstanding, “Between episodes, many people with bipolar disorder are free of symptoms, but some people may have [normalized] lingering symptoms” (Bethesda, 2009). Essentially overlying all the environmental contributions which can worsen or better the Bipolar situation, thus, is strong hereditary research which directly correlates the imbalances of Bipolar Disorder with the engineering of brain activity (especially in the hippocampus and amygdala), and therefore there’s no shame in taking medication for the rest of one's life, if necessary (Martin, 2006).


 Many people insist that mentally ill people can train themselves to control their symptoms. But as empowering as “self-training” sounds, the idea is a fallacy that rests without any professional psychiatric endorsement.  Bipolar Disorder is a complicated disease caused by chemical imbalances in the brain; even mainstream psychiatric treatments that have been proven efficacious are only effective while in the patient’s maintained use. Nothing in medical history has ever advised “individual willpower” to be the ultimate synthesis for Bipolar Disorder. This myth likely derives partly from the misconception that being Bipolar means having mood swings all day, and that one is symptomatic all the time. But credibly, as formerly mentioned, we know such hypotheses (if they warrant even that label) have been disproved empirically by the greatest experts in psychiatry. Thus, while it might appear that someone has been controlling their Bipolar on their “own”, the reality is they’re just not manic. The Bipolar individual’s exasperated emotional state is not adept to rationally handle even very often what are perfectly normal, everyday burdens - Plain and simple!
          But once one can accept this knowledge, observational determinations about a given individual's recurrence of mania and depression (with main regards to lengths and strengths) can make these extreme episodes of uncharacteristic emotional scatter - and the more moderate but still off-steadying "lingering" symptoms in-between episodes, too - more predictable and, consecutively, more manageable, too. Referencing further, Dr. Bressert explains the beginning state of mania, in itself which personifies the initial unfamiliarity of self, citing, “An early sign of manic-depressive illness may be hypomania - a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior. Hypomania may feel good to the person who experiences it. Thus, the individual often will deny that anything is wrong ... [A]s with nearly all mental disorder diagnoses, the symptoms of manic depression must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” (Bressert, 2010). These guideline pointers are usually very useful.

    
 Bipolar’s central involvement in school and work performance, when apparent, tends to cause the most damage. It can cause temporary depression, disregard, inattentiveness, and strain for long periods. Hypothetically, a teenager could lose academic zeal during a manic state even if they usually flourish in school, and likewise with their social interactions, too. Accordingly, these people get so overwhelmed by their newest unique, suffocating anomaly of emotive battling inside themselves, that they actually become rude, irritable, totally unpleasant to be around, childishly joyful (at inappropriate times, like as a contributor to hyperactivity in school). As a terribly unhelpful addition, uniformly these manic phases always (almost) include some alteration in their sleep pattern, which can just exacerbate the symptomatic misbehavior (Bethesda, 2009). Thus, the bipolar individual will have much difficulty living up (or anywhere close) to his or her maximal function. If mental health professionals were just in on a lucrative scam with the Bipolar phenomenon, then why the many warnings of what does not implement Bipolar? “Symptoms also cannot be the result of substance use or abuse (e.g., alcohol, drugs, medications) or caused by a general medical condition” (Bressert, 2010). Sometimes, yes, unavoidable flaws in the system blaze the fire in patient frustration, and consequentially root the cause of psychiatric misconceptions (mania and aside). Particularly, Bipolar receives that assorted negative backslash when mishandled as the disorder which is sociologically burdened to overcome people's DEEP sensitivities: Attention Deficit DisorderTricky indeed, the main problem is that Bipolar, in its earliest manifestation in adolescence or young adulthood, seems to also have an adverse affect on school and work performance. Complicating matters, though, it so happens that decreased performance in work/school is one main symptom of ADD, too. Unfortunately, an initial ADD mislabel leads Bipolar persons to dismiss their temporal seizures of depression and mania - not to mention the tertiary inattentiveness that made for their misdiagnosis to begin with - regardless of their excessive time spent in episodic suffering, due to society's generalized disbelief in ADD. Most adults with Bipolar are already way too used to emotional instability, so that factor, on top of the rampant stigma on ADD that is, makes for a clear-cut systematic misunderstanding of the psychiatry's basis. Regardless of these complexes of pride and denial, the fact still remains that during manic and depressive phases, the typical bipolar individual just CANNOT distinguish between what is emotional stability versus an unstable emotional state, and why? 

       Easy: when a Bipolar individual is spiraling through their sporadic phase of mania (which, one must remember, is essentially nothing short of an extreme emotional disturbance), a significant impairment of their judgment is in sequence, though surely self-unrealized. Touching upon this complex, Dr. Martin - a leading researcher on bipolar disorder in children - in explaining the importance of psychiatric consultation, makes very specific implications, like his worry that many parents especially lose faith in the mental health system if it “failed". Naming anti-depressants the greatest stigma of mental health, Dr. Martin explains, “Medications such as corticosteroids, medical conditions such as thyroid disease, and neurological diseases such as Parkinson’s syndrome may present with features of bipolar disorder. The diagnosis of bipolar disorder is made only when none of these conditions are present” (Martin, 2006). Truthful to this across the epidemic of Bipolar Disorder, patients can be easily misdiagnosed as suffering from ADHD (most commonly guessed incorrectly if the child is early in hyperactivity of excess), chronic depression (if bouts of high mania are not carefully brought upon by identity), Obsessive Compulsive Disorder, even Borderline Personality Disorder (which attains some Bipolar-like traits). 

