Finding The Positive Side of Bipolar Disorder

By Elizabeth Forbes







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People share their stories of how optimism has helped them cope with and manage their bipolar disorder.



In the decade since she was diagnosed with bipolar I, musician Sara L. has developed some ideas about what might be called the upside of the illness.

“This is just my own kind of pet theory,” explains Sara, 39, “that it confers personality characteristics … drive, ambition, energy, enthusiasm and self-confidence. And when you’re well, those things come across in a positive, pro-social way.”

Of course, Sara knows all about the “life-trashing” side of bipolar. As a punk rocker with dark moods, she spent her 20s overindulging in alcohol and marijuana. When she rebounded from a deep depression into extreme mania after a romantic breakup, symptoms like religious delusions, incoherent speech and agitation landed her in the hospital.

With medication to smooth out her mood swings and talk therapy to defuse the distorted thinking of depression, she’s able to see some pluses to having bipolar.

“Research is showing that there are links between creativity and bipolar disorder,” explains Sara, who is now studying for a master’s in counseling psychology. “I think it remains to be seen exactly if or how, but in my own life I’ve always been a creative spirit. Or maybe not so much that bipolar causes a creative mind—it may, but it’s more that it gives you drive and ambition.”

That combination of creativity and drive helped Sara make her mark as a singer-songwriter, recording and touring with her indie-pop band Vancouver Nights and a well-received project called the Gay. She still performs with her band and other musicians occasionally, but facing off against bipolar has given her a new passion: helping other people with mental illness.

She’s developed the view that “it’s a belief about having bipolar disorder that really can make or break our ability to live well. I think when people get the message that, ‘Oh, this is a chronic illness and you better just hunker down and try to get through life, and you’re going to be very limited in what you can do’—people internalize that message,” she says.

“I think it’s still a struggle day-to-day with everyone who has bipolar because of the moods … so it takes vigilance and it does take resilience,” Sara adds. “And I guess part of that is acknowledging the positive things it’s brought to you.”

Helpful Traits

While it may sound surprising to put “bipolar” and “positive” in the same sentence, an analysis published in the Journal of Affective Disorders in February 2011 found that having bipolar disorder may enhance “certain specific psychological characteristics … that are generally viewed as valuable and beneficial morally or socially.”

The authors reviewed 81 studies that noted positive characteristics in patients with bipolar and found a strong association with five qualities: spirituality, empathy, creativity, realism, and resilience. Nassir Ghaemi, MD, MPH, and colleagues from Tufts Medical Center in Boston concluded that encouraging an appreciation of the positive aspects of bipolar could help combat stigma and improve patient outcomes.

Ghaemi, a psychiatrist who directs the Mood Disorders Program at Tufts, went a step further in his recent book A First-Rate Madness: Uncovering the Links between Leadership and Mental Illness. The widely publicized book argues that because leaders with depression or bipolar disorder have stronger qualities of empathy, realism, creativity and resilience, they are better equipped for times of crisis.

“Depression enhances empathy and realism and the mania enhances creativity and resilience … so when people have bipolar disorder, they have the full gamut of benefits,” says Ghaemi.

By contrast, research into “positive cognitive bias” shows that people without a mental illness tend to overestimate both their own capabilities and their control over the environment, as well as interpret events with an overly optimistic lens. During a crisis, Ghaemi says, it’s better to be able to assess situations more clearly—thanks to a trait researchers have identified as “depressive realism”—and have the greater flexibility of mind and higher tolerance for risk that go along with hypomania.

In his book, Ghaemi notes that his thesis upends the commonly held assumption that mental illness is “inherently bad.” He does distinguish, however, between mild symptoms that can be helpful and severe symptoms that lead to dysfunction.

Ghaemi says A First-Rate Madness was inspired by patients with bipolar who are quite successful in business and politics. Since discussing those people would violate patient confidentiality, “historical leaders is a way for me to bring out those examples in a way that is publicly accessible to people.”

Better With bp?

While Ghaemi’s thesis has some detractors, he is not alone in finding advantages to having bipolar.

Most notably, Kay Redfield Jamison has championed creativity (in Touched With Fire) and a passion for life (in Exuberance) as positive hallmarks of bipolar disorder. In his 2005 book The Hypomanic Edge: The Link Between (A Little) Craziness and (A Lot of) Success in America, clinical psychologist John D. Gartner, PhD, argues that a mild form of mania has fueled American innovation.

Gartner links relatively high rates of bipolar disorder in the United States to a gene pool heavily weighted with immigrants. The idea is that many immigrants made the leap to a new country thanks to hypomanic traits such as entrepreneurial drive, a high tolerance for risk-taking, creative vision and brash self-confidence. In individuals who don’t cycle into mood swings this is known as a hyperthymic temperament, and it is found disproportionately in relatives of people who have full-blown bipolar.

