Understanding Bipolar DisorderMay 22, 2017
What is bipolar disorder? Dr. Charles Hodges explains the signs and symptoms of bipolar disorder. Hodges recalls the first time he ever met someone who was bipolar, and Bob Lepine talks about his own father, who struggled with this diagnosis.
What is bipolar disorder? Dr. Charles Hodges explains the signs and symptoms of bipolar disorder. Hodges recalls the first time he ever met someone who was bipolar, and Bob Lepine talks about his own father, who struggled with this diagnosis.
Understanding Bipolar Disorder
Bob: Is there a difference between sadness and depression? Dr. Charles Hodges says, “Medically, the differentiation has shifted over the years.”
Charles: When I was in medical school, if someone was going to have major depression, they would have to be someone who had a depressed mood and then all the symptoms that go along with it; but they shouldn’t be able to tell you why. Those were the people we called depressed in the 1970s; but after 1980, cause was removed. Up until 1980, if you could tell me why you were sad, then, I didn’t say you were depressed—I said you were grieving. As a result, right now, we think that—with regard to depression—maybe, the over diagnosis may be as high as 90 percent.
Bob: This is FamilyLife Today for Monday, May 22nd. Our host is the President of FamilyLife®, Dennis Rainey, and I’m Bob Lepine. We’re going to talk today about what it is that causes people to be sad or depressed and different ways of responding to that diagnosis. Stay with us.
And welcome to FamilyLife Today. Thanks for joining us. I have been looking forward to our conversation today because—well, because of my history—you’re aware of a little of my history here.
Dennis: Right. Your dad struggled with something that we’ll be talking about today. Let me introduce our guest; and then, let’s come back and explain to our listeners what we’re talking about. Dr. Charlie Hodges joins us on FamilyLife Today. Charlie, welcome to the broadcast.
Charles: It’s good to be here.
Dennis: Charlie—and he said it’s okay to call him Charlie. He is Dr. Hodges because he is a family physician; but Charlie’s a licensed marital and family therapist. He’s been married to Helen since 1971. They have four children. He is both a golfer, and he is a runner who gets attacked by geese. [Laughter]
We found that out before we came into the studio here.
But he has written a book called Good Mood, Bad Mood: Help and Hope for Depression and Bipolar Disorder. That leads us back to you, Bob—
Dennis: —and the story about your dad.
Bob: Yes; that’s what piqued my interest, because my dad was a World War II veteran. In fact, he was on a landing carrier called the Susan B. Anthony that went into the beaches of Normandy the second day of the invasion. The landing craft hit a mine and sank. Dad wound up on the beach. Everybody survived the sinking—but Dad wound up on the beach and, actually, passed out on the beaches of Normandy—was taken back to England and recouped. He had a knee injury as a result of the landing craft sinking. Of course, I didn’t know much about any of this when I was growing up; because Dad didn’t talk much about World War II. A lot of veterans—
—one of the ways they protected their families was by not talking about their battle memories.
Bob: But I was aware of the fact—especially during my teen years—I was aware of the fact that my dad drank and often drank to excess. I would see that lived out in kind of silly behavior on his part, sometimes, when he had too much to drink and he was trying to be funny—it was just awkward.
Dennis: Sohe wasn’t violent?
Bob: He wasn’t violent. It was just—it was obvious that he wasn’t thinking straight, and it was a little embarrassing. I remember, one night, when a friend of mine was over at the house. We were just spending the evening. Dad came home from a party, and he’d had too much to drink. I was just kind of embarrassed that—here was my dad, acting silly in front of my friend—but didn’t really think much about it—was just kind of there. I knew that when Dad would come home from work, he’d fix a drink first thing when he got home.
Then, I began to see, in my high school years, that this was creating tension in his relationship with my mom—
—that Mom and Dad were arguing and fighting. I also began to see behavior that was different than I had seen before. I don’t know if this was just because I hadn’t seen it before or if it started to appear more regularly when my dad was in his early 50s.
