Is bipolar disorder a problem with chemicals in the brain, or a mental illness?

I imagine it would affect insurance policies, but other than that it doesn’t really matter. The last half of your question confused me a bit, could you clarify?

It’s a mental illness caused by chemicals in the brain.

It seems a bit like an artificial designation to me. Certainly, there are other mental illnesses that are a result of imbalances in neurotransmitters and other brain chemicals. Don’t all mental illnesses have a anatomical/chemical/genetic basis?

There are also plenty of physical illnesses (for lack of a better way to designate “other than mental”) that are a result of chemical imbalances (thyroid diseases, diabetes, etc). They are designated differently than injury as the result of trauma, or illness as the result of infection, but I don’t think they are singled out as “chemical imbalance” disorders.

Thankfully, medicine has come a long way from the days of “you’re depressed (fill in the blank) because you’re lazy/hysterical/female/homosexual/stupid”. Hopefully, some day soon any remaining stigma attached to mental illness will be eradicated. In the meantime, if changing the terminology helps, then I have no problem with it.

I think niki and syz have said it all and well.

Why can’t it be both? It is a mental illness caused by a brain disorder. There is a proven genetic link, as far as I’m concerned that makes it somewhat “chemical.”
It is a potentially fatal disease, just like cancer or diabetes and is manageable with medication.
I guess I’m confused. Are you talking about moving it from psychology to neurology (like they are considering with OCD?)

Aren’t they both the same thing?

If your thyroid (like mine) doesn’t produce enough of what the body needs, there are drugs you can take to make up for that. There is no stigma, it’s just medicine.

If you pancreas doesn’t make enough insulin, you’re diabetic, and you take enough insulin to make up the difference. There’s no real stigma, it’s just medicine.

When a woman hits menopause, she doesn’t make enough estrogen anymore, and she might take something like Premarin to make up the difference. There’s no stigma, it’s just medicine.

If your brain doesn’t make the right chems, there’s medicine for that, too, and the brain is an organ, just like the thyroid, the pancreas and the ovaries. However, suddenly there’s some kind of stigma attached because the patient is “demented” or “crazy” or something. But it’s no more “crazy” than the ovaries or pancreas, it’s just an organ out-of-whack that needs meds.

The chaotic brain chems make it a “mental” illness, just like diabetes is a “pancreatic” illness. A person with diabetes or in menopause doesn’t (generally) try to go without meds because they feel like their true self is being compromised through chemistry – they take meds to get back to a life that’s worth living. I wish there were less of a stigma about people who take meds for their brains for the same reason.

Some folks become confused when they hear the term brain chemical. They believe that the only way to change a brain chemical is by taking a drug. This is not the case. You can change brain chemicals through your behavior, your outlook, your relationships, the list goes on. Some need to take drugs because their best efforts do not sufficiently stabalize their mood.

I have read papers and books by people who feel that mental health is being taken over by pharmaceutical companies. The idea behind the chemical designation would be to place a bias on the use of drugs as a cure. What makes things even worse is that there is some uncertainty about the exact nature of the chemical imbalance, in particular as regards Serotonin.

What is definitely true is that it is hard to distinguish between the mental and the physical. A person can experience chemical brain changes from psychotherapy that does not make use of drugs. In a sense it does not matter whether mental illness is caused by chemical imbalance or if chemical imbalance is simply a manifestation of some underlying mental illness. In either case the cure or at least alleviation of symptoms may be accompished by a variety of means which may or may not include use of drugs. As someone with unipolar depression who is taking medication, I am skeptical of the efficacy of the medication.

I hadn’t heard about this. I think it’s odd. I’d like to see a day when all “mental illness” is just considered an illness like anything else our bodies need help with.

Well I have met some people with bipolar and have had bad experiences, but I am not too sure on this topic.

I think this question really can’t be answered, until we know what mental illness is. Or perhaps we need to understand the relationship between chemistry and behavior. I’m assuming that everything our bodies do comes down to chemistry of one sort or another.

