Calming the Bipolar Storm: A Guide for Patients and Families
Robert G. Fawcett, MD
Rowman & Littlefield, 2021
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Drawing from the author’s experience treating patients with bipolar disorder for more than forty years, Calming the Bipolar Storm presents an in-depth, engaging overview of bipolar disorder, punctuated with case vignettes and interesting glimpses into the history behind today’s concept of bipolar disorder and its treatments. Readers will come away with a better understanding of bipolar disorder and a clearer path to better treatment.
Robert G. Fawcett M.D. graduated with honors from Michigan State University and was elected to Phi Beta Kappa. He majored in psychology and then pursued studies in that field at Duke University until he realized he wanted to be a clinical psychiatrist and use both psychotherapy and the growing number of medications and biologic treatments to help persons with emotional disorders. He obtained his M.D. from Wayne State University School of Medicine, interned at the Maine Medical Center, and completed his residency in psychiatry at the University of Michigan. Settling in Petoskey, Michigan, he joined the Burns Clinic, a large multispecialty clinic, later serving on its board of directors. Dr. Fawcett served as medical director of a 14-bed acute inpatient unit and treated private outpatients, as well as working at several community mental health centers. He has treated some individual bipolar patients for over thirty years and members of three generations in several families. He served as president of the Northern Michigan Medical Society, and was designated a Distinguished Life Fellow of the American Psychiatric Association. He has had publications in several prominent psychiatric journals and has given scores of lectures to clinical colleagues.
Ernest Hemingway, a preeminent figure among twentieth-century writers, and Nobel Prize winner for literature, suffered from bipolar mood disorder. He described his depressions in a letter to fellow writer John Dos Passos, “I felt that gigantic bloody emptiness and nothingness.” He said he could not fight, write, or have sex, and was “all set for death.” One biographer wrote that ”the pendulum in his nervous system swung periodically through the full arc from megalomania to melancholy.” As a youth, he would stay up all night drinking and reading poetry aloud. His first wife described his elated period thus: “sky high, emotionally intense, and ready to explode.” He wrote prolifically during these high spells, completing seven short stories during a high spell in 1924.
Hemingway described his episodes of mixed mania and depression: “Had a spell where I was pretty gloomy…and didn’t sleep for about three weeks. Took to… going out to the little house to work until daylight because when you’re writing on a book and can’t sleep your brain races at night and you write all the stuff in your head and in the morning it is gone and you are pooped.”
Hemingway avoided treatment until late in his life, instead self-medicating with alcohol. His enthusiastic pursuit of hunting and fishing perhaps channeled some of his intense emotions. He told Ava Gardner, “Even though I am not a believer in the Analysis, I spend a hell of a lot of time killing animals and fish so I won’t kill myself.”
Later in life, his disease worsened. He had delusions that the FBI was watching him and that his friends were plotting to kill him. He entered the Mayo Clinic for seven weeks in 1960. His blood pressure medication, reserpine, now known to sometimes cause depression, and his barbiturate sleep aids were stopped. He received electroconvulsive treatments (ECT), a treatment for depression that preceded our current arsenal of psychotropic medications. The treatment was successful. He wrote A Moveable Feast in that post-hospital period. But his depression returned with a vengeance, so severe that he was unable to write. He became desperately suicidal. His wife found him as he was loading a shotgun. He was hospitalized in Ketchum, Idaho, then transferred back to Mayo Clinic. On the trip there, while changing planes at an airport, he strode toward the whirling blades of an airplane propeller. The pilot stopped the engine in time to avert disaster.
At Mayo, he once again received ECT during his two-month hospitalization. Despite his outward appearance of improvement, he remained terminally depressed. Within a week of discharge, he slipped away from his sleeping wife and shot himself in the head with both barrels of his shotgun. His suicide in 1961 was a close re-enactment of his father’s suicide in 1928. This family tendency toward suicide claimed the lives of his younger brother Leicester, younger sister Ursula, and his niece Margaux.
Genetics plays the primary role in the causation of bipolar disorder. His father who had several prolonged “rest cures” for his depression and was prone to periods of high irritability was probably bipolar. His mother had problems with depression. Alcohol abuse, which plagued Ernest, is common in bipolar disorder and tends to aggravate its course, with more hospitalizations and suicide attempts. Nevertheless, many persons with bipolar disorder drink to calm their racing thoughts and insomnia.
Hemingway’s childhood included abusive events that may have enhanced his risk for both drinking and for suicide. His father, prone to fits of anger, used a razor strop to whip Ernest. As a young boy, his mother dressed him like a girl to an age that surpassed the usual practice in those Victorian times. Ernest harbored a strong sense of hatred towards her. This cross-dressing may have stimulated a reaction toward the hypermasculine pursuits of big game hunting, fishing, and placing himself in dangerous fronts during the World Wars.
