History and symptoms of a pathology of which little is said, between social stigma, myths and daily pitfalls.
Fuani Marino is a psychologist and journalist. He has written on Flash Art, The Towner, Prismo, Rivista Studio. His latest book is “Wake me up at midnight” (Einaudi, 2019)
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S.on the cover of Kanye West’s eighth album, Ye, the inscription in fluorescent green stands out: “I Hate Being Bi-polar – It’s Awesome”. Whether the rapper really has a mood disorder or not, the statement “I hate being bipolar, that’s great” seems to encompass all the contradictions that this condition represents. The clinical pictures once referred to by the generic term of “manic-depressive psychosis”, in fact consist of syndromes of psychiatric interest characterized by an alternation between two different conditions of psychic activity: its excitement (the so-called mania) and the opposite its inhibition, or depression, combined with neurosis or thought disorders. World bipolar disorder day falls every March 30, the day of the birth of Vincent van Gogh, who suffered from it. In his day, however, there was no DSM,
According to the documentary film Vincent van Gogh: a new way of seeing , over one hundred and fifty psychiatrists have tried over the years to classify the painter’s symptoms, with the result of about thirty different diagnoses, and the World Bipolar Day it could therefore take the form of a belated tribute by psychiatry to what Antonin Artaud called the “suicide of society”. In his essay, the French playwright supports the radical thesis according to which van Gogh’s genius is “one of those natures of a superior lucidity that allow them in all circumstances to see farther, infinitely and dangerously farther than the immediate and apparent real of facts “. People who for this reason are “full of intuitions, premonitions, presciences, divinations, which have always constituted an impending discomfort for the conscience of every day”, “the vulgar and common conscience of every day, which gives a century, psychiatry was invented as a defense ”. This view, in some ways anti-psychiatric,Franco Basaglia who with the law 180 sanctioned the closure of the asylums. Compared to just fifty years ago, psychiatry and society have both made immense strides. In terms of diagnosis and treatment, the former, including the latter. But when van Gogh began to show his first symptoms in the second half of the nineteenth century, psychiatry was not at all prepared to face the progress of his illness, nor was the small community of Arles in which he lived like an outcast prepared to welcome him.
World bipolar disorder day falls every March 30, the day of the birth of Vincent van Gogh, who suffered from it.
To date, there is still no unanimous consensus on how many types of bipolar disorder exist. In the ICD, the World Health Organization’s international classification of diseases and related problems is presented as a spectrum of disorders occurring along a continuum. The distinction between the various clinical subtypes essentially occurs on the basis of the course and the symptomatological connotation of the different phases collected with the anamnesis.
The DSM lists three specific subtypes: type I Bipolar Disorder, characterized by the presence of at least one major depressive episode interspersed with at least one spontaneous manic episode (i.e. one which has not changed following the intake of antidepressant drugs). In most cases, manic episodes are followed by one or more depressive episodes, although these are not at all necessary for making the diagnosis. Indeed, in a small percentage of cases only manic relapses occur, the latter forms which most often show a late onset. On the other hand, type II bipolar disorder shows a clinical course characterized by at least one major depressive episode, interspersed with at least one hypomanic episode, which is therefore attenuated compared to type I mania.
When a specialist gave me my bipolar diagnosis several years ago, he prescribed, along with the drugs, the reading of a text by Kay Redfield Jamison, the American clinical psychologist considered one of the leading experts on the disorder from which she herself suffers. What emerges in the pages of A restless mind, is first an attempt to understand her condition and, once done, to keep it hidden, particularly from the academic world in which Jamison worked and which she feared might brand her damaging her career. Many of his efforts were aimed at concealing symptoms, as well as concealing lithium in his bathroom cabinet when receiving guests at home. This happened because, as with any psychiatric pathology, even bipolar disorder, unfortunately, projects a large dose of prejudice and social stigma on those who suffer from it.
