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Article of Interest - Bipolar Disorder

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Bipolar Disorder in the News
Carlos Santos, Times-Dispatch, December 12, 2005
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Cynthia Power has been bipolar since she was 18. Peter Armetta has had the disorder most of his life, too. Both say that it's a cruel, complicated mental illness, but also that it can be controlled and life can be good.

"You probably know people with bipolar disorder and don't even know it," said Power, who is 58. "I'm not exactly like someone who doesn't have the disorder. Life is more difficult like breast cancer makes life more difficult. But it makes you stronger, too."

"I've wrecked my life," said Armetta, 41, who was only recently diagnosed as being bipolar. "I've lived in 22 places in 22 years. Never been married. I ran away from women, though I always make a great first impression. . . . But now I'm doing well, and I'm hoping to stay that way."

Power and Armetta are two of about 2.3 million Americans who have been diagnosed with bipolar disorder, which is also known as manic depression. It's a mood disorder that's different from the ordinary ups and downs, instead characterized by periods of extreme elation or irritability countered by periods of severe depression.

The manic symptoms include overly inflated self-esteem, increased physical agitation and increased talkativeness. Stress can trigger the manic phase.

"It's not just moods," said Gary S. Sachs, the director of the bipolar mood-disorder program at Massachusetts General Hospital and one of the foremost authorities in the country. "Their thoughts and perceptions color their entire life experience. . . . It's highly treatable. It's just not curable."

"It affects men and women equally," said Anita Clayton, professor of psychiatric medicine at the University of Virginia. The mood changes are cyclical and "not driven by anything in particular," she said. "It is biologically based."

The disorder has been mentioned in both state and national news stories recently, raising questions about the treatment of the disorder and, perhaps, unfairly stigmatizing those who carry its burden.

On Wednesday, Rigoberto Alpizar was killed at Miami International Airport after bolting from a jetliner and claiming to have a bomb in his backpack. He was shot by federal agents after ignoring requests to cooperate. His wife said her husband was bipolar and had not taken his medicine.

In Henrico County, Joe Casuccio fatally shot his girlfriend and then killed himself, writing a note to his mother that "having bipolar took away the freedom to live. I've been tortured since 99."

Benjamin Fawley, a suspect in the death of Virginia Commonwealth University freshman Taylor Marie Behl, has been described by his lawyer, Chris Collins, as suffering from bipolar disorder. He is being held without bond on unrelated firearms and child-pornography charges.

There are other recent cases, in the state and across the country, in which men and women with bipolar disorder have been charged with crimes, but the incidents appear to be more a coincidental series of events than a reflection on those with the illness, experts say.

Are people with bipolar disorder more dangerous than anyone else?

"In 23 years of treating thousands of patients, there's been no [physical] incidents," Sachs said. "Not a patient of ours has been arrested for anything like attempted murder or murder."

Bipolar people have more workplace accidents because of their impulsiveness during the manic phase, Sachs said, and they are "over-represented in prison." In part, that is because during the manic phase "your perception of risk and the downside of things is greatly reduced," he said. "You take a quick read on something and sometimes react inappropriately to the situation.

"There is an elevated risk of violence," Sachs said. "But the odds ratio is only very slightly different" from those without the disorder.

Clayton, who has treated many patients with bipolar disorder, said they "are no more dangerous than anybody else. Almost no one with psychiatric illness is dangerous."

Power said she believes that "people with mental disorders are more likely to be victimized than to do the victimizing. I can't say with a clear conscience that bipolar doesn't contribute to violence. Having been there, it's a scary place. I never inflicted harm. It may have been by the grace of God."

"That guy on the plane [in Miami] seemed to have that anger that some folks with bipolar disorder have," Armetta said. "I had the peace and love aspect. . . . The problem with all mental illness is getting the right treatment. People should be no more afraid of people bipolar than anybody else. That bipolar people are violent has no credence with me."

Carol G. Cutler, a clinical assistant professor at Virginia Commonwealth University who has studied bipolar disorder, said the "stigma is out there, but it shouldn't be. It used to be schizophrenia was the particular illness that got targeted out of proportion" as leading to violence. "Most people who commit crimes aren't bipolar."

The irony is that bipolar disorder, which can make life so difficult, often is borne by unusually creative and talented people.

"They're very talented and exceptional people on the whole," Sachs said. "They are over-represented at the highest level of corporate America for example," though often no one knows they have the disorder. "They are creative and industrious. A controlled bipolar illness makes a terrific citizen.

"They have great facility with language, music and math," he said, noting that a number of historical figures are believed to have had bipolar disorder, including President Abraham Lincoln and writer Mark Twain.

"Despite the stigma attached to the illness, they're really a remarkable group," Sachs said. "But that doesn't take away from the extraordinary cruelty of this condition."

Armetta understands that characterization. In the throes of his disorder, he would commit to doing more work than anyone else. "I would run until I dropped," he said.

He now works helping foster children in Charlottesville. "I do a lot of writing. . . . I am creative. . . . I knew I was not a conventional person."

The treatment for the disorder, which includes psychotherapy, has improved over the years with lithium, anti-convulsants and what are known as atypical anti-psychotic drugs used separately or sometimes in conjunction, Sachs said.

"We've had effective treatments for decades, but in the last 10 years, especially the last five, we've had treatments that patients perceive as less burdensome" because of lessened side effects, he said. "It's been a terrific boon. . . . Patients still get off their medicine, but not like they used to."

Power and Armetta take medication. "I'm doing well on meds, but it's just a piece of the treatment," said Power, who believes family and a passion for work and other interests make up the framework that stabilizes her. She works in Charlottesville as a volunteer in the mental-health field.

"I look over my life and it hasn't been so bad," she said. "In fact, my life has been pretty good.

"I know a lot of people with bipolar. Some are well-hidden. There is a community of us. There is a sense of camaraderie," she said. "We live under a stigma and I see our movement as being a civil-rights type of movement. You can't characterize us. We're just people like anybody else."

She doesn't like the condescending attitude that some people have with those struggling with mental illness. "The assumption is I got sick and I got stupid the same day. . . . We are never going to erase the stigma of this disorder if we don't stand tall and say it's OK."

Armetta said his high moods would last over a year "without let up. . . . I was too happy, too gleeful. My hyper-focus could be a bad thing. . . . I looked like two people -- this Pollyannaish, affectionate guy, then a guy who couldn't function" when the depression phase took over.

Armetta, who says he once lived in a desert for eight months just for the experience, said that though he has been diagnosed as bipolar, "that is not who I am.

"People are scared of what they don't understand. If you don't understand it, learn about it."
     

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