Acknowledgments
I offer thanks to my incredibly talented medical team at Group Health Cooperative in Seattle, including my psychiatrist Dr. Donna Lohmann, my psychotherapist Mike Welsch, MSW, and retired psychiatric nurse Mary Louise. From them I learned how to survive and thrive while living with bipolar disorder, and the ten steps in this book grew out of the years of care they have given and continue to give me. Skilled, patient, kind, and supportive, they taught me to trust my instincts and believe in myself.
To the members of the online support group at DailyStrength.org, thank you for your stories, support, and ideas. Thanks to National Alliance on Mental Illness (NAMI) and Depression and Bipolar Support Alliance (DBSA) for providing me with support and up-to-date information, and also for giving me the opportunity to influence policy affecting services to the mentally ill.
Thanks to my students for being patient, caring, and understanding and for giving me the freedom to be me by accepting me as I am.
Thanks to Dr. Steve Hinshaw, dean of the Department of Psychology at the University of California, Berkeley, who believed, and helped me believe, that my story could benefit the profession and those living with bipolar disorder.
Thanks to Kristen, Geoff, Donna, Sanyu, and Melissa for taking care of Maya and me when I could barely take care of myself. Thanks to Keith for your love, kindness, gentleness, support, and acceptance. Lastly, I thank my daughter Maya, who believes that no matter how crazy our world gets, I am still the best mommy in the world; and if I am, it is because she is my reason for living when all other reasons seem to no longer apply.
Ruth C. White
Ruth C. White, Ph.D., MPH, MSW, is assistant professor of social work at Seattle University in Seattle, WA. She has worked in mental health for many years, and for the last seven years has taught and trained social workers as a member of the faculty of the College of Arts and Sciences of Seattle University. White has also taught at McGill University in Montreal, QC, Canada, San Francisco State University, and the University of California, Berkeley, where she received her doctorate in social welfare. She is a member of the National Speakers Bureau of the Depression and Bipolar Support Alliance. Visit her online at www.ruthcwhite.com.
John D. Preston, Psy.D., ABPP, is a licensed psychologist and professor of psychology at the Sacramento, CA, campus of Alliant International University. He has served on the faculty of the University of California, Davis, School of Medicine and has lectured widely in the United States and abroad. Preston is the recipient of the Mental Health Association Presidents Award for contributions to the mental health profession and coauthor of The Handbook of Clinical Psychopharmacology for Therapists, Integrative Treatment for Borderline Personality Disorder, and Clinical Psychopharmacology Made Ridiculously Simple.
This chapter will give you a broad research-based overview of bipolar disorder, including its symptoms, course, diagnosis, treatment, and management, as well as state-of-the-art knowledge gleaned from reliable sources such as the National Institute of Mental Health, classic texts, and current academic literature.
What Is Bipolar Disorder?
You may ask, whats the difference between the blues, happiness, or depression and bipolar disorder? Although everyone has shifts in mood (for example, anger, sadness, or happiness) related to his or her surroundings and life circumstances, people with bipolar disorder (also known as manic-depressive illness) experience unusual, and sometimes drastic, shifts in mood, energy, thoughts, behavior, and ability to function that are out of proportion or unrelated to their environments. Moods swing from extremely high or irritable to sad and hopeless with short or extended periods of stable mood in between. These shifts in mood are called episodes and are chronic (that is, recurrent over time) and severe in intensity of symptoms.
The Causes of Bipolar Disorder
The use of new brain-imaging technology, such as magnetic resonance imaging (MRI), positron-emission tomography (PET), and functional magnetic resonance imaging (fMRI), have begun to give clues to the process of bipolar disorder in the brain. These technologies have revealed differences in the brains of people with bipolar disorder and those of people without the disease.
The body of research on bipolar disorder points to instability in the transmission of nerve impulses in the brain, which is related to the brains biochemistry. This tendency toward mood instability is considered to be genetically transmitted. People with this biochemistry are more vulnerable to emotional and physical stresses, and the negative impact of stress on treatment is reduced effectiveness. Stress is also a major trigger for the onset of symptoms (Kleindienst, Engel, and Greil 2005).
Although the cause of the disease has not yet been identified, the known triggers for episodes are amenable to intervention and prevention. The major triggers are lack of sleep and high levels of stress. Trauma has also been known to trigger bipolar episodes.
Trauma and Bipolar Disorder
Recent studies have found that childhood trauma does not directly causebut does hastenthe onset and severity of bipolar disorder. Children who had been abused were more likely to have early onset, in adolescence or earlier (Leverich and Post 2006; Garno et al. 2005).
Action Step 1.1: Assessing YourExperience of Past Trauma
Consider writing about any past history of childhood trauma in your life. However, if this trauma still negatively affects your life, you should only consider doing this exercise under the supervision of a mental health practitioner, because it may be emotionally difficult. If you feel ready to write about your experiences, do so in as much detail as possible, mentioning times, places, people, and details of what occurred. Dealing with this trauma can often be a significant piece of treating your bipolar disorder and may help explain other symptoms or co-occurring mental illnesses that you may have. You will want to discuss this with your mental health care provider or in a self-help group.
Understanding Your Bipolar Disorder
Increasing your knowledge about your illness and doing the series of exercises in this book will help you better understand bipolar disorder and its impact on your life. Doing these exercises gives you useful information that you can share with your mental health care provider, and it also can help you manage your symptoms, avoid your triggers, and get control of your life. First, start to understand your emotions, because bipolar disorder is about swings between extremes of the emotional spectrum. Keeping track of your emotions will help you see patterns that can be useful in deciding how and where you can make changes in your life that might relieve you of some of bipolar disorders devastating impacts.
Normal Mood Changes or Bipolar Disorder?
The most marked symptom of bipolar disorder is significant shifts in mood from a high feeling, sometimes associated with irritability (mania), to sometimes-severe feelings of sadness and hopelessness (depression).
These episodes can occur over years or within weeks, days, or even hours, depending on the rate of cycling, the period between mood swings. Symptoms for episodes can be mild, moderate, or severe. The various mood states can be viewed as on a continuum, with people who have bipolar disorder experiencing the extremes of the range.
Symptoms of Mania
According to the Diagnostic and Statistical Manual of Mental Disorders