Unpacking Bipolar Disorder

Summary

Short Wave: Unpacking Bipolar Disorder

Episode Released: May 28, 2025 | Host: Emily Kwong and Regina Barber | Duration: Approximately 15 minutes

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Introduction to Bipolar Disorder

In the episode titled "Unpacking Bipolar Disorder," NPR's Short Wave delves into the intricacies of this mental health condition that affects approximately 40 million people worldwide. Hosts Emily Kwong and Regina Barber, together with expert guest Kay Redfield Jamison, explore the cyclical nature of bipolar disorder, characterized by fluctuations between depressive lows and manic highs.

Kay Redfield Jamison (00:44): "In depression, the mood is overwhelmingly hopeless, despairing, lack of pleasure in things that you would ordinarily find pleasure in. The mood in mania most of the time is euphoric, expansive, grandiose. People feel like it can do anything, anything. Boundless energy."

Kay Redfield Jamison: A Pioneer in Bipolar Research

Kay Redfield Jamison, a professor of psychiatry at the Johns Hopkins School of Medicine, is renowned for her extensive work on bipolar disorder. She has authored both academic texts and personal memoirs, notably "An Unquiet Mind," where she candidly shares her own experiences living with bipolar disorder.

Emily Kwong (01:05): "Kay Redfield Jamison is a professor of psychiatry at the Johns Hopkins School of Medicine. She has written extensively about bipolar disorder, from medical textbooks to personal memoirs about her own experience."

Jamison's journey with bipolar disorder began in her late teens, marked by severe depression that significantly impacted her life and career trajectory.

Kay Redfield Jamison (01:38): "And all of a sudden I had not only had no energy, I was morbid. I wanted only to die... it's like a bolt out of the blue and you have no idea what's going on."

Understanding the Causes of Bipolar Disorder

The discussion shifts to the etiology of bipolar disorder, where Jamison emphasizes the complex interplay of genetic and environmental factors.

Kay Redfield Jamison (05:11): "I would say what we do know is it's genetic, has a very strong genetic component. It runs in families."

While genetics play a crucial role, environmental triggers such as sleep deprivation and substance abuse can precipitate manic episodes, especially during the typical age of onset around 18 years.

Kay Redfield Jamison (06:06): "Sleep deprivation and substance abuse, particularly alcohol, marijuana... increasing their alcohol level."

Treatment Options and the Importance of Accurate Diagnosis

A significant portion of the episode is dedicated to treatment modalities for bipolar disorder. The gold standard treatment remains lithium, a mood stabilizer that is particularly effective for individuals whose manic episodes precede depressive ones.

Kay Redfield Jamison (07:06): "The gold standard of treatment for bipolar disorder, which remains lithium."

Jamison underscores the necessity of an accurate diagnosis, as misdiagnosis can lead to ineffective or harmful treatments.

Kay Redfield Jamison (08:00): "If you get a wrong diagnosis, you're going to get likely the wrong treatment... make people worse."

Self-Care and Managing Bipolar Disorder

Emphasizing self-management, Jamison advises patients to recognize their symptoms and maintain treatment adherence. Educating both patients and their families is pivotal in managing the disorder effectively.

Kay Redfield Jamison (08:49): "There are two major clinical problems in treating bipolar illness. One is to get people to acknowledge or recognize that they have something that needs and can be treated... the other thing is, once they're in treatment, to keep them in treatment."

Navigating Emotions and Personal Experiences

Jamison shares her personal approach to emotions, advocating for experiencing a full range of feelings without letting bipolar disorder impede natural emotional responses.

Kay Redfield Jamison (10:18): "You want to go through life with a full range of emotions."

She also highlights strategies used in therapy to monitor and detect early signs of mania, such as changes in behavior like excessive spending or staying up late.

Kay Redfield Jamison (10:27): "The earlier you can catch mania, incipient mania, the easier it is to treat and the less damage and harm is done."

The Therapeutic Power of Writing

Jamison discusses the dual role of writing in her life—both as a scientific endeavor and a personal therapeutic outlet. Her memoirs have been instrumental in demystifying bipolar disorder and providing solace to those affected.

