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Bipolar disorder: More than a punchline

Sunday, November 18, 2007

Dr. Kishore Khot is a psychiatrist at the Community Counseling Center in Cape.
For a recent "Tonight Show" skit, Jay Leno held up a bag of "Nutty" brand pancake mix. That's not truth in labeling, the comedian said, turning the package around. On that side the brand name was "Bipolar."

At least people who have bipolar disorder weren't laughing.

A powerful stigma is attached to being bipolar. "The stigma is that everybody who's bipolar could go wild," said Sue Floyd, a board member of the Depression Bipolar Support Alliance in Cape Gir?ardeau.

Many people don't understand the disorder and its varying severity. Their first impulse is to stay away from someone who's bipolar. People who have the disorder fear that reaction. That's one of the problems with Leno's joke.

"If people are laughed at, it's just going to drive them back in their shell," said Dr. Kishore Khot, a psychiatrist at the Community Counseling Center in Cape Girardeau.

An estimated 3 percent of the U.S. population has bipolar disorder, and the diagnoses numbers are increasing, especially among children. Adult cases doubled between 1994 and 2003. In the past decade the diagnosis of bipolar disorder among children in the U.S. has increased 40-fold.

According to a report recently published in the Archives of General Psychiatry, "Either bipolar disorder was historically underdiagnosed in children and adolescents and that problem has now been rectified, or bipolar disorder is currently being overdiagnosed in this age group."

Missouri's Department of Mental Health saw 3,227 people whose diagnosis included bipolar disorder in 1995. In 2006, the number had more than doubled to 7,243. Part of the increase could be due to the expansion of community outreach services that has accompanied the shrinkage of the state hospital system during that period, but the numbers are in line with national statistics.

In famous company

Long known as manic depression, the disorder remains misunderstood outside the mental health community. Many who have bipolar disorder can be treated with medication and psychotherapy and can hold jobs. They're in famous company. Ted Turner, Dick Cavett, Peter Gabriel, Charley Pride and Patty Duke have talked about their bipolar disorder. In an analysis of the lives of artists and manic-depression, psychologist Kay Jamison counts George Frederick Handel, Peter Tchaikovsky, Irving Berlin, Cole Porter, Herman Melville, F. Scott Fitzgerald, Charles Dickens, Mark Twain and many others as manic-depressives.

Bipolar disorder is a chronic illness like diabetes or hypertension. The term comes from the switch between depressed and manic states. People who are bipolar have had at least one manic episode during their lives. During that four-to-seven-day period they are overloaded with energy. They have trouble sleeping, can be agitated and irritable. "They start indulging in activities that might seem pleasurable, such as spending sprees or increased sexual activity," Khot said.

There are two types of bipolar disorder. In bipolar I, the most serious type that affects 0.4 to 1.6 percent of adults, symptoms include grandiosity, invincibility, racing thoughts, sleeplessness and impaired judgment. People with bipolar I can be dangerous to themselves and others. When manic they can behave recklessly. Fifteen percent commit suicide, accounting for nearly half the suicides in the U.S. Kurt Cobain, Ernest Hemingway and Virginia Woolf were manic-depressives.

Bipolar II, found in 0.5 percent of the population, is indicated by a slight high and deep depression. There are varieties. Some people cycle up and down rapidly all the time. People with mixed bipolar are up and down at the same time. Another diagnosis is so individualized that it doesn't fit into the other categories but is still considered bipolar. Yet another, called cyclothymia, involves only mild mood swings.

The cause of bipolar disorder is undetermined. A genetic tendency seems clear because the disorder seems to run in families. It can, however, skip generations.

Stress is one trigger of bipolar episodes, said Dr. Prabhakar S. Kamath, a Cape Girardeau psychiatrist. Kamath thinks an overload of emotions is involved in bipolar disorder. His book, "Is Your Balloon About to Pop?," likens the mind to a balloon that keeps filling and filling with emotions until release is inevitable. "The result is like the household voltage going up from the usual 120 volts to 300, 400, 500 or even 600 volts," he writes.

The person is burying feelings rather than dealing with them and will tell you nothing is going on their life, Kamath said. "They are masters of self-deception."

But Khot said episodes sometimes occur in the absence of stress. "It's not clear what the triggers are," he said.

