Bipolar Disorder: More than Moodiness
By Diana Somerville

From Vincent van Gough to Virginia Woolf, many outstanding artists -- and their turbulent lives -- have fed the idea of a link between mental illness and creativity. And, according to University of Colorado psychology professor David Miklowitz, the persistent myth is, indeed based on medical fact.  Many cultural icons of creativity share what's now called bipolar mood disorders.

Once called manic depression because of the wide mood swings that characterize this clinical brain disorder, "bipolar is the only mental illness with both positive and negative attributes," says Miklowitz. Co-author of "Bipolar Disorder: A Family Focused Treatment Approach," he heads the Colorado Family Project at CU, part of a multi-year national effort to evaluate the role of families in treating bipolar mood disorder.

Bipolar mood disorders are, in essence, disturbances in the brain's delicate balance of neurotransmitters, the chemical messengers that carry information in the brain and nervous system. Genetics are to blame for a more fragile, easily disrupted brain chemistry. Bipolar mood disorders usually spring from a family tree peppered with troubled people, their difficulties often entwined with drinking or drug use.

Imbalances in the brain's neurotransmitters can alter mood moods with stunning speed, or shift gradually over time. When these neurochemicals get out of whack, however, emotional equilibrium goes out the window -- often with devastating consequences for families and intimate relationships. Since 1989, the Colorado Family Project has been evaluating outpatient family-focused treatments. "While bipolar disorder affects the functioning of families, family relationships also affect the course of bipolar disorder, " says Miklowitz.

Study participants must be at least 18 years old and living in a family-like setting. They're randomly assigned a 9-month educational program where, in addition to appropriate medications, they learn about bipolar disorder and receive training on how to communicate effectively to solve problems.

More than "just being moody," bipolar mood disorder is a "spectrum diagnosis" with recognizable patterns of behavior, characteristic ways of thinking and a range of symptoms, Miklowitz says. "What's unique is that they are very influenced by minor changes in sleep-wake cycles." Even a trans-Atlantic flight can trigger a disruption. Day-to-day life changes like moving or working different hours -- and especially changes that increase stress -- are difficult.

Bipolar disorder can show up at any age, even among young children, although it commonly begins around age 19 to 23. Bipolar I strikes men and women equally while Bipolar II, which usually begins with a depression, is more common among women.

Women are more likely to have rapid, frequent mood cycles while men tend to display risk-taking behavior -- speeding, heavy drinking, gambling or spending sprees, says Boulder psychiatrist Richard Suddath, who prescribes drugs for patients in the CU study. "Women respond differently, probably because of menstrual cycles and the fluctuations of hormones that have mood effects in the brain." People with Type II don't have as much dysfunction because their mania is milder; instead they're more likely to hover on the edge of depression.

Bipolar mixed state, another part of the spectrum, has little of the exhilarating euphoria. Instead, the high level of mental activity is expressed in irritability, impatience, unpredictable outbursts of rage or depression. It's common for those with a mixed state to be misdiagnosed with simple, unipolar depression, but given antidepressive drugs, they get worse instead of better  -- "which is why it's important to do an accurate diagnosis," says Suddath.

As knowledge about the brain's biochemistry increases, the diagnoses are changing. People once diagnosed with personality disorders, such as borderline or narcissistic personalities, are now seen as dealing with biochemical mood disorders. Given the right medication, their difficulties "may melt away," says Suddath. Often children who have been diagnosed with Attention Deficit Disorder (ADD) actually have bipolar disorders, he adds.

With the exception of lithium and calcium channel blockers, the drugs prescribed for bipolar disorders are anti-convulsants used to prevent seizures, although there is no evidence that bipolar disorder is related to seizures or epilepsy.

"Once, people were considered to have a defective personality -- a 'personality disorder' rooted in something in their past, something wrong with how they were raised, some trauma -- not a medical problem," says Dawn Taylor, a psychologist who also works part time with the Colorado Family Project. "The truth is, their behavior -- whether they're bleak or optimistic, or they way they treat other people -- is not always under their control," she says. Given a medical diagnosis, however, people "have more compassion for themselves. It allows the family to be less critical and judgmental, less angry. And then with less animosity, the family member does better.

Drugs and alcohol can complicate the picture. "People are using alcohol and  drugs to self-medicate," she says. Taylor has a sure-fire way to find out if addiction is the problem:  "Once they're medicated for a mood disorder, they just stop drinking."

Miklowitz encountered the family dimensions of mood disorders while finishing his doctorate at UCLA.  "One rotation shift was dealing with families of bipolars and how they experienced life. Cycles of illness were often followed by periods of intense family interactions," he says.

Intrigued, he studied a college-age group, young adults from 18  to 22, most of whom lived with their parents. Measuring the level of conflict in each of their families, he found that in "highly conflictual families" -- where chaos and confrontation reigned -- the patents were two-to-three times more likely to have relapses.

According to national estimates, one in seven people suffer from some form of mood disorder. Creative folk have eight to 10 times the usual rate of depression and 10 to 20 times the rate of bipolar disorder according to both historical and contemporary studies.

Kay Redfield Jamison, on the psychiatry faculty at UCLA, was among the first to explore this provocative link in "Touched With Fire: Manic Depressive Illness and the Artistic Temperament."  Jamison, who is herself bipolar, has helped to remove some of the stigma surrounding mental illnesses, and contributed to making bipolar a sort of "glamour diagnosis," producing television specials about the arts and manic depressive illness. She found that people with bipolar disorders tend to use words more imaginatively, think more quickly and have creative outbursts.

Nevertheless, it's still a serious medical condition: Artists have eight to 10 times the rate of depression as the general population and up to 18 times the suicide rate. Moreover, there's no simple correlation.  Most people with bipolar disorders are just garden variety folks and most accomplished artists don't suffer from the recurrent mood swings of Ernest Hemingway or Sylvia Plathr, she stresses.

The good news is that bipolar disorder  may be the most responsive to treatment of any mental illness.  When the CU project and sister studies at other universities are finished, their answers will benefit the more than 17 million adults with bipolar disorders, helping to smooth out the emotional rough places without dimming their creative fire.