by Chris Aiken and James Phelps
W. W. Norton, 2017
Review by Hans Krauch on Oct 31st 2017
Bipolar, Not So Much - an excellent book on the nature, symptoms and causes of Bipolardisorder. Indeed, 'Not-so-much' is a colloquial phrase that attempts to communicate how complex this disorder really is. The word they use is 'spectrum' – where one falls between a level of depression or mania balanced between a neutral or opposite state of mood. There is a generally dismissive attitude in the general public about this disorder because of the ubiquity of experiencing highs and lows in everyday life. Yes, all people experience highs and lows, but that is not the prerequisite for suffering from bipolar– neither is it a person laughing one minute and hysterically crying the next.
The problem is not that the patient is experiencing highs or lows, but the lack of reason for those swings and the intensity of those swings which cripple the patient's ability to function normally. The one part of this book that is of concern is that it mentions that one not ought to ask oneself is they do have bipolar disorder, but how bipolar one is. Does picking up this book qualify oneself as being Bipolar, or is bipolarity a reflection of every normal person and only near the ends of the spectrum is one in need of medical help?
This book is adequately referenced and provides an easy to read structure. Additionally, it includes a convenient reference guide to help understand available medications like side-effects, causes, and ideas for dealing with uncontrolled mood swings. It provides excellent advice for all conceivable aspects of dealing with this illness – from being a patient, to their families (or places of work), and their care providers. It is a truly holistic view on the nature of care required for mental illness. Indeed, wellness and healing originates within the individual. However, when the balance is thrown off and the individual can no longer bring oneself back to a state of manageable chaos, then the help of professionals is necessary.
Whether or not one is suffering from a broken bone or broken spirit, the point of seeking medical help is the same. The Cartesian mind/body duality is a myth, meaning the concept of 'mental' in 'mental health' ought to be approached and treated in a similar manner to other forms of medical issues. The problem with mental health is that extrapolating symptoms to the correct disorder is more an art form than science considering what we know about the brain thus far.
Of all the branches of medicine, mental health is likely the most difficult to correctly diagnose and treat. The ability of the patient to correctly articulate the nature of the problem they are facing is paramount to the ability for the care provider to determine a correct diagnosis. This book is interesting in that is written for both the patient and the care-provider. In the beginning, it may be thought that this could be a problem because of the view that the doctor/patient relationship is hierarchical (specifically, it is the patient's job to listen to and obey the commands of the doctor). To write a book for both blurs this line, and gives power of care back into the hands of the patient. Being someone suffering from a mental illness, one ought to approach the matter of it not as expecting the care-provider to automatically know the correct diagnosis, but help reach the solution together.
This makes perfect sense considering the nature of mental health. There are few objective tests the practitioner can use to determine the problem (or even if there is a problem), how the problem was manifested, and what can be done to alleviate it. So little is known about the workings of the mind, how genetics and the environment goes into shaping moods, and the state of mind where we can agree is either normal (healthy) or abnormal (unhealthy). Therefore, correctly diagnosing a mental disorder is near impossible without some method of trial and error.
The authors are obviously experts on the field, and treat the subject matter with the tact and care that the discipline requires. Especially interesting is the matter of discussing one's medical issues with their places of work. This book was written for an audience within the United States (though this can be seamlessly carried onto other Western Nations or similar cultures). In the United States there exists certain legal rights for those suffering from a mental illness, but I would recommend that readers from other countries take their legal rights (or lack thereof) into consideration before letting one's coworkers and bosses know.
The authors put considerable effort into describing various medications, their side effects, which are better at certain ailments, and if there are known side-effects. It was surprising to learn the history of Lithium and perhaps it is the most misunderstood medication treating mental illness today. Simply put, people have been using too much of it, and of course this has caused its patients to exhibit less than favorable symptoms. Also surprising is that the most popular drugs these days are not deemed the most effective at combating the ill effects of bipolar disorder.
A subtle theme throughout this book is the relationship between care-providers and pharmaceutical companies. The authors give credit that the huge profits enjoyed by these companies are a way for these companies to fund further research and therefore come closer to both understanding bipolar disorder plus finding a cure. On the other hand, those companies only produce drugs that make money, so only desire to sell medication that makes them money. The most profitable drugs may not be the best available at treating the symptoms of the disorder, so it does not behoove companies to find a permanent solution to the symptoms of mental illness.
One of the greatest pieces of advice given in this book is how we can combat the effects of bipolarity by simply changing the environment we are in. Our personal genetics may make us susceptible to mental illness and the environment in it can trigger those genes. Therefore, we are naturally predisposed to things that (in previous generations) were of no issue – like eating healthy natural foods, waking and sleeping at regular hours according to the sun and getting plenty of sunshine/exercise. What is being recommended is to replicate the environments our ancestors were found in. Cube-farms were not a thing a thousand years ago, neither was working 12 hour night shifts under the glow of fluorescent neon lights nor eating food saturated in artificial colors and flavors were available to us in generations past. I do not propose that happiness was commonplace for the masses in ages past, simply that the causes of disorders today were not around then.
The authors spend a good deal of effort recommending various activities to do when one is experiencing the negative effects of bipolar disorder. It was a good idea, but implemented rather haphazardly. I would recommend a list of which symptoms are better with tackling which activity. I doubt one suffering from a bout of severe depression would read something saying 'do bicycling' and be inspired to do actually do it.
On the other hand, it was great advice to those who negatively express their Bi-Polarity into a less harmful way (like pouring glue on the skin then take it off instead of cutting oneself). I suppose a level of depression would require a level of activity needed to start the ball rolling into a more active lifestyle. One with severe depression and unable to leave the house ought not to be expected to jump right into something like skydiving. Perhaps a better suggestion would be go get out of the house to see a movie at a cinema, or go have a coffee with a friend. Afterwards, as one's mood improves, one may step up the activity.
All in all, I highly recommend this book. Even if one is not suffering nor knows anyone that suffers from bipolar disorder, this book ought to give the reader enough information to remove the stigma from this little known disorder, indeed of mental illness as a whole. If this disorder has an active role in your life (directly or indirectly) then this book serves as an excellent reference until (hopefully) our knowledge of this disorder grows to the point to make it obsolete.
© 2017 Hans Krauch
Hans Krauch is a graduate student atSofia University "St.Kliment Ohridsky", Faclulty of Philosophy.