Inside the Manic Mind

The news seems overly-focused on the antics of actor Charlie Sheen, who has been described by some commentators as suffering from bipolar disorder and who is viewed as currently in a state of mania. Because I have never met Sheen, I am not in a position to diagnosis him -- nor are the other commentators. But if he is truly bipolar, the prognosis is not good, unless he comes to terms with the illness and gets the appropriate medication.

Bipolar disorder is a life-long mood illness, often with the first onset during late adolescence or early adulthood. An essential element of bipolar disorder is that the individual has had at least one episode of "mania" (that is not due to a drug reaction -- such as the use of cocaine). When someone is manic, they often have a decreased need for sleep (they can feel energized on two hours of sleep), they talk rapidly, their ideas fly from one thought to another, they think they are magnificent, they can have increased sexual activity, overspending, and risk-taking activity and they can be irritable, hostile or violent. A significant number of people who are manic have paranoid ideas, believing that others are out to get them or that others are trying to block them from getting what they want to get. Manic individuals often have grandiose schemes or activities, sometimes presenting a list of "exciting projects" which often reflect little awareness of their own limitations. Manic individuals often lack any insight into their behavior -- either not being aware of how they appear to others or not caring. Sometimes they have difficulty recalling their behavior, not realizing that they had acted in bizarre and inappropriate ways. As a result, the therapist often will seek out the assistance of family members to gain a more accurate picture of the history of mania. Manic individuals are poor historians about their own behavior.

In my own writing on this topic I have tried to identify how manic people think about making decisions -- since the decisions they make can often be devastating. As I indicated, manic individuals take excessive risk in spending, investing, sexual activity, driving behavior, social interactions, often expressing bizarre and offensive opinions, engaging in aggressive and violent behavior toward others, or making other "risky" decisions. What accounts for this? Obviously, the primary cause is the biological component of bipolar disorder which is why these patients need to be on a mood stabilizer (such as lithium or an anti-convulsant -- or, in some cases, an anti-psychotic medication). However, there is an internal "logic" to manic thinking and this is what I want to describe here.

Why would they engage in such risky behavior? People who are manic often believe that they have unlimited resources and abilities -- they can afford anything or that they can accomplish anything. Thus, taking on a risky behavior seems less risky. They also believe that they can absorb any downside -- so, if their marriage fails or they lose the money in their investment, they believe that they will bounce back easily. Manic individuals have a sense of urgency -- that they need to make a decision right now so that they don't miss the opportunity that sits in front of them. They seem to speed through the day, one activity after another, trying to get as much done as they possibly can.

Manic individuals believe that they can predict the future accurately -- and that it will be filled with boundless rewards for them. Since they believe that they have the genius that others lack, they easily dismiss the opinions of others who are sometimes viewed as inferior people who are trying to block the endless opportunities that are available. Manic individuals believe that whatever they attain will be extremely enjoyable -- that they will have incredible pleasure from what they achieve -- so they are willing to take the risks to pursue those gains. In short, manic individuals are risk lovers -- they believe that taking risks is exciting, a sign of their special abilities and the means of greater fulfillment. Since they believe that they have these special abilities they become agitated when others try to dissuade them and they view medication as dampening their creativity and incredible genius. Each positive experience magnifies the desire for more positives as they "ascend" higher into a manic episode.

Sadly, bipolar disorder can have devastating effects on family, fortune, friends and future life. Most manias crash into depressive episodes -- sometimes with a high risk of suicide. Marriages end, jobs are lost, people are injured in accidents. Watching someone like Charlie Sheen -- who has been labeled by some as bipolar -- is not amusing to me. Regardless of the obnoxious comments that he displays, he is still a human being. Laughing at mental illness is a sad reflection of our lack of understanding of its devastating effects. People crash from manias and they and their families and those who love them may feel left alone to pick up the pieces. Think of Mr. Sheen's children.

