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Bipolar Disorder: Definitions and Overview
It often feels as if we live in a world of endless contradictions. The more we work, the more money we make, yet ironically, the less time we have to enjoy it. Another classic example, according to Pentagon officials, is that the more bombs we build, the safer we will ostensibly be. How do we handle these and life's other fundamental contradictions? We pay attention to events around us, we continue with our daily tasks, and we simply hope for the best. When it comes to life's inherent contradictions, the world of mental illness is no exception, claiming as its own a disease that truly embodies the meaning of the word "opposite": The disease is bipolar disorder, formerly and more commonly known as manic-depressive illness. Bipolar disorder can be likened to the painted face of a circus clown: at once robustly joyous and at other times profoundly sad.
The clown analogy, which is commonly used when describing bipolar disorder, is an apt one, but it does not begin to address the complexity of the illness. The disease is perhaps one of the most mysterious and understudied illnesses in the field of mental health. It is estimated that 11 to 15 million Americans suffer from some form of mood disorder, whether it be major depressive disorder, dysthymic disorder, bipolar I disorder, bipolar II disorder, or cyclothymic disorder. Of the afflicted, at least 2 million people, or 0.4 to 1.6 percent of the population in the United States, experience the "highs" and "lows" of bipolar disorder.
Bipolar disorder is differentiated from other forms of depression by its periods of intense mania and/or hypomania. Sufferers experience black and hopeless moods of depression, but also euphoric feelings of hypomania and often psychotic periods of mania. In between episodes of depression and mania, patients may experience periods of balanced moods, where they feel relatively normal or "euthymic." A person may, for example, be manic for three to six months, euthymic for six months after that, and then depressed for six to nine months. As we come to understand more about this illness that takes its toll on spousal, familial, and other interpersonal relationships, we know that far more people have lived with bipolar disorder than was formerly thought. A devastating reality of bipolar disorder is that fewer than one-third of those who have the illness are ever treated for it. For a host of complex reasons, bipolar disorder is often misdiagnosed or simply goes undetected, sometimes at the expense of the sufferer's life. We do know that at least 15 percent of those who have bipolar disorder take their own lives, that men who suffer from the illness are more likely to commit suicide than women, and that these people take their own lives most often during a depressive episode.
Often, describing just the technical aspects of a disease like bipolar disorder tells only half of the story. Without personal anecdotes and case studies the material can seem dry, removed, and not terribly relevant. This is why, throughout the book, we will be presenting stories and histories of individuals coping with the disease.
Has bipolar disorder existed for a long time?
One of the great mysteries of bipolar disorder is its etiology, or cause. We will explore this subject at greater length in chapter 3, but it may help to address some of the issues here. There is a substantial amount of evidence that mood disorders, including bipolar, have existed since antiquity. Many ancient documents, including the Old Testament story of King Saul and Ajax's suicide in Homer's Iliad, describe serious depressive episodes. Even the father of medicine, the Greek physician Hippocrates, noted both mania and melancholia when discussing certain mental abnormalities. The alternating moods of bipolar disorder were not formally recorded until about the mid-nineteenth century, when two French doctors, Jules Falret and Jules G.F. Baillarger, noted that several patients showed both depressed and manic symptoms over a period of time. It was not until 1882 that the German psychiatrist Karl Kahlbaum coined the term cyclothymia, which describes depression and mania as parts of the same disease. In 1899, psychiatrist Emil Kraepelin, using the knowledge of his French and German predecessors, established a criterion for a manic-depressive psychosis that psychiatrists still use for diagnosing bipolar I today.