Unpacking Bipolar Disorder

Around 40 million people around the world have bipolar disorder, which involves cyclical swings between moods: from depression to mania. Kay Redfield Jamison https://profiles.hopkinsmedicine.org/provider/kay-redfield-jamison/2777322 is one of those people. She's also a professor of psychiatry at the Johns Hopkins School of Medicine and has written extensively about the topic, from medical textbooks to personal memoirs. Today on Short Wave, she joins us to talk about the diagnosis process, treating and managing bipolar disorder. Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. Got a question about mental health? Let us know at [email protected] mailto:[email protected]. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 0:00Speaker 00

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• 0:18Emily Kwong?

  Before we start, we just wanted to let you know that this episode does talk about sensitive topics, including suicide, suicidal ideation, and depression. You're listening to Short Wave from NPR.

• 0:33Emily Kwong?

  Hi, Short Wavers. Emily Kwong here, and today we are going to talk about bipolar disorder. Around 40 million people around the world have bipolar disorder, which involves cyclical swings between moods, from depression to mania.

• 0:47Speaker 02

  In depression, the mood is overwhelmingly hopeless, despairing, lack of pleasure in things that you would ordinarily find pleasure in.

• 0:57Speaker 02

  The mood and mania, most of the time, is euphoric, expansive, grandiose. People feel like you can do anything about this energy.

• 1:08Emily Kwong?

  Kay Redfield Jamison is a professor of psychiatry at the Johns Hopkins School of Medicine. She has written extensively about bipolar disorder, from medical textbooks to personal memoirs about her own experience. Kay was one of the first scientists living with bipolar to write a memoir about that experience. It's called "An Unquiet Mind." Growing up, she loved school. She jumped out of bed each morning and couldn't wait to see her friends. But when she was 17, a senior in high school, she suddenly got severe depression.

• 1:40Speaker 02

  And all of a sudden, I not only had no energy, I was morbid. I wanted only to die. I had never had any of these thoughts before, which is not uncommon. Some people have kind of... Premorbid personalities that are consistent with this. Other people are just like I am, just it's like a bolt out of the blue and you have no idea what's going on.

• 2:02Emily Kwong?

  And she wouldn't fully know for years. Throughout college, Kay's mood continued to fluctuate. And it wasn't until she was 28 years old and had just become an assistant professor of psychiatry at UCLA, that Kay says she had her first manic episode.

• 2:18Speaker 02

  It was undeniable. I mean, I knew I was psychotic. I knew I was completely beyond the pale and the people who were around me knew that. And so I had to go to a doctor for the first time. And fortunately, it was a doctor who knew what he was doing. Deeply skilled psychiatrist, psychopharmacologist, psychotherapist, all rolled into one.

• 2:42Emily Kwong?

  It often takes years for someone to get diagnosed after their first symptoms and ultimately to get help. And when Kay realized how little scientists had studied bipolar disorder, she wanted to do something about it. In 1990, she and psychiatrist Frederick K. Goodwin co-authored what is now considered the standard medical textbook on bipolar disorder. This book catalyzed all kinds of research and Kay's own desire to open the doors for others towards treatment by talking about it.

• 3:12Speaker 02

  The thing I would emphasize from the start, over and over again, is that it's treatable and that it's really important to get it treated because it's also very associated, more than anything really, with suicide, with substance abuse, with a great deal of suffering for individuals who have it and for family members.

• 3:31Emily Kwong?

  So today on the show, understanding, treating, and managing bipolar disorder with one of the field's pioneering researchers, Kay Redfield Jamison. I'm Emily Kwong and you're listening to Shorewave, the science podcast from NPR.

• 4:00Speaker 00

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• 5:25Emily Kwong?

  Okay, Kay, so we are talking about bipolar disorder. Do researchers know what causes bipolar? What are some of the leading theories?

• 5:36Speaker 02

  Well, yes and no. I mean, it's hopelessly complicated. You're talking about an illness that affects mood, motivation, behavior, personality, temperament. You know, it affects so much of what goes on in a very complicated brain. I would say what we do know is it's genetic. Has a very strong genetic component, runs in families and people have known that for hundreds, if not thousands of years. And the research is going on now to try and find out what causes bipolar illness would focus on the changes in biorhythms in the brain, the body, but certainly genetics.

• 6:20Emily Kwong?

  If a person's parent has bipolar, it doesn't mean that that person will necessarily get it, but it does mean they're more likely than someone without a family history. But what other conditions might increase someone's risk for bipolar?

• 6:32Speaker 02

  Certainly, some people would say environmental factors, but the genetic propensity has to be there. So I think that if you look, once people reach the age of risk, which in bipolar illness was about 18 or so, then the things we know are very likely to precipitate the onset of mania are sleep deprivation and substance abuse, particularly alcohol, marijuana. This is really unfortunate for college kids because they're right at the age of risk. And when they go off to college, they stay up all night, they leave their work to the

• 7:14Speaker 02

  last moments, and they're in parties and using alcohol for the first time are increasing their alcohol level.

• 7:23Emily Kwong?

  Okay. So let's talk about treatment, about living with and thriving with bipolar disorder. What treatment options are available for people?

• 7:31Speaker 02

  There are all sorts of combinations. Oddly enough, the major, the gold standard of treatment for bipolar disorder, which remains lithium. One of the best predictors of lithium outcome is whether your mania comes first, followed by depression, or the other way around. So people who have manic periods first tend to be more responsive, respond better to lithium.

• 7:57Emily Kwong?

  Lithium is a mood stabilizer medication. Why would it work best for those who have mania first?

