Bipolar affective disorder, often shortened to bipolar disorder, is a severe, albeit curable, mental illness characterized by episodes of elevated and agitated mood. It should be noted that terms of bipolar disorder, manic depression, and manic-depressive illness have been used interchangeably for the purposes of this paper. According to the most conservative estimates, 200 million people in the world suffer from this chronic, recurrent mood disorder. There is a flurry of speculation as to whether some groups of people are more susceptible to the vicissitudes of mood than the others. This dangerous psychological illness has many far-flung implications that run the gamut from the exorbitant financial costs of treatment and rampageous growth of crime to the deterioration of familial relations and splitting up of married couples. There is also a higher incidence of suicidal tendencies among people with bipolar disorder. It has been estimated that one out of three people with manic-depressive illness attempted to commit felo-de-se at one point or another (Novick, Swartz, & Frank, 2010). Therefore, the opportune diagnosis and effective treatment of patients with bipolar disorder can help prevent their premature deaths and improve the quality of their lives in general. Hence, the need to study this psychological disorder is as pressing as ever.
The history of studying the mood disorders dates back to an earlier pre-Christ age. In the 5th century BC, the ancient Greek physician, Hippocrates spread a reasonable deal of light on such conditions as melancholia and mania (Healy, 2010). However, it was not until the late 19th century that the German psychiatrist, Emil Kraepelin introduced the concept of manic-depressive disorder into scientific psychiatry. He, however, applied this term to all known mood disorders. For the sake of knowledge, it should be noted that the illness characterized by a succession of manic and depressive episodes had been known before. In the middle 19th century, Jean-Pierre Falret acquainted the staid world of the French Academy with the term circular insanity. Approximately at the same time, his counterpart Jules Baillarger presented his own observations on the so-called dual-form insanity, which was essentially the same disorder (Noggle & Dean, 2012).
However, Kraepelin was the first to differentiate a manic-depressive illness from schizophrenia. Basing his work on the findings of Kraepelin, Ernst Kretschmer, another German psychiatrist, concluded that some groups of people, designated Cycloids by him, were more predisposed to have the manic-depressive illness. Kretschmer described Cycloids as being vivacious, debonair, gregarious, malleable, and emotionally labile individuals. However, according to Kretschmer, these vitality and impulsiveness made Cycloids prone to the recurrent oscillations of mania and depression, a condition, which could get out of control under the influence of stress (Goodwin & Jamison, 2007). Shortly afterwards, the more politically correct term bipolar disorder supplanted its somewhat offensive predecessor manic-depressive illness. Largely, the latter term was left on the scrapheap of history because of its stigmatizing effect. Indeed, for many people, the word manic is reminiscent of homicidal maniacs, which distorts the real meaning of the term. It is interesting that the bipolar disorder is not as prevalent among serial murderers as, for example, dissociative identity disorder.
The psychiatrists passed another milestone on the road towards unraveling the mystery surrounding the heterogeneity of the bipolar disorder in the 1960s, when a venerable Swiss psychiatrist Jules Angst singled out two different types of this disorder, namely unipolar and bipolar depression (Healy, 2010). A decade later, his counterparts further divided bipolar disorder into two separate categories bipolar I disorder and bipolar II disorder. The former is characterized by a succession of depression and mania, very agitated mood, which can seriously impair the functional ability of a patient and demands extensive treatment. Simultaneously, people with bipolar II disorder are not vulnerable to manic episodes and suffer primarily from milder hypomanic episodes (Marneros & Goodwin, 2005). Some studies revealed that the unipolar depression is often a springboard for the development of bipolar disorder (Goodwin & Jamison, 2007). It is not medically expedient to treat such patients with antidepressants only, because this may be conducive to the occurrence of resistance and suicidal tendencies in them. Cyclothymia is a mental state characterized by the marked swings of mood between depression and elation, which are not as severe and pronounced as those in the aforementioned types of bipolar disorder. It is considered a mild form of the bipolar disorder. Provided that a person is diagnosed with the bipolar disorder, but his/her symptoms do not fall under any of these three categories, this person is considered to have the bipolar disorder not otherwise specified.
