Wednesday, June 10, 2009
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.