Dennis: And you were how old, again?
Bob: I’m 17 years old—I’m a senior in high school. The behavior that I was seeing was Dad being erratic. He was being—and I wouldn’t have used this term, at the time—but people talked about him being grandiose. He was doing things that were larger than made sense. For example, he went on a business trip one time with about ten friends. He came back and told my mom that he decided to buy dress shirts for all of them while he was on the trip—just went out and bought a new dress shirt for everybody. I don’t know what that cost—three or four hundred dollars in those days. Mom was appalled: “Why would you buy dress shirts for all your coworkers?” I think the coworkers were probably a little stunned—
—it was kind of confusing behavior to them as well.
Well, this all culminated with an event—this was the fall of my senior year in high school. We got a call one night. Dad had been in to see the company psychologist at the company where he worked. The psychologist had said: “You have two options. You can either go and check yourself into the hospital—into the psych ward to get treatment for what’s going on”—this had become apparently an issue at work—“or we’ll let you go. You’ll be dismissed from the job.”
He called home. He got Mom and me on the phone—he said, “They want me to go into this psych ward. They think that I need help. Is that what you think I ought to do?” And Mom and I both kind of looked at each other and said, “Well, yes, seeing what we’ve seen around the house, we think you need to do that.” I found out, later, that the psychiatrist had called home and talked to my mom and had said, “We’re going to have this meeting with him.”
So, they were on the same page before all of this happened.
Well, my dad came home. He packed his suitcase—I remember he got out a small suitcase and put it on the bed. Mom said, “I think you’re going to need a bigger suitcase.” He said, “No, watch this—watch.” He started to stuff more than would fit into this small suitcase. It became obvious to both of us that what he was trying to pack was not going to fit in that small suitcase; but rather than saying: “Okay, you’re right. I should have gotten a bigger suitcase,” he kept stuffing and, finally, got a paper sack and put what wouldn’t fit in the small suitcase in the paper sack. So, he headed off to the psych ward with a suitcase and a paper sack.
One final story and then we’ll talk to our guest; and we’ll get your perspective on what I experienced, as a teenager. My dad was an outpatient in the psych ward. He had a business associate who would come and pick him up.
They’d go out and play a round of golf—this was part of the outpatient treatment.
Well, they were driving back from the golf course. There was a farmer selling eggs on the side of the road. Dad said: “Pull over. I think I need to buy some eggs.” And they went up to the farmer. Dad was asking, “How much are the eggs?” and he said, “I think I need a dozen gross of eggs.” Now, a gross of eggs is 144 eggs. The friend, who was with him, was able to talk him out of—“That’s probably / you’re heading back to the hospital, and…”—but this was just another indication that this behavior / this way of thinking—something had gotten messed up in his head.
Bob: And I’ll just draw the story to a conclusion. He was in the psych ward for three weeks. He was medicated and eventually came home. He, for the rest of his life, stayed on medication. He also did eventually quit drinking.
It was about five years later that he quit drinking through another series of events; but that’s the first time I had ever heard expressions like “manic depression” or “bipolar disorder.” And I got a chance to see, firsthand, the impact that can have on a marriage and a family—how a wife can be confused, and alone, and not know what to do, and looking for help. She’s trying to figure out, “What do I do with my son in this situation?”
Bob: I mean, I just had a chance to experience that, growing up, in my family of origin. So, I thought, “This would be good for us to talk about”; because I’m sure there are a lot of families where this kind of a diagnosis has been given, and this kind of behavior is going on, and families aren’t sure what to do about it.
Dennis: And I’m sure, Charlie, when you came down here to be interviewed on FamilyLife Today, that you never dreamed we would start the broadcast with—
Bob: —with a case study.
Dennis: —with a case study for you to begin. Tell us what your thoughts are about what was taking place in Bob’s dad’s life.