 
     Indisputably, the unproven common belief that “willpower” alone is enough to handle Bipolar disorder isn't anything but the senseless makings of a phenomenal societal distrust toward the field of professional psychiatry;The stigma is only helped by countless more in-detail lies, which all together make psychiatric patients less prone, sometimes, to seek out professional mental health assistance. Lack of real change from effective treatment will only mean a lack of real improvement, which will always be the continuous result of transgressing more energy into the misconceived oxymoron about this “curability in self-willfulness” nonsense. Philosophically speaking, what's simplistically discernible from all this, arguably, is the dismal realization appointing blame on society itself for allowing dangerous misconceived thoughts to proceed growth (Martin, 2006). It should be evident by now that the further one searches into Bipolar's depth, the more confirmation there is debunking the misconceptions. At front-line is the officiated separation of Bipolar into types: within the illness separate categories of manic depression - “Bipolar I” and “Bipolar II” respectively - interactively are the best tool to touch surface on estimating and learning more about someone’s Bipolar, individual life tolls. Psych Central’s “An Introduction to Bipolar Disorder” carves distinction between the two types: “I” is distinguished as consistent of, “[The] presence of only one Manic Episode and no past Major Depressive Episodes”, and also clarifies that "I" is the worse of the two.  Pointedly, the researcher defines an important key factor, recurrence, "...[A]s either a change in polarity from depression or an interval of at least 2 months without manic symptoms” (Bressert, 2010). Disassociated, Type “I” patient are broadly susceptible to intense mania and will rarely disengage into an unfixed, extreme depressive phases; “II”, interestingly enough, is as a converse easier defined, characterized by, “Presence (or history) of one or more Major Depressive Episodes and at least one Hypomanic Episode. In addition, there has never been a Manic Episode or a Mixed Episode” (Bressert, 2010). (See below for further elaboration.)


   A ‘hypomanic episode’ pertains to symptoms common in adolescent vulnerability, to young persons’ mentality ever-development, except never seeming to leave. Henceforth, the connotation medically separating “II” is its deemed limitation, 'hypo'. Notwithstanding, in many times decreasing the extraordinary deal of confusion on the topic, innovating research increasingly spreads the two farther apart: Type I's mania (or depression) surpasses all emotional escalation thinkable, and evidences to demonstrate itself as obviously not at all self-controllable; in fact, any sane person unbiased about mental health would surely agree to that in witness of ‘Type 1’ Bipolar people intoxicated in their mania, after watching their maneuvers down highly destructive paths which terminate to harm both for themselves and others, too. Cursed to suffer the results of their overbearingly emotive self-wars, ‘Type 1’ cases are basically at the mercy of a top-notch genetic predisposition to Bipolar; this extenuating hereditary vulnerability - alone the substance which establishes the need for a 'Type 1' differentiation in the first place - premises the Type 'I' cases an essential distinction: specially excruciating manic phasesNonetheless, unfathomable as it sounds, even the most compellingly written description of the implacable Bipolar mania specified to "Type 1" - the best summation ever detailing it, that even had the highhanded substantiation of the world's best psychiatrists - could just touch the tip of the iceberg ... Well, maybe (Martin, 2006). So with that noteworthy comparison in mind, how can we continue and not cease our societal distrust in the field of psychiatry - how?! Has most the western world lost perspective on the focal frontier behind a progressive, transient humanity? Lost the timeless, omnipresent goal to heighten the quality of human life, to achieve harmoniously existing societies within a man's lifetime? Is pride, learned stubbornness, denial (each a unique entrapment in ignorance, bold I venture) too precious to dispose of for the sake of betterment? 

         In conclusion, we live in a day where we should be grateful to have access to resources which, thanks to each concretion of progress in psychiatry, serve the needs of mental health. Instead, millions of importunate opponents have, in their refutation toward the psychiatric field, caused nugatory, infamous widespread denial over the reality of our certain psychiatric illness in question, despite irrefutable proof that it exists from the mental sufferings of 5.7 million Americans: Bipolar Disorder has inherited a cyclonic phenomena of disbelievers who promote inaccurate misconceptions that are suffice to uproar the public! Bipolar Disorder, a disease doubtlessly more serious than most moderate forms of visible physical harm (i.e. broken legs, leg rashes, acne), is, in proficient extent, much too severe for disregarding. The torment that everyone with Bipolar Disorder uncontrollably is guaranteed because of a mere genetic chemical imbalance remains just egregious, and the millions afflicted mustn't face it untreated! Let’s save these very sick individuals who misfortunately have inherited Bipolar Disorder, not stigmatize it! After all, Bipolar Disorder's misleading media attention has already made it the victim of accelerated vilification, inadvertently having singled it out for emphatic defamation by opponents to the entire mental health field. At end, the collective ideal, singular goal worth having is transparent as ever: as a re-inspired America, altogether we must unite against the barricade stopping mentally ill people from seeking professional help. After all, accept it or not, Bipolar Disorder, just like every other psychiatric ailment, affects EVERYONE in some way. 


   
 

References



American Psychiatric Association. (2005). Let’s Talk Facts about Bipolar DisorderWashington, DC: American Psychological Association.

Bethesda, MD. (2009). Bipolar Disorder in Children and Teens. National Institute of Mental Health. Retrieved on July 8, 2011 from

Bressert PH.D, S. (2010). An Introduction to Bipolar Disorder. Psych Central. Retrieved on July 8, 2011, from http://psychcentral.com/lib/2007/an-introduction-to-bipolar-

Caruso, K. (2009). Bipolar and Suicide. Suicide Prevention, Awareness, and Support. Retrieved on July 8, 2011, from  

Martin, B. (2006). Risk Factors for Bipolar Disorder. Psych Central. Retrieved on July 8, 2011, from http://psychcentral.com/lib/2006/risk-factors-for-bipolar-disorder

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