Mary Rhodes*, 48, doesn’t remember much of anything from her first manic episode. Her husband said she was acting “hyper” and kept repeating one phrase, then laughing hysterically. She was also frantically trying to clean their entire house.
Concerned about her behavior, he took their three children to his mother’s house. Unsure what else to do, he drove Mary to the hospital emergency room, but she refused to get out of the car. Desperate, he called Mary’s mother, who lived out of state.
“She begged me to get out of the car and at least get checked,” says Mary, who to this day has no recollection of what turned into a week-long hospitalization in July 2010. “The psychiatrist there said it was a manic episode, but one of the nurses said they just thought it was a period of memory loss. Upon discharge, I was told to take iron tablets and multivitamins. At that point my memory was back and I was acting normal.”
The Rhodes family was living in New Hampshire at the time. Mary had a demanding job working for the state, one that required long hours and significant travel. Although she was good at her job, it was stressful. Cocktail parties with co-workers became routine during the many trips she was required to make. Soon, Mary was not only drinking at the gatherings but also back in her hotel room at night while she completed reports and paperwork.
No one in Mary’s family realized how dependant she’d become on alcohol until November 2011.
“It was a Friday, and when I left work, I just felt like something was ‘off.’ I called my mother in Florida and asked if I could fly down,” says Mary. “I got there Friday night, and within two days I was in the psych ward at Munroe Regional. My mother found mini bottles of wine and alcohol in my suitcases and threw them out. I don’t remember much of that hospitalization except for seeing my brother sitting by my bed crying. They had security guards guarding my room, so it must have been bad.”
During that hospital stay in Florida, a social worker saw Mary and applied for social security disability for her. This required a second opinion on her condition. At this point, she was back in New Hampshire where she was referred to a psychologist, who diagnosed her with bipolar I disorder in March 2012.
“It was really a relief to realize there was a reason this was happening,” says Mary, who had never suspected the problem might be mental illness. After this diagnosis, Mary resigned from her job.
Two months later, in June 2012, she had a third manic episode and, after going to the ER, was transferred to the state mental health hospital in New Hampshire. During this stay, doctors put her on medication; she has not had another episode since.
“One psychiatrist I saw said he wasn’t sure whether the bipolar disorder triggered the drinking or the drinking triggered the bipolar disorder,” says Mary. “I realize now it doesn’t matter which came first; both are serious diseases that I have to be aware of and control the rest of my life. Now I identify as an alcoholic and have gone to AA meetings and taken classes at a mental health center as an outpatient. I have three years of sobriety under my belt.”
After living in New Hampshire for 14 years, Mary and her family returned to her home state of Florida in 2012 and now live in Marion County. Mary’s bipolar disorder is well-controlled with a routine that includes medication and psychotherapy.
“The medication keeps me stable; I really don’t ever want to have one of those episodes again,” says Mary, who has only had manic episodes, never depression.
As is common with bipolar disorder, her illness affected the entire family.
“Two of my children refused to come see me during my first hospitalization. I was acting abnormally and didn’t even know their names,” she says quietly. “It was hard for my son to cope with my illness. He was so resentful; he started acting out and having problems at school. Eventually, my husband and I sent him to live with my sister so he could have a more structured environment.”
That sister, Doris Jones*, has traveled the hard road of bipolar disorder with Mary and her family.
“Mary was always there for me. She was the strong one in our family,” says Doris. “I felt defeated and sad that I couldn’t figure out what was wrong with her. I was afraid, angry and drained because I didn’t know what to do. It was hard to see her and her family struggling and the strain it brought to their household. I think if she’d been diagnosed earlier, things would have been different for her family.”
Complicating the issue was the fact that, initially, doctors told Mary’s family her symptoms were due to alcohol. At first, her children blamed her before they understood she had a disease she couldn’t control.
“Being in the African-American community, I feel that mental health issues have been overlooked,” notes Doris. “I had never known anyone with bipolar disorder until this happened to my sister. It wasn’t until she was hospitalized and diagnosed that we started learning about it and what symptoms to look for. Once I did that, I realized I might have known other people with the same problem; I just didn’t know what it was.”
What is Bipolar Disorder?
Odds are you know someone with bipolar disorder, a common chronic mental illness. Approximately 10 million people in the United States—about three percent of American adults—have bipolar disorder. Men and women are affected in equal numbers. Although it can occur at any point in a person’s life, the average onset age is 25.
“African-Americans have been known to be misdiagnosed about bipolar disorder more commonly than Caucasians. This adds to the complexity of getting a proper diagnosis for those individuals,” notes Ken Duckworth, M.D., Medical Director at the National Alliance on Mental Illness (NAMI). “The first manifestation of bipolar disorder may be a depressive episode. Bipolar disorder commonly occurs with substance use, which can also make the diagnosis harder. Getting the right diagnosis is important, so I encourage individuals to get a second opinion if they are not sure.”
It often takes as many as 10 years from the first signs and symptoms before a proper diagnosis is made and treatment initiated. Almost 83 percent of cases are classified as severe.
People with bipolar disorder experience significant shifts in mood, energy and thought processes. It’s as though they were riding a mood roller coaster with dramatic highs (mania) and lows (depression).
