Written by: Anet Khechoumian, Licensed Marriage and Family Therapist
Most of the world has seen and heard a lot from Kanye West in the recent weeks, either by twitter, or his political campaign rally. The speech given at his political rally drew curiosity and began questioning the unruliness of his behavior. Mr. West has been open about his diagnosis of Bipolar Disorder, as the cover art for one of his recent music albums, “Ye ” had the text, “I hate being Bi-Polar, its awesome” written on it, which is emblematic of his diagnosis all together. Throughout the years, Mr. West has discussed that he has not always maintained a stable medication regimen, which draws the unknown factor, of when he may be on public display while on or off of his psychotropic medication, since his behaviors look different from the times when he has actively said to be taking his medication.
What is Bipolar Disorder?
Clinically we characterize Bipolar Disorder by extreme mood swings (that can range from mania to clinical depression), lasting at least one week, and present nearly everyday, for most of the day. Other distinctive characteristics may include grandiosity or inflated self esteem, pressured speech, decreased need for sleep, flight of ideas or racing thoughts, distractibility, increase in goal directed tasks, harm to self or others, and excessive involvement in activities that can have unwanted consequences (ie: large shopping sprees). The mood disturbance is significantly severe and causes marked impairments in social or occupational functioning.
Grandiosity can afford a person the ability of having high accolades and expressing how they are often singled out enough to be excellent in their craft, or be the world’s best at what they do. Within this belief system, being in that 1 % range, increases the chances of having the thought pattern prevalent outside of the manic state, which may give way to creative and successful outcomes, when actively carried out. Synesthesia is a known neurological condition, where information meant to stimulate one of your senses (such as sight) stimulates several of your other senses (such as sound). Synesthesia is incorporated with such thought patterns, which are described as seeing color when hearing music, or visa versa, which is generally when we see how the heightened state of thinking or mania can display high levels of creativity. Those with bipolar disorder, will often share that they see and hear sensations in assorted ways. Fusing things together by having an elevated thinking state during mania, allows for more creativity and more of an opportunity of being “out of the box.”
All the Hype about HypoMania
Before mania, we commonly see what is called hypo mania (which is a more mild form of mania, though it can still cause some lifestyle disturbance and show higher than normal levels of energy). One aspect of Mania to remember is that you can have psychosis within a manic episode, which is likely to include hallucinations and/or delusions. A Manic episode requires meeting a minimum of three criteria , such as showing distractibility, indiscretion (doing things that you normally would not be doing), and hypersexuality (which is not limited to excessive desire for sex). These characteristics are even more apparent when our executive functioning is not intact. Oftentimes, what you are thinking can come out impulsively, as seen in pressured speech. Pressured speech is best defined not by speed, but rather impatience and difficulty to stop talking. This can be seen when someone is speaking at a pace that is intense and can quickly digress, with a shifting stream of thoughts. There can be a variation of how similar traits are displayed, versus meeting the strict criteria of a diagnosis. Although, the rule out should be exhaustive, and should ideally take several months to monitor a pattern of when the onset of symptoms arise. Bipolar is often diagnosed between a person’s teen-years to mid 20’s (early adulthood).
Normal or Not
The word normal is defined in the Webster dictionary as, “conforming to a type, standard, or regular pattern,” which can be said to be a subjective and nebulous term.
Being outside the realm of “normal” is significant, when even within that realm, the behavior is still seen to be unusual. Thoughts in the mind can become so intense, that to your own accord, you feel the emotional catharsis to scream, cry or yell. The emotional lability that a person can have when in a depressive or mixed episode state is not so much relevant to the event, but can rather be a small prompt to evoke a strong emotional response (evident by clear display of anger, confusion or hurt). We look at a significant influx of energy, which can reflect numerous activities that can individually be seen as normal, although seeing them all being done concurrently is significant. Additionally, these such activities are carried out for multiple weeks at a time, with little needed sleep or rest. Thought distortions are common while being very productive during a hypomanic phase (as there is less desire to come back down), and can be difficult to recognize. Family and support can recognize that more so than individuals experiencing the mood changes. Familial containment helps the person acknowledge that they need help and be less inclined to resistance. Before Bipolar Disorder is diagnosed, there are other factors that need to be ruled out, which is what the clinical term refers to as a differential diagnosis. If providers are not making accurate assessments, a misdiagnosis can occur more frequently, and cause continued distress and agitation.
Misdiagnosing Minorities
Within the minority populations (particularly African Americans), patients may present with symptoms of mania, although if providers are not culturally competent, they may not consider the symptomology related to mental illness. If you are emotionally labile, volatile or displaying an alarming thinking process, providers can often times see that to be either a cause of any form of substances use, or have a higher probability of misdiagnosing a more severe disorder (such as Schizophrenia or Schizoaffective Disorder). Minorities have the same prevalence as others, to have bipolar disorder, but are more often undiagnosed or misdiagnosed. The cultural competency presents with challenges, as psychosis or bipolar induced psychosis need to be better deciphered.
Treatment
Bipolar disorder is known to show a depressive presentation, which often directs physicians to more likely prescribe popular antidepressants (such as an SSRI like Zoloft, Sertraline or Paxel). These medications can cause what is called a “flip,” which is seen when targeted symptoms are not adequately reduced, and the presenting problems are still prevalent. Other conditions that are commonly known to also cause emotional lability, (such as being hypoglycemic, or having hypothyroidism), need to be ruled out before psychiatric medication is taken. Though genetics do play a role, environmental stressors are a strong contributor as well. Genetic vulnerability decreases resiliency and can make it easier to be affected by environmental stressors or triggers. You can be selective with choosing your providers, and inquire about practice patterns to help feel comfortable and establish a reciprocated dialogue.
Treatment can be difficult because the adherence to medication is challenging, as continuity of treatment and consistency of engagement are key factors to sustainable health. We often see that after clients near the one year mark, they show stability and progress, as that is a time when medication may begin to taper off, and clients feel that the medication is no longer necessary. When inevitable stressors occur and triggers are present, patients are then reluctant to tell people they are struggling, and have reservations about returning back to treatment. Find a provider you can relate to. The stigma remains because when improvements are made, people do not usually want to talk about them later, and they are not visibly apparent. Mental illness is recommended to conjoin with talk therapy to help manage the triggers, decrease irritability, and better manage emotional responses.
It may be confusing for others to witness the behaviors of Mr. West, as his mood impairments are seen on a large public scale, which is why we strive to educate others and encourage more empathy and understanding. The mental health community is undoubtedly grateful for the vulnerability that Mr. West and his family share, as their efforts contribute to decreasing the negative stigma of mental illness. By understanding how mental illness is presented, it discourages judgment and shame, and allows more room for support and care.
Anet Khechoumian, MS, MBA, LMFT
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