Understanding Bipolar Disorder
From the time Tracy was in early adolescence, she had “hyper” spells
for several days at a time. She would read two or three books at
once, cook large quantities of food even though she normally did
not like to cook, and go on buying sprees. At first, Tracy’s
family thought this was normal adolescent behavior. But after awhile
they began to notice that Tracy had low spells after her hyper periods.
She stayed in her room for several days and refuse to talk to anyone.
Her cycles became more intense and frequent until Tracy was finally
hospitalized for a suicide attempt during one of her depressed periods.
In another case, John started displaying an extremely high level
of energy, began sleeping less than three hours nightly, and started
talking excitedly about some big plans and ideas with nearly everyone
he met. One night he started running at 1:00 A.M. and ran until
he was so exhausted that he fell down and injured himself. Then
up the rest of the night writing 100 pages of fiction that he was
convinced would be published. The next morning he did not feel
Tracy and John were both suffering from bipolar disorder—one
of the most perplexing and severe psychiatric adjustment conditions,
and one that can cause incredible suffering for the individual and
his friends and family.
Formerly known as manic depression, bipolar disorder gets its
name from the unpredictable mood swings ranging from the pole
highs (mania) to the pole of deep lows (depression).
Imagine the emotional high you feel after a very positive event—like
receiving an award at work, falling in love, or reaching the top
of a mountain you’ve climbed. Then multiply the intensity of
that feeling three or four times, speed it up to “fast forward,” triple
your energy level, and imagine feeling that way around the clock
for days, weeks, or even months until you collapse from exhaustion.
This is a little of what mania feels like.
one person of
every one hundred suffers
from bipolar disorder."
What’s the problem with having so much energy? here’s the problem:
First, you are probably doing a lot of exaggerated, unwise things during your
manic state. Many of your ideas are unrealistic and your perpetual motion and
excited, exaggerated talking tend to alienate even the best of friends. Second,
your high to end. When it does, you come crashing into deep depression. Ten to
fifteen percent of people with bipolar disorder end up committing suicide. Tracy,
for example, whom we introduced at the beginning of this booklet, became suicidally
depressed after she came down from a manic episode. “There’s no hope,” she
said. “My mood swings just get worse and worse, and I’ll never have
a normal life.” She lost interest in most things and slept through of the
day, finally trying to “end it all.”
At least one person of every one hundred suffers from bipolar
disorder. The illness typically begins in the late teens or early
twenties with men
first have an episode of mania, and women more likely to first experience
a depressive phase. The earlier bipolar disorder begins, the more severe
course of the
disorder tends to be.
Unmanaged bipolar disorder wreaks havoc in one’s personal, vocational,
and family life, and the symptoms recur throughout a person’s life. Over
a ten-year period, people with bipolar disorder experience an average of four
episodes and five hospitalizations. Even those who have few repeated crises can
experience significant ongoing problems between full-blown episodes.
The good news is that bipolar disorder is one of the most treatable
of mental disturbances and not all people suffering serious
fall into the
extreme disturbances of bipolar disorder. Some suffer from cyclothymic
disorder, a less
severe problem with fluctuating moods that last for shorter periods and
are much less debilitating.
Although bipolar disorder causes significant disruption in the
life, many people with mild to moderate forms of the disorder are exceptionally
creative and forceful leaders. In fact, some of history’s most influential
figures have been retrospectively judged to have suffered from bipolar disorder
or some other closely related emotional disorder. Among them are political figures
like Winston Churchill, Daniel Webster and Benito Mussolini. Religious leaders
like Joseph Smith (founder of Mormonism), William Cowper (poet and hymnwriter),
and C.T. Studd (founder of the student missionary movement) all seem to have
suffered from bipolar disorder.
People in a “manic episode” are excessively elated, irritable, moody,
and energetic. They have little need for sleep (two to three hours per night
is common), have rapid and pressured speech, racing thoughts, and may jump abruptly
to unrelated topics without transitions. They are also distractible and impulsive.
