In 2002, after a life long battle with an unseen menacing authority over my ability to function like other people, my then wife insisted that I seek professional help. The appointment with my general practitioner was one of the most mixed emotion doctor’s visits I had ever had. 2002 was the year I was diagnosed with bipolar. What followed was a misconception on my part, my wife’s part, and just about everyone that I knew, that by taking a pill my brain would level out and everything would finally be normal. What wasn’t known in my circle of community, and what turned out to be society in general, was that bipolar is a disease much like diabetes in the sense that at times, even with adherence to treatment, the disease still runs amok. This resulted in a lot of devastation in my life such as divorce and alienation from my children. As the years have gone by, I have come to understand that this type of devastation is not exclusive to my life and in fact affects millions of lives in the same way across this country. If only people understood that reclassification of bipolar disorder as a disease becomes increasingly necessary after examining the physical ramifications of this illness fewer people would have to suffer the same fate.
One of the most common statements in regard to mental illness, and is commonly in jest, is that “it is all in your head.” In the case of bipolar the statement is surprising true, though not in the way one might think. In 2000, a researcher with the National Japanese Research Institute by the name of Kato Tadafumi concluded that bipolar could be linked to mitochondrial breakdown in the Hippocampus region of the brain. Illustration 1a (Best, 1990) identifies the location of the Hippocampus and how mitochondria cells exist within the cells that make up the Hippocampus.
The primary function of mitochondria is to convert sugars into ATP which is used as an energy source for the cell that mitochondria exist within. Mitochondria are found throughout the body and could be viewed as the energy factories that keep our various bodily systems functioning.
What was so profound about Tadafumi’s discovery was the impact it had on opening the doors to researching bipolar as a true disease and not simply a mal-adjustment to coping with the various stresses of life. In many respects the Hippocampus could be viewed as a type of hub of brain activity with various functions beyond simply mood being impacted by its activity. Motor skills, immune systems, and releases of various chemicals not only within the area of the brain but throughout the body can all be attributed to the Hippocampus.
The understanding that mitochondria were breaking down within this region of the brain, which would have impact on how the Hippocampus functioned, began to steer studies in the direction of looking at the potential impact of this disease not only on mood but on the body as a whole.
However, Tadafumi’s original study results in and of themselves were not viewed as conclusive in there implication that bipolar is in fact a mitochondrial disease. Even today, nearly a decade later, a methodical process of study not only by Tadafumi, but by an array of various researchers and study groups designed to put to the test Tadafumi’s original findings continues. By looking at a sampling of what has been discovered, one can get a better understanding of not only the indications of bipolar being a disease, but how broad of an effect it has on the sufferer beyond simply mood changes. In addition, it becomes apparent how close to a conclusion this process is.
In a Science News article (Saey, 2008) a study by Hemmo Drexhage, which was inspired by the realization that sufferers of bipolar were three time as more likely to develop autoimmune thyroid disease, looked at the possibility of using monocytes (a white blood cell) as a possible indicator of bipolar. As the article points out, monocytes are always active and have an effect on several genes in people with bipolar. These effects often lead to inflammatory illness like autoimmune thyroid disease and some data suggests even type 1 diabetes. The study was conducted to see if testing for elevated monocytes could be an indication of bipolar prior to the onset of symptoms. Drexhage addresses the question of why monocytes could be a possible indicator by saying of bipolar “It’s not just a disease of the brain, it effects the entire system.” The findings showed among other things that activity levels of 19 genes were altered in people with bipolar. This gene signature was found in 55% of people studied with bipolar, and in only 18% of people without the illness.
Another study conducted by Ortiz et al (2007) examined the possibility of variations in immunity levels in people with bipolar between manic and depressed episodes. Their study focused on measuring the serum levels of cytokine to see if there was a difference between manic and depressed phases of bipolar. The study concluded that there was in fact a marked difference in the serum levels between these two phases. The implication is that not only is mood affected by shifts caused by bipolar, but the ability to fight off infections is as well.
What both of these studies point out, all be it subtly, is that there are genetic factors at play. Bipolar has an effect on the genetic expressions of many systems within the body which causes a wide variety of consequences beyond the now lacking description of bipolar being elevated highs with a type of euphoric superman kind of thinking followed by terrible lows that often lead to suicidal thoughts. A study done by German researchers and covered in a 2008 article in Medical News Today, found that gene expressions found in depressed states of bipolar lead to the release of chemicals similar to that found in animals going into hibernation. Another study examined rates of co-occurring illness in bipolar sufferers and found that in nearly every form of illness, less cancer, sufferers of bipolar had a higher rate of occurrence than non-sufferers. So motivating are the findings of these and many other studies that continue to show that bipolar is a disease that affects mood as well as physical health with the same relentless yo-yo style ups and downs that a movement has begun to take place within the medical field to reclassify bipolar from a disorder to a disease.
In a well argued editorial found in the Journal of Psychiatry and Neuroscience (Young, 2007) a case is made that the evidence which keeps being produced by the various studies oriented around bipolar leads to a single conclusion which is that of bipolar quite likely being a “metabolic disease”. The editorial is packed with supporting studies and evidence, and very systematically draws correlations between each them. It is a culmination of viewing the many aspects of today’s research around bipolar and being able to connect the dots of what it all means. Should bipolar be classified as a disease? All the evidence viewed by this paper and many others points to yes. But is that the whole picture?