The important point to keep in mind is that coming to terms with the illness is the most important step to take. Following this, involving family members as part of the treatment team can help the patient and therapist identify the beginning signs of mania (for example, lack of need for sleep, talking rapidly, risky behavior, irritability), thereby helping the physician prescribe the appropriate medication. Staying on a mood stabilizer is essential. Some manic individuals believe that "Now that I feel better I don't need the medication." Wrong. Staying on the medication will decrease the risk of the dangerous (although "enjoyable") ascent into mania or the devastating descent into depression. Psychotherapy -- such as family therapy, cognitive-behavioral therapy and interpersonal psychotherapy -- can help patients and their families cope. The outcome -- and life-course -- is not necessarily bad -- although some patients, regardless of medications, will have break-through episodes of depression and mania. Taking the illness seriously is the key. Laughing at Mr. Sheen is like laughing at someone who has been badly mangled in an accident. This is serious business. Illness is not a matter of entertainment.

 

 

 

Follow Robert Leahy, Ph.D. on Twitter: www.twitter.com/AICTCognitive

Comments

[Terry Graves]

12:33 AM on 03/17/2011

Mr. Leahy's blog entry is a welcome relief. The reporting on and spoofing of Charlie Sheen — who does seem to be afflicted with bipolar disorder and in the midst of some kind of mania — is no more ethical or moral than interviewing a mentally ill person living under a bridge. It's pure voyeurism and it's cruel.

We seem to have decided that picking on the blind, the deaf, AIDS patients, the crippled, and so on is immoral and in poor taste. Why is it OK to gawk at a person whose mind is unraveling, and also OK to use terms like loony and psycho?

[Terry Graves]

11:18 PM on 03/16/2011

Thank you for being the voice of reason and compassion.

[Willow712]

08:10 PM on 03/14/2011

My daughter is 37. She has been schizoaffective since she was 14. She has only been manic a few times, depressed much more often. Three years ago, in NYC, her psychiatrist put her through electroshock therapy for depression. They knock her out, give her a shock, then wake her up. She has felt much better for the last few years, easier to get up and moving, enjoying things more. She did have some memory losses for a few days after the last one. But she feels its been productive to do this.

[Joseph Burgo PhD]

08:23 AM on 03/12/2011

As a reader of Robert Whitaker's THE ANATOMY OF AN EPIDEMIC, and a mental health professional with 30 years' experience in the field, I question the often-repeated assertion, as if it wereproven fact, that depression and bipolar disorder are malfunctions of biology, with chemical imbalances that should be treated by medication. The diagnostic label "bipolar disorder" gives a false sense that we are dealing with "illness" in the medical model, and that drugs are the answer. Mania and depression have psychological content and emotional meaning; they can be understood and modified slowly, over time. Drugs may have some limited benefit for stabilizing patients in the early phases of a manic episode, but after the first four weeks they play a destructive role in perpetuating rather than "curing" the illness.

Joseph Burgo PhD
http://www.afterpsychotherapy.com/bipolar-disorder
http://www.afterpsychotherapy.com/hopeless-problems-perfect-answers

[Terry Graves]

11:24 AM on 03/17/2011

I don't know why you believe that medications for bipolar disorder are destructive after four weeks. This is categorically false and potentially harmful. Indeed, sometimes the challenge of having a loved one with bipolar disorder is to convince them to stay on their medications.

That a health-care professional such as Mr. Burgo to make such an assertion is irresponsible.

[Joseph Burgo PhD]

04:27 PM on 03/19/2011

My statement is based on exhaustive data discussed in Robert Whitaker's excellent book. He analyzes outcomes data on cases of bipolar patients who have been on meds for more than 8 weeks and compares them with those who were never exposed to them. The prognosis for the latter is FAR better. The incidence of recurring manic episodes is FAR HIGHER for individuals taking psychiatric meds. Regarding bipolar disorder, see my response below. And you really should read this book.

