Notes on Manic-Depressive Illness, 2e, by Goodwin & Jamison

Volume 1. New York: Oxford UP. 2007.

manicdepressiveillness

 

p. xix “Manic-depressive illness magnifies common human experiences to larger-than life proportions.” [Living large. Yay.]

xix “manic-depressive illness is the most common cause of suicide.” [Ergo, I think people who bully the mentally ill are attempting murder.]

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xxiii “The high mortality associated with this illness cannot be overemphasized.” [So will you assholes stop acting like it’s no big deal?]

xxiii “The age-old link between ‘madness’ and creativity has been studied with increasingly sophisticated methods in recent years. Research has demonstrated that it is not schizophrenia but manic-depressive illness, especially its bipolar forms, that is more often associated with creative accomplishment.” [Normal brains produce normal thoughts, which are advantageous in… some… situations.]

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3 “Aristotle, who differed with the Hippocratic writers by seeing the heart rather than the brain as the dysfunctional organ in melancholy, introduced the notion of a ‘predisposition’ to melancholy.” [Hey, you mean it’s not just a phase?]

4 “Deliberations on the relationship between melancholia and mania date back at least to the first century BC…” [Looks like it’s not just trendy after all!]

5 “The period that followed was, in retrospect, a dark age, when mental illness was generally attributed to either magic or sin or possession by the devil.” [Maybe the horror community wants to keep up the stigma to sell books?]

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5 “The explicit conception of manic-depressive illness as a single disease entity dates from the mid-nineteenth century.” [oh those clever pathologizing Victorians]

12 “Current data indicate that manic-depressive spectrum conditions… may be found in 5 – 8 percent of the population” [never said I was a unique snowflake, asshole]

15 “significantly more manic-like symptoms in their bipolar depressed patients–especially irritability, racing thoughts, and distractibility–than in unipolar patients.” [bipolar depression borrows some of the crazy from our other pole]

15 “bipolar-II depressed patients have been noted to have less stability and uniformity of symptoms across episodes than unipolar patients” [my bipolar depression is different from regular-brand depression]

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21 “…within the broadly conceived cyclothymic temperamental domain there are ‘dark’ and ‘sunny’ types. Although family history for bipolar disorder is equally high in both groups, in clinical practice bipolar-II associated with the darker core cyclothymic temperament is more likely to be diagnosed as a personality disorder.” [I come from a Southern Gothic family]

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30 “Despite the shortcomings of language and the highly personalized vocabulary often used by patients in describing their manic-depressive illness, certain words, phrases, and metaphors are chosen time and again, forming a common matrix of experiences. Often these images center on nature, weather, the day-night cycle, and the seasons; often, too, they convey unpredictability, periodicity, violence, tempestuousness, or a bleak dearth of feelings. Religious themes and mystical experiences pervade the language, conveying an extraordinary degree and type of experience–beyond control, comprehension, or adequate description.” [Me & Virginia Woolf!]

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31 “As we shall see, ‘pure’ affective states are rare: mania is often complicated by depressive symptoms, and conversely, depression, especially the bipolar form, usually is accompanied by at least one or more symptoms of mania… far from being a ‘bipolar’ disorder, with the assumption of clinically opposite states, the illness is characterized by co-occurrence of manic and depressive symptoms more often than not.” [so please no more Jekyll/Hyde jokes, which is a misreading of the novel anyway]

34 “For many patients, excessive energy translates directly into pressured writing and an inordinate production of written declarations, poetry, and artwork.” [no wonder my damned emails can get so long]

36 “The profoundly disturbed and psychotic behavior of delirious mania underscores the origin of the phrase ‘raving maniac.'” [I wonder if I have that to look forward to]

37 “These feelings, analogous to the beatific and mystical experiences of saints and other religious leaders, share certain features with contemporary experiences of ‘universal communion’ induced by mescaline, LSD and other hallucinogenic substances.” [I don’t know jack about universal communion, but I can tell you that being hypomanic is a little like LSD… but then again, how would I know how LSD affects a normal brain?]

