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What Does Bipolar Disorder Really Look Like?

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Having just finished testifying as an expert witness in the Hemy Neuman Dunwoody Daycare murder trial, I'm reminded of how little progress we've made as a society in understanding mental illness.

Sadly, society still associates mental illnesses with a stereotyped look of someone with glazed eyes and a drooling mouth, looking as if he or she is from or belongs in outer space. Nothing could be further from the truth.

In my experience in treating people with depression and bipolar disorder, I see ordinary, professional individuals who happen to have mood states that sometimes debilitate them. Granted, this is only one segment of people afflicted with the illness, but it's a significant segment nonetheless.

During the trial, Mr. Neuman was presented as a successful engineer with a long history of fluctuating moods that resulted in periods of depression and periods of hypomania. When he was hypomanic, he would be very productive at work taking on several projects at once and sometimes making impulsive personal decisions that would destroy his finances and home life. He flew under the radar of detection and never sought treatment for years.

Unfortunately, his symptoms escalated to a delusional state, producing disastrous consequences which ultimately resulted in the death of his co-worker's husband. Mr. Neuman was tried and convicted of murder after a jury found him guilty but mentally ill.

I spent two-and-a-half days on the witness stand explaining and defending my opinion that Mr. Neuman was legally insane at the time of the shooting. During this process I was confronted with questions about why most people who came in contact with him did not notice that he looked "crazy." In this case, crazy was depicted as a person who walked around with eyes glazed over and looking "out of it."

The look of someone with bipolar disorder depends on the person's functioning level prior to being ill and the severity of the illness. For example, there are some who end up in and out of the hospital and do not function well in between episodes. Yet there are others who are successful and may have even used their hypomanic episodes to advance themselves in their careers. When they are not having an episode, they may function well in their jobs and home lives.

In Mr. Neuman's case, remaining untreated for years contributed to his symptoms, which resulted in the tragic shooting of his co-worker's husband. This is not the typical course for someone with bipolar disorder. Unfortunately, this publicized case makes the stigma of mental illness worse and reinforces stereotypes that are not grounded in reality.

In describing bipolar disorder, I compare it to a motor with a dial that can be turned up or down. When the dial is turned down, you are in a slowed, depressed state. You may have no motivation to do things and the world may look and feel palpably dark.

Turning up the dial speeds you up. This speeding process can affect your thinking as well as your activity level. A person in this manic or hypomanic state will typically not need to sleep much, and have the ability to take on more work.

It would be great if we could bottle up hypomania and give it to people who need a boost of energy and drive. But, when not controlled and monitored, this state can cause irritability, explosive anger and in some cases even evolve into psychosis.

Hypomania is like a tropical storm that has the potential to grow into a Category 5 hurricane or not.

If you came into contact with someone who is psychotically manic, you have a greater chance of observing "obviously crazy" behavior. An example of this might be seen in the recently reported case of the flight attendant who went berserk over the intercom, frightening passengers.

But, at the same time, you can also have someone who is quietly delusional where the mental illness is not noticeable unless his delusional thinking is somehow tapped into.

The period in between episodes is aptly called the "inter-episode" period. The typical course of bipolar disorder is that over time, especially if the illness goes untreated, you will have more episodes closer together in time. A sizable percentage of people have mild symptoms even in between episodes.

But there are some who, if they take their medication, can return to their usual functioning when they are not having an episode of depression or mania. How long one can go in between episodes is variable from person to person. I have seen patients who go years between episodes and some who never seem to fully recover from an episode.

Bipolar disorder is a complex illness with multiple presentations. With the proper treatment, a person can still lead a productive, accomplished life. It is more common than many think, and is not something that can be seen by just looking at someones outward appearance. As more high-profile people like Catherine Zeta-Jones identify themselves as having this disorder, perhaps we will become more accepting of this as an illness that affects ordinary people.

For more by Tracey Marks, M.D., click here.

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