Sent to an institution

Belinda (not her real name), a 54-year-old Cape Girardeau housewife, was not diagnosed with bipolar I until 2000. But her first episode occurred when she was 18 -- close to the median onset age of 20 -- while living in Louisiana. Her suspicious father was waiting when she got home the night she lost her virginity. He slapped her and went looking for the boy with his shotgun.

She experienced what was then called a nervous breakdown. The next day Belinda wore her prom dress waiting for her Prince Charming to rescue her. Three months later her family sent her to a state mental institution in Mandeville.

At Mandeville, Belinda was forced naked into isolation, where she had to urinate and defecate on the floor. A doctor sexually abused her, she said. She had no diagnosis and was hospitalized twice more before marrying a man in the military. He authorized shock treatments for her. They had four children before divorcing.

People with bipolar I have difficulty holding jobs and handling their personal lives. Belinda has had many jobs: housekeeper, real estate broker, health-care administrative assistant and temp. She has worked for two accounting firms. The job she liked best was as a deputy clerk for a circuit clerk, but she couldn't type fast enough to keep up. She was fired from her most recent job in August.

Ray (not his real name) is Belinda's fourth husband. They met in 1996 when he was managing a grocery store in northern Missouri. When they married, she told him about her teenage episode.

"I didn't think anything was wrong," he said.

But Belinda soon became withdrawn. "I got scared," Ray said. "I thought, 'Marriage isn't going to work. My wife doesn't like me anymore.'"

During one manic episode she went on a buying spree, covering the deck of their house with flats of flowers. She bought bunches of pinwheel toys. "I didn't know I was acting weird," she said. "You think you're fine. Somebody has to tell you."

In 1999, her doctor put Belinda on a suicide watch and said she could no longer drive a car. "She said, 'You are like someone with ADHD,'" Belinda said.

After a hospitalization for depression her doctor told her she should not go back to work. That provoked a manic episode. Not working stresses her, she said. "I'm used to bringing my share to the table."

Stress triggers her episodes. She was hospitalized after the terrorist attacks on Sept. 11, 2001. She has been hospitalized twice this year. Each episode lasts three months. Violence has never been part of one. "I think it would have to be in your nature to do that," she said.

Belinda's conversation can be difficult to follow. "It's like a tree. It branches off and branches off," Ray said. "Anytime she goes to tell me something I don't know where the point has gone."

For better or worse

All of Belinda's children are grown and on their own now. She said two have accepted her condition and two don't want to talk about it.

"It takes a lot to live with a person like this," she said. "I don't know if I could do it."

Ray says he can. "Do I understand the disease? No. Do I accept it? Yes. It would be the same as if another person had developed diabetes," he said. "I'll take her for better or worse."

Ray commutes more than an hour to the grocery store he manages. He can't find as good a job nearer to home and needs the health benefits. Each hospitalization for Belinda sets them back financially. Some people with bipolar disorder qualify for state disability benefits. Belinda's application was denied, and her appeal won't be heard until spring. In the meantime they're in danger of losing their house.

"To keep her I'll lose it," Ray said.

Part of the difficulty in treating bipolar disorder is that people who start feeling better because of their medication want to stop taking it.

Khot said many people with bipolar disorder are walking around undiagnosed. Some self-medicate with alcohol and drugs, which actually can trigger episodes. "They don't want to go to a psychiatrist -- especially males," he said.

Treatment includes medication and psychotherapy. All the medications have side effects, including fatigue, weight gain and stiffness of hands and legs.

Lithium, a medicine that has been around for many years, is still the gold standard for treating bipolar disorder. Some patients take a cocktail of three or four medications to control the disorder, but Khot said he always starts by prescribing just one and assessing its effect.

One of Khot's medical school colleagues had bipolar disorder. The surgeon found a medication that worked but made him sleepy and made his hands shake. "You can imagine a surgical resident whose hands are shaking," Khot said. "It works, but does it really work?"

Kamath thinks bipolar disorder is being overdiagnosed. Despite the inferences of advertisements, people who have mood swings are not bipolar, he said. "Thanks to the drug companies, we are now on the verge of becoming a bipolar nation," he writes in his book.

Local help

Help is available through the Depression Bipolar Support Alliance. The group meets at 7 p.m. the fourth Monday of every month in the Assisi Room at Saint Francis Medical Center. The phone number is 334-1100.

