And who are you? ” asked the Caterpillar. […] Intimidated, Alice replied: “I – at this point I almost don’t know anymore, sir – or rather, I know who I was this morning when I got up, but since then I think I’ve changed more than once” ».
Lewis Carroll
“My own brain is in my eyes the most inexplicable contraption – perpetually humming, buzzing, rising, roaring, plunging and sinking into the mud. And why? What is all this torment for? “
Virginia Woolf
Bipolar disorder, what is it?
The bipolar disorder comprises a series of syndromes (set of signs and symptoms) whose main characteristic is represented by changes in mood in the pathological sense. Physiological fluctuations in mood, between the extremes of sadness and joy, are common and daily experiences, generally triggered by external agents.
In mood disorders these physiological mechanisms are altered: mood changes become pathological and therefore problematic due to some characteristics that distinguish them from normal fluctuations: they are unpredictable , uncontrollable , prolonged , extreme , excessive , accompanied by other associated changes , in thoughts, in the way of behaving and also in biological systems, all modifications that compromise daily functioning, also upset the way of life , causing significant problems in the one who suffers from it and / or in others (Scott, 2001).
The emotions of a person with bipolar disorder can quickly go from a deep depressive state to an inordinate excitement, for no apparent reason. In the manic phase, the disorder typically manifests itself in forms of exasperated disinhibition and other excessive and socially inappropriate behaviors. On the contrary, the depressive phases can be so serious as to lead to episodes of self-harm. Alcohol and drug abuse associated with bipolar disorder is not uncommon.
Within the category of bipolar disorders we find:
Bipolar I Disorder
it is characterized by the alternation of depressive and manic or mixed phases, or by the mere presence of recurrent manic episodes. Generally the manic phase and the depressive phase follow each other without the presence of a free interval; in other forms, on the contrary, there is a period of stable mood (euthymia) between one phase and another.
Bipolar II Disorder
it is characterized by episodes of major depression and by states qualitatively similar to mania, but less intense, called: hypomanic.
Cyclothymic disorder is characterized by a chronic mood alteration, present consecutively for at least two years. To diagnose cyclothymic disorder it is necessary to have several hypomanic episodes and periods with depressive symptoms; the depressive symptomatology does not reach the criteria of severity and duration of the Major Depressive Episode . Onset is often early, in adolescence or early adulthood.
How common is bipolar disorder?
It is estimated that around 1% of the population has bipolar disorder . The odds are the same between males and females. Usually the first episode of manic-depressive syndrome develops in late adolescence or early adulthood, and then recurs again, more or less frequently, over time. Affecting 1.13-1.7% of the population, bipolar disorder currently represents a significant public health problem, ranking fifth in terms of self-reported disability.
What are the causes of bipolar disorder?
The age of onset for bipolar disorder tends to be lower than for major depression, with an average age of 18 years for bipolar I disorder and 22 years for bipolar II . Although the etiology of bipolar disorder is not clear , several hypotheses have been formulated that support the idea of a multifactorial pathogenesis of the disorder. There is no single reason behind the onset of bipolar disorder, but the familiarity of the disease is demonstrated, which suggests that genetic factors play an important role in the vulnerability to the disorder. Other factors that play an important role can be particularly stressful events, excessive alcohol consumption, severe sleep irregularities, etc.
Psychotherapeutic Treatment of Bipolar Disorder
The aim of psychotherapeutic treatment is to reduce the frequency and severity of manic and depressive episodes, as well as to prevent future relapses. Most people with bipolar disorder also need long drug treatments, combining both mood-stabilizing drugs and tranquilizers that are more effective in acute periods.
In the most difficult moments (in the case, for example, of dangerous behaviors and irreversible self-harm), hospitalization is indicated to have an intensive treatment under constant medical supervision. Vismara et al. (2018) pointed out that suicidal behaviors are extremely common among individuals with bipolar disorder (BD), as well as being responsible for a considerable burden of disease for patients and healthcare professionals. The Cognitive Therapy – Behavioral , along with a family therapy, can still play a beneficial role, first by providing the necessary knowledge to understand the impact of the disease on the individual and on family relationships.