There are “physical” diseases that have mental effects. A brain tumor might make a person put words together strangely, or discuss ideas that don’t makes sense. Maybe it can make you have hallucinations, too.

Alzheimers affects behavior and mental acuity. There are probably a number of other diseasses that bring on dementia.

My point is that the physical (chemistry) and the mental (behavior?) are interlinked in ways that are difficult to separate out. For most diseases, we say the cause of the strange behavior is physical. Yet, for mental illness, we seem to suggest that it’s not really physical, but somehow volitional.

Leehorton, for example, asserts that we can change our brain chemicals with our behavior. I know a lot of people believe this, and there are many studies that purport to show that CBT or ACT or any number of other therapies can really help people. I haven’t looked at these studies, so I don’t know how help is defined, nor do I know exactly how they measure these things (although I assume it’s on some kind of mood assessment instrument).

My guess is that if they find a patient is back to maybe 80% of former positive mood.. Oh, that doesn’t makes sense. No one has a baseline mood to compare to. So they must be looking at how much improvement they see. So someone could have a 5% improvement in mood, and they’d call the intervention successful.

I’m sure they are doing the best they can, and they’ve thought about most of my issues with respect to study design, but the crux of the matter, I believe, both for researchers and for us patients, is that these things are experiential, and no one can ever get inside someone else’s head.

Maybe I’m well, and I don’t know it. Maybe this sense of existential malaise is just normal for humans. But how can I know that what you consider happy is what I consider depressed?

BTW, it’s not really happiness I’m after, but a sense of rightness with the world. I don’t know what happiness is (another unmeasurable thing, I think), but I have this sense that I’m coping just fine, and then I have a sense (most of the time now) that I’m missing something I used to have.

These things are ephemeral and philosophical and existential, and so no one really knows what anyone else is talking about. And that is the problem with diagnosing a mental illness.

Let’s suppose we find out all there is to know about brain chemistry, and we can “fix” it all. We can turn people into something we call “normal”. What happens when someone experiences the world differently? More troublely? What if they see visions? What if they act super smart one day, and unable to get out of bed the next?

We can change that. We can fix it. What if the patient refuses to be fixed? Is that a symptom, or a rational choice, or even an irrational choice the person has a right to? We allow people with physical symptoms to refuse treatment. We can criminalize mental illness, and hold folks responsible for their choices (now that they could choose to be normal), and throw them in jail when they hurt others.

Right now, we argue over prison or a psychiatric hospital. 60% of the prison population has a mental illness, I believe. This is what we do with the mentally ill. We act as if they choose to behave this way, but do they really?

Behavior, it seems to me, can be determined by chemicals. When we know it well enough, we’ll be able to give people pills to make them smart, or happy, or introspective, or develop a musical talent, or another language. We’ll have pills for docility and cooperativeness, and pills for beligerance and aggressiveness.

What, then, is the responsibility each person has for their behavior, now that we know that have abnormal chemicals determining that behavior? What is their responsibility under the influence of a drug that is designed to make them quick to anger?

Well, enough of this. I didn’t start out to write a treatise, but that’s the kind of shit I think about most of the time, so sorry for letting it spam out of my brain. Hmmm. Maybe it’s the chemicals!

Dude, I think you are fundamentally asking the $64,000 question. Is our behavior accounted for by chemicals? If so, how can we hold anyone responsible for what they do?

I’m pretty sure anyone who had a real answer to these questions would deserve a Nobel prize. That said, I can dig up some articles about CBT and brain chemistry if you’re interested.

Brains are complicated.

I can tell you one thing: without meds my life would suck hugely. Even with meds it sometimes sucks, but I can talk or work my way out of the worst of it.

Without meds my son’s life would suck even more than it does, if he still had one (gets suicidal). With meds we have a hope of getting through to him to try to get him to learn to work his way out of it.

