Bipolar disorder: the 'stalking beast'

John O'Donoghue has suffered from bipolar since he was 17. Now he's helping the largest ever study into it

• John O'Donoghue
• guardian.co.uk,
  
• Monday 3 May 2010 22.00 BST
• Article history

John O'Donoghue gives a blood sample for the study into bipolar disorder. Photograph: Frank Baron for the Guardian

When I heard about the mood disorders study I got in touch straight away. I was diagnosed with bipolar in the mid-70s when I was 17. My symptoms first manifested themselves after my father died, when I was just 14. I was fostered at 15, and first sectioned aged 16. From then on I was on the psychiatric merry-go-round – hospitals, therapeutic communities, halfway houses – until I was 28.

Back then it was called manic depression, but it's now known in clinical circles as bipolar disorder, and comes in two forms: type I, where highs and lows alternate with periods of stability; and type II, where highs are less severe and lows often predominate. Bipolar type I – my diagnosis – affects 1% of the population.

There's evidence to suggest that creativity may be linked to bipolar. Kay Redfield Jamison, a leading authority on the condition, has traced the links between creativity and mood disorder in her study Touched With Fire. Robert Lowell, Jackson Pollock and Sylvia Plath were all sufferers, according to Jamison. It's a curious illness, both a harrowing scourge and a byword for talent.

You often hear of "nervous breakdowns" but social breakdown can be just as traumatic for sufferers of bipolar. Career disruption, relationship break-ups, even bankruptcy and homelessness can all be consequences. Suicide rates are also 15% higher among people with the disorder.

So I was very keen to do my bit for the researchers at Cardiff and Birmingham, who are conducting the largest ever survey into the condition. They have interviewed 3,000 people in the UK, and intend to interview another 3,000. Stephen Fry and Kerry Katona have taken part and the research team hope they will attract more people to the study. According to Nick Craddock, professor of psychiatry at Cardiff University, the aim is to find "better approaches to diagnosis and management" through understanding why people get the disorder.

"We're trying to understand the relationship between a genetic predisposition to bipolar disorder, life events and the triggering of illness," he says. "This allows us to obtain DNA and try to identify common gene variants that can influence the risk of illness." But he stresses, "We're not searching for a single 'bipolar gene' – there are many, many genes that influence risk and any single variant on its own has a tiny influence on susceptibility – and of course life events can be important trigger factors. Pinpointing the susceptibility genes will help us understand which brain chemicals are most important in illness and help explain why one person might get bipolar disorder after, say, a bereavement or a disturbed sleep pattern, whereas most people do not."

There is evidence to suggest that genetics does play its part. Ernest Hemingway committed suicide, as did his brother, his sister, his father, and one of his grandchildren. This is not uncommon. But in my life I have been determined not to let a diagnosis be my destiny – I've tried to manage as best I can, and the emphasis on management intrigues me.

So John Tredget, research nurse at Cardiff University, pays me a visit. The interview lasts about an hour and he asks: "Have you noticed anything that tends to trigger depression? During periods of high mood do you experience exaggerated self-esteem? Decreased need for sleep? Increased talkativeness? Have you ever had four or more mood episodes (depression or mania) in one year?" There are questions about delusions, hallucinations, and voices; alcohol intake and drug use; and traumas such as bereavements experienced during childhood.

This last question, in particular, resonates. I first developed the symptoms of bipolar after my father died. This in turn affected my grief-stricken mother, who became unable to look after me, and was hospitalised herself. I was fostered, turned to religion, and very soon lost my moorings after I was "exorcised" by a rogue vicar. I am a little hazy about some memories, but Tredget is patient.

Most of my troubles took place when I was younger, although I did have a very bad relapse last summer, when I was hospitalised and put on medication. I've had all of the symptoms the questionnaire covers and of course the long remissions that also characterise bipolar. Stephen Fry talked about the illness as a "dreaded stranger" that comes back into his life to disrupt and disorientate him. I feel, now, that I've learned to live with this stalking beast, and while I haven't tamed it, I know what to do about its reappearance in my life. I must let it run its course, withdraw from the world, and give myself time to recover in the supportive environment of my family.

Tredget takes a blood sample, and tells me that the study also aims to help clinicians understand better the delicate biochemistry of the brain and what happens during highs and lows. The implication seems to be that imbalances can be treated with chemical fixes: mood stabilisers (such as lithium), antidepressants (such as fluoxetine) and anti-psychotics (such as olanzapine). Tredget is at pains to point out that this is only one approach to managing mood disorder. Avoiding excessive stress, moderation in alcohol intake, regular sleep, exercise – all these have proven to be useful in managing the condition and will be better understood as a result of further research.

I think about my own approach, the good fortune I have in my family, the writing that has sustained me in so many ways since my father died, the relatively stress-free lifestyle I'm lucky to enjoy. And then I think about the times I've been so ill I couldn't function, and I hope the study goes a long way to helping others like me.

• John O'Donoghue is the author of Sectioned: A Life Interrupted (John Murray 2009)

To contact the Study email: moodresearch@cardiff.ac.uk/moodresearch@contacts.bham.ac.uk

Website bdrn.org

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