Charles: Well, Bob’s dad sounds very much like the first manic depressive patient that I ever saw when I was in medical school. We had to do a rotation on psychiatry, and they brought a salesman in to talk to us. He was telling us about all these big business deals that he had to get done. His main concern was that we get him out of the hospital before the day was over because, if we didn’t, he was going to lose a lot of money.
And we were all a little amused by it. He was a pleasant person—he was kind of funny / he was engaging. Most of us, at that level of training, didn’t really think he was sick—which is probably why people like this can get in fairly deep into difficulty because a lot of their behaviors are just viewed by other people as being amusing or whatever.
Dennis: So, you didn’t think he was suffering from an illness, at that point.
Charles: No; actually, we thought the cure was worse than the disease, you know, because we saw him a couple weeks later, after they’d treated him for a couple weeks.
It was sort of like they’d taken all the fire out his engine. He was taking, I think, lithium at the time. He didn’t talk about business anymore. He wasn’t cracking jokes, and he wasn’t particularly funny.
When the interview was over, and we were talking to the psychiatrist later, we sort of allowed that we thought / we wondered whether he was better off now than he was before. What the psychiatrist explained was that he understood our thinking; but he said, “What you have to understand, for the person who is in the middle of it, it’s a lot like driving a car down the street. You’re going a hundred miles an hour, and it’s a crowded street; and you don’t have a steering wheel or brakes. That’s how they feel.” And he said that once they’re on their medicine, they generally do feel better. So, Bob’s father sounds very much like he had manic depression.
Bob: And as you described the treatment—I went to see my dad in the hospital about two days before he was released. I remember that night, as we sat and visited, I thought: “He’s not better. He’s been here three weeks, and he is not better.”
Now, I later learned that how they were dealing with this—and this was back in the ‘70s. They had him in the hospital—every day, they were giving him a dosage of lithium. Every day, they were giving him a little bit more. When they got to the point that the dosage was toxic and he started to vomit, they went back to the previous day’s dosage and said, “That’s your dosage.”
Charles: Well, now, they do it a lot better than that.
Bob: Well, that was how they did it with him. And they told us—
Bob: —first of all, they’d never given a patient as much lithium as they’d given him. They also—when he came home, there was about a month where he was pretty flat—not catatonic but almost like he wasn’t fully there. And I remember thinking like you—I’m wondering: “Which is better?—how he was before, which was kind of crazy, and how he is today, which is kind of gone.”
Charles: Which is, I think, the observation that a lot of people might make who aren’t very familiar with people who have what we now call Bipolar Disorder I.
When I went to medical school—in between 1971 and 1975—it was called manic depression. It was changed to bipolar disorder in 1980. The American Psychiatric Association revised, under the direction of Robert Spitzer, the DSM-III. At that point, it became bipolar disorder. Manic depression was known as Bipolar Disorder I. But back then, the treatment that your dad received was a good treatment. Today, they would do blood levels and things like that.
I can remember, when I was in psychiatry—and it was a very imprecise science, at the time—and I was at the psych ward at Marion County General Hospital at the time. I was the staff physician. I was a junior medical student—I was a staff physician for 15 people who were on the ward. I would ask the psychiatrist, who would come around a couple times a week and ask us how things were going and tell us what to do: “How much of this medicine should I give this patient?” The response was: “Well, you just keep giving it to them until they don’t hear voices anymore.
“Then, that’s the dose,” which is very much like what you were talking about.
Charles: Things are far more precise now.
Dennis: How many Americans suffer from this disease / this illness? And second part of the question is: “What causes it?”
Charles: Well, first part of the question: “How many people suffer from it?” People, such as Bob’s father, probably, make up one-tenth of one percent of the U.S. population—that is a very small number. That would be logical; because you don’t run into people who are so affected, as his dad was, very often.
Now, it gets a little complicated now because, in 1980, they changed the name to bipolar disorder. They said that Bipolar Disorder I would be the old manic depression; but then, they added another layer of categories, which were meant for people who might look a little bit like they had bipolar disorder / manic depression but were not considered to have it.