Self-help coach and author Tom Wootton drew on personal experience to develop his “bipolar advantage” approach, which mirrors much of Ghaemi’s thinking. By accepting and wisely managing the illness, Wootton teaches, an individual with bipolar can harness elements of hypomania such as enhanced creativity and productivity. Depressive introspection can yield deeper awareness and insights. And emotional pain can be a catalyst for personal growth.

Steve B. of Colorado Springs, Colorado, was especially struck when he read Wootton’s books. He relates Wootton’s message to a remark made by a successful friend with bipolar.

“My friend, who is a published author, said a lot of the reason we can do what we do is not necessarily in spite of [having bipolar], it’s because of,” explains Steve, 54, a licensed insurance agent who founded a statewide organization of the Depression and Bipolar Support Alliance (DBSA).

For example, Steve says, “If I’m in kind of an arrogant mood, I’ll just go to somebody and I’ll say, look, don’t mess with me because I can out-think you and I can out-talk you. There’s times when the racing thoughts and the tangential thinking and the pressured speech can get you into a lot of trouble, but also it can help you sell things—that’s my background, sales and customer service—and be able to problem-solve.

“If you leverage it properly and don’t go overboard, it’s amazing the things you can do.”

Steve believes that traits associated with his bipolar I helped him create and run the nonprofit BrainStorm Career Services for Psychiatric Disability, a subsidiary of DBSA Colorado Inc., while holding down a day job.

“The leadership qualities, I think, have always been there,” says Steve, a longtime community organizer and former district chairman for the El Paso County Democratic Party. “But when I figured out why it is I act the way I do, and when I got past the real dysfunctional behaviors, yes, [bipolar] absolutely has fueled and accelerated the leadership stuff.”

Tipping Point

Celebrating the “hypomanic edge” sets off alarm bells for many professionals who treat people with bipolar.

Russ Federman, PhD, sees a dangerous tendency among the students with bipolar he counsels at the University of Virginia, where he is director of counseling and psychological services. In the early stages or “lower levels” of hypomania, he says, students find themselves more productive than usual. Then they’ll avoid treatment to protect their energized mood.

David Miklowitz, PhD, director of the Child and Adolescent Mood Disorders Clinic at UCLA’s Semel Institute, puts it this way: “I think where we get into trouble … is when it’s implied that bipolar people are more creative than other people and then the logical leap that people make is, ‘Well, if I go off my medications, then I’ll be really creative.’ And that’s when disasters tend to occur.”

A 2006 study in the Hungarian journal Ideggyógyászati Szemle (translated as Clinical Neuroscience) cites the “inverted U” theory: Elevated mood facilitates creativity only to a certain point, after which increasing elevation of mood has an adverse effect on achievement. The tipping point marks a gateway to the scattered thinking, grandiose delusions and destructive behaviors of mania.

Big Daddy Tazz, a stand-up comic in Winnipeg, Manitoba, knows all about the tipping point.

“If I could be grounded and still be manic, which is never ever going to happen … that’s when my brain works the best,” says Tazz, a 44-year-old father of two. “I am so creative and so willing to take a risk and so thinking outside the box.

“It’s a different level of thinking, but also it’s the most destructive.… It’s like not having an off switch,” he adds.

Tazz says it took him seven years, from 1994 to 2001, to fully accept that he has bipolar and needs to stay on medication. It doesn’t seem to have hurt his career, though: His post-treatment appearances include the CBC Winnipeg Comedy Festival, the Just for Laughs festival in Montreal, The Comedy Network’s Comedy Now! series, and the show Mixed Blessings, on which he played the male lead’s best friend.

An average performance might have him riffing on growing up in a small prairie town, being a fat guy, interpreting toddler speech and his elder son’s ADD—a diagnosis Tazz shares. Then there are his sets as the “Bipolar Buddha,” dedicated to spreading enlightenment about mental illness through humor.

“I have accepted what other people perceived as the biggest blow to me, which is bipolar disorder or a mental illness or whatever you want to label it. I’ve not only come to terms with it, but joke about it and speak about it in a positive light,” he says.

‘Mental Vaccine’

That kind of good outcome in the face of life’s blows pretty much defines resilience. In A First-Rate Madness, Ghaemi summarizes the psychological view of resilience as an interaction between temperament and adversity. In conversation, he points to research that suggests having a hyperthymic temperament provides insulation against post-traumatic stress disorder.

More broadly, exposure to adversity can provide what Ghaemi calls a “mental vaccine” against future hardship. In his view, mood shifts create a petri dish for cultivating resilience.

“People with bipolar disorder … have traumatic manic or depressed episodes, and then it goes away. They actually recover from these episodes,” he explains.

For Tazz, experience and education have fed the resilience that helps him weather mood shifts.