In some situations both medicine and behavior will cure illness. For example: Type II diabetes can be managed with appropriate doses of insulin. Some cases can also be managed by diet and exercise alone, or by a combination. I think mental illness is the same. There are things we can do to change the balance of chemicals in the brain towards a better mix. However, some folks need more re-balancing than they can do on their own, so meds are needed.

There is one other thing to consider and that is the sociology of mental illness. I don’t think that it makes sense to talk about mental illness in general without looking at the cultural background.

There are those who say that the mentally ill are canaries in the coal mine, indicators of problems in the larger society. The nature of mental illness varies in place and time. The particular neuroses that Freud based his theories on were largely an artifact of Victorian society. Current American society with its competitiveness and emphasis on extroversion and material goods may be particularly hostile to people who are depressed. Depression is the most common mental illness in the U.S. and perhaps part of the problem is cultural.

Perhaps our social evolution has outstripped our physcial evolution. People like Robert Putnam in Bowling Alone have pointed to the breakdown of community. There is evidence that being in a natural setting has a positive impact on a person’s mental state, but natural settings are getting increasingly more difficult to come by. If we evolved to live communally in a natural setting then our departure from such conditions may go a long way toward explaining mental illness.

@Nikipedia: I would be interested in seeing any studies showing the impact of CBT on brain chemistry. In fact, I’d find that fascinating.

@Lost: that’s an excellent point. I have often fantasized about living in a community with all my friends, like I did in college, where I was happiest. Actually, I did it after college for three or four years, and was not only happy, but getting laid regularly, so it’s a toss-up about which was best.

When one woman left that community, it was the beginning of the end. I was upset about it, although I later regretted that, because, in New York City, there is nothing so valuable as someone paying rent and not being there. Except, I think I preferred the company.

Cohousing is one attempt at building tighter communities, and I’d love to have the opportunity to build a cohousing project in Philadelphia. I haven’t heard much about urban cohousing—if it exists. I’m pretty sure that if I was continually around a lot of people, having different interesting conversations (does this remind you of fluther?), that I would have a much harder time being depressed.

Still, the psychiatrist and the therapist both tell me that I shouldn’t blame myself when I’m depressed. I didn’t make it happen. I was always confused about this, since CBT tells us we can make it not happen. If that’s the case, and we know how to do it, but don’t do it, doesn’t that make us responsible for being depressed?

ANyway, I’m working on learning mindlessness… uh mindfullness now. They also say they have research to show it works. Isn’t that interesting?

@daloon You may find this interesting regarding urban cohousing communities.

It’s good to know they exist. Thanks, Marina. Now I gotta find out how they work and what they are actually like. Hmm. I could ask a question! What a brilliant idea!

Ive been skimming the responses here, I gotta say… Bipolar is an interesting thing. I belive it is very hard these days to even research the diagnosed. In the past 25 years we have seen a dramatic increase of people being diagnosed not only with bipolar, but aldo many other mental disorders. we are led to believe that there have been advances in the research of these conditions, but is that really true? psychology has been studied for a very long time. we have some quacks out there, and some really good researching doctors… so what really changed in the past 25 years? THE PHARMACEUTICAL INDUSTRY!!! listen, I have been diagnosed with BiPolar. Ive had emotional trouble since I was for after my father committed suicide. I have been on every medication under the sun to try and “fix” my problem. you know what the weirdest thing is? I went through intense counseling life altering programs and began to structure my life around positve things and learned how to let go of the negative. I have been off medication for months, and they have been the best months of my life. Not a BiPolar manic best, but genuinely productive and happy. My family doesnt know. the only difference they have seen is that I have been happier. let me back this up tho, I am not saying that drugs are bogus. Some people need them. I needed them to get me to a point where I could work out my emotional issues. The point is, these companies pushing drugs are making billions of dollars a year. I was on one medication that doubled my body weight in under 6 months, and it cost $1000/month! I also didnt laugh, cry, get angry… but thats not what I need! I am a huge supporter of NAMI (National Alliance for Mental Illness). I also feel strongly that medication is helpful. I just dont think that we need to be diagnosing everyone and their dog with mental illness and doping them up. Some people need it, and will be on it for the rest of their lives, and there is nothing wrong with that, but I believe we are over diagnosing. People used to be afraid to go to a shrink for their kid cause they didnt wanna hear “you just need to be better parents!” now they go and even if they are bad parents, they just throw drugs at the kids! my mother and father have made mistakes raising me, but they are also the best thing that has ever happened to me. they hung in there and tried to find the solution, at first it was drugs, but now they love me enough to let me be a person not an illness, and live a productive life. Drugs can help, but they arent for everyone. some of whats wrong IS bad parenting, some of it is just plain chemical imbalance. Lifestyle changes need to happen weather you take drugs or not. think about it like this, if you were an asthmatic, you would avoid high risk areas, but have an inhaler with you at all times to ensure that if the worst should happen, you are covered.