Kay Redfield Jamison (11:32): "I've always loved reading and writing. I mean, I had been very fortunate... Robert Lowell... an extraordinary gift to my life."

Support Systems: The Role of Family

A pivotal support in Jamison's life is her husband, Thomas Trail, who has been a consistent source of love and understanding.

Kay Redfield Jamison (13:27): "He's a remarkably kind, funny, loving person who respects privacy and just I couldn't be luckier."

Conclusion

The episode concludes with a heartfelt message of hope and support for individuals living with bipolar disorder and their loved ones. Jamison reiterates that bipolar disorder is treatable, and with the right support and treatment, individuals can lead fulfilling lives.

Kay Redfield Jamison (03:10): "The thing I would emphasize from the start, over and over again is that it's treatable and that it's really important to get it treated because it's also very associated more than anything really with suicide, with substance abuse, with a great deal of suffering for individuals who have it and for family members."

Resources and Support

Listeners are encouraged to seek help if they or someone they know is experiencing suicidal thoughts. The episode provides resources for those affected by bipolar disorder, ensuring that support is accessible.

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Key Takeaways:

• Bipolar disorder is a complex mental health condition with strong genetic factors and environmental triggers.
• Kay Redfield Jamison combines her personal experiences with professional expertise to provide comprehensive insights into bipolar disorder.
• Lithium remains the cornerstone of bipolar treatment, emphasizing the necessity for accurate diagnosis.
• Self-care, education, and family support are critical components in managing and thriving with bipolar disorder.
• Writing and personal expression serve as therapeutic tools for individuals living with bipolar disorder.

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Notable Quotes:

• "The thing I would emphasize from the start... it's treatable..." – Kay Redfield Jamison (03:10)
• "You want to go through life with a full range of emotions." – Kay Redfield Jamison (10:18)
• "The earlier you can catch mania... the easier it is to treat." – Kay Redfield Jamison (10:27)

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For more information and resources on bipolar disorder, listeners are directed to the episode page and the NPR website.

Transcript

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[Emily Kwong]

Just want to let you know that this episode does talk about sensitive topics including suicide, suicidal ideation and depression. You're listening to Short Wave from npr. Hi Short Wavers, Emily Kwong here. And today we are going to talk about bipolar disorder. Around 40 million people around the world have bipolar disorder, which involves cyclical swings between moods from depression to mania.

[Kay Redfield Jamison]

In depression, the mood is overwhelmingly hopeless, despairing, lack of pleasure in things that you would ordinarily find pleasure in. The mood in mania most of the time is euphoric, expansive, grandiose. People feel like it can do anything, anything. Boundless energy.

[Emily Kwong]

Kay Redfield Jamison is a professor of psychiatry at the Johns Hopkins School of Medicine. She has written extensively about bipolar disorder, from medical textbooks to personal memoirs about her own experience. Kay was one of the first scientists living with bipolar to write a memoir about that experience. It's called An Unquiet Mind. Growing up, she loved school. She jumped out of bed each morning and couldn't wait to see her friends. But when she was 17, a senior in high school, she suddenly got severe depression.

[Kay Redfield Jamison]

And all of a sudden I had not only had no energy, I was morbid. I wanted only to die. I had never had any of these thoughts before, which is not uncommon. Some people have kind of pre morbid personalities that are consistent with this. Other people are just like, I am just it's like a bolt out of the blue and you have no idea what's going on.

[Emily Kwong]

And she wouldn't fully know for years. Throughout college, Kay's mood continued to fluctuate. And it wasn't until she was 28 years old and had just become an assistant professor of psychiatry at UCLA, that Kay says she had her first manic episode.

[Kay Redfield Jamison]

It was undeniable. I mean, I knew I was psychotic. I knew I was completely beyond the pale. And the people who were around me knew that. And so I had to go to a doctor for the first time. And fortunately it was a doctor who knew what he was doing. Deeply skilled psychiatrist, psychopharmacologist, psychotherapist, all rolled into one.

