Also known as manic depression, bipolar disorder is experienced by patients as serious swings in behavior, thinking, energy and moods, usually from the extremes of the lows of depression and the highs of mania. Bipolar disorder occurs in cyclic episodes than can last for months, weeks or even days but is not to be confused with short-lived changes in bad moods or good moods.According to the latest edition of theDiagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) the cardinal symptom of bipolar disorder is mania, in the absence of which the condition would be categorized as Depressive Disorder(McCormick, Murray, & McNew, 2015).DSM-5 is the most recent edition of the classification standard of mental disorders used in the United States by professionals in the mental health arena such as counsellors. It classifies bipolar disorder into several types based not only on the pattern of depressive and manic episodes but also in the specific duration of those episodes. In addition to these, the classification of bipolar disorder also takes into consideration other episodes of mania that are clinically significant but do not meet the diagnostic bipolar criteria.
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This paper investigates the topic of bipolar disorders as a mental illness, by delving into the illness’ history, possible causes, treatment, and prevention, cultural and biblical perspectives.
The Historical Context of Bipolar Disorder
‘Manic depressive illness, circular type’ is the term that was used to refer to what is now commonly known as the bipolar disorder. To be best understood in the world, the term bipolar is more characteristic of the illness as it makes reference to the swinging between the depressive pole and the manic pole. This mental illness cannot be traced to the ancient times although there is existence of a Greco-Roman view of mania that made general reference to mental agitation or mental excitation and did not include the defining characteristics that go into the definition of bipolar disorder(Beveridge, 2009). The Greco-Roman notions of mania and the definition of bipolar disorder in the 21st century despite being rather different, have similarities based on the original Latin translations by current experts in the study of bipolar.
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In Europe, the 19th century was characterized by case studies and efforts of describing the symptoms of bipolar disorder and the mapping of clinical patterns of manic depression(Beveridge, 2009). Having analyzed family generational data, a study shared its findings in 1952 giving the evidence of genetic transmission of bipolar disorder among biological relatives with the definitive clinical description for bipolar disorder being provided by Emil Kraeplin in 1986(Beveridge, 2009).This was amid the numerous studies that were being carried out in the mid-20th century in an effort to investigate the causes and origins of bipolar disorder.
Cause of Bipolar Disorder
As is the case with other affective disorders or mood disorders, the cause of bipolar disorder is not understood fully but is attributed to an imbalance of certain chemicals in the brain known as neurotransmitters(Kerner, 2013). There are numerous studies being conducted by scientists with the aim of finding out the possible causes of bipolar disorder. Study findings so far have led to the indication that bipolar disorder is not caused by a single factor but is produced by a combination of many factors acting together. The fact that bipolar disorder runs in families has prompted researchers on the subject to investigate genetic process that might increase the chances of a person inheriting the illness. By studying identical twins who share identical genes, researchers have arrived at the conclusion that genes alone are not responsible for the development of bipolar disorder since it is not automatic that if one identical twin has the illness, then the other one will too(Kerner, 2013). This has gone to show that besides genetic composition and genetic processes there are other factors; environmental or otherwise, that areresponsible for the development of the illness.
The first episode of a person with bipolar disorder can be either manic or depressive with the peak age for the onset of the illness being between the adolescent age and the early twenties, with the exception of a few rare cases that start much earlier from the age of about 10 or even younger(McCormick, Murray, & McNew, 2015). It has been observed that incidences of a first bipolar episode decrease gradually after the twenties and diminishes even further as age 50 is approached to less than 10% of cases exhibiting their first episode at this age and above(Kerner, 2013). There are sporadic cases where first bipolar episodes are experienced by people aged over seventy years but such cases are extremely rare although not impossible to come by.
Treatment of Bipolar Disorder
Bipolar disorder is treatable with results aiming for significantly stable mood swings and the other symptoms synonymous with the illness. Due its recurrent nature, preventive treatment with a long-term view is usually indicated and recommended strongly for bipolar disorder, often adopting a treatment strategy that combines both psychosocial treatment and medication for optimal management of the illness.Psychosocial or psychotherapy such as psychoeducation, interpersonal and social rhythm therapy, family-focused therapy and cognitive behavioral therapy have observed as effective treatments for bipolar especially when combined with medication(McCormick, Murray, & McNew, 2015). Better results of bipolar disorder treatment have been observed with treatment that is continuously administered as opposed to irregular treatment. Changes in moods are to be monitored even when the patient is under treatment because they may occur and ought to be reported to the doctor promptly if a full-blown episode is to be avoided with an alteration of the treatment plan.
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When experiencing a manic high, the patient would refer to having periods of intense euphoria or intense burst of energy, which would present in the form of exaggerated optimism, heightened moods, increased mental and physical activity and energy. Aggression, excessive irritability, impulsiveness, and reckless behavior coupled with an exaggerated self-confidence, a sense of self-importance that is inflated, and delusions of grandeurare also characteristic of mania. Patients with bipolar disorder may exhibitflight of ideas with racing thoughts, racing speech,a decreased need for sleep without experiencing fatigue and in very severe cases of mania may experience hallucinations and delusions(Holtzman, Lolich, Ketter, & Vazquez, 2015).
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Medical doctors and psychiatrists prescribe mood stabilizers to control bipolar disorder, such as anticonvulsant medications and lithium, which can be prescribed alone or as a combination for maximized effect. As the first medication for stabilizing moods that got an approval from the U.S. Food and Drug Administration (FDA), Lithium has been found to be an effective treatment for mania since it not only controls mania but also prevents the recurrence of both depressive and manic episodes(Moore, Little, McSharry, Goodwin, & Geddes, 2014). There are numerous anticonvulsant medications in the market, such as Valproate that was approved as a treatment for mania in 1995 by the FDA, and has proved to be useful especially in the treatment of bipolar episodes that a lot more difficult to treat(McCormick, Murray, & McNew, 2015).