Some drive recklessly. Others go on wild spending sprees, running up thousands
of dollars on credit cards or bouncing check after check. Many have an exaggerated
sense of their importance and abilities.
In milder manic episodes, the increased energy, rapid thinking,
and limited need for sleep can temporarily lead to incredible productivity.
People can also become extremely outgoing and sociable and may be
convinced that they are brilliant conversationalists or the life
of the party.
In severe manic episodes, people with bipolar disorder become
psychotic; that is, their thought processes and ability to
judge reality are
radically impaired. They may begin by being slightly overconfident
about their abilities, eventually becoming convinced that they can
predict the future or run the country. Sometimes Christians in a
manic phase may stop their regular responsibilities and intensely
read the Bible or talk to one person after another about God for
hours and hours.
Jerry, for example, ran a small but successful shoe store for
nearly ten years. Then he entered a manic state and started
plans for expanding his business. He was convinced he had a plan
that would corner the market in his entire state, and probably the
entire United States. He rented space for two dozen more stores and
ordered tens of thousands of pairs of shoes before his family could
stop him. Fortunately, his wife was able to make arrangements to
nullify the new building leases and return the shoes to the manufacturer
before the family and the business went completely bankrupt!
The elevated, expansive mood that is part of bipolar disorder
is often difficult to diagnose at first. Many people think
a manic person
is simply a very happy, high-energy, elated person. They do not recognize
that the mania may also cause the person to be paranoid, irritable,
and excessively intense. Mild mania is easily confused with normal
Like Tracy, some people with the disorder have to see many different
doctors over a period of several years before someone diagnoses the
real cause of their problems.
Depressive episodes of bipolar illness are characterized by the
opposite of the manic pole of the emotional continuum. People
episodes feel sad and depressed. They have low energy levels, an
increase or decrease in sleep, loss of interest in enjoyable activities,
feelings of worthlessness, difficulty concentrating, and suicidal
thoughts. Christians in a depressed state typically feel incredibly
guilty and self-condemning and may be convinced that God couldn’t
love them or that they have lost their salvation.
with the disorder have
to see many different doctors over
a period of several years before
someone diagnoses the real cause."
Some typically alternate between the extreme
moods of mania, depression and normality. Occasionally, however,
both the mania
at the same time. This is referred to as a “mixed episode.” Such
an episode is characterized by irritability, anxiety, feelings of worthlessness,
and sometimes suicidal thoughts accompanied by high energy and activity levels,
decreased sleep, and impulsive behavior. Mixed episodes can be extremely dangerous
if the person is suicidal, because the manic symptoms may give a person enough
energy to carry out the suicide plans which the depression has triggered.
Both manic and depressive episodes place incredible stress on
friends and family. Since people in a manic state can be unreasonable,
emotional, and impulsive,
family members fear they will do something hurtful or disastrous. They may
get the family into serious debt, have several affairs, quit their jobs, and
engage in other foolish behavior. Family members of those in a depressed state
can become extremely frustrated when, time after time, their efforts to support
and encourage them are rejected and rebuffed.
Currently, we do not have a clear understanding of precisely
what causes bipolar disorder. The higher frequency of bipolar
disorder among first degree relatives,
however, strongly suggests a genetic basis as a major, if not the major factor
in causing the disorder. Coupled with this genetic predisposition may be other
physiological factors, as well as long-standing emotional conflicts.
From a spiritual perspective, while all human problems ultimately
stem from the disobedience of Adam and Eve which brought sin
and evil into society and
into individual’s lives, there does not appear to be any particular sin
problems in the lives most of people suffering from bipolar disorder. Many
fine Christians struggle for much of their lives with this distressing difficulty.
When Christians suffer from bipolar illness,
they usually experience major shifts in their spiritual life.
During manic states they
can be excited and
extra visionary, throwing themselves into Bible study, witnessing, or ministry
with nearly superhuman effort. They are sure that God has given them a special
plan. Then, during depressed states, they become lethargic, guilt-ridden, and
even hopeless about having a relationship with God at all.
