by Karen R. Brock
Review by Roy Sugarman, PhD on Jan 20th 2015
In the big scheme of things, Bipolar Affective Disorder is not too prevalent, but when it does hit, despite its rarity, it hits hard. Many will take their own lives, as my cousin and a friend or three have done, or will spend their lives unable to keep a job or marriage going. Diagnosis is not guaranteed either, taking years in some cases. As with any major mental affliction, it takes family and friends along on a bumpy ride. As one of my friends noted, when he took his life just after getting engaged to be married, being up was great, but being down again, which he knew was coming sooner rather than later, sucked badly, so he took his own when happy, rather than at the bottom of the pit.
One of my psychiatry professors warns that people with BAD need to think of living a non-challenging, boring life, to cope. Dr Brock here wants sufferers to manage their lives better and avoid the disasters that plague both health and reputation from time to time along the illness trajectory.
Brock begins with discussions on how BAD sufferers get to the point of malfunction, and where they go from there. She then describes the illness in terms of the behavioural impact, including some personal vignettes of her experiences with some harmless but stigmatized and troubling patients, and then the basics of the classification and symptoms of the condition, and why it is a physical, chronic condition. Apart from the highs, the lows are given some attention, as well as the Bipolar Spectrum, which may present with quite high functioning hyperthymia, with recurrent brief episodes of malfunction, often drug-resistant.
She goes into genetics in Chapter 6, with of course the thorny issue of childbearing and rearing responsibilities, and risk taken into account. On the same note, gender does provide variation in the presentation compared to men, dealt with here. Chapter 8 deals with treatment and outcomes of treatment, and Ch 9 with the medication options themselves.
Coming back to my professor’s prescription of calmness, the next chapter takes on a discussion on lifestyle modifications and the talking therapies. Medication, stable lifestyle and therapy make up the three pillars of treatment, and these are discussed here. Given stressors are a major trigger, managing them is a key ingredient of therapy, rather than lying on a couch. This then would include managing a daily schedule, and maximizing community resources as well as alternative medical interventions. Despite this, there is a darker side to BAD that we all recognize, including psychosis, mania and suicide and so on, with loss of reputation and financial security so common. Living with this is not easy for anyone. Creativity is linked to both depression and hypomania/mania and so is perhaps an edge for the sufferer with more positive value, and Brock points this out in the various historical figures she presents in Chapter 17.
Finally she offers hope to those who need to get and keep control. This is only a few pages.
So for the novice, Brock discusses the condition extensively, and if knowledge is power, then she gets it right with a comprehensive overview, a drive-by shooting of Bipolar Affective Disorder at most, for the sufferer and family with little knowledge and no medical sophistication really.
What the book could have done a little better was tell more fleshed-out stories in case histories, and take a deeper dive into diagnosis and treatment for each of the variations, and the controversies about early diagnosis and treatment, especially in the thorny and variable presentations of childhood.
Otherwise, a comprehensive look into the condition, and a great source of rudimentary education in the trajectory and impact of the stigmatized and scary condition.
© 2015 Roy Sugarman
Roy Sugarman PhD, Director: Applied Neuroscience, Performance Innovation Team, EXOS™, USA.