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American psychologist, and professor of psychiatry, Kay Redfield Jamison, is one of the world’s
foremost authorities on bipolar disorder. She’s spent her career researching, lecturing,
and writing seminal books on the condition.
A condition that she also happens to have had her entire adult life.
In her memoir, “An Unquiet Mind,” Jamison details what it really means to be bipolar.
She writes of not sleeping for days on end, of feeling long periods of euphoria, and filling
whole notebooks with her racing thoughts and grandiose ideas.
While in these manic states, she experienced a tremendously inflated sense of self-esteem
and did impulsive things that felt good at the time but had painful consequences, like
going on lavish shopping sprees, engaging in promiscuous behavior, racking up credit
card debt, and emptying her bank accounts.
But these episodes were followed by emotional crashes: Crippling bouts of depression that
sent her into a suicidal spiral. At the age of 28, Jamison tried to kill herself by taking
an overdose of Lithium, lapsed into a coma, but thankfully emerged from it determined
to find help through medication and therapy.
Through her research and writing, Dr. Jamison has pioneered our understanding of bipolar
disorder, depression, and the nexus of mental struggles that we now think of as mood disorders.
And she’s probably one of the best ambassadors we have for all those people who live successful,
productive lives with mental illness.
Just like the anxiety disorders we talked about last time, mood disorders are misunderstood.
They’re diluted by depictions of depression as something that can be treated with one
day at a spa or descriptions of people as manic depressive just because they were sad
yesterday and aren’t today.
As students of psychology, our job is to understand what mood disorders really are, how they manifest
themselves, and what might cause them. And as you probably guessed, this can be pretty
tough terrain to explore. These disorders can take people from terrifying highs to pits
of despair that seem all but bottomless.
But! In between there’s what Jamison has called, “A rich, imaginative life”
— all made possible by your moods.
We’ve been talking a lot about terms and concepts that mean something different than what you
think they mean, but this time, the term “Mood” is not one of those.
In a psychological context, moods are pretty much exactly what you think they are: Emotional
states that are even more subjective and harder to define than the emotions themselves.
And while psychologists have defined about 10 basic emotions, moods tend to fall
into two broadly and infinitely variable categories. You got the good moods and the bad moods.
Probably the most important distinction between emotion and mood is that moods are long-term
emotional states rather than discreet, fleeting feelings.
And “mood-disorders,” which are characterized by emotional extremes and challenges in regulating
mood tend to be longer-term disturbances.
These include depressive disorders, typified by prolonged hopelessness and lethargy, and
bipolar disorders, the most prominent of which involve alternating between depression and mania.
Depression has been called the common cold of psychological disorders. Which is not to
say that it isn’t serious, but it’s common and it’s pervasive and it’s the top reason
people seek out mental health help.
We’ve all felt down before, obviously, often in response to a specific loss: a breakup
or a lost job or the death of a loved one.
And the fact is, you probably should feel bad at times like those. It can actually be
good for a mind and body to slow down, to help digest losses that you experience, but
in general, sadness is temporary. It’s when sadness and grief extend beyond the generally
accepted social norms, or plunge into a depth that causes serious dysfunction that you find
yourself in the territory of depressive disorders.
The DSM-5, our handy (if super flawed) user’s guide to psychological disorders officially
diagnoses a major depressive disorder when a patient has experienced at least five signs
of depression for more than two weeks.
These symptoms include not just depressed mood, but also significant weight or appetite
loss or gain, too much or too little sleep, decreased interest in activities, feeling
worthless, fatigued, or lethargic, difficulty concentrating or making decisions, and recurrent
thoughts of death or suicide.
So while everyone experiences sadness, depression is a physiological as well as psychological
illness. It messes with your sleep, and appetite, and energy, and neurotransmitter levels, all
interfering with the way your body runs itself.
Plus in keeping with our definition of psychological disorders, to be considered a true disorder
this behavior needs to cause the person or others around them prolonged distress – the
feeling that something is really wrong.
Just as a person with a severe, generalized anxiety disorder may never want to leave the
house, a clinically depressed person often feels so hopeless and overwhelmed that they
have trouble living a normal life. And unlike the bipolar disorders, the depressive disorders
tend to be all lows.
You’ve probably heard of manic depression. It’s the outdated term for bipolar disorders.
These include those classic dark lows of depression, but also bouts of the opposite – of extreme
mania in more severe cases. Someone suffering from a bipolar disorder may flip back and
forth between normal and depressive and manic phases within a single day or week or month.
And a true manic episode doesn’t just mean being energetic or happy, it’s a period of
intense, restless, but often optimistic hyperactivity in which your estimation of yourself and your
abilities and your ideas can often get skewed. Like, really, REALLY skewed.
