My Friend Paul - Bipolar Disorder


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Paul Schofield

One to two percent of adults in the United States today suffers from some form of bipolar disease. Formerly called manic depression, this category includes bipolar I and II disorders, as well as cyclothymia and dysthymia (milder forms of the condition). The words "bipolar" and "manic depressive" both refer to the severe mood swings that occur with these illnesses, in which people careen between the "poles" of a super-bright view of life and a tragic, hopeless perspective. Even if they are primarily manic, people with a bipolar condition operate from a depressive base. How far "up" a person swings on the pendulum depends on how much he or she avoids the depressive side.

The term "manic depressive" has gone out of fashion because it carried a connotation of psychosis (psychosis being a complete loss of contact with conventional reality). While bipolar people may sometimes be psychotic, many times they are not.

Detection of the bipolar condition is not always easy. A full-blown manic episode is fairly obvious, as the individual's behaviors change drastically. When in a manic state, a person may spend lots of money, have inflated self-esteem or engage in high-risk sexual behaviors. He or she may speak quickly, and have a decreased need for sleep and food. Clinical depression is also relatively noticeable. Depressed people sleep and eat much more or less than usual, cry often and are visibly dejected. More difficult to detect, however, is "hypomania", when a person displays manic qualities that are not as severe as in a full-blown manic episode. In addition, when behaviors are not highly dramatic and consistent over a long period, they can be construed as a person's regular personality, so the disease may not be noticed or diagnosed.

Such is the case with the film MY FRIEND PAUL, in which Paul's bipolar illness is never recognized by well meaning friends and relatives. While trying to find Paul a place to live, his friend, director Jonathan Berman, asks him not to "talk crazy," as if Paul could stop if he put his mind to it. Another friend comments that in the future, Paul is sure to do something "really creative." They think of him as eccentric, but not mentally ill, since from childhood, he has always behaved erratically. Paul requires intensive, consistent treatment for his condition. Without this, it is no wonder that friends and family are frustrated when their efforts to help are fruitless.

"He's my son. I'm a mother. I carried him under my heart... If I could cut off both my arms and Paul would get better, I would."

The tragic primary theme in the film - an inability to help - is all too common off-screen as well. Manic and hypomanic people can seem functional, particularly in American culture, where originality and high energy are valued traits. So the disease often goes undetected and various problems result. People with bipolar illness are frequently unable to maintain close relationships and have a high rate of divorce. At another level, as in MY FRIEND PAUL, the person may end up devoting his life to drugs and/or street crime. At their most severe, people with bipolar disorders may commit murder or suicide.

While serious, bipolar disorders are also treatable. Medication, especially lithium has been successful in addressing body chemistry imbalance, which is seen as a common cause. Research is currently underway to find a gene for the disease and this may spark new treatments in the future. Personal history also has a bearing on the cure and management of the disease: Freud determined that "an important precursor to depressive inclinations is the experience of premature loss." A therapeutic relationship in which that early loss can be grieved and worked through is instrumental in bringing the person out of his/her bipolar world and into a relatively healthy life.

If you think you or someone you know may have some form of bipolar disorder, there is no reason to suffer alone with the disease. The most important thing is to responsibly research and choose a treatment. Ask your doctor for more information or check out the Web resources on this and other sites.