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Notwithstanding the fact that psychiatrists have made remarkable discoveries in studying bipolar disorder, many modern physicians are unable to cope with the task of diagnosing this pathology in individuals. Furthermore, there are many other problems related to the bipolar disorder that need to be tackled with a certain degree of urgency. Although the mood stabilizers have been used to treat intense and sustained mood shifts for more than 50 years now, the efficacy of such medications leaves much to be desired. Lithium, valproates, anticonvulsants, and atypical antipsychotics have been used with intermittent success to treat this illness (Angst & Marneros, 2001). Nevertheless, despite the undeniable progress in the field of psychopharmacotherapy, the treatment of bipolar disorder still poses a perplexing conundrum to many physicians and psychiatrists.
The biggest problem that people suffering from bipolar disorder must overcome is the fact that they cannot control their mood. One minute, they sink into a deep melancholy and literally burst with an outpouring of delirious happiness a few moments later. Such people often get a powerful surge of energy all of a sudden, but this energy is hard to tame (Mountain, 2003). It is not also uncommon that individuals with bipolar disorder usually wake up in the morning with a feeling of fatigue, lassitude, and torpor. As a rule, these episodes last from two weeks to two years, with an average duration of several months. However, according to the unimpeachable historical source, there were instances when such episodes lasted up to seven years (Goodwin & Jamison, 2007). It is also curious that the manic and hypomanic episodes are usually four times shorter than the depressive ones. One of the major problems associated with this peculiar occurrence is that the number of episodes, as well as their order, duration, and severity are hard to predict.
Many psychiatrists do not believe that a hypomanic phase should be diagnosed as a psychiatric disorder, because the overwhelming majority of patients perceive it simply as an inexplicable fit of energy with a concurrent onrush of the mellow mood. Individuals experience spiritual elevation or even feel themselves like they have the necessary aplomb to do things they have never done before. This confidence keeps them going, motivates them, and spurs them on to greater efforts (Stahl, 2008). During the hypomanic phase of the bipolar disorder, patients sleep less and work themselves into a frenzy over various tasks. At the same time, they feel an unquenchable desire to create new social contacts and take an unusually concupiscent interest in the opposite sex (Stahl, 2008). At first glance, it seems like there is not much bad about this condition, but it has the side effects too. On the downside, at a hypomanic phase, patients become excessively arrogant and supercilious and find it hard to take a sober view of the situation. Such people brim with enthusiasm to get involved in the matters they would not otherwise even consider. Moreover, they tend to make rush decisions, take unnecessary risks, dissipate money, and make promises they cannot keep (Stahl, 2008). Appallingly enough, it is difficult to put these individuals out of conceit with leading such a lifestyle.
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At this phase of the bipolar disorder, people seldom realize that there is something wrong with them, unless they can see an evident contradiction between their condition and the real state of affairs. For instance, an individual may begin to entertain strong suspicions if they feel exhilarated because of the loss of job or by a marital break-up. However, these changes are patently obvious for those who have known the affected person for a certain period of time. In order to understand what swirls in the mind of patients during the hypomanic phase of bipolar disorder, it is wise to immerse in The Marriage Plot by Jeffrey Eugenides (2011):
As Leonard strode along, thoughts stacked up in his head like air traffic in Logan Airport to the northwest. There were one or two jumbo jets full of Big Ideas, a fleet of 707s laden with the cargo of sensual impressions (the color of the sky, the smell of the see), as well as Learjets carrying rich solitary impulses that wished to travel incognito. All these planes requested permission to land simultaneously. (p. 176)
One way or the other, hypomanic people are self-contained enough so as not to look bizarre or do violence to the feelings of the social milieu around them. On the other hand, the onset of a manic episode wrecks havoc on the patients feeling of self-command, upsets their equanimity, and causes a baffling array of other uncomfortable symptoms. At this phase of the bipolar disorder, a person may find their thoughts in complete disarray, succumb to the delusions about their own power and importance, and start pursuing some vague and quixotic goals. Such individuals wax angry about the minor problems and their talk about life often vibrates with indignation. They become petulant and quickly dissipate their energy resources.