@Landonscranton ; just for the record, your family knows! (lol)
@everyone, Please allow me to introduce you to my amazing, wonderful and talented son
@Landonscranton .

@Landonscranton – Welcome to Fluther. From what I have seen, your mother is very proud of you and what you are doing these days.

I hope my son can get to your point, but in the meantime drugs have so far been the only things that have kept him from hallucinating or killing himself. I hope someday he will take charge of his life and decide to make the changes we and his doctors and therapists have suggested for many years. But we will do what we can to keep him alive until that point. If it takes drugs, then so be it.

Of course, he is only fifteen and still has to survive being a teenager.

A person with diabetes or a thyroid condition is not going to have any personel effect on MY health or wellbeing.

A crazy person is! lol

Not minimizing others troubles, but, I don’t do crazy.

I am a very emotionally healthy & stable person, and I have no desire to be around those that are not.

Emotionally consistant behavior is a good barometer of ones mental health.

I won’t judge, but I will keep my distance from those that show instability of mood and other chronic issues.

@Coloma; I suppose you avoid fat people too?
Prejudice and stygma like you spout are what cause people to fear seeking treatment.
People with mental illness can live healthy “consistant” lives with propper treatment and medications. It just takes a lotcmore work.
I hope you never become afflicted with a mental illness, but it’s not like these people CHOOSE to have a mental illness.

@Judi

I have empathy for those that struggle with mental/emotional problems, but..I have experienced the moodiness and inconsistancies with several in my life and choose to not attempt to date or befriend those with emotional issues.

Doesn’t mean I wish them ill will, just means that my emotional health counts as well and I am not into willingly subjecting myself to those that have serious mental health problems.

I dated a man last year that turned out to have depression issues….he could only manage about 2 weeks of consistant behavior and then the moodiness, withdrawl, crappy comments,....uh uh…sorry, I have worked hard over the years on my health, mental, emotional, spiritual why in the world would I sign up for that kind of roller coaster ride!?

Attempting any sort of relationship with someone with these issues is going to be unhappy, unhealthy and dysfunctional.

I would be comprimising my emotional health and well being and there is no shame in choosing to be around healthy others.

There is a saying…don’t expect healthy behavior from unhealthy people.

If I knowingly sign up for a relationship with an unhealthy person and then am unhappy with how they show up, well..that would make me unhealthy as well. lol

Everyone can experience a situational depression, have a few drinks, eat some french fries…but…chronic depression, alcoholism and morbid obesity all fall into the emotionally/mentally unhealthy zone, and these issues DO cause pain for more than just the person afflicted.

Thats just a fact, not a judgement.

Intimate relationships are one thing. I thought you were saying that you wouldn’t associate with someone who suffered a mental illness when you said “I don’t do crazy.”
In a relationship, all health connditions are fair to consider. Some people couldn’t see themselves with someone with a family history of diabetes or heart condition either. It IS hard LIVING with mental illness.