• 8:02Speaker 02

  I don't think anyone really knows. It's just that we know that at the heart of Bipolar illness is the tendency to fluctuate, to be often be seasonal, to come and go. And lithium, above all else, affects that rhythmic pattern.

• 8:20Emily Kwong?

  Yeah, and of course, to get a lithium prescription for bipolar, people first need a diagnosis.

• 8:25Speaker 02

  You know, it's like any field, I think, in medicine, if you get a wrong diagnosis, you're going to get likely the wrong treatment. And it not only can not do anything to remedy the situation, but it can make people worse. For example, antidepressants, however effective and important they are for major depression and anxiety and other things, can in many people with bipolar illness make people worse. So you've got to get it right. You've got, it's not enough to diagnose depression. You've got to know whether that depression is in the context of somebody who has bipolar illness, or in the context of someone who has depression alone.

• 9:05Emily Kwong?

  Hmm, yeah. What do you do to take care of yourself? What do you recommend people do to take care of themselves if they're experiencing symptoms?

• 9:15Speaker 02

  So there are two major clinical problems in treating bipolar illness. One is to get people to acknowledge or recognize that they have something that needs and can be treated. That's one thing. The other thing is, you know, once they're in treatment, to keep them in treatment, because people tend to, particularly younger people, and it will tend to get worse over time if it's left untreated, and much harder to treat. When I'm teaching residents at Johns Hopkins, I always emphasize that's the art and science of treating mood disorders. It's just they're complicated, that there are huge feelings involved, and denial, and hopelessness.

• 9:59Speaker 02

  So the very thing that you need to get better, which is your brain, is making you hopeless. And so I think you need to educate patients, family members, to the extent that you can get families in to talk about what's going on, what kind of questions, what kind of plans should be made if somebody gets manic, or somebody gets depressed, or somebody gets suicidal. I mean, there are all sorts of things that you can do just by being straightforward and educated yourself as a clinician.

• 10:30Emily Kwong?

  I'm wondering, as someone who's, you know, lives with bipolar, how do you navigate your own emotions? Because emotions are such a part of being human, right? And you wouldn't want to not feel your feelings. What is your relationship to your emotions now?

• 10:44Speaker 02

  For sure, you don't want to consider happiness and joy to be a symptom of psychopathology, you know?

• 10:52Emily Kwong?

  Right.

• 10:53Speaker 02

  You want to go through life with a full range of emotions. One of the things that people do, my colleague at UCLA, David Michalowicz, does with adolescents, for example, is to, and their family members, is to make people more aware of when their moods are getting up. So if somebody's starting to buy more things, or somebody's staying up too late, or somebody's starting to clean the house, which is a very common sort of thing. You know, the earlier you can catch mania, incipient mania, the easier it is to treat and the less damage and harm is done.

• 11:28Emily Kwong?

  In addition to writing so much formative medical literature about bipolar, you've also written very personally about it. You have authored several books, including Touched with Fire, An Unquiet Mind, Night Falls Fast, Exuberance, Nothing Was the Same. You are a prolific writer. What is writing to you?

• 11:52Emily Kwong?

  What has it been for you throughout your life in learning and understanding yourself and others?

• 11:58Speaker 02

  Well, I think writing 1,400 pages of very fine, double-column textbook, it was very therapeutic in many respects to just find out what's known in the field and what's not known. But when I decided to write about my own experience, I was terrified for a lot of obvious and a lot of not-so-obvious reasons. I was... Were concerned about my state licenses in California and the District of Columbia, and how my colleagues would think about me, whether I'd lose my job. But the writing of The Unquiet Mind was actually very easy and very pleasurable.

• 12:39Speaker 02

  I've always loved reading and writing. I mean, I think I had been very fortunate when I was in high school to have a high school teacher that took me very seriously and I think understood that I was having a breakdown, but never said anything, but just gave me some books to read. And among them was Robert Lowell, great American poet. And his life, his courage, the complexity of his thinking and problems and his 20 hospitalizations with mania were, to me, just an extraordinary gift to my life. I mean, they're pieces of music and literature

• 13:18Speaker 02

  that you cannot believe can be so beautiful. I mean, I don't sit around putting Beethoven on when I'm depressed and get a chirpy. But I do find the very fact that it exists when I'm feeling normal a remarkable sustaining thing.

• 13:38Emily Kwong?

  Another support that you've mentioned is your family. Your husband is sitting right beside you. He helped set up the interview recording and has been and has been listening in the background this whole time. What what is his name?

• 13:53Speaker 02

  Thomas Traill.

• 13:54Emily Kwong?

  How has he supported you over the years and beyond?

• 13:56Speaker 02

  Mainly, he's just a remarkably kind, funny, loving person who respects privacy. And I couldn't be luckier. I wake up every morning and say I'm the luckiest woman in the world.

• 14:11Speaker 03

  Oh, please.

• 14:12Speaker 02

  Oh, please stop it.

• 14:15Emily Kwong?

  I just gotta say, you are quite a team. Thank you both. You're both you're both wonderful. And Kay, it was great to talk to you about this.

• 14:22Speaker 02

  Thank you.

• 14:23Speaker 03

  Bye, now.

• 14:25Emily Kwong?

  Short waivers. We care about you. And if you or anyone you know has been having suicidal thoughts, call 988, the Suicide and Crisis Lifeline. We've put several resources together for people who are bipolar, people who love people with bipolar. Check them out on the episode page.

• 14:47Emily Kwong?

  This episode was produced by Rachel Carlson and was edited by our showrunner, Rebecca Ramirez. Tyler Jones checked the facts. Kwasi Lee was the audio engineer. Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy. I'm Emily Kwong. Thank you for listening to Shore Wave from NPR.

• 15:14Speaker 04

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