Wednesday, June 10, 2009

Trick Question: Bipolar vs Cycling


The term, bipolar disorder, is used to indicate the duality of the illness: depression at one end and mania at the other. True or false?

True - uh false. No true. Maybe. Never mind. No, wait ...

In the second edition to "Manic-Depressive Illness," Goodwin and Jamison point out that while bipolar is useful to help explain "the coexistence of opposites," just as important (perhaps even more so) is "cyclicity."

A major drawback to the "bipolar" way of looking at things, the authors point out, is that we tend to separate out the dimensions of the illness with no attempt investigate how they tie in together.

Cyclicity is all about the dynamics of the illness, how two apparently unrelated features - depression and mania - relate. In 1854, the French physician Jean Pierre Falret coined the term, "la folie circulaire," in recognition that depression and mania were not separate illnesses, but different manifestations of the same underlying circular phenomenon.

One state, in effect, predicted the other, and back again.

A cyclic view encourages clinicians to investigate their patients over long periods of time and thereby help predict the future course of their respective illnesses, with a view to improving the outcome. For instance, a clinician treating depression needs to anticipate the likelihood of mania, and vice-versa.

In short, it is probably more useful to treat the cycle rather than the symptom of the day.

A few weeks ago, I had a conversation with a brain scientist at the American Psychiatric Association annual meeting in San Francisco. She told me that they do not have an animal model of bipolar. In other words, they have yet to figure out a way to get a lab rat to behave like a bipolar patient.

Wait a second, I interrupted. We can give rats methamphetamines to make them manic and psychotic. We can give them forced swim tests and foot shocks to induce them into learned helplessness (roughly equivalent to depression).

Yes, she said. But we can't do it in the same rat.

Oh, I said.

Technically, we can induce learned helplessness in the little guy before we feed it meth, but that's not going to teach us how we (humans, that is) cycle from one extreme to the other. We have yet to come up with a way of making the rat cycle. And cycling is the key to understanding bipolar, she informed me.

You know, I knew this all along, but suddenly the light bulb went off.

Oh, I said again, or something equally intelligent.

9 comments:

Anonymous said...

poor rat... or rats..no one should have to cycle.

Anonymous said...

Why cycle when you can fly... then crash... then fly again? This site is brilliant - I'm finally learning how to just... walk :o)

edward said...

I always thought of it as the swing of the pendulum, the farther it swings in one direction... and the idea that "normal" had to be like hovering around the middle all the time? Yuck. But the depression(s) were getting harder and harder to deal with. On meds had to mourn the loss of my manic, and current depression has been dragging on way too long...

Anonymous said...

I suppose being an ultra-rapid cycler, I understand Jamison's definition - somewhat. I think using a diagnostic term that highlights polarity is misleading. I feel like a ping-pong ball with less bounce. Another simile, like a paddle ball in the hands of an inexperienced user. You know how they swing it and wrap the string around the paddle this way and that with a lot of bouncing here and there in between? It would be more appropriately termed mood inconsistency disorder.

John McManamy said...

Hi, Edward. Pendulum is an apt metaphor, as well, as in mood swing. The term cycle, though, has this advantage - it encourages researchers and clinicians and patients to investigate the tie-in to other cycles: sleep, seasonal, circadian, etc. Some of the research supports the idea that there is a malfunction in the "master switch" that regulates these cycles.

John McManamy said...

Hi, Anonymous. "Mood inconsistency" disorder - very interesting. You're making me think, here. Okay - let's try this out: "Cycle" actually implies a consistency of sorts. We are encouraged to look for patterns so we can predict the likelihood of the next phase of the cycle. In other words, we are not completely helpless bystanders. "Inconsistency" may be more accurate, but it kinda plants the notion of helplessness in my head.

I'd be interested in your thoughts ...

Anonymous said...

In my case, "Randomised Mood Disorder" would be closer to the mark. The only way to deal with it I have found is to exercise like crazy and use sleeping tablets when I'm manic (to force myself down) and isolate myself a bit when I'm depressed. Depression isn't too bad if I feel I'm "in charge". Lithium robs me of that control and makes the depression phase much longer. I imagine a rat would hang itself in it's cage before it figured all that out...

Anonymous said...

It is just a way I use to explain it to myself. I don't find any consistency in my cycles. There is some pattern consistent with PMS but it is hard to tell if it is hormonal or bipolar. Of course, Dr. Hyman in his book The Ultramind Solution discusses hormonal imbalance as a contributor to the mind not functioning correctly. I don't feel helpless because I know this is not a character issue, nor is it some shadowy mystery illness needing to be beaten down with Haldol. :-) It is a nuerotransmitter imbalance and since I can find the physical existence of nuerotransmitters in the gut as they are created by a physical digestive system in a physical body ... I believe that bipolar disorder (and all mental illness) is physical in basis. Stigma arises from other basis. Just my opinion and I admit, I am opinionated. As far as helplessness goes: cultivate that attitude and you can kiss your backside goodbye with this illness. I can't think of a day in my life that I was ever helpless or even felt that way for very long. This is because of the personality evident in these posts but it is more because Jesus Christ is the center and focus of my life. I am safe in His hand and what challenges this life throws my way He turns them into blessings. And I praise Him for I could trade bipolar for quadriplegia and I would still not be helpless. It is simply not a word in my vocabulary. Bless you for this website and all the time and effort you put into it. It does stand head and shoulders above others on the net though many others do a good and sincere job as well.

malieie said...

I just want to get better. mood-:(