[beyondliberal]

03:59 PM on 03/19/2011

I couldn't disagree more, even if someone paid me to agree with you.
I had 15 years of CBT during which I learned to identify and cope with my symptoms. I've had 20 years of medication changes, either from the "poop-out effect" or because better meds came on the market. I haven't been hospitalized in 20 years (diagnosis came when I was hospitalized three times in 6 months) largely because of the skills of my psychiatrist; all this in spite of having severe ultra-rapid cycling bipolar 1.
Please don't spread disinformation. Some of us have a clear response to medication. It saved my life. Remember that a mind is like a parachute-- it only functions when open.

[Joseph Burgo PhD]

04:23 PM on 03/19/2011

One of the more devastating chapters in Mr. Whitaker's book looks at the data which shows, beyond a reasonable doubt, that the advent of Prozac and other SSRIs coincides with a huge spike in the incidence of rapid-cycling bipolar disorder. His persuasive conclusion is that, while these people didn't have a chemical imbalance before taking the meds (there's NO evidence to support the theory of chemical imbalance), those drugs in fact CREATE one, in many cases inducing a condition of bipolar disorder where one did not exist before.

Once people have been exposed to psychiatric meds and attempt to get off them, or hit the point where they stop "working", they find that they are much worse off than before and must find a new drug cocktail to re-stabilize. The drugs CREATE a chemical imbalance that makes you dependent upon those very drugs for the rest of your life. And since you've been taking those drugs for so long, I'm sure you're familiar with the side effects.

Don't take my word for any of this, however. Read Robert Whitaker's book. It's a well-researched book full of convincing data and does not rely on anecdotal reports of people who say their meds do or do not work.

I've just started a three-part discussion of the most important findings on my website.

http://www.afterpsychotherapy.com/chemical-imbalance-in-your-brain.

[JOHNSPEAKS]

08:47 AM on 03/11/2011

Anybody with mental illness will have tremendous odds against them in seeking real recovery? They can do nothing and live with their mental disorder or they can seek out treatment and have a lifetime of experimentation with antipsychotic drugs with horrendous side effects? They will have medical experimentation such as -Electroshock Therapy- and -Deep Brain Stimulation- and some form of -Lobotomy- etc.? They will have never ending brain washing -Therapy- by a therapist who wll get them to accept the above pain and suffering? The above treatment plans will never end until they end all their suffering with -Suicide- that will finally end their pain and suffering? If the mentally ill are not violent toward others why must they suffer unimaginable -Horrors- just to keep this never ending mental health -Ponzi Scheme- going? Think twice before -You- get involved with the mental health industry or the mental health -Foundations- that help finance this pain and suffering???

[kayla777]

12:11 PM on 03/11/2011

Please stop spreading misinformation. I am bipolar. I have never had electroshock, brain stimulation or a lobotomy, thank you. I take medication and am happily married and live a good life. I am thankful to the mental health industry.

[JOHNSPEAKS]

03:36 PM on 03/11/2011

-You- are one of the rare few who sounds like their mental illness is under control and I hope and pray that your success continues? The vast majority of mentally ill clients suffer horribly everyday of their lives because the supposed mental health professionals treat them as experimental lab rats? Since I worked for years at a top mental health rehabilitation facility(FH) in northern new jersey and also interacted with thousands of clients in over a dozen mental health facilities in the northeast? I am an expert at observing clients with -Empathy-and -Respect- so when I see a -Ponzi Scheme-, I am trying to warn trusting human beings and their caregivers to be very careful? By doing this they might be able to find a humane mental health professional that believes in humanity not torture and experimentation?

[Vivian Alicia Evans]

08:38 PM on 03/12/2011

I too am bipolar and have never had the three treatments mentioned. Though I have had my ups and downs I have never been offered this form of treatment.... even when I was in despair and asked for electroshock therapy.

[JohnFromCensornati]

10:08 AM on 03/12/2011

What is the mental disorder called when someone engages in behaviors like paranoid obsession with liberals or ending *every* sentence with a question mark?

