Cassandra Robbins* wrote her first will when she was 19 years old, certain she would die young. Some days she lived like an adrenaline junkie, moving from thrill to thrill. She was the life of the party, the picture of invincible youth. Then her mood would turn and she would walk through a period of deep depression, which she felt she had to hide from the world around her. But hiding didn’t make her trouble disappear. In fact, her episodes of depression got worse until her suffering was almost unbearable and she turned to substance abuse in an effort to manage her emotional pain.
Years later, married and raising children, Cassandra realized her substance abuse was controlling her life. She found herself in an emergency room after attempting suicide by overdose. Later, after a second suicide attempt, she joined a Celebrate Recovery group to get support for recovery from dependency. And when the substance abuse subsided, her mood instability was still there, more troubling than ever.
When her brother was diagnosed with bipolar disorder, Cassandra read a checklist of common symptoms and recognized her own struggle. She consulted a doctor and at 30 years of age, received the diagnosis herself. She began to take medication and do therapy. She got educated about the disorder, began tracking her moods, and made changes to her eating, sleeping, and exercise habits.
Three years later, after abruptly stopping her medication, Cassandra found herself back in the hospital, this time as a psychiatric patient. “I was a wife, a mom, a Girl Scout leader, on staff at a church. I preached in a women’s prison and volunteered in many community activities. Part of me thought those things would exempt me from something like this.”
While she was in the hospital, Cassandra saw other patients abandoned by loved ones. She began to fear that her husband would walk away from her too. But he proved loving and supportive during her recovery. She rededicated herself to living well, and today she is in her third year of remission—her disorder has not been cured, but her mental health is stable and well managed.
A Disruptive Disorder
Cassandra is not alone in her diagnosis or her experience. Each year, bipolar disorder affects 2.6 percent of adults in the United States and nearly 4 percent over the course of a lifetime. The disorder can affect children as well, but it usually begins in late adolescence or early adulthood. Women are diagnosed with bipolar disorder more often than men, with a ratio of about three women for every two men. The illness tends to look different in women than it does in men, and it tends to show itself later in women. It is a highly disruptive mental illness, with more than 80 percent of cases classified as “severe.”
Bipolar disorder, like other brain disorders, is not as mysterious as it once was. Once considered a spiritual, intellectual, or moral deficiency; a character defect; or “insanity” with no known cause, today it is more thoroughly (although not completely) understood by neuroscientists. It is a condition which causes extreme mood swings, far more significant than what most people experience. In the manic phase, people can experience extreme euphoria, high productivity, thrill-seeking behavior, a sense of invulnerability, misperceptions of reality, and other symptoms. In the depressive state, they can suffer from crippling sadness, hopelessness, and suicidal thinking. There are various types of the disorder, and different people can experience it in dramatically different ways.
Because the symptoms of bipolar disorder profoundly affect people’s moods and behavior, many naturally believe the trouble is moral or spiritual in nature. But like other forms of illness, this disorder has its roots in the body—in this case, in the most complex organ in our bodies. The real problem is in the brain’s chemicals. “The neurotransmitter most often associated with the bipolar disorders is norepinephrine (NE),” says Dr. Matthew S. Stanford, clinical neuroscientist and CEO of Hope and Healing Center & Institute in Houston, Texas. “NE is an excitatory neurotransmitter involved in mood, attention, motivation, and stress. Studies in bipolar disordered individuals have shown an increased level of NE in the brain during the manic phase of the disorder. In depression, reduced NE neurotransmission has been associated with lack of pleasure, decreased alertness, low energy, and problems of inattention, concentration, and cognitive ability.” When NE fluctuates dramatically, it triggers extreme variations in the ways people think, feel, and behave.
According to Dr. Stanford, recent research has revealed that bipolar disorder is neurodengenerative, meaning people with untreated bipolar disorder can lose up to 5 percent of their brain matter per year. Studies of twins and first-degree relatives have both shown a genetic component to development of bipolar disorder. While most people with a family connection will not develop the disorder, they are at greater risk.
Medical intervention focuses on reestablishing chemical balance, protecting the brain from damage, and rebuilding brain cells that have been destroyed by the disorder. Because people’s brains—and symptoms—vary, psychiatrists often experiment with various medications and dosages before finding the best combination to ease a person’s suffering. This can be an excruciating process for the person seeking relief from symptoms, and sometimes people give up on the process before discovering the right solution. It can also be difficult for loved ones, who suffer alongside the person with the disorder.
Donna Hoefs, whose mother had bipolar disorder and died by suicide, knows very well what it means to love someone who lives with this disease. After 15 years of marriage, her husband was diagnosed with bipolar disorder after a manic episode led to public embarrassment and dismissal from his job as a senior pastor. His diagnosis “brought some relief to know there was a reason for his behavior and there was help.” At the same time, “it also brought great sadness and fear, as I had lost my mother to bipolar disorder. It gave me determination to do whatever we needed to do to get him better. I was not going to lose another loved one to this disease.” Despite her determination, her family’s adjustment was difficult, and she struggled to rebuild trust in her husband and his commitment to manage his illness. His symptoms had led to spending sprees, damaged relationships, and losses.
