The awful black feelings, it should be pointed out at once, are only half of bipolar disorder, a condition which deals its blows by swinging between a depressed mood of hopelessness and its polar opposite (hence the name) – an elevated mood of euphoric grandiosity, energy, self-belief and sometimes an embarrassing loss of social or sexual inhibition. It is is easy to think that these upswings are a kind of compensatory bonus that allow manic depressives to be more creative and artistic than other people. While it may be true that certain celebrated writers, painters, composers, statesmen, warriors and inventors have appeared (inasmuch as such retrospective diagnosis can safely be believed) to have been manic depressives, anyone who lives with a seriously bipolar person can tell you that the manic elevated mood is in fact harder to cope with than the black depressed one and that â€ścreativeâ€ť is not a word one would often use of it. This is not even to mention the â€śmixedâ€ť or â€śtransitionalâ€ť states that often combine the worst aspects of both extremes.
Let no one be under any illusions. At its most serious, bipolar disorder can be a very very serious condition. Its morbidity rate is high, often because it can typically trace a descent from social norms and supportive structures into homelessness, friendlessness and all the disastrous effects on physical health that poverty, addiction, social rejection and loneliness bring in their train.
Those who think manic depression is a â€ścelebrity disorderâ€ť made up by tabloid cuties to excuse their excesses, addictions and descents into bad behaviour, should look at mental healthâ€™s most serious victims: the marginalised, the poor, the ethnically isolated, the lonely. They have no voice, save the jeers of stone and insult throwing louts, it is they who form the silent majority of sufferers.
It can be no surprise that so many with bipolar disorder, a condition over which they have no control, reach for something that can predictably lift or lower their mood at their bidding in their own time and under their own terms. Drugs and alcohol appear to offer at least that kind of relief. This is known in the trade as â€śself-medicationâ€ť or amongst those without sympathy, imagination, sense or decency as â€śa feeble excuse for weaknessâ€ť or â€śself-indulgent nonsenseâ€ť. But just imagine how tempting it is to reach for a bottle or narcotic powder: the intensity and misery can be numbed and life can seem more bearable. At a cost, naturally: a financial cost, a social cost, a physiological cost, a cost that can lead to ruin. As with all addictions progressively more of the stuff is needed to produce the same effect until inevitably the substance abuse becomes the problem, masking the mood disorder beneath.
Which is not to say that all alcoholics or drug addicts are bipolar or that all with bipolar disorder succumb to substance abuse. The uncomfortable, as well as the miraculous, fact about the human mind is how it varies from individual to individual. The process of treatment can therefore be long and complicated. Finding the right balance of drugs, whether lithium salts, anti-psychotics, SSRIs or other kinds of treatment can be a very hit or miss heuristic process requiring great patience and classy, caring doctoring. Some patients would rather reject the chemical path and look for ways of using diet, exercise and talk-therapy. For some the condition is so bad that ECT is indicated. One of my best friends regularly goes to a clinic for doses of electroconvulsive therapy, a treatment looked on by many as a kind of horrific torture that isnâ€™t even understood by those who administer it. This friend of mine is just about one of the most intelligent people I have ever met and she says, â€śI know. It ought to be wrong. But it works. It makes me feel better. I sometimes forget my own name, but it makes me happier. Itâ€™s the only thing that works.â€ť For her. Lord knows, Iâ€™m not a doctor, and I donâ€™t understand the brain or the mind anything like enough to presume to judge or know better than any other semi-informed individual, but if it works for herâ€¦. well then, it works for her. Which is not to say that it will work for you, for me or for others.