[Emily Kwong]

It often takes years for someone to get diagnosed after their first symptoms and ultimately to get help. And when Kay realized how little scientists had studied bipolar disorder and she wanted to do something about it, in 1990, she and psychiatrist Frederick K. Goodwin co authored what Is now considered the standard medical textbook on bipolar disorder, this book catalyzed all kinds of research and Kay's own desire to open the doors for others towards treatment by talking about it.

[Kay Redfield Jamison]

The thing I would emphasize from the start, over and over again is that it's treatable and that it's really important to get it treated because it's also very associated more than anything really with suicide, with substance abuse, with a great deal of suffering for individuals who have it and for family members.

[Emily Kwong]

So today on the show, Understanding, Treating and Managing Bipolar Disorder with one of the field's pioneering researchers, Kay Redfield Jamison. I'm Emily Kwong and you're listening to Short Wave, the science podcast from NPR.

[Kay Redfield Jamison]

Foreign.

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[Emily Kwong]

Okay, Kay, so we are talking about bipolar disorder. Do researchers know what causes bipolar? What are some of the leading theories?

[Kay Redfield Jamison]

Well, yes and no. I mean, it's hopelessly complicated. You're talking about an illness that affects mood, motivation, behavior, personality, temperament. You know, it affects so much of what goes on in a very complicated brain. I would say what we do know is it's genetic, has very strong genetic component. It runs in families. And people have known that for hundreds, if not thousands of years. And the research that's going on now to try and find out what causes bipolar illness would focus on the changes in biorhythms in the brain, the body, but certainly the genetics.

[Emily Kwong]

If a person's parent has bipolar, it doesn't mean that that person will necessarily get it, but it does mean they're more likely than someone without a family history. But what other conditions might increase someone's risk for bipolar?

[Kay Redfield Jamison]

Certainly some people would say environmental factors, but the genetic propensity has to be there. So I think that if you look, once people reach the age of risk, which in bipolar illness was about 18 or so, then things we know are very likely to precipitate the onset of mania are sleep deprivation and substance abuse, particularly alcohol, marijuana. This is really unfortunate for college kids because they're right at the age of risk. And when they go off to college, they stay up all night, they leave their work till the last moments, and they're in parties, and using alcohol for the first time are increasing their alcohol level.

[Emily Kwong]

Okay, so let's talk about treatment, about living with and thriving with bipolar disorder. What treatment options are available for people?

[Kay Redfield Jamison]

There are all sorts of combinations. Oddly enough, the major. The gold standard of treatment for bipolar disorder, which remains lithium. One of the best predictors of lithium outcome is whether your mania comes first, followed by depression or the other way around. So people who have manic periods first tend to be more responsive, respond better to lithium.

[Emily Kwong]

Lithium is a mood stabilizer medication. Why would it work best for those who have mania first?

[Kay Redfield Jamison]

I don't think anyone really knows. It's just that we know that at the heart of bipolar illness is the tendency to fluctuate, to be often be seasonal, to come and go. And lithium, above all else, affects that rhythmic pattern.

[Emily Kwong]

Yeah. And of course, to get a lithium prescription for bipolar, people first need a diagnosis.

[Kay Redfield Jamison]

You know, it's like any field, I think, in medicine. If you get a wrong diagnosis, you're going to get likely the wrong treatment. And it not only can not do anything to remedy the situation, but it can make people worse. For example, antidepressants, however effective and important they are for major depression and anxiety and other things in many people with bipolar illness make people worse. So you got to get it right. It's not enough to diagnose depression. You've got to know whether that depression is in the context of somebody who has bipolar illness or in the context of someone who has depression alone.

[Emily Kwong]

Yeah. What do you do to take care of yourself? What do you recommend people do to take care of themselves if they're experiencing symptoms?