Jennifer (not her real name) attends the support group meetings. She originally was diagnosed with schizophrenia, then post-partum depression. "Early on I didn't think they knew what they were talking about," she said.

She didn't take the medications prescribed and had manic episodes that sent her to the state mental facility in Farmington.

"Initially it feels good, better than I ever felt," she said. "I was real elated, real talkative. Then I start to come down and have hallucinations.

"It's like living a nightmare in real life."

Her manic process takes three weeks, and the state hospital in Farmington requires people who are admitted to stay a month. "That's two months out of your life," Jennifer said. "I'm usually begging to get out."

Her last stay was 14 years ago. She works part time and doubts she could handle the stress of a full-time job.

Bipolar disorder can be treated but can get worse if left untreated. "It is not a crazy disorder," Khot said. "People don't have to think they're going crazy. This is an illness that can be treated."


335-6611, extension 137

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Interesting article!

-- Posted by coke zero on Sun, Nov 18, 2007, at 3:07 AM

It is important to remember that people who seek help are not the ones to worry about. It is those who don't that can lead to trouble.

-- Posted by SWBG on Sun, Nov 18, 2007, at 7:35 AM

"Either bipolar disorder was historically underdiagnosed in children and adolescents and that problem has now been rectified, or bipolar disorder is currently being overdiagnosed in this age group." Ya think? Come on folks. Everyone that acts out, does something crazy to get attention gets their pass, a bi-polar diagnosis which essentially says they can't help it. There is certainly a very small portion of the population that truly have mental health problems but now their are so many "mental health professionals" trying to make some money that a bi-polar diagnosis is just one Dr. visit away. Like ADHD lots of expensive drugs are prescribed, dosages changed and then other drugs and Dr. visits are required. Lots of money is made but is anyone truly helped?

-- Posted by stevmo on Sun, Nov 18, 2007, at 9:54 AM

Read the article stev mo....there are criteria needed to diagnose Bipolar Disorder ! You seem to have the same mindset like Jay leno!

-- Posted by orangeinsight on Sun, Nov 18, 2007, at 10:13 AM

I found this a very interesting article.

I have been trying to get some answers for two members of my family who have been diagnosed with Bi-Polar disorder.

stev mo, I felt the same as you, but in my research, I have found some very interesting things. Has any of our local doctors checked into the nutritional aspect of this disease? I am specifically referring to the Magnesium and Calcium Balance. I went to a website yesterday and read an article on the subject of how much stress effects our lives. How many of us today live with much more stress than we should have to deal with?

Peter Gillham's article "The Important Role of Nutritional Magnesium and Calcium Balance in Humans Living with Stress" is a very interesting article. You can find it at: www.petergillham.com

I know that this disease has been in my family for several generations. I remember as a small child wondering what was wrong with my grandfather. He had very irrational behavior and you could see in his eyes that he was searching for help. It was the look in his eyes that I will never forget.

So yes, I realize that many people today might be misdiagnosed and put on drugs that are doing more harm than good, but I also know that there are people who suffer from this disorder. I pray that there is an answer found for them.

I personally believe that there should be more research done to find out if Bi-Polar disorder possibly could be linked to a nutritional deficiency.

I know there is not the big money to be made with natural remedies since the pharmacutical companies cannot make money off of natural cures, but I am hoping that there are some doctors who do not care about the money part as much as they care about seeing individuals live a healthy, productive life.

-- Posted by newsong on Sun, Nov 18, 2007, at 11:02 AM

If you can have a 40 fold increase in the bi-polar diagnosis in a ten year period the diagnosis obviously means nothing. What once was bad behavior is now bp. Anti social? Self destructive? Doing poorly at school or your job? Trouble focusing? It can all be bi-polar. Most of this is about money not medicine.

-- Posted by stevmo on Sun, Nov 18, 2007, at 11:13 AM

I'm not bipolar.

-- Posted by Professor_Bubba on Sun, Nov 18, 2007, at 11:21 AM

Me niether.

-- Posted by Professor_Bubba on Sun, Nov 18, 2007, at 11:22 AM

But we may be schizophrenic.

-- Posted by Professor_Bubba on Sun, Nov 18, 2007, at 11:22 AM

Peter Gabriel has never been quoted as having bipolar disorder.

