Good morning, Frank!

I know several people with bipolar disorder, all under drug treatment, though not all with lithium. A couple of them also have alcohol problems, which is not uncommon in this illness. It's an attempt at self-medication that usually starts before the medical treatment and turns into an addiction due to the pyschological/metabolic effects of the disease.

It's a difficult disease to treat, because during the manic highs, the person feels like he can do anything, and is often capable of extraordinary effort and concentration, as well as unusually creative outside-the-box kind of thinking. Bipolar sufferers, when not in the depressive cycle of their disease, are people you would want around you, the very image of the traditional movers and shakers. For that reason -- because they themselves value the high so much -- there is a tendency to go off the medication during those periods because the medication tends to flatten the highs even as it raises the lows. They achieve great things. As the high spirals up, they also overspend and engage in other bizarre activities. Feeling the slide into lack of control, this period is often when a repetition of alcohol abuse comes into the picture, followed by the inevitable slide into depression.

Medical researchers into the disease have been concerned about this set of behaviors for some time, because it indicates the the treatment is considered part of the problem by the sufferers. Research has focused on trying to find drugs that raise the lows without flattening the exhilerating, productive phase of the highs quite so much.

It bothers me a lot when I see individuals identified by their illnesses, especially neurological disorders with behavioral symptoms like bipolar. To me, to be asked whether I want to be identified with a bipolar sufferer is like asking whether I want to be identified with a diabetic or a blind person or someone with cancer. Do we define people by the sum of their deeds or by the handicaps they have? Do we identify with their successes, or with their failures, or with the efforts that they have made to improve themselves and their world?

No wonder it's so hard to admit one needs help for mental health problems. It's like a brand, the way cancer was a couple of decades ago. It's the same reason we hardly ever see pictures of FDR in a wheelchair or using his crutches. It's poison, because it frightens us so much: a mysterious, invisible ailment. Perhaps if we stay far enough away, we won't be identified with it -- er, him.

I know this isn't how you meant it, Frank, but this is one of the results. It's also one of the causes. A cycle of fear and isolation: it hurts the sufferers most, but it hurts the rest of us too, because it perpetuates the problem that will touch most of us, one way or another, some day.

Regards--
Mary Anne