Bipolar Disorder and Schizophrenia - More Closely Related than You Might Think
What I miss most about trimming back my public speaking to almost nothing is what I learn from interacting with my audience.
Last week, at a Q and A with a NAMI group in Pasadena, a young man asked: "I have schizophrenia. Will I benefit from your book?"
Yes, I replied without hesitation. In my warm-up to the Q and A, I had referred to stress as complicit in virtually all symptoms and behaviors, and that included bipolar and schizophrenia.
No longer can we refer to bipolar and schizophrenia as if they were two entirely separate illnesses. I mentioned that most bipolar patients experience at least some symptoms of psychosis. In addition, the most promising suspect genes for bipolar happen to be schizophrenia suspect genes.
I also referred to the pioneering diagnostician, Emil Kraepelin, a contemporary of Freud who coined the term, "manic-depression." Kraepelin saw no distinction between unipolar depression and bipolar disorder. To him, mania and depression were part of the same phenomenon, part of a recurring pattern with mania and depression bleeding over into each other.
When we hear about cutting edge psychiatrists talking about "the mood spectrum," it all goes back to Kraepelin.
But Kraepelin made a clear split between manic-depression and what he called "dementia praecox," which his followers later renamed schizophrenia. It was a practical working distinction that has held up for nearly a century, but even Kraepelin toward the end of his life, I pointed out, was beginning to question it.
So think of a broad spectrum incorporating depression at one end and overlapping into mania, with mania overlapping into psychosis, which in turn overlaps into depression.
What I neglected to mention was a number of other shared features between bipolar and schizophrenia, namely that schizophrenia patients often experience depression, and bipolar patients often experience cognitive dysfunction, even in symptom-free states.
Another thing I neglected to mention was that whatever is going on inside our brains may manifest differently over the course of a lifetime. There is very little data on this, but it is starting to become a hot topic in research circles. At one time in our lives, we may present with mainly schizophrenia features, at another with mainly bipolar features.
I did mention that for those of us with bipolar, the prospect of our illness being so closely related to schizophrenia is a frightening prospect. Left unsaid, but something that everyone in the audience clearly understood, is that those unfortunate enough to receive the schizophrenia diagnosis invariably get written off. It's as if schizophrenia were code for "abandon all hope."
I wrapped up by saying that we bipolars need to reach out and welcome as brothers and sisters those who have schizophrenia.
One of my heroes is Pope John XXIII. During World War II, as a Vatican diplomat serving in Turkey and Greece, he used his office to help save thousands of Jewish lives. In his all too brief four-year reign as Pope, through Vatican II, he initiated the greatest reforms in Church history.
John led by example. He broke precedent by traveling outside his cloistered Vatican environs. One of his first visits was to a prison. "You could not come to me," he said, "so I came to you."
In a similar spirit, he made an unprecedented outreach to the Jewish community. Quoting Hebrew Scripture, he told a Jewish delegation, "I am Joseph, your brother."
Ignorance and prejudice tend to guide our thoughts and actions in regard to groups of people we know little about, particularly those with an illness that we like to pretend has nothing to do with ours. We may have bipolar, but the reality is that we are close relations to a group of individuals psychiatry classifies as having schizophrenia.
It is time to acknowledge what binds us rather than what separates us. It is time to make an outreach.
I am Joseph, your brother.