Diagnosis du jour

Like changing hemlines, there are fashions in mental health. In the 1980s, taking Prozac was hip and, on the cocktail circuit, you were embarrassed if you weren’t taking the little blue and white capsule. A decade later, attention deficit hyperactivity disorder (ADHD) was the ‘in’ condition, not just among children and adolescents, but also among driven adults. And now, in the new millennium, the diagnosis of the moment is bipolar disorder.

A new study conducted by researchers at Columbia University http://www.nimh.nih.gov/press/rates_bipolar_diagnosis.cfm?OututPrint) finds that 1 in every 100 youth aged 19 or younger has bipolar disorder (and 2 in every 100 adults). That may not sound so bad – just 1 percent – but taken in the context of trends, it is disturbing: the rate of bipolar diagnosis has increased forty-fold in ten years among adolescents.

Forty-fold.

What the hell’s in the water?

Probably nothing. Historically, bipolar disorder has been under-recognized, under-diagnosed, and under-treated, especially in pediatric populations. The mood swings, excess energy, and restlessness associated with bipolar parallel the signs and symptoms seen in other conditions, including ADHD, oppositional defiant disorder, psychotic disorders, and garden-variety depression. Not to mention the normal angst and sturm of adolescence.

But now it appears we may be swinging to the other side of the pendulum: over-diagnosis. And a consequence of any diagnosis is usually a treatment. The medications used to treat bipolar disorder – lithium and other mood stabilizers, anxiolytics, antidepressants, and antipsychotics – are not innocuous. They are powerful, mind-altering drugs which, when used appropriately, confer tremendous medical benefit. But they also have potent and dangerous side effects, ranging from the inconvenient and uncomfortable (loss of libido, dry mouth, shaking) to the downright dangerous (blood dyscrasias, weight gain, diabetes).

In BRIGHTER THAN BRIGHT, Ben is bipolar. Diagnosed at age 16, he’s a model patient, compliant with his lithium and psychotherapy for the past four years. But a series of events cascade and lead him to ‘forget’ his happy pills and he starts the upward spiral into mania…

My very atoms vibrate: from caffeine, from sleep deprivation, from the constant moving forward. From erratic consumption of my mood regulators. But my mind is sharp, focused; my dreams, Technicolor wonders. Everything I touch explodes from this magical, sub-cellular energy surging within me. When I press the closed hollow-wood door to Bruce’s office, it flies open with a bang. The knob gouges the plaster wall. He sits at his desk, the room dim but for the green glow of a single lamp, head down, not noticing my tumult.

The Midnight Disease

Enough on mental illness, drug abuse, and all that jazz… I got a new disease to ponder - hypergraphia. The Midnight Disease. The primary symptom of this condition is an overwhelming urge to write. A compulsion to write. Although hypergraphia is not actually a disorder, it is associated with temporal lobe changes seen in epilepsy and manic episodes.

Hypergraphia often strikes without warning. On January 1, 2006, I contemplated my modest goals for the upcoming year (which did not include writing a novel). The next day, a mysterious impulse entered my then-tranquil mind and screamed, “WRITE!’ I obeyed. For three months, I catharsed. Nights, after work, dinner, and kiddy time, I’d sit at the kitchen table, oblivious to the blare of the television, to the crick in my back, the gurgling of my stomach, the late hour, and write. Words streamed from my fingertips, effortless, and onto the computer screen. 183,000 of them. It was exhilarating. Thrilling. A rollercoaster of immense emotion. I wrote with fury, afraid the ideas and images and words and conversations would disappear, without warning, as suddenly as they arrived. I rode my story with a manic rush to the end.

A year and one-half later, I'm still riding. And writing.

(I wonder: Is it any coincidence that Ben, my protagonist, is bipolar?)

This was the genesis of my novel BRIGHTER THAN BRIGHT. The need to write continues. And so I do. I’m on my sixth and, I hope, penultimate revision. Two more novels sit in the recesses of my brain, waiting impatiently for their turn. But instead of being exhausted, my hypergraphic nature fuels me: I walk with a perpetual zing in my step, a new lightness and clarity to my life. And every day I pray this funny ailment remains my constant affliction, niggling always at my mind, stretching me, transporting me to places I never dreamed possible…