37 “The dendritic, branching-out quality of manic thinking was described by nineteenth-century art critic and writer John Ruskin… ‘I roll on like a ball, with this exception, that contrary to the usual laws of motion I have no friction to contend with in my mind… I am almost sick and giddy with the quantity of things in my head–trains of thought beginning and branching to infinity, crossing each other, and all tempting and wanting to be worked out.” [from a letter to his father, 1833]

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37 “The overwhelming and often terrifying nature of racing thoughts… Grandiosity of delusional proportions and a compelling sense of moral and social awareness…” [enough to make you take a long walk into the ocean, in fact… that’s another Woolf reference]

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40 “Research on mood symptoms in mania… demonstrates that most patients, on average, are depressed (46 percent) or labile (49 percent) nearly as often as they are euphoric (63 percent) or expansive (60 percent); they are irritable (71 percent) even more often.” [Thus, the idea that we flip from highs to lows is way off. The euphoria sounds lovely to me, but I tend toward the dysphoric, alas]

43 “In some patients, the manic episode progresses further to an undifferentiated psychotic state (stage III), experienced by the patient as clearly dysphoric, usually terrifying, and accompanied by frenzied movement. …Delusions commonly are bizarre and idiosyncratic, and some patients experience ideas of reference, disorientation, and a delirium-like state.” [And I thought “ideas of reference” permeated my fiction just because I really like The Crying of Lot 49… hmmm.]

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45 “manic patients appear to be more disordered in thought structure, whereas schizophrenic patients appear to be more disordered in thought content… manic thought disorder was ‘extravagantly combinatory, usually with humor, flippancy, and playfulness.'” [I think most of my villains are shaded manic in their dialogue, and several stories in Peritoneum are flat-out manic in structure…]

50 “73 percent of hospitalized manic patients demonstrated severe levels of bizarre-idiosyncratic thinking” [I am anxiously awaiting a medical definition of “bizarre”… seems to be thought disorder, but I can’t help thinking of Lewis Carroll type of stuff]

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52 – 53 “Depressed patients tend to qualify more, to talk more in terms of a ‘state of being,’ and to talk more both about themselves and other people. Manics, on the other hand, tend to talk more about things than about people, to discuss them in terms of action, and to use more adjectives to describe them.”

57 “Manic delusions are usually grandiose and expansive in nature, often religious, and not infrequently paranoid. [Dr. Fincher]

59 “Lowe (1973) studied 22 bipolar patients… comparing these patients with others who had organic, paranoid, or schizophrenic psychoses, he found that they reported mainly auditory and visual hallucinations when manic… in retrospect, the hallucinations were believed to be ‘less real’ but were also perceived to be less controllable… the patients always believed the hallucinations to be experienced only be themselves.”

59 “mania was more characterized by enhanced sensory awareness and ecstatic or beatific experiences. Manic hallucinations tended to be of the more visual type; strikingly vivid and associated with bright, colorful sensations; and often coupled with intensely pleasurable or ecstatic feelings (similar to psychedelic experiences).” [Suspiria, Martyrs… my “TR4B,” “Door Poison”]

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64 “irritability–racing thoughts, which, as noted earlier, is putatively a dysphoric expression of hypomania (Benazzi and Akiskal 2003)”

I DON’T HAVE THE ATTENTION SPAN RIGHT NOW TO KEEP READING EVERYTHING IN ORDER, SO I’M GOING TO START SKIMMING ALONG!!!

135 “More recent evidence supports the conclusion that the influence of life events in triggering mood episodes is more prominent in earlier than in later phases of bipolar disorder.”

150 “Chronic persistence of symptoms can be expected in about 20% of cases, and social incapacity in about 30%.”