[syntax facit saltum]

01:06 AM on 03/16/2011

That's not very atheistic of you to say that to someone.

[angel-girl]

07:57 AM on 03/10/2011

I agree, what's happening with Sheen is not really funny at all. But I think sometimes we laugh at things that make us uncertain or uncomfortable because we don't know how else to respond. Most of us are not mental health professionals, but we are getting Sheen 24/7 and we can only respond to him in whatever way we understand. For most of us that is uncomfortable laughter.

[HeevenSteven]

07:14 AM on 03/10/2011

I'd like to recommend Kate Redfield Jamison's "An Unquiet Mind: A Memoir of Moods and Madness" It is an excellent and beautifully written book. She's a clinical psychologist and a bi-polar sufferer.

[HeevenSteven]

07:06 AM on 03/10/2011

I think I want to be manic..

[Natalie Guerrier]

08:25 PM on 03/11/2011

You've clearly never experienced full-blown mania and/or psychosis. Romanticizing mania is damaging to those who've suffered greatly in its clutches, both the manic individual and their loved ones. (And yes, I've experienced both - and while there were silver linings to be found later, I would not wish that kind of pain and terror on anyone.)

Natalie Guerrier
Mental Health Advocate
www.rockpapershutip.com

[HeevenSteven]

10:35 PM on 03/11/2011

Oh, duh!.

[VirgoLinnea]

02:20 AM on 03/14/2011

May I suggest to you the less severe hypomania?

[MerrieWay]

03:04 PM on 03/09/2011

The wrong cocktail of Meds can send a patient into a psychotic realm, as well. Thank God certain drugs have been black-boxed and were proven to be suicidal precursors for adolescents. Nami suggests avoiding lockdowns that it doesn't necessarily help bipolar except in acute situations and the revolving door syndrome is a predictable occurrence.
This is a tragic illness for the acute sufferers...and hopefully we can do the underlying tests that show indicators that might be addressed like high cortical levels, etc. Thank you Dr. Leahy for bringing up the lack of awareness the our society has...and their lack of compassion.

[beyondliberal]

04:05 PM on 03/19/2011

Cortical= cerebrum, cortisol= stress hormone.

[pyt333]

02:57 PM on 03/09/2011

I could not agree with you more. I don't find what is happening to Charlie Sheen entertainment. I dated a man who was diagnosed bi-polar, on medication and was "supposed" to have everything under control. He did not, and it was the most painful, devestating experience of my life. Mental disease isn't funny. His poor children will have to deal with this for the rest of their lives. As well the ex-wives. I feel badly for people who suffer from bi-polar disease, but I have no interest in ever dealing with any bi-polar person again. I hope he gets help.

[kayla777]

12:15 PM on 03/11/2011

I can understand the way you feel because of your experience. But that's like saying you will never deal with a person of another race again because you had a bad experience with one. There are bipolar people out there who are living "normally". I know because I am one of them and I also happen to be happily married. And my husband is too.

[ShipCritic]

10:26 AM on 03/23/2011

I know what you mean about not getting involved with bi-polar people. I've seen people who refuse to take meds (very common with this disease) in full-blown mania and it was frightening to witness. A bipolar person on the right medication is an entirely different story; he/she can have very successful relationships.

[Willow712]

02:17 PM on 03/09/2011

I believe he is probably bipolar, at the least, could even be schizoaffective. How would I know? I was married to a perfectly normal good husband, after 7 good years of marriage, became manic, spent weeks getting sicker and sicker. he then alternated daily, between mania and depression. I became his caregiver, until he decided while manic (on prozac and stelazine) to rob our bank with an unloaded gun (I had hid the bullets). He was in a suicide watch cell for 3 months, found innocent due to disease or defect. When he came back home, on medical probation, he tried to kill himself in the barn. he would be manic, and feel wonderful for hours, but would always decline into a dark deep weird place where he was paranoid, hearing voices, etc. then would cycle into depression where he could not get up off the floor. He was eventually diagnosed schizoaffective. So when I see Charlie Sheen on TV, I get kind of sick feeling, because I saw it over and over for several years.

