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"Bipolar Disorder"
What Is It?
By Anitra L. Freeman

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   There are children, like myself, whose lives were severely disrupted by not being properly diagnosed. There are other children whose lives have been severely disrupted by being falsely diagnosed, or misdiagnosed. If you suspect that a child may be suffering from bipolar disorder or any other mental illness, please ask these questions. (These may also be helpful for adults.):

Is the child's behavior actually damaging to themselves, or is it simply an annoyance to the adults around them? There are some personalities that are simply, from birth, at a "higher carburetor setting" than the rest of their family. They are "into" more things, ask more questions, have more wide-ranging interests, are more active and voluble and enthusiastic—and sometimes more moody, needing "quiet times" to digest their active experience. This range of "mood swing" isn't necessarily unhealthy.
If the child is definitely suffering an illness, check out all possible medical explanations before seeking a mental health diagnosis. Mental and emotional effects may have a variety of causes, including allergies, hypoglycemia, and nutrition deficiencies. Once the "mentally ill" tag is hung on a child—or anyone else—physical symptoms may be discounted.
Research your family history as honestly as you can. Current medical opinion is that bipolar disorder does have a genetic influence. Very possibly, like many diseases, a predisposition is inherited and some other factor—not yet identified—may trigger it. Are there ancestors or relatives with the reputation of being "moody" or "erratic"? Other patterns to look for—often found in the family history of others with mood disorders—are depression, alcoholism, fibromyalgia (chronic muscular pain without apparent cause), ADD (Attention Deficit Disorder), and allergies.
If the diagnosis does turn out to be bipolar disorder, firmly remind yourself that it is a disease, and not a character fault—not your fault, and not your child's. You are not responsible for your genes, or for passing them on to your child. Circumstance is what happens to us—but life is what we make of circumstances. Go on from here.

   You think you may be bipolar. Now what? The next step, for most people on insurance programs, is to consult with your medical doctor. Explain why you believe you may be bipolar, and that you want to seek treatment. Your medical doctor will give you a referral to a psychiatric doctor.

   A good doctor is one who ) takes time to listen to you, ) regards your opinion on your own experiences and treatment as important, ) makes an accurate diagnosis, ) prescribes appropriate and effective treatment, ) is aware of the need for non-medical support for both you and your family and can make helpful referrals for that. Finding a good doctor is a crap shoot. This is true in any matter, but it is even more difficult in the area of mental health because of an almost universal tendency to immediately devaluate the testimony of someone with a mental illness, even if the diagnosis is not yet confirmed. There are people who have been treated for years with the wrong medication because a doctor refused to believe their own reports of its effects. Sometimes this has been fatal.

   One member of the bipolar disorder list got a doctor referral from Peter Whybrow, author of an excellent book on bipolar disorder. Seeking referrals from people with such credentials is a great thing when you can get it. Dr. Ivan Goldberg, of the Depression Central site, is also willing to recommend a reputable University clinic in your area, which increases the level of accountability your doctor will be subject to. It can greatly improve a patient's chances for effective treatment and long-range survival if their family is supportive, stays in communication with their medical personnel, and is willing to challenge the doctors when necessary.

   I'm going to share something very painful. My mother was treated with Thorazine during her manic episodes even after she had been diagnosed with multiple myaloma, a type of cancer, in which Thorazine is specifically contraindicated because it creates extra stress on the spleen. Mom had tried for years to tell the doctors that she had terrible side effects from the Thorazine, including bleeding from the nose and ears. The doctors told us, her family, that she was delusional, this simply wasn't happening, and she "needed the Thorazine." Mom fought her multiple myaloma into remission several times, living longer than 98% of the people diagnosed with that particular disease, but eventually died of failure of the spleen. It was ten years later that we learned about the side effects of Thorazine and its contra-indications—and the guilt hit.
There are questions developed by NAMI (National Alliance for the Mentally Ill) for patients to ask their doctor. If the patient cannot ask these questions, a family member should ask them for her:

1. What is your diagnosis? What is the nature of this illness from a medical point of view? 2. What is known about the cause of this particular illness? 3. How certain are you of this diagnosis? If you are not certain, what other possibilities do you consider most likely, and why? 4. Did the physical examination include a neurological exam? If so, how extensive was it, and what were the results? 5. Are there any additional tests or exams that you would recommend at this point? 6. Would you advise an independent opinion from another psychiatrist at this point?7. What program of treatment do you think would be most helpful? How will it be helpful? 8. Will this program involve services by other specialists (i.e., neurologist, psychologist, allied health professionals)? If so, who will be responsible for coordinating these services? 9. Who will be able to answer our questions at times when you are not available? 10. What kind of therapy do you plan to use, and what will be the contribution of the psychiatrist to the overall program of treatment? 11. What do you expect this program to accomplish? About how long will it take, and how frequently will you and the other specialists be seeing the patient? 12. What will be the best evidence that the patient is responding to the program, and how soon will it be before these signs appear? 13. What do you see as the family's role in this program of treatment? In particular, how much access will the family have to the individuals who are providing the treatment? 14. If your current evaluation is a preliminary one, how soon will it be before you will be able to provide a more definite evaluation of the patient's illness? 15. What medications do you propose to use? (Ask for name and dosage level.) What is the biological effect of this medication, and what do you expect it to accomplish? What are the risks associated with the medication? How soon will we be able to tell if the medication is effective, and how will we know? 16. Are there other medications that might be appropriate? If so, why do you prefer the one you have chosen? 17. Are you currently treating other patients with this illness? (Psychiatrists vary in their level of experience with severe or long-term mental illnesses, and it is helpful to know how involved the psychiatrist is with treatment of the kind of problem that your relative has.) 18. What are the best times and what are the most dependable ways for getting in touch with you? 19. How do you monitor medications and what symptoms indicate that they should be raised, lowered or changed? 20. How familiar are you with the activities of the National Alliance for the Mentally Ill (NAMI) and your state alliance?

National Alliance for the Mentally Ill (NAMI) primarily focuses on the families of mental health patients. There are other organizations of mental health clients themselves, often referring to themselves as "mental health survivors." These organizations campaign against abuses in the mental health system, and for patients' rights. They also have information on taking charge of your own care and treatment.

   To me, a doctor who is focused on helping a patient become more functional and self-responsible will encourage the patient's participation in their own treatment. Medical studies have also shown that patients who are knowledgeable about their own health and treatment, and make decisions about their own health and treatment, recover better and stay healthy more. Read. Learn as much about the illness, the medications, and alternative treatments as you can possibly absorb.
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