At the opening of this paper it was proposed that if more people understood that bipolar was in fact a disease it would help reduce the amount of tragedy often associated with it. The science behind the disease is only a part of the picture that needs to be painted in order for there to be a true understanding and thereby a new sense of humanity associated with bipolar. The fact is, despite the influence of solid science and detailed research there is a human element that more closely regulates our daily lives.
Statistics of near 80% divorce rates, elevated rates of job loss, homelessness, alcoholism, and incarceration all represent the more human element behind the science. We are made of cells, chemical processes, electrical impulses, and DNA all interacting to comprise a walking talking human being. But what makes up the part that feels, loves, laughs, and is able to connect with others on those same levels? Is science’s explanation of the internal malfunctioning mechanisms enough to evoke changes in the way one views bipolar?
The simple truth is that most people’s views of bipolar are not predominately shaped by the science associated with it. Instead, views are formed around the experiences they themselves and others have had through interacting with sufferers. This is not to say the science is irrelevant. Understanding the science is a very important step in learning a new perspective but it is just a step. The role it plays is one of encouragement to forgive. When a person is slowing ones progress up the stairs because they are on crutches there is a deeper understanding afforded them. When a person with diabetes is picky about what they eat, it is an accepted part of what they must do to live. It is the science behind bipolar which helps us to associate the same understanding and acceptance with sufferers of this disease.
Applying the science to the human element seems to be the challenging part for many people. In many ways it is understandable. Watching loved ones trying to endure a depression where everything seems to come to a standstill and nothing matters anymore. The feeling of helpless as they do not eat, bath, or hardly get off the couch becomes nearly unbearable and seems to consume ones thoughts. A person can find themselves not wanting to come home to that spouse or call that friend while at the same time fearing that a suicidal thought may penetrate to deep resulting in the loss of that person.
The path of bipolar can lead to watching your loved one in a state of continual thought, a frantic expression of ideas and goals. Trying to keep up can be exhausting as the sufferers relentlessly expounds on one idea after another needing little to no sleep. They spend money they do not have despite your warnings, all the while you know that when the dark days come again it will be an added source of grief for them. It is easy to again find yourself wanting to distance yourself from that loved one but again with an element of fear. It is a fear that their reckless behavior will get them into serious trouble if you are not there to help keep them out of it.
Has science changed these aspects of bipolar? In some ways it has. Many medications have been developed to help reduce the severity of the symptoms associated with bipolar. What is not often talked about is how long it can take before a person finds a medication that works well for them, or some of the side effects and how they can leave a person just a shell of who they were. Another thing not often talked about is that medications rarely eliminate the symptoms all together and there are still challenges that have to be faced in living with bipolar.
But living with bipolar does not have to be all up or down, there are benefits to be had for those willing to look for them. They are all the same benefits a person would find in a relationship of value with any other person but with one difference, just as bipolar amplifies the highs and the lows, it amplifies the things that can make for a great relationship. Passion, empathy, understanding, concern, are just a few. Unfortunately they are often lost among the challenges. That is where science comes in.
Science gives us a reason to hope. It gives us hope that one day there might be a cure or at least a better treatment to help make things more manageable. It gives us hope that the person we love is still in there and that they will come back. It is a hope born of the understanding that this person who has challenged us, or even hurt us is in fact suffering themselves and would change it if they could. For the sufferer, it gives them hope that they are or can be that person they desire. That the hurt they may sometimes inflict is not on purpose and maybe the one they hurt will understand.
Having viewed the science behind this disease and understanding the human element and how the two interact, your view of bipolar has most likely shifted. Consider that much of the evidence presented within this paper is the result of a single discovery by researcher Kato Tadafumi. Also, consider that similar discoveries have not yet been made for other mental illnesses like schizophrenia or borderline personality disorder but could be. When combining that with the human element, what affect will this have on your view of mental illness? Will you find yourself viewing sufferers in a new light? The challenge to you is to view all mental illness in the same light as physical illnesses and discover for yourself the affect it has in your life. Remember, it is estimated that 1 in 4 individuals will suffer from a diagnosable mental illness within their lifetime. The odds are that you will know at least one of those individuals and it could be your brother, best friend, spouse, or even you.
References:
Best, B. (1990) Learning, Memory and Plasticity, p 5. Retrieved October 23, 2008 from
http://www.google.com/imgres?imgurl=http://www.benbest.com/science/anatmind/
FigIII25.gif&imgrefurl=http://www.benbest.com/science/anatmind/anatmd3.html&h=
389&w=503&sz=5&tbnid=k5hV6lDZ5HgJ::&tbnh=101&tbnw=130&prev=/images%3Fq%
3Dhippocampus%2Bdiagram&hl=en&usg=__5EU5EnKbn3NGHvtkCByOOjleuMs=&sa=
X&oi=image_result&resnum=4&ct=image&cd=1
Medical News Today. (2008). Health News. Retrieved October 20, 2008, from
http://www.medicalnewstoday.com/articles/121472.php
Ortiz-Domínguez, A., Hernández, M., Berlanga, C., Gutiérrez-Mora, D., Moreno, J., Heinze, G.,
et al. (2007, September). Immune variations in bipolar disorder: phasic differences. Bipolar
Disorders, 9(6), 596-602. Retrieved November 5, 2008, doi:10.1111/j.1399-
5618.2007.00493.x
Saey, T. (2008, April 12). Body and Brain. Science News, 173(15), 228-229. Retrieved
November 5, 2008, from MasterFILE Premier database.
Young, L. (2007, May). Is bipolar disorder a mitochondrial disease?. Journal of Psychiatry &
Neuroscience, 32(3), 160-161. Retrieved November 5, 2008, from CINAHL Plus with Full
Text database.