[Vivian Alicia Evans]

08:44 PM on 03/12/2011

Oh how watching Martin in this state makes me cringe and stir stuff in my memory banks I wish I could not remember. Everyday I wish I had never put my family through my own bouts of mania and depression and I also feel so very sad when I think of those close to me who are bipolar. Thankfully I am religious about my meds and have the support of vetted mental professionals. A healthy life style helps additionally.

[Willow712]

11:46 PM on 03/13/2011

The good news is people have now learned that mental illness is not a weakness, its not bad judgment, its a chemical problem within the brain. You could not help it, just as my ex couldn't. Not enough salt, or too little seratonin and that's what happens. I am glad you have gotten treatment and support.

[maori]

12:33 PM on 03/09/2011

Wow,

Sounds like being manic would be just the push I needed to get things done. Too bad I'm not.

[kayla777]

12:18 PM on 03/11/2011

The energy part is great. The euphoria feels great. But, be careful what you wish for.

[beyondliberal]

04:10 PM on 03/19/2011

Not everyone experiences pleasure from hypo or full-blown mania.
Personally, I have very helpful markers when either coming; irritability, impulsivity, agitation, and racing thoughts. I know to contact my psychiatrist when it happens, and we make necessary adjustments with medication changes or dosage tweaking.

[Chi--townfool]

11:35 AM on 03/09/2011

Yea lets just put labels on people and then give them drugs to "correct" their behavior. Some the greatest achievements in human history were accomplished due to people in a manic stage, it's part of human evolution, correcting behaviors like mania and ADD and the such are not progress they are a step backwards, psychology is bunk

[beyondliberal]

04:12 PM on 03/19/2011

YOU try living with bipolar disorder. Let me know how you do; I assure you, you'd be very likely to change your mind.

[ken derow]

11:16 AM on 03/09/2011

I know something about mania, and bi-polar illness, and, if Charlie Sheen is not on a manic high, near psychosis, he is mimicing this conditon very well. The grandiose, maybe delusional thinking, the helter-skelter conversation and apparent thinking pattern, the belligerence and irritability, the non-stop, almost stream-of-consciousness talking-all signs of a manic high and disordered thinking. Mr. Sheen clearly needs some assistance in his struggle for normality, and, although he maybe a "bitchin' rock star from Mars", he plainly is exhibiitng some very human frailities.

[ChangeAgent007]

10:34 AM on 03/09/2011

I absolutely agree. It isn't funny. I believe my brother is bipolar. He was in a hit and run accident on Monday and we still can't find him. We have tried multiple times to get him help, but he either doesn't think he needs it. And the mental health system is no help either. Obviously if he is getting in accidents he is a danger to himself and others. This time no one was hurt. Does he have to kill someone before something is done?

I have great compassion for families who have a family member with this illness. I understand all too well the pain that comes with it. You just want the best for your family member. You know they are capable of living a healthy life and it is just frustration after frustration.

Thank you for writing this.

[signgrrl]

11:47 AM on 03/09/2011

good luck, i hope your brother gets help. my bro in law was bipolar, caused HUGE stress in their marriage, got help but too late to save marriage. he is now my 2nd favorite BIL.

[kayla777]

12:28 PM on 03/11/2011

Sorry to hear about your brother. I hope you find him soon. I understand and am going through the same frustration with a family member. If nothing else, Charlie Sheen is definitely bringing awareness to mental illness. Laws are out there to "protect" the mentally ill. But, how is it protecting them to let them destroy their lives when they don't even realize something is wrong with them. And then when something tragic happens, everyone looks around and asks why the signs were missed. The signs are there, the laws are just set up so nothing can be done about it.

[beyondliberal]

04:14 PM on 03/19/2011

CS has too many syncophants around him "protecting" him.