So, if you ask how many people in the U.S. have bipolar disorder today, you might hear a number anywhere from six to eight percent. That was part of the reason why I wrote the book.
Bob: As a doctor, you’re looking at current practice and saying: “There is an over diagnosis of this disorder. Some people, who are dealing with significant mood swings, are being labeled bipolar when that’s not really what’s going on with them.”
Charles: I would say that bipolar disorder in the United States today is being over diagnosed, for certain. When I wrote Good Mood, Bad Mood, I set out to write a book about bipolar disorder; but the problem was—I couldn’t find a publisher who thought it would be good for 15 chapters. They just didn’t think there would be enough information for a whole book—which was a very good thing because, then, I had to agree to write about mood disorders / I had to write about depression.
What I found out, as I researched, was that not only did they change the criteria for bipolar disorder / manic depression in 1980—they also changed the way they make the diagnosis of depression. I think that is the key to understanding why we’re seeing so much more diagnosis today of bipolar disorder.
Dennis: Did they lower the bar, so to speak?
Charles: Yes; well, it was one important thing that they did. They took away the requirement for cause. When I was in medical school, if someone was going to have major depression, they would have to be someone who had a depressed mood and then all the symptoms that go along with it; but they shouldn’t be able to tell you why—it was sadness without cause. Up until 1980, if you could tell me why you were sad, then, I didn’t say you were depressed—I said you were grieving—grieving over a loss / a significant loss.
As a result, right now, we think that, with regard to depression, maybe the over diagnosis may be as high as 90 percent—
—that in 90 percent of the people who, today, are labeled depressed—you can sit down and talk with them, and you can find out the day they started to be depressed, and you can find out what it was they lost.
Dennis: So, the percentage of people today in our country that suffer from depression—and again, I guess you’re going to have to clarify which definition you are going to use here—what’s the percentage though?
Charles: Numbers vary, but it can range everywhere from 10 percent to 20.
Bob: That’s the number who are being treated for what’s labeled as depression; right?
Charles: Oh, yes.
Bob: But how many people would you say have real, legitimate depression versus a grieving or sadness?
Charles: Probably, I would say somewhere around two percent—you know, a much lower number—people who can’t tell you why they’re sad. That’s the big difference.
Dennis: So, you’re going back to the old definition?
Charles: Yes; I am. Part of the reason for that is that people, who are currently being treated for depression with antidepressants—
—we found they don’t respond nearly as well as we had hoped—that the medical treatment of depression is less effective for individuals.
There was a study that came out in the Journal of the American Medical Association in 2010. The authors of it noted that people—who were mildly depressed, moderately depressed, and even severely depressed—of those people, if you looked at them—and they make up probably 87 percent of the people who are labeled with depression—that most of the benefit of taking medication for those people can be attributed to the placebo effect of just taking a medicine. Now, placebo, of course, is a pill that looks like—does not contain the actual medicine. What they found was that people in that first 90 percent—let’s say 87-90 percent—
—people in that group would respond just as well to a pill that didn’t have the medicine in it as they would to the pill that did.
Bob: Charlie, we’ve got people listening to us today, hearing this discussion—they’re going to their email, right now, to write to us. They’re saying: “This is so typical of Christians that I’ve heard, who want to tell me, ‘You’re not really depressed.’ They don’t know what I’m battling through. They want to tell me it’s all in my head; and if I’d just pray more, I’d feel better.”
Charles: That’s not true. I really liked what Irving Kirsch said—who did a lot of the studies at Harvard University Med School in placebo research, actually. His response to it was: “It isn’t an answer for folks, like that, to do nothing.”
I do not look at people, who come to me and tell me that they are sad, and tell them that: “If they just went to church three times a week, and read their Bibles—three chapters a day and four on Sunday—and memorize a verse every week that their sad mood would go away.”