There is not just one bipolar disorder, but several subtypes to identify which require specific expertise and long experience.
The goal of World Bipolar Day and other similar events (the world day dedicated to autism is celebrated on April 2, also highlighted by the recent media case of Greta Thunberg, the young Swedish activist suffering from Asperger’s syndrome) is precisely to combat the stigma associated with the disease by making its characteristics better known. In the case of bipolar disorder, much of the confusion stems from the fact that there is actually not just one, but several subtypes to identify which require specific expertise and long experience.
Today, alongside the classic forms (bipolar disorder I and II), other subtypes are also distinguished based on the polarity of onset (i.e. whether the disorder manifested itself for the first time with a depressive phase or with one of euphoria), the polarity prevalent (or simply the greater tendency of the disorder and its relapses), and the type of evolution over time (the way in which depressive or manic episodes alternate and the presence or absence of a period of well-being between one and the other ).
A precise diagnosis, and formulated taking into consideration all these variables, allows the clinician to make a prediction (technically “prognosis”) on what evolution the pathology may have in the individual case and, above all, on which short and long-term treatments are most useful. The message conveyed by World Bipolar Day is that bipolar disorder is a disease that as such can and must be treated. If kept under medical supervision it is compatible with a normal and productive life but, as happens with asthma or diabetes, often the treatments to which one must undergo last forever. Accepting the diagnosis and the need for treatment is not easy, and the graphic novel Marbles tells us this double aspect . Mania, depression, Michelangelo and Me(translation by Micol Beltramini, BD Editions) to whom the American designer Ellen Forney gives her experience as a psychiatric patient. It is a memoir on the pitfalls that bipolar disorder hides and on treating it through the right drugs and the help of psychotherapy. The one with a cognitive orientation is the most suitable, while from a psychopharmacological point of view the mood stabilizers allow to keep the fluctuations under control and to prevent relapses. As for unipolar depression, the disorder has a seasonality (for van Gogh the symptoms tended to recur in the winter months, while I fear the arrival of heat and summer every year) and a periodicity, as it tends to recur cyclically.
Perhaps to console themselves for their own diagnoses, both Forney and Jamison (the latter in the text Manic-Depressive Illness. Bipolar Disorders and Recurrent Depression that he signs with psychiatrist Frederick K. Goodwin), list the many geniuses affected by bipolar disorder. Jamison, in particular, underlines the greater predisposition of brilliant and creative people to manifest manic-depressive illness and, according to the results of a study carried out on some sixteen-year-old Swedes, the four times greater probability of developing this pathology for those who among they excelled in intelligence.
For any alleged or actual manifestation of genius, there is a flip side, and one of the most serious consequences of the disorder is suicidal ideation.
Jamison is not the only scholar to support this correlation, and some psychiatrists have resumed the studies of Cesare Lombroso or analyzed the works of Johann Wolfgang von Goethe and Richard Wagner trying to deduce in which phase of bipolarity the authors were. However, there is a different school of thought, and new studies seem to refute the thesis of some connection between creativity and mental illness.
For any presumed or actual manifestation of genius, there is a downside, and one of the most serious consequences of the disorder is suicidal ideation, which leads to attempts, to the point that one in three patients with bipolar disorder has a past history of suicide attempts, averaging 10 to 20 times that of the general population. The age group most at risk for suicide is between 15 and 25 years, during the onset of the disease, when the person and his family do not yet know how to deal with it. The fluctuations in mood and, in general, in the functioning of the person caused by the disorder, can also compromise work activities and social relationships. This happens not only in the two extremes of the disorder (i.e. when one is completely depressed or in a state of mania or hypomania) but also in the phases in which a mixed state occurs, characterized by a coexistence of depressive and manic symptoms, with the predominance of irritability, anxiety and restlessness. Because as Kanye West sings in his songWaves , the waves do not end, nor do they stop, and we bipolars can only learn to live with them.