The other two people in my family made it more difficult, not because they wanted to make it difficult for me, but because they had actually the same illness that I have and they really very much believe that medication was bad, that it was a weakness to depend upon medication, and it made it difficult for me to accept the idea. I came from a military background and a really conservative background -- not politically but socially. And it wasn't done -- to see a psychiatrist. It wasn't done to admit you had that kind of problem. So they inadvertently made life more difficult than it could be.

I think what you have to do is surround yourself with people who make it easier for you and who try to understand you. I think what you find is that many people are eager to be educated about it and to learn about it. Try and get people that are in your family to read about it, learn about it as a medical illness, learn about the treatments, learn about the consequences of not being treated and if it's appropriate, have them come in and talk to your psychiatrist or psychologist with you so that they can learn more. It's a place where education goes a long way.

MEMBER:
Yes, but I'm a jock and in my group no one sees a psychiatrist and no one has these kinds of problems or else you're just a "head case."

JAMISON:
Yes, I appreciate the problem. I think that it's probably almost certainly true that they say that and they may make you feel that way. But the odds are that some of them have problems, if not the same as your own, similar to your own.

I think the good thing is that people are learning a lot more about these illnesses. People are more tolerant than they used to be. They are still not nearly as tolerant as one would like, but they are more aware of what we know about the brain and research and treatment. And I think as the years go by, people are going to get even more tolerant as they understand more.

MEMBER QUESTION:
I'm 54 and have been living with bipolar 25 years. I take it you are med compliant. Do you feel this disease is progressive as we age?

JAMISON:
Yes, I am med compliant. As I say, I nearly died from not being compliant with my medications, and ever since then I have taken them religiously.

The illness progresses if you don't get treated, or tends to progress -- not in everyone but in many people it does tend to get worse over time. The great advantage of treatment is that it prevents that progression and it largely prevents recurrences when the medications are working properly. That's one of the really terrific things about medication -- it can prevent the illness from getting worse over time.

MEMBER QUESTION:
You are my hero. People now come to the support board with rapid cycling. Traditionally this was defined as more than four cycles a year, but now people feel sad in the morning and then have something good happen and they say they are manic. No one will accept medication to a point they feel nothing. How do you divide up what's the disease and what's just learning to cope with life?

JAMISON:
Well, sometimes it's complicated and sometimes it's pretty straightforward. One of the reasons why psychiatry and psychology have diagnostic criteria is because those criteria allow clinicians to try and sort through what is illness and what is just a normal response to life. Sometimes it can be difficult to sort that out but generally it's more straightforward than you would think.

MODERATOR:
That can be particularly difficult when you're dealing with an adolescent who has bipolar disorder because adolescents go through so many mood swings whether they have the disease or not. They are constantly on this emotional journey towards adulthood. So sometimes it can be extremely difficult to understand what's the disease and what's teen behavior.

JAMISON:
I think that's true up to a point, but actually one of the things that's quite interesting from psychological research, most adolescent are more normal than people give them credit for being and their moods are actually more stable than most people give them credit for being. Not to say that there isn't a certain moodiness and so forth in adolescents, but it's probably been exaggerated.

I think one of the things that has been very helpful, and I could not say enough good things about good psychotherapy and enough bad things about bad psychotherapy, is that when psychotherapy is done properly, one of the things that it addresses is exactly that. How much of this is my response to other people, how much of it is my character structure, how much is my personality, how much of it is my mood disorder? Those are very complicated medical issues and existential issues; psychotherapy, in the hands of someone who is very well informed about the biological aspects of mood disorders, can be a lifesaving sort of thing.

MEMBER QUESTION:
Do you feel menopause plays a role in bipolar disorder?

JAMISON:
It certainly can. Any time along a woman's life where there are substantial hormonal changes can affect moods and mood disorders.