Quite on the other hand—you could come back at this from the other side and say, “Well, we’ve been treating people with antidepressants now since 1988 at an ever-increasing level.” The number of people who are taking antidepressants has skyrocketed and the amount that we sell every year has, I think, doubled in the—
Bob: It’s the number-one drug prescribed in America; isn’t it—is antidepressant drug?
Charles: Yes; I would say it is. We have written and given this to everybody and anybody who even remotely looks like they might have depression.
Now, I would say something about taking medicine. From 1986 until present, there has been this constant argument about whether it is right or wrong to take medicine for things like depression, anxiety, and stuff like that. My response is that we’ve been asking the wrong question all this time. We shouldn’t have been asking whether it was right or wrong to take it. I think the question we should have been asking is: “Does medicine actually work? Does it really help the people who take it, or is it just a medicine that actually changes their personality but doesn’t really help them with their issue?”
Bob: And I want to be clear here, too, because—just like the person who was getting ready to write us and say, “You guys are just saying I should pray more,”—now, there are some people who are listening, going: “Well, I’m taking Prozac®. I heard the guy on the radio say it’s probably not helping me. Should I just quit taking it?”
Charles: Oh, never! In my book, and whenever I speak to people, I always tell them, “You should never change the dose of medicine that you are taking / you should never stop any medicine you’re taking without talking to your doctor.” I don’t advise people to change their medicines or stop taking them.
Bob: I just wanted to make sure that we were clear and no listener was going: “He said, ‘Throw the Prozac away. It’s not doing you any good.’”
Charles: I write prescriptions for antidepressants—I give them to people. I try to explain to them that I don’t think it’s going to change their life but that it probably will affect their personality—and they may not like the way that it affects their personality—but if they come to me and ask me for it, and if I think they meet the criteria for depression,
I will write the prescription for them, and follow along, and take care of them as a physician.
Bob: Well, I don’t know that you can do this or would do this, but I would sure think that if you had somebody who you were writing a prescription for, that you also would encourage them to get a copy of your book. I mean, I would. I think your book does a great job of helping people understand what they are going through and whether there is something medical at play or whether it is just a profound emotional sadness that they are experiencing, and “How can you tell which is which?” and “How do you respond to what you find out?”
We’ve got copies of Dr. Hodges’ book in our FamilyLifeToday Resource Center. The book is called Good Mood, Bad Mood: Help and Hope for Depression and Bipolar Disorder. You can order a copy of the book from us when you go online at FamilyLifeToday.com or call to order at 1-800-FL-TODAY.
Again, the website is FamilyLifeToday.com. Or you can call to get a copy of the book, Good Mood, Bad Mood,by Dr. Charles Hodges. Our number is 1-800-358-6329—that’s 1-800-“F” as in family, “L” as in life, and then the word, “TODAY.”
We want to say, “Thank you,” real quickly to those of you who are regular listeners—who, in the last few weeks, have been getting in touch with us and helping us reach the goal we’re trying to reach this month. We’re trying to raise $1.1 million during the month of May—a significant milestone number for us—but it’s a number that will enable us to continue work on a variety of projects that are under way, here, at FamilyLife. This will help us be able to continue working on these through the summer—that’s why we established this goal.
We’ve had friends of the ministry, who have come along and said, “We want to help encourage listeners to be generous during May.” These folks have offered matching funds. In fact, you can go to our website for an update on how we’re doing in attempting to take advantage of the matching-gift funds. I haven’t seen the latest numbers; but they are available, online, at FamilyLifeToday.com.
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Now, tomorrow, we want to talk about why God might take us into a season where we experience profound depression—
—it happened to David / it’s happened to many followers of Christ throughout the years, including people like Charles Spurgeon. What is God up to when he takes us into those seasons? We’ll explore that tomorrow with Dr. Charles Hodges. I hope you can be back with us for that.
I want to thank our engineer today, Keith Lynch, along with our entire broadcast production team. On behalf of our host, Dennis Rainey, I’m Bob Lepine. We will see you back next time for another edition of FamilyLife Today.
FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas; a Cru® ministry.
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