“I’ve been in the deepest pits that I have ever been in, some of them dug by myself, and I can climb out of them,” he says. “I also know that the next thought is just a feeling. If I am suffering a depression, it’s just depression. It’s not really based in anything other than maybe some chemistry.”

So is resilience an attribute of the hyperthymic temperament or developed through dealing with bipolar’s Bethges? Are traits like creativity and leadership inherently linked to the disorder or merely enhanced by elevated mood?

The jury is still out on those questions, and the chicken-and-egg debate spills over to the qualities of spirituality and empathy. Do the altered states of mania and depression produce mystical insight, or are people with bipolar more in need of faith’s comforts? Is there a neurological relationship between depression and empathy, or does personal suffering increase compassion for the suffering of others?

“I personally think that people with bipolar disorder have a unique way of perceiving the world,” says Roumen Milev, MD, PhD, head of the psychiatry department at Queen’s University in Kingston, Ontario, and clinical director of the Providence Care Mood Disorder Research and Treatment Service. “They have increased sensitivity.”

For example, he says, “When people are depressed they experience the world in a different way. They become more sensitive to the world and to the pain in the world.”

A Better Outcome

Miklowitz prefers to focus on a different aspect of the Tufts study: how positive psychological traits can contribute to a better outcome with bipolar.

In his view, traits like spirituality, creativity, and resilience are worth cultivating as protective buffers. Having a supportive faith community, or a satisfying outlet like painting or playing an instrument, provides a life-affirming counterweight to mood extremes.

It’s very important, he says, “for people with bipolar disorder to think about their personal goals for recovery—not just taking medication and only taking medication, but are there other things that could be helpful to their long-term quality of life?”

Beth A., a veterinarian in New York state, counts spirituality as one of the many coping skills she has learned to help manage her bipolar.

Beth says she grew up in a Christian household, but her faith was not very strong when she went through a series of hospitalizations for depression throughout the 1990s. If anything, she says, she was angry at God for messing up her life. Her outlook began to change after a particular exercise during inpatient group therapy.

The therapist had the patients write down all their anxieties, “past, future, present,” Beth recalls. Then they had to figure out which items on the list they could actually influence that day. Everything else was placed in a symbolic “worry box” and left in the hands of a higher power for the time being.

Beth recounts her illumination: “We could not change people. We couldn’t change their reactions. It helped me to realize how much I didn’t have control over, and I think that pointed me towards developing more of a faith.

“There are so many things that we have to let go of and put into the hands of a higher power, whatever that may be, and simply try to hang on to that sense of faith that … things will get better with time.”

Beth says that when she can’t feel any hope during a depressive episode, faith reassures her that the dark period will eventually end. In turn, she says, spirituality helps her see having bipolar as more of a blessing than a curse.

“I feel a common bond and energy with all of humanity.… I feel God has challenged me with this illness so I would develop empathy for others and not take anything I do have for granted.”

Steve B. says the empathy he has developed through having bipolar “gives me a reason to get up in the morning.”

When he was first diagnosed, he recalls, it was the worst of news. He was convinced he would never own another business, that everything he tried to do would fail. As he got more involved with the peer support community, however, he found a power surge to rival hypomania.

“I’m in a world that I never even thought existed … helping people that I never even thought of wanting to help,” he explains. “And it just energizes me.”

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A Method in His ‘Madness’

“In the storm of crisis, complete sanity can steer us astray, while some insanity brings us to port.”

In A First-Rate Madness, Nassir Ghaemi, MD, MPH, brings psychiatric analysis to bear on historical figures (plus a few modern-day leaders) to demonstrate that premise.

Ghaemi backs up his argument with a wide body of research that makes for interesting reading. He shows that depressive pessimism links to a more realistic assessment of circumstances, that the “divergent thinking” of hypomania enhances creative problem-solving, and that aspects of depression and bipolar disorder increase resilience.

Thus Winston Churchill, whose well-documented deep depressions and energized moods indicate bipolar II, became a pre-eminent leader during World War II. He was realistic about the threat Hitler posed, perceived that war was required, and rallied the nation to endure hard times just as he had survived bleak periods.

His predecessor, Neville Chamberlain, is condemned for appeasing Hitler. In truth, Ghaemi says, Chamberlain was hampered by the unrealistic optimism and attachment to the status quo characteristic of average mental health.

Ghaemi convincingly explains that the mercurial Civil War Gen. William T. Sherman invented the “total war” philosophy, destroying a swath of the South because he saw the harsh necessity. Franklin Roosevelt, who exhibited persistent hypomania, was willing to experiment with new programs during the Great Depression.

Ted Turner, however, fared poorly in a corporate setting because his bipolar traits were better suited to entrepreneurial pursuits like creating CNN. We can’t all lead a country through turmoil, but it makes sense to find a role that plays to bipolar strengths.

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Printed as “Accentuate the Positive”, Winter 2012