One of the most difficult things about treating bipolar disorder
is that there is no complete “cure.” However, while bipolar disorder is difficult
to deal with, it is also true that this problem can usually be effectively
managed with proper professional care over the long term. Medication, psychotherapy,
and lifestyle changes minimize and overcome the most devastating effects of
this disorder and enable the sufferers to generally live normal lives at home,
work, school, and church. Treatment, however, must be planned for the rest
of a person’s life, and it nearly always involves taking medication for
many years. Although this can be difficult for bipolar patients and their family
members to accept, it is absolutely essential.
The current drug treatments for bipolar disorder typically include
what are referred to as mood stabilizers—usually lithium carbonate,
divalproex sodium (Depakote), or carbamazepine (Tegretol). Depending
on a number of factors such as the specifics of the person’s
symptoms and the stage of the disorder, the physician may also prescribe
antipsychotic, antidepressant, or antianxiety medication.
While medications do not work perfectly, they help a substantial
percentage of people. Approximately 50 to 70 percent of people in
a manic state are helped by lithium. Unfortunately, many bipolar
patients don’t stay on their medications. Some miss the “high” they
experienced during manic episodes and want to return to a state in
which they felt on top of the world. Others are bothered by unpleasant
side effects like weight gain, memory or concentration problems,
and tremors. Others who begin to feel better assume they do not need
to continue with medication, and quit without consulting their physician.
One of the most helpful things family members can do for a person
suffering from a bipolar disorder is to help him keep taking his
medication. If you are close to someone with this disorder, encourage
him or her to begin or continue psychotherapy and learn to deal with
these issues. This will help the person accept dependence on medication
and treatment—which could be life-saving.
One of the critical issues at the beginning of treatment is to
address any drug abuse. Fifty to sixty-five percent of people
disorder abuse drugs—usually stimulants like cocaine or amphetamines,
or depressants such as alcohol. They use these drugs for several
reasons—especially to recreate the “high” of a
manic episode, or to relieve their depression. Drug use may also
be caused by the impulsive pleasure-seeking of a manic episode. Good
treatment always includes attention to drug abuse because it will
sabotage any efforts to manage the disorder.
psychotherapy and lifestyle
changes minimize and overcome the
most devastating effects of this disorder
and generally enable the sufferers to
live normal lives at home, work, school."
Psychotherapy is an essential complement to medical treatment
for people with bipolar disorder. Professional counseling helps
deal with the emotional
problems and stressors that trigger the onset of manic or depressive episodes.
It can also resolve many of the unstable relational problems, internal struggles,
and depressive moods that accompany acute phases of the disorder. Medication
alone does not have nearly the positive effect as medication combined with
good, long-term, ongoing psychotherapy.
In addition to working closely with a psychiatrist, being faithful
in taking prescribed medication and receiving psychotherapy,
there are several lifestyle
changes that can help people manage their bipolar disorder:
- Abstain from the use of all drugs or alcohol. Stimulants can
trigger a depressed bipolar person to flip into a manic episode,
while sedatives can trigger a
- Get regular sleep. Bipolar disorder is closely tied to a person’s core
body rhythms. While a manic episode can change a person’s sleep patterns,
changes in sleep can also trigger a manic episode.
- Minimize caffeine intake. This can also indirectly trigger
a manic episode.
- Educate oneself and one’s family about the disorder.
Then work together to prevent stresses that trigger recurrences.
- Discuss with family members ahead of time a plan of action.
It helps to deal with future episodes ahead of time. This is
most effectively when the
bipolar person’s insight and judgment are not impaired during the
middle of an acute manic episode.
- Join a support group. This should include both close Christian
friends who can offer regular spiritual support, and a
support group with other
with bipolar disorders along with and their family members. Since people
with bipolar disorders often feel that no one understands their mood
erratic behavior, support from others who have had similar experiences
can be very helpful.
People suffering from bipolar disorders can go through periods
of incredible suffering, as can their families. With competent,
thorough, and consistent
counseling, medication, and practical lifestyle choices, however, they can
lead very successful and meaningful lives.
Frequently Asked Questions About Bipolar Disorder
1. What causes it? Physiological factors appear to play the
most important role in causing bipolar disorder. There is
some evidence of a genetic link.