[Kay Redfield Jamison]

So there are two major clinical problems in treating bipolar illness. One is to get people to acknowledge or recognize that they have something that needs and can be treated. That's one thing. The other thing is, once they're in treatment, to keep them in treatment, because people tend to quit, particularly younger people, and it will tend to get worse over time if it's left untreated and much harder to treat. When I'm teaching Residents at Johns Hopkins. I always emphasize that's the art and science of treating mood disorders and is that they're complicated, that there are huge feelings involved and denial and hopelessness. So the very thing that you need to get better, which is your brain, is making you hopeless. And so I think you need to educate patients, family members, to the extent that you can get families in to talk about what's going on, what kind of questions, what kind of plans should be made if somebody gets manic or somebody gets depressed or, or somebody gets suicidal. I mean, there are all sorts of things that you can do just by being straightforward and educated yourself. As a clinician.

[Emily Kwong]

I'm wondering, as someone who lives with bipolar, how do you navigate your own emotions? Because emotions are such a part of being human. Right. And you wouldn't want to not feel your feelings. What is your relationship to your emotions? Now?

[Kay Redfield Jamison]

For sure, you don't want to consider happiness and joy to be a symptom of psychopathology, you know?

[Emily Kwong]

Right.

[Kay Redfield Jamison]

You want to go through life with a full range of emotions. One of the things that people do, my colleague at ucla, David Micklewood, does with adolescents, for example, is to and their family members, is to make people more aware of when their moods are getting up. So if somebody's starting to buy more things, or somebody's staying up too late, or somebody's starting to clean the house, which is a very common sort of thing, you know, the earlier you can catch mania, incipient mania, the easier it is to treat and the less damage and harm is done.

[Emily Kwong]

In addition to writing so much formative medical literature about bipolar, you've also written very personally about it. You have authored several books, including Touched with Fire, An Unquiet Mind, Night Falls Fast, Exuberance, Nothing was the same. You are a prolific writer. What is writing to you? What has it been for you throughout your life in learning and understanding yourself and others?

[Kay Redfield Jamison]

Well, I think writing 1400 pages of very fine double columned textbook, it was very therapeutic in many respects to just find out what's known in the field and what's not known. But when I decided to write about my own experience, I was terrified for a lot of obvious and a lot of not so obvious reasons. I was very concerned about my state licenses in California and the District of Columbia and how my colleagues would think about me, whether I'd lose my job. But the writing of an unquiet mind was actually very easy and very pleasurable. I've always loved reading and writing. I mean, I think I had been very fortunate when I was in high school to have a high school teacher that took me very seriously and I think understood that I was having a breakdown, but never said anything but just gave me some books to read. And among them was Robert Lowell, great American poet and his life, his courage, the complexity of his thinking and problems, and his 20 hospitalizations with mania were to me just an extraordinary gift to my life. I mean, they're pieces of music and literature that you cannot believe can be so beautiful. I mean, I don't sit around putting Beethoven on when I'm depressed and get a chirpy, but I do find the very fact that it exists when I'm feeling normal a remarkable sustaining thing.

[Emily Kwong]

Another support that you've mentioned is your family. Your husband is sitting right beside you. He helped set up the interview recording and has been listening in the background this whole time. What is his name?

[Kay Redfield Jamison]

Thomas Trail.

[Emily Kwong]

How has he supported you over the years and beyond?

[Kay Redfield Jamison]

Mainly he's just a remarkably kind, funny, loving person who respects privacy and just I couldn't be luckier. I wake up every morning and say I'm the luckiest woman in the world. Oh please, oh please, stop it.

[Emily Kwong]

I just gotta say you are quite a team. Thank you both. You're both wonderful. And Kate, it was great to talk to you about this.

[Kay Redfield Jamison]

Thank you. Bye now.

[Emily Kwong]

Short Wavers. We care about you and if you or anyone you know has been having suicidal thoughts, call 988 the suicide and Crisis Lifeline. We've put several resources together for people who have bipolar, people who love people with bipolar. Check them out on the episode page. This episode was produced by Rachel Carlson and was edited by our showrunner, Rebecca Ramirez. Tyler Jones checked the facts. Kwesi Lee was the audio engineer, Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy. I'm Emily Kwong. Thank you for listening to short wave from NPR.

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