-- Posted by sueklaus on Sun, Nov 18, 2007, at 11:22 AM



-- Posted by coke zero on Sun, Nov 18, 2007, at 7:51 PM

Steve Mo, you have obviously never struggled with a mental disorder. Your comments are an example of the ignorance of some people, who do not understand mental illness. i agree with you that i think bipolar disorder is being overdiagnosed in children. But i completly disagree with you that people who are diagnosed with bipolar disorder are trying to get attention. I was diagnosed with bipolar disorder when I was 15 yrs old. I am not sure if I actually have bipolar disorder. But, i definetly have depression. In all due respect, I am very dissapointed in people like you who are so extremely ignorant.

-- Posted by bsw on Mon, Nov 19, 2007, at 3:10 AM

Steve Mo, you have obviously never struggled with a mental disorder. Your comments are an example of the ignorance of some people, who do not understand mental illness. i agree with you that i think bipolar disorder is being overdiagnosed in children. But i completly disagree with you that people who are diagnosed with bipolar disorder are trying to get attention. I was diagnosed with bipolar disorder when I was 15 yrs old. I am not sure if I actually have bipolar disorder. But, i definetly have depression. In all due respect, I am very dissapointed in people like you who are so extremely ignorant.

-- Posted by bsw on Mon, Nov 19, 2007, at 3:11 AM

Interesting article...thank you for writing it...this is NOT a topic for anyone to find humor in...I hope research continues in this area so that more people can get help.

-- Posted by AlwaysHelping on Tue, Nov 20, 2007, at 10:14 AM

I imagine some Bi Polar people would have been offended by that joke, but I'd guess at least as many would not have been. Some people, including Bi Polar types, just don't have a sense of humour. In fact, it seems to me that the people most likely to be offended by jokes about illness are the Politically Correct folk who think they know what's best for us ill folk! Bi Polar people, like a lot of depressed people can and will laugh at themselves and their condition because it's a way of belittling its impact on us (I'm Bi Polar.) It makes sense since humour helps us cope with feeling very depressed. After all, laughter IS the best medicine!

-- Posted by harryf200 on Fri, Nov 23, 2007, at 1:55 PM

Well it may be the case in the USA that doctors are diagnosing mental illness to make extra $$$s but that can't be the case in the UK because there is no financial gain for them to do so. The psychiatrists, whuich are in short supply, get paid a fixed salary from the National Health Service and we patients don't have to pay a penny towards our treatment (save for income tax, of course.) However, the rates of mental illness in the UK appear to be very similar to those in the USA. Hmmm... methinks you guys may be seriously under estimating the honesty of your medical professionals ... just because there are some bad apples in the barrel doesn't mean all the apples in the barrel are bad, y'know!

-- Posted by harryf200 on Fri, Nov 23, 2007, at 3:17 PM

This was a very interesting article. I also have Bipolar disorder. And yes my symptoms include grandiosity, invincibility, racing thoughts, sleeplessness, impaired judgment, and recklessness. It can be hard thing to live with sometimes. The manic days are good for me, but the bad days can be very sad. I have friends that understand and work with me when I'm haveing bad days. I was lucky that the Power of Rock N Roll has saved me many times. When medication just left me zombiefied, I quit takeing it. I found other means to self medicate with much better results. And when things look bad, I just turn up the music! Thanks for running this story.

-- Posted by timexx on Sun, Nov 25, 2007, at 12:46 PM

There is still a lot of stigma attached to mental illness. A lot of people suffering from mental illnesses do not seek help because they fear they will be ridiculed. So whereas a joke may seem harmless to the majority of people it will further reinforce this stigma. Imagine making fun of a diabetic or a hypertensive patient!

harryf2000 and steve mo.......most of the physicians i know in this area work on a fixed salary. They do not get paid more to diagnose or treat patients. There has been an increase in children being diagnosed Bipolar but what is being discussed in the article including the symptoms and treatment is of Adult Bipolar Disorder. Research is s till being done on childhood bipolar disorder.

Timexx if the medication for bipolar is making you zombiefied talk to your physician about it instead of self medicating.There are other treatment options.Cheers!

-- Posted by orangeinsight on Sun, Nov 25, 2007, at 3:26 PM

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