Some patients experience mania only rarely, but when they do, it can be destructive. Kay
Jamison has testified to that.
Once during a manic episode, she bought up a drug store’s entire supply of snake-bite
kits, convinced of an imminent attack of rattlesnakes that only she knew was coming.
In another, she purchased 20 books by the Penguin Publishing House because she said,
“It could be nice if the penguins could form a colony.”
In other words, bad judgment is common. And it can get worse.
Full blown manic episodes often end up in psychiatric hospitalization, since the risk
to self or others can become severe. When the highs eventually end, they’re often followed
by dark periods of depression. When left untreated, suicide or suicide attempts are common, another
element of the disorder that Jamison herself can attest to.
Like so many things in psychology, the cause of mood disorders is often a combination of
biological, genetic, psychological, and environmental factors. We know, for example, that mood disorders
run in families – genes matter. And you’re more likely to experience a bipolar or depressive
disorder if you have parents or siblings who suffer from them.
Studies have of identical twins show that if one twin has a bipolar disorder, that the
other has a seven in ten chance of also being diagnosed, regardless of whether they were
raised together or apart.
And while a stressful life can’t give you bipolar disorder, it could trigger a manic
or depressive episode in someone with a pre-existing condition. Or start a descent into a major
depressive episode in someone who never before had experienced depression. In other words,
a person who loses a loved one could go from sad to depressed or slide into a bipolar episode,
but it couldn’t cause them to have the disorder to begin with.
In the case of depressive disorders, for most people, after weeks, months, or even years,
their depression can end, hopefully with the return to baseline healthy functioning.
World-wide, women tend to be diagnosed with major depression more often than men, but
many psychologists think this is simply because women tend to seek treatment more. It’s also
possible that depression in men tends to manifest itself more in terms of anger and aggression,
than as sadness and hopelessness.
This is just an example of how depression is much more than just being sad and that
the characteristic lack of purpose and helplessness can manifest itself in a lot of different ways.
Looking at mood disorders from a neurological perspective, we see that depressed, manic,
and average brains show very different brain activity in neural imaging scans. As you might
expect, a brain in a depressed state slows down. While a brain in a manic state shows
a lot of increased activity, making it hard for that person to calm down or focus or sleep.
Our brain’s neurotransmitter chemistry also changes with these different states. For example,
norepinephrine, which usually increases arousal and focus, is severely lacking in depressed
brains, but kind of off the charts during manic episodes. In fact, drugs that seek to
reduce mania in part do it by reducing norepinephrine levels. You may have also heard about how
low serotonin levels correlate with depressive states. Exercise, like jogging or break dancing
or whatever, increases serotonin levels, which is one reason exercise is often recommended
to combat depression. And most medications designed to treat depression seem to work
by raising serotonin or norepinephrine levels.
And of course there’s yet another way to look at things. The social-cognitive perspective
examines how our thinking and behavior influence depression.
People with depression often view bad events through an internal lens or mind set that
influences how they’re interpreted. And how you explain events to yourself, in a negative
or positive way, can really effect how you recover from them – or don’t.
Say you were humiliated in the lunch room when someone tripped you and chicken soup
flew all over the place, and you sat down on a brownie, and it was just a bad day. A
depressive mind might immediately start thinking that the humiliation will last forever, that
no one will ever let you live it down, that it’s somehow your own fault, and you can’t
ever do anything right.
That negative thinking, learned helplessness, self-blame, and over-thinking can feed off
itself and basically smother the joy out of the brain, eventually creating a vicious self-fulfilling
cycle of negative thinking.
The good news is that the cycle can be broken by getting help from a professional, turning
your attention outward, doing more fun things, and maybe even moving to a different environment.
But again, that social-cognitive prospective is just part of a much bigger puzzle. Positive
thinking is important, but it’s often inadequate on its own own when up against genetic or neurological factors.
So mood disorders are complicated conditions and rarely are they eliminated with a single
cure. Instead, they’re often things you just live with. And as Dr. Jamison has shown us,
you can live well.
Today we talked about what mood disorders are, as well as what they aren’t. You learned
about the symptoms of depressive and bipolar disorders, and the possible biological, genetic,
environmental, and social-cognitive causes of mood disorders.
Thank you for watching this episode, which was brought to you by Marshall Scott and
crediblefind.com. Thank you so much to all of you that have supported us! To find out
how you can become a sponsor or supporter, just go to suppable.com/crashcourse.
This episode was written by Kathleen Yale, edited by Blake de Pastino, and our consultant
is Dr. Ranjit Bhagwat. Our director and editor is Nicholas Jenkins. The script supervisor
is Michael Aranda who is also our sound designer. And the graphics team is Thought Cafe.
This post was previously published on YouTube.
Photo credit: Screenshot from video.