June 3, 2008

My Life With Bipolar Disorder Pt II: The Allure of Mania

Almost every person I've spoken to who lives with bipolar gives the same account. Bipolar disorder, they say, is not all black and white. It' full of gray. At times, it's full of vibrant hues, all the colors of the rainbow. It can even be full of energy and laughter and excitement. Sure, there's depression. Bipolar depression is neither fun, nor vibrant, nor energetic. It's dangerous--lethal. So lethal that if you're bipolar, you're 10 to 20 time more likely to commit suicide than someone suffering from monopolar depression. But mania, the other side of the bipolar coin, has an undeniable upside. Even better is hypomania, which has all the fun of mania without its most serious consequences.

"Mania is fun," my father once confided to me. "Being manic is fun. It may not be fun for the people who are watching, but it's fun for the person who's manic." And therein lies the paradox of bipolar disorder. Creativity, determination to succeed, the drive to love and live fully; some people insist these aspects of their life are driven by mania. And that's oftentimes true--to some extent. It's also true that mania, left unchecked, can lead to delusions, substance abuse, and impulsive, destructive choices that crush creativity, obliterate careers, and ruin relationships.

Part of accepting bipolar disorder is accepting the fact that the negatives of the disease coexist with the positives. Pretending the positives don't exist won't help. The top reason people with bipolar disorder give when they stop taking their medication--and each year almost one out of every two people with bipolar will do so--is that they feel the mood stabilization means deadening of thought, creativity, feeling and energy.

You're excited. You're interested in everything around you. Your mind is sharp as a tack. If there's a problem, you can solve it. You feel like you could squeeze beauty out of a stone. Mania. What's not to like?--aside from the irritabillity that starts to creep in and the voices you start hearing after your second week of no sleep, that is.

The cutting edge of mania is that no matter how bad it can get, it still hold that shining promise of a near-perfect you in a near-perfect world. The energy feeding into you opens your mind just a little wider and gets you moving just a little faster. It lets you reach a little farther for what was previously just beyond your grasp. The downsides are there, and if you've been there before, you know what they are. But that doesn't deny the beauty of the moment, the power that mania can hold over you.


The creative impulses and relentless drive and energy of mania can serve, at least for a while, as a type of release. Those same impulses--plus the natural grandiosity that can be part of being bipolar--can turn a shy, retiring type with a few interesting ideas into a true leader. These are the sort of people--men, at least in the earlier part of history--who seemed to possess a sort of cult of personality. People were drawn into their sphere and seemed to be led effortlessly. Some of the most prominent leaders in history had (or at least were suspected to have) bipolar disorder and reads like a Who's Who of military and political history. Alexander the Great, Napoleon, Winston Churchill, Teddy Roosevelt, Oliver Cromwell, all dealt with bipolar disorder. In more recent years these dynamic types have been driven to the boardroom. Take Ted Turner, the founder of Turner Broadcasting, has openly talked about his diagnosis with bipolar disorder. He reportedly once quipped, "If I only had a little humility, I'd be perfect." Never before has there been such a concise, if unintentional, definition of manic grandiosity.

Impaired Insight, a Predicament

Denial is wanting not to hear what you're hearing; it's refusing to see what you're clearly seeing. Denial requires you to actively work against what you know to be true--to deny it access to your life or your plans or your consideration. In bipolar disorder, denial is the tip of a largely dangerous iceberg. One of mania's most insidious side effects is called impaired insight. Impaired insight goes way beyond your desire not to see what's happening or being unable to recognize that mania is bad or destructive; it's not being capable of seeing it. It is, says Nassir Ghaemi, M.D., director of the Bipolar Disorder Research Program at Cambridge Health Alliance, an actual, biological phenomenon. In about half of all case of mania, you literally can be physically incapable of knowing if and when you're manic. In fact, there's even a name for it: anosognosia.

The brain's frontal lobe is the culprit in the impaired insight mechanism. The physical link between stroke, Alzheimer's disease, and bipolar disorder lies in this area, the seat of both thinking and emotions. Certain changes to that area of the brain might make it impossible for you to logically asses what's going on around you, yet you need just that sort of process when you're becoming manic so you might have a chance to pick up on the mania before it gets out of control. Instead what you get is severely impaired insight--so impaired that when someone suggests to you that your behavior has turned somewhat manic, you begin to rant and rave, convinced that your friends are turning against you. You won't even consider the possibility that your friend might be right, that you might be becoming a bit manic, because you actually are unable to see what the friend is talking about, unable to recognize that anything is wrong or off.

When the mania disappears, however, so does your insight impairment. After the fact, you'll usually be able to recall most of what went on while you were manic. You'll be able to gain some insight into your disorder.

By then, however, it might be too late. It's these excesses that make bipolar disorder so very fascinating to so very many people. Face it: depression is not fun to watch. But mania...mania can be titillating. Mania can be exciting. Mania can be fun. And that's just from the outside. From the inside, it's equally exciting--at least while it's happening. But when the ride is over and the music stops, you're the one left holding the bag. You're the one who has to put the pieces back together, to try to make your life whole again. And you have to do it despite not always being quite sure what really happened in the first place.

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