Emotional factors, however, such as excessive stress and loss of close
relationships, can trigger the disorder.
2. Can it be cured? There is no absolute cure for bipolar illness.
Most sufferers, however, can remain relatively symptom free if they
comply rigidly with their medical regime, receive competent, ongoing
psychotherapy by a therapist who understands the depth issues of
the disorder, and adjust their lifestyle (e.g. absolutely no alcohol
or non-prescription drugs).
3. Can a person with bipolar disorder keep his/her job? By all
means. People who are compliant with medications, continue
and adjust their lifestyle are able to live normally for most of
their lives. If or when they do have recurrences, family understanding
and proper medication can generally restabilize them in a relatively
short period of time.
4. Does bipolar illness involve demon possession? No. Many committed
Christians suffer from bipolar disorder and, like non-Christians,
they respond to medications like lithium carbonate. When a person
responds to medications, that is clear evidence that the problem
is physical or emotional—not a matter of demon possession.
5. Are there any side effects of the medical treatments for
bipolar disorder? Yes, there often are. But the consequences
of not taking
medication may literally be death by suicide or impulsive, dangerous
behavior. The person must stay on his or her medication.
6. How long does it take for medication to work? Often within
one week of beginning treatment. On lithium carbonate, however,
many medications, it may take much longer to find precisely the correct
dosage. The correct dosage is the one that provides optimal relief
of symptoms with a minimum of side effects.
7. How can psychotherapy help? First, by helping patients understand
the disorder and learn the importance of taking medication regularly.
Second, by helping patients accept themselves with their disorder.
Illnesses such as bipolar disorder can tear at one’s self-esteem
and make one feel lonely, isolated, and cut off from others. Third,
by helping patients grow stronger emotionally, and learn to regulate
their moods and handle the conflicts and stresses that can precipitate
an acute phase of the disorder. Psychotherapy can also assist patients
and their families to deal with family struggles better and to work
together to control the patients’ illnesses.
suffering from bipolar illnesses
and their family members can receive
great strength from their faith in Christ
as well as their dependence on the
Word of God. Christian fellowship
also provides much-needed support."
8. How can I help a family member with bipolar
illness? Get professional help for that person as soon as you see
a manic or depressive episode
Help him or her comply with medical treatment. Be patient and encourage that
person to accept him/herself with the disorder. Pray for him. If your family
member becomes suicidal or a danger to himself or others, get help immediately
from the police or other crisis team.
9. Can’t God heal bipolar illness? Yes, He can. But He rarely does that
apart from medication and the counseling and personal growth that comes from
facing one’s suffering. People suffering from bipolar illnesses and their
family members can receive great strength from their faith in Christ as well
as their dependence on the Word of God.
Christian fellowship also provides
much-needed support. The result is that patients can grow incredibly by learning
to accept and face their suffering as part of living in a fallen, sinful
world. They can also learn to help others as a result of out
of their own suffering.
And they can have lasting hope that the best of life is yet to come—life
in eternity with our Heavenly Father. Faith, in other words, can help people
live well with their disorder.
One Book You Must Read
One book is a must read for anyone suffering from bipolar disorder,
as well as the members of his or her family. It is written
by a professor of psychiatry
at Johns Hopkins School of Medicine who personally suffers from bipolar
disorder. It is a beautifully written, professionally accurate,
moving personal account
of learning to live well with bipolar illness. The author does not indicate
that she is a Christian, but the book can be extraordinarily helpful to
Christians as well as non-Christians. Do not miss this book!
An Unquiet Mind by Kay
Rafield Jameson, Vintage Books, New York, 1996.
Other Helpful Resources
Depression and Anxiety Library
National Alliance for the Mentally (NAMI)
200 North Glebe Road, Suite 1015
Arlington, VA 22203-3754
(703) 524-7600 (800) 950-NAMI
Depression and Bipolar Support Alliance
730 North Franklin Street, Suite 501
Chicago, IL 60610
(312) 642-7243 (800) 826-3632
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