In the manic (ìhighî) state, symptoms can include:
Elated or euphoric mood
Excessive anger and touchiness
Decreased need for sleep
Increased activity and energy levels
Racing thoughts/jumping from one idea to another
Changes in thinking, attention and perception
Impulsive, reckless behavior
In the depressed state, symptoms can include:
Sadness, feeling “blue”
Loss of interest in things that are normally enjoyable
Loss of weight and appetite
Trouble concentrating and making decisions
Some people will have manic and depressed states in rapid sequence. If episodes are severe, they may also experience psychotic symptoms (hallucinations, etc.), which can wrongly lead to a diagnosis of schizophrenia. If the manic state doesn’t include psychotic episodes, it is defined as “hypomania,” a milder form of mania.
According to The Diagnostic and Statistical Manual of Mental Disorders (DSM), there are four types of bipolar illness:
Bipolar I Disorder:The person has experienced one or more episodes of mania. To be diagnosed with bipolar I, a person’s manic or mixed episodes must last at least seven days or be so severe that hospitalization is required. Episodes of both mania and depression are common, although an episode of depression is not necessary for a diagnosis.
Bipolar II Disorder: The person shifts back and forth between depressive episodes and hypomanic episodes but never a full manic episode.
Cyclothymic Disorder or Cyclothymia:The person experiences hypomania and mild depression over a period of at least two years and generally has chronically unstable moods. They may have brief periods of normal mood, but “normal” periods last less than eight weeks.
Bipolar Disorder “other specified” and “unspecified”: The person doesn’t meet the criteria for bipolar I, II or cyclothymia but experiences periods of clinically significant abnormal mood elevation.
Self-destructive, addictive behavior is often tied to bipolar disorder. It’s common for people to turn to drugs and/or alcohol, which only makes the situation worse. Some people use drugs to intensify their euphoric “high” periods; others may attempt to “self-medicate” and dull painful emotions during their depressed periods. As happened with Mary, family members and friends may mistakenly think the person simply has a substance abuse problem.
What Causes It?
Unfortunately, scientists aren’t sure of the exact cause of bipolar disorder. Multiple factors likely come together to create a chemical imbalance in the brain.
It does tend to run in families, so there’s a genetic component, meaning some people are born with genes that make it more likely for them to experience bipolar disorder symptoms.
Life stress can also contribute to symptom development. First episodes of bipolar disorder have often been shown to follow such stressful occurrences and major life changes as sudden loss, relationship problems, chronic illness and financial difficulties. (It’s unclear if these events themselves lead to symptoms, or the fact that they tend to cause lack of sleep and disruption of schedule, both of which have been known to contribute to mania and depressive episodes.)
Abuse of alcohol and drugs can also trigger bipolar disorder.
Diagnosis and Treatment
It’s not unusual for someone with bipolar disorder to have other illness, such as Attention-deficit Hyperactivity Disorder (ADHD), Posttraumatic Stress Disorder (PTSD) and/or substance abuse. It’s vital to receive an accurate diagnosis, so acute treatment and then preventative maintenance treatment can begin. When untreated, the symptoms of bipolar disorder tend to worsen and become more pronounced.
Bipolar disorder must be considered a chronic condition and be treated accordingly. A successful treatment and management plan should be customized for the individual and may include:
Medications (mood stabilizers, antipsychotic medications and antidepressants)
Psychotherapy (cognitive behavioral therapy and family-focused therapy)
Electroconvulsive therapy (ECT)
Self-management strategies and education
Complementary health approaches (meditation, faith and prayer)
It’s common to hear people joke about someone being “off their meds.” For people dealing with bipolar disorder, this is no laughing matter. Many people living with the illness come to a point in their recovery where they haven’t had an episode in so long that they feel they can discontinue taking their medication. Doctors strongly advise against this without an in-depth discussion with your health care provider about all treatment options.
Medication is only one part of the puzzle. Support groups and therapy are proven components of treating bipolar disorder. Education about the illness is important for both the patient and their family members. Being aware of triggers and symptoms can help identify an episode as it emerges, rather than when it becomes advanced. It’s common for symptoms to emerge in the same, or similar, patterns as in prior episodes.
“We have also learned through research that self-care is important to prevention,” adds Dr. Duckworth. “Getting regular sleep, being mindful of stress and exercising all improve your chances of avoiding future episodes.”
For Family And Friends
Mary Rhodes knows she will always have to continue her treatment programs, but she is vastly relieved to know her condition can be managed.
“I would tell other families, if you see a loved one who has drastic behavior change, try to encourage them to seek mental health evaluation,” she says. “There’s such a stigma around a mental health diagnosis, including alcoholism, that people tend to let things go on for years and years.”
“Things are better for our family now, and we’ve grown closer. Once my sister had a diagnosis and we knew what the problem was, we could acknowledge it and deal with it,” adds Doris. “We learned what triggers to look for, so if we saw something starting, we could make sure she’s taking her medication and getting the therapy she needs.”
Her advice to other families?
“If someone in your family is struggling with this, don’t stop at one consult. Continue until you get them diagnosed and into treatment,” urges Doris. “It’s not something to be ashamed of. It’s not that person’s fault and it’s not something they chose. You have to be open-minded and open-hearted. Be willing to be there for them.”
Knowledge is Power
The following resources will shed more light on bipolar disorder:
For family members: nami.org/familytofamily
If you are struggling with bipolar disorder and have suicidal thoughts, call the NAMI Helpline at (800) 950-6264.
*Interview subjects and their stories are real, but names have been changed to protect privacy.