A Teachable Moment... Mental Illness

               

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Which is it? Bipolar Depression OR Bipolar Disorder?







When it comes to Mental Illness, apparently we're not all on the same page.  Take Illinois Congressman Jesse Jackson, Jr., for example. CNN reports he is being treated for BIPOLAR DEPRESSION.  

Not true!  Contrary to what CNN and its medical advisor have reported... the evidence is lacking; there really is no such diagnosis as BIPOLAR DEPRESSION. Have you ever heard a mood disorder described as Bipolar Manic or Bipolar Manic Depression? So why Bipolar Depression? Why one end of the spectrum and not the other with a term (bi) that means two? In the Diagnostic and Statistical Manual-IV (DSM-IV) the term bipolar depression is not used. 

But let's give CNN some credit, it is beginning to explore the difference between the two terms and it does cite the Mayo Clinic as the source for it's use of the term bipolar depression. But there's even more to the story: one word (manic) was dropped out of the original statement that the Mayo Clinic issued.

The correct term or diagnosis for severe mood changes remains Bipolar Disorder. It was originally called Manic Depression years ago. After the DSM changed that label, the mood disorder then became classified as Bipolar Disorder and further differentiated into Bipolar I or Bipolar II, to indicate mild and more serious mood swings between highs and lows.  It is thus incorrect to use the term: bipolar depression.

CNN is not the only media outlet using the incorrect label of bipolar depression. On the same day (August 13, 2012), newspapers' headlines across the country used both terms - bipolar disorder and bipolar depression (see above examples). But... language does matter, especially, since so many of us in the health care field, are working to educate the public about mental illness. As a certified teacher, via the National Alliance on Mental Illness (NAMI), for caregivers who have relatives with mental illnesses, it helps if we're all on the same page.  

Further, I press the case because the term Bipolar refers to two poles or opposite ends of a continuum; it is thus not correct to say Bipolar Depression. Why not just say severe depression and drop the bipolar reference? Moreover, it should be noted that treatment takes time.  It's not unusual for it to take months to find the right medicines to treat a Bipolar Disorder. We are, after all, talking about chemical changes in the brain. 

So when Representative Jesse Jackson, Jr. leaves the Mayo Clinic, it is important to remember that his treatment is not done. Instead of in-patient care, he moves to out-patient care where he will definitely need a strong support network of family and friends, as well as, medicine.

There is every reason to expect the congressman to be functional and able to do the job he was elected to do, in time, and... as long as he follows the specified treatment plan of medicine and therapy.  But it does take time for stabilization. Many persons with a Bipolar Disorder diagnosis are highly functional and able to hold full-time jobs successfully. 

Without medicine, however, the side effects of  Bipolar Disorder can include: impaired judgment and/or impulsiveness, an inability to concentrate, fatigue or loss of energy, an impaired reality, and memory problems. And we should remember that we're not talking about regular depression here or feeling down a few days or weeks out of a month.

A clinically depressed or "deeply" or "severely" depressed person has behavior that differs dramatically from regular depression.  It is thus imperative that the Cable News Network, it's medical advisor, web sites about mental illness, and others cease using the incorrect term of bipolar depression; doesn't exist. Since so many of us still get our news from television, I propose that at a minimum the media should explain the diagnostic terms used for mental health issues.

To do so is to help de-stigmatize mental illness. Interestingly, my preliminary research indicated how the incorrect term came to be used in the first place. 

Although the Mayo Clinic's original statement said Rep. Jesse Jackson, Jr. was diagnosed with Bipolar II Depression, someone in the media, ended up dropping the reference to "II," and suddenly Jesse Jackson, Jr. had bipolar depression.

And that is why... we had conflicting headlines like these all on the same day.

Jesse Jackson Jr. Bipolar: Mayo Clinic Releases Statement Detailing Diagnosis

August 13, 2012.  According to Huffington Post Chicago:

The Rochester, Minn.-based clinic specified his condition as Bipolar II, which is defined as periodic episodes of depression and hypomania, a less serious form of mania.

Rep. Jackson being treated for bipolar depression, clinic says

August 13, 2012.  |By the CNN Wire Staff   According to CNN, U.S. Rep. Jesse Jackson Jr. is responding well to treatment for bipolar depression, the Mayo Clinic said Monday. The Rochester, Minn.-based clinic said Jackson is regaining his strength but offered no further information on his condition. 

August 13, 2012 6:11 PM

Jesse Jackson Jr. says he has "bipolar II depression": What is bipolar II?

(CBS News)   By  Ryan Jaslow      U.S. Congressman Jesse Jackson Jr. is being treated for bipolar II disorder at the Mayo Clinic in Rochester, Minn., the hospital said Monday in a statement.

"Following extensive evaluation, Congressman Jesse Jackson, Jr. is undergoing treatment for Bipolar II depression," the statement read. "Congressman Jackson is responding well to the treatment and regaining his strength."

Jesse Jackson Jr. undergoing treatment for bipolar disorder

Posted by Rachel Weiner at 02:56 PM ET, 08/13/2012

Illinois Democratic Rep. Jesse Jackson Jr. is undergoing treatment for bipolar II depression, according to a statement issued this afternoon from the Mayo Clinic.“Bipolar II disorder is a treatable condition that affects parts of the brain controlling emotion, thought and drive and is most likely caused by a complex set of genetic and environmental factors,” the clinic wrote.

