Breaking Down Bipolar

John McManamy Health Guide
  • In response to one of my blogs, Louise posted:


    "Physicians - mostly trained as biologists - need to go back to their roots. Taxonomy is very specific. Diseases are not."


    Louise, Louise, Louise.


    "Bipolar disorder is not a taxonomically consistent ‘thing,'" she continues. "It's not a plant that always presents in a nearly identical way with very identifiable features."


    Damnit, Louise. You're forcing me to think.


    "Someday," she concludes, "when doctors remember that they are biologists, they'll be more inclined to say that all these illnesses are members of the X Family of neurological disorders and subclassify them accordingly. In the meantime, should it be any surprise that bipolar, schizophrenia and other ‘mental illnesses' share symptoms?"

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    That does it, Louise. Now I have to cancel my world didgeridoo tour with Willie Nelson and Wynton Marsalis and get to work on this. Why me?


    Louise happens to be a good friend of mine, revealed in previous post exchanges. She posted this on May 30, but I only spotted it several days ago in the process of catching up from an inexcusably horrendous work backlog. Naturally I dropped everything I was doing. That's what friends are for.


    Here's my starting proposition: Think of all human behavior (including mental illness) as reaction meeting thought. Where over-reaction meets irrational thinking is where we are most likely to find frightening behavior.


    So I set pen to paper (forgive the poetic license) and starting plotting a series of grids. Each grid contains two intersecting axes, kind of like what you see in all those algebra and geometry classes I flunked. The horizontal grid represents the limbic system, responsible for alerting us to danger, as well in stimulating us into seeking pleasure and reward (with over-reaction at one end and under-reaction at the other). The vertical grid represents the thinking brain, with rational thought at one pole and irrational thought at the other.


    "Deconstructing Mental Illness," I call the project. The purpose is to get away from standard labels and classifications and break down behavior into its component parts and see what happens when worlds collide.


    What happens, say, when your boss says he wants to see you right now? Do you take the situation in stride or do you react as if he were an assailant with a knife? Or do you simply not care?


    What happens, say, when you are transported into transcendent ecstatic realms by someone you just met? Do you prudently propose marriage right away? (Just kidding.) You get the picture.


    The outer part of the grid represents how we react and the inner part how we respond. It took me a good three days of tinkering before I could lie to people about the grid being just right. To further tease out reactions and responses, I added certain modifiers, one modifier per grid. My first grid contains an "Ego" modifier and my second its opposite, a "Social" modifier.


    My third and forth grids will contain "High Energy" and "Low Energy" modifiers. I will stop producing grids when I run out of modifiers.


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    In a state of "High Arousal," the limbic system is fairly amped up. But while the thinking brain is capable of toning down this activity, the irrational brain is likely to cede executive control.


    So with the restraints off, from an "Ego" perspective, the limbic system is "reacting" to high arousal with ecstasy, panic, or rage, most likely in various combinations. The irrational brain, with a "Grandiose" high self-interest ("Overbearing" and "No Self-Interest" also figure in the grid), is likely to "respond" in an uninhibited, impulsive, or explosive manner. Not good.


    With the restraints on, limbic reaction is more likely to be along the lines of euphoria, anxiety, or dysphoria, probably in different combinations. The rational "Expansive" thinking brain (also included are "Measured" and "Disinterest") is likely to respond in a decisive, aggressive, or exuberant manner. Much better, enviable, perhaps, over the top, maybe.


    Now we go to the "Social" modifier. In the irrational thinking brain, "Grandiose" translates to what others might describe as a "Loose Cannon." resulting in "Volatile" interactions with people, characterized by unrealistic idealization or vilification. Definitely not good.


    Meanwhile, at the rational pole, a "Charismatic" social individual is more likely to have "Impassioned" interactions with people, characterized by "Love or Hate." Again, this could be better than normal or over the top.


    Surprise-surprise, I recognized right away that the responses coming out of the irrational thinking brain were consistent with personality disorders, such as borderline personality disorder.


    Are you ready for this? The realization soon hit me that the type of behavior that could be attributed to hypomania or mania was emerging from the rational thinking brain. No way!


    Yes, way. A manic brain may be hyperactive to the point of irrational, but can presumably readjust to rational. By contrast, with a personality disorder, the brain may not readily readjust back to rational.


    My thinking is in line with the gist of what I have been hearing from brain scientists over the years. Imagine for the sake of argument that we all have the same limbic wiring that works way too well for comfort. The brain scientists are telling us that our response can manifest in a number of different ways that may include mood or personality disorders.


    What seems to be governing our various limbic outcomes are our thinking brains, the product of our genes plus life experience.


    But before we starting bragging to people about how rational we bipolars truly are, it behooves us to observe that even saints have personality issues in abundance and that our manias and hypomanias tend to come wrapped in a lot of weird things going on.


    Which means the Nobel Prize selection committee won't be getting to me any time soon. (Dang! I could really use the money.) No Willie Nelson and Wynton Marsalis accompanying me on my didgeridoo. I have miles to go before I sleep.


    There, Louise, I hope you're happy.


Published On: July 17, 2007