The therapy also provides knowledge and useful tools to deal with manic and major depressive episodes. For example, it has been shown that maintaining regular behaviors with regard to nutrition, sleep and, more generally, with respect to one’s activities, can be useful in avoiding excessive mood imbalances. Therefore, it is useful for the disturbed subject to keep a diary of emotions and activities so that he does not indulge in excessive behavior. The diary, in fact, allows to identify particularly stressful and harmful events for the subject, the signals that a manic or depressive episode is coming, and consequently allows to devise appropriate response strategies.
The psychoeducational intervention is proposed as a complementary strategy to pharmacological treatment, through the “information” of the patient based on the axiom that there is a close relationship between the patient’s knowledge of his own illness and the improvement of its course.
The mania
“When you’re up it’s awful. Ideas and feelings are as fast and frequent as shooting stars and you follow them until you find better and brighter ones. Shyness goes away. Suddenly, the right words and gestures are there, the power to captivate others is felt as a certainty. Feelings of ease, intensity, power, well-being, financial omnipotence and euphoria pervade one’s marrow ” Kay Redfield Jamison, A Restless Mind, 2012.
The characteristic of mania is an elevation of the mood. Contrary to the depressive episode, this state is extremely unstable and a modest external stressful stimulus is often sufficient for anger, irritability, aggression or deep sadness to take over, fluctuations usually of short duration, with return, within a few minutes or a few hours, to the previous condition of euphoria. Sometimes the prevailing mood is that of dysphoria : the subject appears fickle , polemical , grumpy , intolerant and aggressive towards others.
This is associated with an increase in motor activity and energy: you cannot stay still for long; mimicry and gestures appear extremely lively, exaggerated and changeable; clothing is often showy , bizarre , brightly colored, in the most serious forms disorder and poor personal hygiene prevail. There is logorrhea , the tone of the voice is high, the language is verbose. An increase in work activities and hobbies is evident, but it is not finalized: as the disease progresses, the activities become more and more intense until they appear disorganized and confused, with a loss of the ability to achieve the set goals and a sharp decrease in productivity.
The subject often takes on potentially risky behaviors by virtue of the “conviction potercela do,” and engages in risky enterprises , impulsive, sometimes illegal (extravagant spending and futile, not suited to his ability, reckless driving , gambling , acts obscene ), moved by a feeling of omnipotence for which rules and constraints are lacking. When motor arousal is severe, frankly pathological behaviors are possible, in which the subject may dance and sing in public, strip naked , or become violent or aggressive, both verbally and physically, towards objects or people or otherwise impulsively carry out suicide attempts .
The content of thought is represented in the lightest forms by ideas of greatness , with overestimation of one’s own abilities and resources; in the most severe forms delusions develop .
In the manic episode there is a constant decrease in the total hours of sleep due to lack of the feeling of tiredness, increased or reduced appetite, increased sexual desire. The duration of the manic episode varies from a few days to 4-6 months and rarely becomes chronic. In the majority of patients there is a lack of disease awareness, the subject rarely realizes the pathological nature of his condition, is convinced that he is well and can react aggressively if contradicted.
If you agree with the description, contact a specialist (psychiatrist / psychotherapist) as soon as possible.
If you want to learn more: bipolar disorder and cinema
If you are passionate about cinema and want to learn more about bipolar disorder, we suggest some films that have told the life of people suffering from this disorder.
- The Positive Side (2012)
- Mr Jones (1993)
- Backwind (2004)
- Sucker Punch (2011)
- American Psyco(2000)
- The Black Swan(2010)
- The hours (2002)
- Emma it’s me (2003)
- She is so Lovely(1997)
- Tenderly Insane(2014)