Prevention of Bipolar Disorder
Bipolar disorder is now known to have four basic types: Bipolar I disorder, Bipolar II disorder, Cyclothymic disorder also known as Cyclothymia and other specified and unspecified bipolar and disorders that are related(Moore, Little, McSharry, Goodwin, & Geddes, 2014). These classifications of bipolar disorder are based on their characteristic presentation where bipolar I refer to manic episodes that are so severe requiring hospitalization, bipolar II refers to less severe manic episodes defined by hypomanic episodes and depressive episodes. Cyclothymic disorder on the other hand refers to symptoms that do not meet the diagnostic requirements like bipolar I and bipolar IIbut is characterized by numerous depressive symptoms and hypomanic symptoms lasting about two years. There are also a number of other bipolar symptoms that occur and not match or present with symptoms similar to those that define these other more elaborate categories of bipolar disorder(Moore, Little, McSharry, Goodwin, & Geddes, 2014).
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Manic episodes are often categorized into four sections of delirious mania, delusional mania, acute mania, and hypomania where episodes of hypomania are set apart from other full manic episodes that are more severe. These characterizations of manic episodes are representative of severity and can be classified as severe with psychotic features, severe, moderate, or mild; terms that refer to the stages of mania, which are useful for differential and descriptive diagnosis. Manic episodes can begin without any warning, where a patient would suddenly experience a surge of vigor and energy that cannot be accounted for(Holtzman, Lolich, Ketter, & Vazquez, 2015). Be that as it may, before a manic episode, more often than not a patient would usually experience a period of exhibiting warning signs.
Although there are no sure-fire ways to prevent bipolar disorder, conditions can be prevented from worsening if treatment is sort at the onset of earliest signs. After diagnosis, an attentive patient can manage symptoms to ensure that minor symptoms are not allowed the transition to fully manifested episodes of depression or mania. This can be achieved by involving family and friends to remain attentive and arrest symptoms as soon as they start to occur by notifying the doctor as soon the patient feels like they are falling into an episode of mania or depression. Avoiding the intake of substances like alcohol and drugs that can make the symptoms of bipolar disorder worse should help to keep the situation stable and prevent an episode. A person diagnosed with bipolar should ensure that they take their medication strictly as prescribed by their doctor and if a change is needed, they should consult with their doctor to ensure a smooth transition without incidences of manic or depressive episodes(McCormick, Murray, & McNew, 2015).
Cross Cultural Issues Pertaining to Bipolar Disorder
Groups in society vary greatly in their definitions of constructs that allude to subjects of ‘abnormality,’ ‘normality’ and ‘distress’ and the variations of these definitions further cause a variance in the definition of mental illness, mental health, coping mechanisms, and expressions of psychopathology(Beveridge, 2009). More often than not psychiatric tendencies, that focuses on the standardized discrete classifications of mental disorders does is not consistent with the provided or known cultural or social explanations. The perception of psychiatric symptoms is thus inseparable from the influence of cultural background, where the interpretation of manic symptoms is observed to vary with cultural biases.
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Besides cultural background, other factors such as years of experience, psychiatric training, gender, and age contribute significantly influence the interpretation of manic symptoms(Holtzman, Lolich, Ketter, & Vazquez, 2015). This implies that epidemiological studies and diagnostic studies have to accommodate these biases to ensure that the diagnosis of bipolar disorder and the design of clinical trials take into consideration the assessment of baseline severity of symptoms and the improvements recommended.
Biblical Worldview of the Bipolar Disorder
For many centuries, the church was charged with the work of caring for the souls of women and men in society, using the empowerment of the Holy Spirit and the trust in scripture to rebuke the rebellious and comfort the afflicted. Preachers would use their ability to write, preach, and counsel to care for the sinners and for the saints who were suffering. According to biblical scriptures, the bible is profitable not only for training in righteousness, for correction or for reproof but also for teaching and such it amply provides the wisdom requires to guide people in all situations encountered in life including the area of mental health, including bipolar disorder(Welch, 2007). There is general belief in the church that although manic episodes may drive one to sin since it creates a world full of temptations, persuading its victims to be trusting instead of suspicious of their intuitive judgments. This kind of an assertion points to the lack of understanding of bipolar as a medical condition as it is based on the notion that despite the fact that humans are both physical and spiritual, spirituality trumps physical needs, implying that adherence to scripture should be enough to suppress physical abnormalities.
In the 20th century, the church began buying into the ideas of psychology as relates to the definition and treatment of mental illness. As findings in Psychology continued to shine a different light on the causes of mental illness and made propositions of new solutions that would not only resolve the mental and emotional problems in society but also the spiritual problems that people face(Welch, 2007). Despite the sometimes-questionable therapies and often-contradictory theories in the area of Psychology, findings from this field of study have significantly changed the worldview on their understanding of the problems of life and the response to them. As the revolution brought about by psychology continues to sweep the world, the church has not been left behind but has found a way to embrace humanistic thinking irrespective of the infinite spiritual resources at their disposal.
Towards finding out the causes of bipolar disorder, more studies can be conducted in the area of brain-imaging techniques would be useful in analyzing the information being collected on what goes wrong in brain functions that produces mental illnesses like bipolar disorder. As the new techniques, clarify the differences between the brains of healthy individuals and the brains of patients with bipolar disorder, then the underlying causes of the illness will become clearer and forms of treatment that are more effective will be developed and recommended.
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