For people who have bipolar disorder, the experience with treatment varies. For Robbins, finding the right medication meant years of trial and error and dealing with difficult side effects. Taryn Linton, who was diagnosed after a breakdown at work, also experiences frustrating side effects from her medication: antidepressants as well as lithium, a natural element that acts as a mood stabilizer and is used to treat manic symptoms. She finds that running and journaling help manage her moods. Arianna Schaffer also finds writing helpful, along with artwork, therapy, and taking medication. Like Robbins, she attends a Celebrate Recovery group. She also belongs to a program that is building her life skills and supporting her independence.
Even with treatment, life with bipolar disorder is challenging. While Linton says, “Many times I forget I have a disorder until I experience a hypomania or depression,” Schaffer has rapid cycling, which means her moods shift more frequently. Her symptoms, particularly depression, have a significant impact on her daily life. And while Robbins’s disorder is well controlled, she says, “There are still some days I take on challenges way greater than my skill set, convinced I can do about anything I try. At other times it takes a lot of effort to even show up to work.”
Perhaps the most significant effects of bipolar disorder are on relationships. Schaffer says she has lost multiple friendships because she was unable to control her emotions. “Friends start tearing me down when I’m not feeling up like they are,” she says. Some have been cruel and have misunderstood the problem, even calling her names. Robbins says her depression can be frustrating for her husband. And because managing her disorder can require a lot of energy, she tends to be irritable toward the end of the day and—as with most people—her exhaustion and stress have the greatest impact on her husband and children. Linton says her illness makes her unpredictable: “When I’m depressed, the vulnerability makes me very dependent, needy, and clingy. When I’m stable, I appreciate my independence, and I feel contempt toward any sort of perceived attempt for others to control me. When I’m hypomanic, I entertain or annoy people, and I often don’t remember either.”
As with other relationships, bipolar disorder can challenge a person’s relationship with God. Like other forms of depression, a depressive episode can cause serious doubts, an inflated sense of guilt or shame, and feelings that God has turned away. Manic episodes can have a different effect, causing what Linton calls a sense of “an elite connection to God.” Schaffer says her disorder makes her doubts bigger and her rejoicing stronger than what most people experience.
These women have seen positive impacts on faith and relationships as well. Robbins says her struggle with bipolar disorder “has given me empathy in how I express my faith, a greater love for the outcasts or those who feel they don’t belong.” Linton agrees, saying her disorder has made her more aware and empathetic toward those suffering from mental anguish. And Schaffer says she is likely to notice when others are hurting, thanks to her own experience. She also claims her experience has made her a more humble follower of Christ: “My bipolar disorder has broken me, my faith has broken me, and they both always lead me back to God. Sometimes I need to be broken. I really struggle with pride. If everything were peachy keen, I would be so proud. I would not give God the credit.”
For all three women, faith has made a lifesaving difference in the way they respond to their disorder. As Linton says it, “If I weren’t a believer, if I didn’t have the hope of resurrection, I’m not sure I’d be here.” Robbins says her faith gives her courage to keep going, “Those times when I feel life is overwhelming, my faith reminds me that my life has a purpose.” Schaffer agrees and claims faith is what has kept her alive.
People with bipolar disorder need to consistently make choices to keep themselves healthy—take medication, attend therapy sessions, live a healthy lifestyle, ask for help when they need it—if they want to have healthy relationships with God and others. Loved ones, friends, and neighbors can also make choices to support and encourage them, and it starts with education. Simply understanding the basics about the disorder and common treatments can quell fear, fuel compassion, and enable a wise response. Knowledgeable people are more likely to make themselves available, offering friendship and practical care when it’s needed.
At the same time, boundaries are important. Hoefs drew a firm boundary with her husband, whose illness created an unstable home for their children before he fully embraced his need for ongoing treatment. “I told my husband as long as he was working on his issues I would be here, but if he chose not to do the work I would be gone.” She knew that she and her children could cope only if her husband stuck with his treatment and took care of himself, and she knew that was what he needed in order to live well.
Schaffer asks people to “Just be there. Don’t try to fix them.” But it is okay to talk about the disorder and even to ask questions we might fear are intrusive, such as discussing experiences with hospitalization or asking whether people are considering hurting themselves if they’re depressed. According to Robbins, “The fear of asking these questions leaves those with bipolar feeling isolated and ashamed and with no outlet to share those aspects of their life.”
It’s important for everyone to understand that, in the words of Dr. Stanford, “A diagnosis of bipolar disorder is not a death sentence.” While it is not curable, many medications and therapeutic treatments are effective in helping people manage their symptoms. Despite what stigma and stereotypes might suggest, people with bipolar disorder have as much to offer the world as anyone else.
Cassandra Robbins is living proof. With her own disorder well managed, she approached her church leaders to discuss the need for a support group for people affected by mental illness. They gave her permission to start a ministry, and now she helps facilitate a group for anyone affected by mental illness—their own or that of a friend or family member. Thanks to treatment, to self-care, and to God’s redemptive grace, her illness has become a source of ministry to others.
*Not her real name
Amy Simpson is an inner strength coach, a popular speaker, and the award-winning author of Troubled Minds: Mental Illness and the Church’s Mission and Anxious: Choosing Faith in a World of Worry (both InterVarsity Press). You can find her at AmySimpsonOnline.com, on Facebook, on LinkedIn, and on Twitter @aresimpson.