FOREWORD
Bipolar illness has long been a source of fascination in the mental health field. The fascination stems from the dramatically different states of mania and depression, which are alternating yet integral components of the same illness and yet often occur simultaneously; the sudden and dramatic processes by which intense depression becomes mania literally overnight, as if a switch had been turned on; the challenge to understand how the same drug (lithium) can bring mania down and lift depression up; and finally, the paradox that in bipolar disorder, arguably the most genetic and therefore the most biological of all the mental illnesses, the psychosocial environment appears to activate the genetic vulnerability, converting it into a lifelong illness.
These features are ample reason for the growing interest among mental health professionals and brain scientists, but what of the recent surge in interest among the general public? To understand this we might turn to another fascinating character of the illness: For many bipolar patients, the dark cloud of the illness is leavened by silver linings--creativity, intelligence, and drive. As a result, the bipolar spectrum is a more frequent phenomenon among those in the public eye: artists, performers, writers, composers, and charismatic leaders.
Of course, this has long been true. So why the explosion of public interest now? The answer, I believe, is both complex and simple. Decades of research investment, principally by the National Institute of Mental Health and the pharmaceutical industry, have yielded effective treatments for many people with bipolar illness, which means there are hundreds of thousands of bipolar patients leading successful and productive lives. In so doing, each of them sends a powerful and destigmatizing message, especially if they are in the public eye.
Not surprisingly, popular books have been the major vehicle increasing public interest, thereby expanding the market for more books. So far, what's out there falls into one of two categories: books by professionals and books by a patient or a family member.
With the appearance of this book, a new genre has been established--a close collaboration between a bipolar patient and doctors. Jan Fawcett, one of the two doctors collaborating on this book, is one of the world's leading authorities on depression and bipolar disorder. The result of this unique collaboration? First, it is a book that vibrates with the flesh and blood of real people--principally, coauthor Nancy Rosenfeld and her story, supplemented by detailed stories and quotes from well-known people with the illness. Nancy at moments seems to jump off the pages, right into your heart. At the same time, the reader is treated to a scientifically sophisticated discussion of bipolar illness--its genetics, biology, and psychology along with its psychosocial impact and pharmacological and psychotherapeutic treatments.
There is no wall between the author/patient and her two coauthors/doctors. The way her story and her reflections are woven with the scientific and professional material paints a compelling portrait of the patient as a full collaborator in advancing the understanding and treatment of her illness. This itself is an important message for the public to absorb.
The book delivers another powerful message, both explicitly and implicitly, that patients need not be defined by their illness. Every one of them is a unique person with their own personality, life experience, strengths, and weaknesses. The authors send this message by using bipolar illness as a springboard to examine various aspects of the human condition--from suggestions for managing stress, advice about sexual happiness, and optimum experience ("flow," or total involvement in life) to strategies for enhancing self-awareness and achieving job satisfaction to a nicely accessible explanation of how cognitive psychotherapy works.
While venturing into these broader areas, the book remains true to its primary focus on the key issues in bipolar disorder: its genetic and biological basis; how psychosocial stress can alter its course; the problems of substance abuse, self-stigmatization, and compliance; the impact of the illness on family, friends, and career; and, of course, state-of-the-art treatment strategies.
The authors are especially to be commended for giving particular emphasis to childhood bipolar disorder and to the issue of suicide, each of which is assigned its own chapter. Only recently has it begun to dawn on our field that the conventional wisdom that bipolar disorder rarely occurs in childhood is a myth. Likewise, for decades, the field of suicidology, spearheaded predominately by sociologists, overlooked the fact that the great majority of suicides occur in the context of a major psychiatric disorder, principally major depression and bipolar illness. In my opinion, Jan Fawcett is our field's leading authority on suicide and the author of the most definitive study of the clinical features of depression that can predict this tragic outcome. Having this information greatly increases the chance of preventing suicide. In addition, new hope that this ultimate tragedy can be averted comes from a recent review of 28 separate reports involving more than 16,000 patients. The review concludes that the suicide rate among bipolar patients treated with lithium is six to eight times lower than it is among bipolar patients not on lithium. This is the first large-scale demonstration in psychiatry that a specific treatment can actually save lives, and it's appropriately noted in this book.
A final note. It's fair to ask how this unique collaboration effort came about and how it so clearly succeeded. I have a one-word answer: Nancy. Her boundless, almost hypomanic energy and enthusiasm were the engines, and her vision was the glue. So, Nancy's "silver linings" made it happen. What better way to teach the public about what's possible for people with bipolar disorder who have the courage to get into treatment and stick with it, working to improve their physical and emotional health every day.
