Chapter Introduction

CHAPTER
7

Depressive and Bipolar Disorders

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TOPIC OVERVIEW

How Common Is Unipolar Depression?

What Are the Symptoms of Depression?

Diagnosing Unipolar Depression

The Biological View

Psychological Views

Sociocultural Views

What Are the Symptoms of Mania?

Diagnosing Bipolar Disorders

What Causes Bipolar Disorders?

The first conscious thought that all was not well with me came … when I was twenty-two. I had been living in Los Angeles for two years, working various temp jobs while trying to establish myself as a writer and performance artist. Out of nowhere and for no apparent reason—or so it seemed—I started feeling strong sensations of grief. I don’t remember the step-by-step progression of the illness. What I can recall is that my life disintegrated; first, into a strange and terrifying space of sadness and then, into a cobweb of fatigue. I gradually lost my ability to function. It would take me hours to get up out of bed, get bathed, put clothes on. By the time I was fully dressed, it was well into the afternoon. When I went out into the city, I would always become disoriented, often spacing out behind the wheel of my car or in the middle of a sentence. My thoughts would just disappear. I’d forget where I was driving to, the point I was about to make in conversation. It was as if my synapses were misfiring, my brain off kilter. A simple stroll to the coffee shop down the block overloaded my senses: sounds of feet shuffling on sidewalks, honks from cars, blinking of traffic lights, loud colors of clothing. It was all bewildering. …

After a while I stopped showing up at my temp job, stopped going out altogether, and locked myself in my home. It was over three weeks before I felt well enough to leave. During that time, I cut myself off from everything and everyone. Days would go by before I bathed. I did not have enough energy to clean up myself or my home. There was a trail of undergarments and other articles of clothing that ran from the living room to the bedroom to the bathroom of my tiny apartment. Dishes with decaying food covered every counter and tabletop in the place. Even watching TV or talking on the phone required too much concentration. … All I could do was take to my pallet of blankets and coats positioned on the living room floor and wait for whatever I was going through to pass. And it did. Slowly. … The problem is that there is no telling when [depression] will go away or for how long it will stay gone…

During the time I was laid up in my apartment making huge efforts to do simple things like brush my teeth and pull open the curtains, people had traveled, landscapes had changed; the world as I had known it before I surrendered and crawled into bed was no more. There was no escaping that episode without acknowledging that something extraordinary had happened to me. Ordinary folks just don’t hole themselves up for weeks on end without bathing, working, reading the newspaper, talking to friends, or watching TV. Deep down, I knew that something had gone wrong with me, in me. But what could I do? Stunned and defenseless, the only thing I felt I could do was move on. I assured myself that my mind and the behaviors it provoked were well within my control. In the future I would just have to be extremely aware. I would make sure that what happened did not happen again. But it did. Again and again, no matter how aware, responsible, or in control I tried to be. Each time, … I chastised myself for not paying attention to my emotions, for allowing myself to sink to such disgusting depths.

Each wave of the depression cost me something dear. I lost my job because the temp agencies where I was registered could no longer tolerate my lengthy absences. Unable to pay rent, I lost my apartment and ended up having to rent a small room in a boarding house. I lost my friends. Most of them found it too troublesome to deal with my sudden moodiness and passivity so they stopped calling and coming around. There were some that tried to hang in there and be supportive, but before long the depression took its toll on those relationships as well. Whenever I resurfaced from my episodes of depression, it was too hard to pick up where we had left off. “You’ve changed,” my friends told me. “You’re not the same person.” How could I be? How could anyone be the same after their entire world has come to a screeching halt?

(Danquah, 1998)

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Lincoln’s private war In 1841 Abraham Lincoln wrote to a friend, “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would be not one cheerful face on earth.”

Most people’s moods come and go. Their feelings of elation or sadness are understandable reactions to daily events and do not affect their lives greatly. However, the moods of certain people last a long time. As in the case of Meri Nana-Ama Danquah, a performance artist and poet who described her disorder above, their moods color all of their interactions with the world and even interfere with normal functioning. Such people struggle in particular with depression, mania, or both. Depression is a low, sad state in which life seems dark and its challenges overwhelming. Mania, the opposite of depression, is a state of breathless euphoria, or at least frenzied energy, in which people may have an exaggerated belief that the world is theirs for the taking.

depression A low, sad state marked by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms.

mania A state or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking.

Mood problems of these kinds are at the center of two groups of disorders—depressive disorders and bipolar disorders (APA, 2013). These groups are examined in this chapter. People with depressive disorders suffer only from depression, a pattern called unipolar depression. They have no history of mania and return to a normal or nearly normal mood when their depression lifts. In contrast, those with bipolar disorders have periods of mania that alternate with periods of depression. You might logically expect some people to display a third pattern of mood difficulty, unipolar mania, in which they suffer from mania only, but this pattern is uncommon.

depressive disorders The group of disorders marked by unipolar depression.

unipolar depression Depression without a history of mania.

bipolar disorder A disorder marked by alternating or intermixed periods of mania and depression.

Mood problems have always captured people’s interest, in part because so many famous people have suffered from them. The Bible speaks of the severe depressions of Nebuchadnezzar, Saul, and Moses. Queen Victoria of England and Abraham Lincoln seem to have experienced recurring depressions. Mood difficulties also have plagued writers Ernest Hemingway and Sylvia Plath, comedians Jim Carrey and Rodney Dangerfield, and musical performers Eminem and Beyoncé. Their problems have been shared by millions, and today the economic costs of depressive and bipolar disorders amount to many billions of dollars each year (NAMI, 2014; Dilsaver, 2011). Of course, the human suffering that severe mood difficulties cause is beyond calculation.

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