The diagnosis depends largely on the symptoms exhibited by patients. If a person experiences manic or mixed episodes, when he/she swings from a manic episode into a depressive phase and back again, he/she is diagnosed with bipolar I. But if a person has had only hypomanic episodes, his/her diagnosis is bipolar II. The latter is considered to be less destructive, but some experts have doubts in its benign nature (Cara & MacRae, 2012). All people with the bipolar disorder, notwithstanding its degree, lapse into depressive episodes of varying severity from time to time. Moreover, the elevated mood states may be immediately followed by a depressive phase (Gillem, 2013). In a matter of days, individuals that used to behave throughout with a certain degree of sangfroid and blithely disregarded everyday pities become quite blase about positive moments in their lives and recalcitrate against every proposal to have fun. As a result, their psychic tone and working capacity dwindle to the accompaniment of sleep disruptions and anxieties. Gradually, patients surrender themselves to a sense of apathy, thereby making it very hard for the psychiatrists to extricate them from the depths of despair. According to Hickey (2013), For many people depression is temporary, for others it causes years of debilitating misery and for yet others it is something that must be lived with throughout their lives. Different people perceive depressive episodes in a different manner. Some prefer to keep a distance from other people fearing that the propinquity might lead him/her into unnecessary temptations whilst others spend as much time with their family and friends as possible. The final stages of depression are believed to be the most dangerous ones in terms of suicidal tendencies, for people feel sullenly resentful against the whole world at such moments.
Much ink has been spilled on the causes of the bipolar disorder, but they are still surrounded by the all-enveloping shroud of mystery. Many experts opine that the illness is transmitted hereditarily, but it is unclear how the inheritance principle works. A number of recent studies suggest that, if one of the twins has bipolar disorder, the second one is also likely to have this problem (Goodwin & Jamison, 2007). Similarly, it has been established that males suffer from a bipolar form of affective disorder more often than females while the latter are more predisposed to have a unipolar form of this dangerous illness. Cara and MacRae (2012) argue that the brain structure is also one of the determining factors in the development of the bipolar disorder. In consistence with the so-called inflammatory hypothesis, when people who are genetically inclined to have bipolar disorder experience stresses, their emotional threshold decreases, giving rise to spontaneous episodes. Some experts also surmise that it is the disrupted balance between inhibitory and stimulating neurotransmitters that spawns abnormal mood swings (Cara & MacRae, 2012). This theory holds especially true in light of the fact that the relation between the bipolar disorder and the endocrine system has been proved scientifically. Indeed, affective disorders can be exacerbated in women during the premenstrual and menstrual phases, as well as during weeks following parturition and pending a menopause (Daw, 2002).
Nonetheless, some specialists reckon that the bipolar symptoms spectrum should not be regarded as a disruption of the organism. As it transpired, genes that, once in large quantities, cause powerful affective disorders may be very useful for the survival in lesser quantities. The predisposition of people with bipolar disorder to have precious energy resources and sleep more during the depressive episodes could have served as a defense mechanism for the primitive people in the days of yore. Milder manifestations of mania could also be advantageous for the affected people, helping them to regain vigor and assertiveness. It is not a rarity that phlegm and determination produced by the full-blown manic episodes carry patients through many difficult situations. Curiously enough, bipolar disorder enables people to unleash their potential and harness their creativity to the full. According to Krishna,
The manic perception of life is one without bounds. This allows for creativity because the person feels capable of anything. It is as if the walls, which inhibit the general population, do not exist in manic people, allowing them to become creative geniuses. They understand a part of art, music, and literature, which normal people do not attempt. (cited in Savulescu, Meulen, & Kahane, 2011)
One way or the other, bipolar disorder has really been a blight on the American society, and its stigmatizing effects are sometimes commensurable to those of schizophrenia. The unemployment rate among people with bipolar disorder is as high as 55% during the first six months and 76% two years into the illness (Goodwin & Jamison, 2007). Similarly, half of the U.S. prison population, representing over one million individuals, experience at least one mental health condition (James & Glaze, 2006).Moreover, between 15% and 24% have a serious mental illness, such as the major depressive disorder, bipolar disorder, or schizophrenia (Diamond, Wang, Holzer, Thomas, & Cruser, 2001). It often happens that people with the bipolar disorder quit their jobs, divorce their spouses, move to another place, and contract venereal diseases because of their lewd and lascivious lifestyle. This all shows that the bipolar disorder takes a heavy toll on the affected people.
Summing up, the bipolar disorder, also known as manic-affective illness, is one of the most prevalent psychic conditions in the world. It is characterized by wild oscillations of mania and depression in the affected people. This paper has described why the bipolar disorder has little to do with maniacs, why the uncontrollable mood swings are dangerous, and why this illness should be treated at the earliest phase possible. Although the bipolar disorder scourges the lives of the affected people, there are also certain positive moments about it. For example, this deleterious cognitive state might occasionally produce benefits to society as a whole through artistic creativity.
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