223 “Comorbidity in manic-depressive illness, in which the mood disorder is complicated by the presence of one or more additional disorders, is the rule rather than the exception, especially for the bipolar subgroup.”

comorbidities

Relatively unexplored comorbidity: dissociation

251 “…a particularly high liability for comorbidity with personality disorders, substance abuse disorders, and anxiety disorders in bipolar-II patients… The evidence strongly suggests that bipolar-II patients have–relative to the general population and to those with bipolar I or unipolar depression–the highest rate of suicide.”

251 “In summary, women with manic-depressive illness attempt suicide more often than men. In contrast to the general population, the suicide rate in women with manic-depressive illness is higher than or equivalent to that in men.” [men may under-report or engage in “suicidal equivalents”]

260 “Although the findings of studies reviewed here point to genetic alterations in the serotonin system as having a relationship to suicidal behavior, the findings with respect to manic-depressive illness and suicide remain inconclusive.”

Bipolar or affective disorder features severe depression alternating with episodes of hyperactivity. Patients have defective regulation of emotions, and they have difficulty with judgment and behavioral decisions. The most popular theory is that a deficiency of serotonin is the primary cause of the disorder. Serotonin is normally produced in the raphe nucleus in the midbrain and upper pons and is distributed to the rest of the brain. Ventriculomegaly is observed in affective disorders, but the finding is nonspecific. Reductions in volume of the frontal lobes, basal ganglia, amygdala, and hippocampus have also been reported. Functional studies have revealed decreased activity in the prefrontal cortex and anterior cingulate gyrus.

“Bipolar or affective disorder features severe depression alternating with episodes of hyperactivity. Patients have defective regulation of emotions, and they have difficulty with judgment and behavioral decisions. The most popular theory is that a deficiency of serotonin is the primary cause of the disorder. Serotonin is normally produced in the raphe nucleus in the midbrain and upper pons and is distributed to the rest of the brain. Ventriculomegaly is observed in affective disorders, but the finding is nonspecific. Reductions in volume of the frontal lobes, basal ganglia, amygdala, and hippocampus have also been reported. Functional studies have revealed decreased activity in the prefrontal cortex and anterior cingulate gyrus.”

 

261 “A passive sense of hopelessness is a chronic risk factor for suicide.”

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262 “The impact of social factors, such as losing an important relationship or a job or facing legal or criminal proceedings, can be devastating to anyone; this is particularly, true, however, for those with a major psychiatric illness such a bipolar disorder. Although rarely sufficient by themselves to cause suicide, social stressors can precipitate or determine the timing of the act. They may trigger suicide in individuals with certain biological vulnerabilities and psychological traits…”

277 – 278 “Thus there is reason to suspect that as a group, individuals with bipolar disorder are endowed with general intellectual abilities superior to the distribution in the general population and may be more likely to have backgrounds of middle and upper socioeconomic levels. Yet is also appears that bipolar disorder is characterized by poorer general intelligence across all phases of illness. If both of these views are correct, it would suggest that the disorder is associated with significant deterioration in general intellectual abilities or that there are compensatory cognitive advantages in a subgroup of individuals with bipolar illness… Studies contrasting patient samples with healthy volunteers likely underestimate the extent of deterioration because they do not account for the premorbid baseline.”

281 [note in IQ, V vs P is verbal vs nonverbal] “The reductions in full-scale IQ seen in mood disorders appear to be largely attributable to a decrement in PIQ, with preservation of VIQ.”

282 “The implication is that the cognitive systems subserving language are spared with respect to an otherwise generalized disease process, are constitutionally endowed at higher capacity, or are complemented by compensatory cognitive advantages of an as-yet undetermined nature.”

298 “Mood congruence refers to the notion that the efficiency of mnemonic processing is biased by the congruence between the current affective state and the affective tone of the material being remembered. In general, it is believed that dysphoric or negative life events are recalled more easily when individuals are in a depressed state than when they are in a euthymic or manic state….”

312 “The literature on encephalomalacia in bipolar disorder…”

 

Talking to you is way more interesting than talking to myself. What do you think?