His impulsivity and recklessness, fueled by both his bipolar disorder and alcoholism, led him into situations where he sustained at least five concussions during his life, in auto and airplane accidents and drunken falls on a boat. Such cerebral trauma may have worsened his mood disorder. Although lithium with its mood stabilizing and anti-suicidal effects was being used in Europe during the 1950’s, it was not available in the States until 1970. Perhaps with the biological and psychotherapeutic treatments now available Ernest Hemingway might have lived several more decades and added more volumes to his literary treasure trove.
Calming the Bipolar Storm gives readers an understanding of the disorder, its symptoms, its multiple forms, and its course. The book discusses the “self-medication hypothesis” among other explanations for the high rates of substance use disorders among bipolar persons and describes how adverse childhood experiences worsen the course of bipolar.
In recent decades bipolar disorder has emerged from the shadows and become more visible in society and in the popular media. Characters with bipolar disorder are frequently depicted in movies, like Silver Linings Playbook, television series, like Homeland, and in popular novels and songs. Actress Patty Duke and newscaster Jane Pauley both wrote autobiographies that detail their struggles with bipolar disorder. Many of these efforts have reduced the stigma of bipolar disorder and made it more acceptable to seek help. This book is an attempt to enlarge the public’s understanding of bipolar mood disorder.
It is estimated that between 1 and 2 % of the population will be afflicted by bipolar I disorder in their lifetime, and an equal number by bipolar II. Bipolar disorder has a very significant impact on them and those close to them, on the health care system, and on our national economy. Calming the Bipolar Storm informs readers about the disorder and its treatment, adding to the coping skills of patients and family members.
The book starts with an overview of what constitutes bipolar mood disorder. The disorder presents in many different ways. Perhaps you wonder whether you or a loved one has bipolar disorder, or whether the emotional difficulty is simply a form of depression or another disorder such as schizophrenia, attention deficit disorder, or borderline personality disorder. This book will help educate you on the fundamental features of bipolar disorder and what makes it different from other disorders with overlapping features.
We will explore the landscape of bipolar disorder itself. How does bipolar I disorder differ from bipolar II? What is bipolar spectrum disorder? What is cyclothymic disorder? We shall look back at the history of bipolar disorder and how the concept has matured and developed through decades of medical research and study.
Naturally, people are curious about the causes of bipolar disorder and whether it is passed along to one’s children and grandchildren. We shall discuss the genetics and inheritance of bipolar disorder. Do childhood traumas, psychological stressors in adult life, drugs, and medical illnesses affect the development of bipolar disorder and its course? We shall look at those questions.
Explaining the pros and cons of various drugs and therapies for bipolar disorder, both traditional and emerging, takes up a sizeable section of the book. We shall look at how bipolar disorder interacts with other psychiatric, substance abuse, and medical disorders and look at the concept of secondary mania (when mania is caused by medical factors). We shall focus on some special areas such as pregnancy, suicide, and bipolar youth, and list some resources for further education and study.
You do not have to read the entire book but can use selected chapters to explore particular areas. However, unless you are knowledgeable about bipolar disorder it is best to read the first three chapters. Some facts and issues are mentioned in several chapters (e.g., the influence of substance abuse on the course of bipolar disorder). The book is based on both my own extensive studies of the scientific literature and my experience treating hundreds of patients with bipolar mood disorder through more than forty years of practice. Some relevant and interesting cases are presented to illustrate concepts in a more lively and poignant way. Certain details may be left out or changed to disguise a person’s identity in those cases. If you do read the entire book you should gain a solid, up-to-date understanding of bipolar mood disorder.
This book does not constitute a treatment relationship with any of its readers. It is very important to coordinate one’s personal medical and mental health care with one’s providers, especially when dealing with a serious disorder such as bipolar mood disorder.
Kenneth S. Lynn, Hemingway (New York: Simon & Schuster, 1987) 427, as quoted in Christopher D. Martin,”Ernest Hemingway: A Psychological Autopsy of a Suicide,” Psychiatry 69, no. 4 (2006): 353.
 Carlos Baker, Hemingway: A Life Story (New York: Charles Scribner’s Sons,1969) 137, as quoted in Christopher D. Martin,”Ernest Hemingway: A Psychological Autopsy of a Suicide,” Psychiatry 69, no. 4 (2006): 354.
 Michael Reynolds, Hemingway: The Paris Years (Oxford, UK: Basil Blackwell, 1989) 194, as quoted in Christopher D. Martin, “Ernest Hemingway: A Psychological Autopsy of a Suicide,” Psychiatry 69, no. 4 (2006): 354.
 Carlos Baker, Editor, Ernest Hemingway:Selected Letters: 1917-1961 (New York:Charles Scribner’s Sons, 1981) 435-436, as quoted in Christopher D. Martin, “Ernest Hemingway: A Psychological Autospy of a Suicide,” Psychiatry 68, no. 4 (2006): 354.
 Aaron Edward Hotchner, Papa Hemingway (New York:Random House, 1966) 139, as quoted in Christopher D. Martin, “Ernest Hemingway: A Psychological Autopsy of a Suicide,” Psychiatry 69, no. 4 (2006): 358-359.
 Ibid., 366.