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Sunday, June 24, 2012 

http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-father-actually-lost-his-mind.html?ref=magazine

When My Crazy Father Actually Lost His Mind

                                                By JENEEN INTERLANDI

And what it took to get him the help he needed.

Elinor Carucci/Redux, for The New York Times

                         The author with her mother, Patricia, and her father, Joseph.

A REVIEW

No one really understands how a person with a broken brain struggles like those engulfed in the struggle. Here's a daughter who tells a poignant story that captures the "craziness" and myth of a working mental health system in the USA. The leaky social net for treating mental illness is so vividly exposed that it becomes clear even the latest health care reform efforts aren't enough.  It takes ten pages for the author to fully tell what happened to her and her family after her father lost his mind to a bipolar disorder.  As you read her story, remember that in the mental illness political ring there are two ongoing narratives:  those favoring unconditional civil rights for the mentally ill and those favoring helping the mentally ill when they can't help themselves, by committing them to treatment against their will.  There is no middle ground. Mentally ill people have civil rights all the time or they don't under exceptional conditions.

As you read this heart-rendering story, you should be able to identify your position by the end of it.  And it's that position that you will want to make clear when you tell your stories about coping with a mentally ill loved one. When you do you will thus be advocating for either AOT or ACT. Assisted Outpatient Treatment (AOT) allows involuntary treatment with a law that moves beyond the narrow "danger to self or others" standard.  Assisted Community Treatment (ACT) sidesteps the involuntary committment issue by using the courts to order a mental health team to provide treatment BUT only if mentally ill persons volunteer or agree to the court-ordered solution.

Please take time to thank The New York Times for publishing this well-written and deeply personal article about mental illness.  The paper's heroic effort helps to lift the stigma veil and helps to bring attention to mental health illness issues; the article is important because it helps to increase  awareness about the second-class treatment of our mentally ill relatives. Thank you NYT and Jeneen Interlandi. You've both done what Hollywood and the White House haven't been able to do: make real the very real experiences of so many American mental health caregivers and their relatives. Anyone who involuntary treatment is unnecessary because violent incidents by the mentally ill are the exception, rather than the rule, miss the point - each act of psychotic violence probably represents tens of thousands of families already struggling to keep the same from happening with their mentally challenged loved-one.

Mental Illness is a huge and often well-hidden problem.  Instead of being treated like modern-day lepers, the mentally ill need better treatment and respect . No one wants to be mentally ill; recovery when it does occur is often a lengthy process.  It's thus in the public's interest to increase beds and services for those who can't mentally handle their situations.  Would you let a person in shock after an auto accident refuse treatment when you see him bleeding on the side of the road?  Would a physician refuse to treat a child with a broken arm? Wouldn't a parent be held negligent for not taking an injured child to the doctor. Yet because few people recognized the physical symptoms of mental illness of any kind (bipolar, schizophrenia, depression, personality disorder, etc.) it often goes untreated in the initial stages.  What makes a mental illness so insidious is that you can't see a broken brain.  That coupled with the disease itself, often causing its victims to declare that they are not sick and don't need treatment, as Jeneen Interlandi's story so painfully depicts.

As a certified teacher for the Family2Family education course for the National Alliance on Mental Illness (NAMI), I continually teach our mantra - you can't know what no one has told you.  Re-education then is the first key; re-dedication to funding mental health programs and positions, is the second.  Treatment works.  But getting long-term and consistent care to help stabilize a problem in the head, is a major frustration for caregiving families and individuals. Not surprisingly families of the mentally ill become exhausted and stressed as they take on the roles of case managers and protectors.

One of the most revealing and painful facts in When My Father Actually Lost His Mind occurs when it becomes clear that getting their loved-one stabilized is more difficult without long-term coordinated services. While it is fortunate that Mr. Interlandi's bipolar symptoms began to subside, which is sometimes the case after many years, it should be noted that his improvement might have come sooner with a better kind of health care system.  Indeed, it should not be forgotten that much of Mr. Interlandi's improvement may also have been the result of the strong support system provided by his loving family.  I know of hundreds of families providing the same kind of up close and personal, intensive-kind of loving care for a mentally challenged loved one.

Jeneen Interlandi thus makes a significant contribution by so eloquently bringing some very much needed attention to an almost hidden epidemic.  By increasing the awareness of millions about mental illness with her story, I am confident that many more are now aware that mental illness is a family issue and a biological problem. Perhaps now more people in and out of the mental health care system will understand to what extent mental illness is a precusor for the increasing number of individuals who are homeless or in our jails.

Because stigma prevails...  we need to keep telling and hearing about stories involving mental illness.  Stepping Forward2Day is one way to do that.  This Blog is therefore being used to sound an URGENT clarion call for action.  The comments and stories you share will be presented to Congress, state legislators, the President, Governors, and other policymakers in September 2012.  It's time to wake-up America with more stories about real people coping with a mental health care system that often does as much harm, as good in the 21st Century.

Again, thanks to the NYT, magazine editor Vera Titunik, and Jeneen Interlandi for sharing an extraordinary and moving story about the ongoing effect of mental illness in our communities.  Well done!

               

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