Columns

This week I’m focusing on the difficulties of being bipolar, because so far I have given more attention to schizophrenic illness (due to the bias of convenience). Bipolar is sometimes thought to be a less severe disease than schizophrenia. People may believe this because bipolar people are more commonly brilliant or talented, while people with schizophrenia sometimes appear dull. (I have been told by a doctor that intelligence level is a separate issue from having or not having schizophrenia; yet schizophrenia affects the “harnessing” of intelligence.) 

According to a psychiatrist who lectured at a NAMI meeting, people with bipolar lose functioning levels with increasing age, and with the wear and tear of repeated manic episodes. And this appears to be the opposite from people with schizophrenia, who are said to get “a reprieve” from the severity of their illness when old age approaches. 

An episode of mania can be triggered by a few nights of insomnia, or it can occur for unknown reasons. This assumes that the person with bipolar is medication compliant. A manic episode can last a few weeks, or it can go on for months. A depressive episode can last more than a year, or sometimes can be over in a month or two. Manic episodes often include unusually high energy levels, rapid speech, exaggerated emotions and thoughts, extreme irritability, and can sometimes include becoming psychotic. Psychiatrists will often prescribe an anti-psychotic medication in an effort to control a manic episode. 

For a person with bipolar going through mood swings, it is helpful when a good psychiatrist is very available, which is rare. A very “hands on” psychiatrist can adjust the medications according to what part of the cycle the patient is at, at any given time. However, this much availability is rare on an outpatient basis. (Most Kaiser and some County psychiatrists limit their visits with a patient to about fifteen minutes once a month.) 

Sometimes it is challenging for a psychiatrist to treat depression in a person with bipolar because if they are too aggressive with antidepressants, it can trigger a manic episode. 

Persons with bipolar can have a lonely time at night if their illness keeps them awake at all hours. Often but not always, the depressive phase of the illness is less intense than the mania, but lasts longer. Sometimes treatment professionals mistakenly believe a person strictly has depression because they are dealing with someone who has a very long cycle. 

A person with bipolar may have periods of being in an “even keel.” During such times, a regular job becomes more plausible. If the person is up or down a lot, or has too much anxiety, they may need to avoid commitments. When not sleeping, it can be hard to avoid grouchiness. Someone with bipolar who works may require extra sick days, and this can be detrimental for their chances of holding a job. 

One of the biggest challenges of being bipolar or of having any mental illness for that matter is that you discover people are not your friend any more. When people find out that you’re bipolar, they automatically may think you’re “weird” or they may just write you off as someone who, to them, is no longer on their map. When someone becomes bipolar a little later in life, they may lose some of the “good things in life” that they took for granted. For example, a person’s spouse may leave, and that spouse may get custody of the children in the family. 

A woman I interviewed for this week’s column, as a result of a later onset of the illness, became divorced, lost custody of one of her two children, lost her job in a very respected profession, and lost most of her friends. She continues to be in jeopardy of losing her house, which for her, is the last remnant of the life she once knew. She also said that the severe depression she experienced was the worst part of being bipolar, and that even on a good day, it is hard to focus. She used to be an avid reader, and now barely picks up a book. 

With any mental illness whether bipolar, schizophrenia or depression, a later onset in life can be harder, because one had become accustomed to the good things that most people take for granted, and which are often out of reach of persons with mental illness.