MUSC psychiatrist explains bipolar disorder and its possible link to creativity

Powerhouse singer Mariah Carey tells People magazine that she has bipolar disorder, a condition that causes extreme mood swings. She says she was diagnosed 2001 but was in denial for years and afraid of being exposed.

Carey is the latest in a series of celebrities to disclose her struggle with the mental illness. Others include singer Demi Lovato, comedian Russell Brand, the late actress and writer Carrie Fisher and actor Jean-Claude Van Damme.

Their willingness to go public with their diagnoses could have a big impact, according to the chairman of the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina. "There is a huge stigma associated with psychiatric disorders and like any disorder, it’s useful for prominent people to come forward and talk about the disorder," Thomas Uhde said.

Here, the psychiatrist answers some questions about bipolar disorder, how it’s treated and its possible link to creativity.

Q: What is bipolar disorder?

A: The person with a bipolar disorder suffers from alternating periods of “highs” (hypomania or mania) and “downs” (depression). High periods represent persistently elevated or expansive mood states. Some people with bipolar illness are mainly irritable during such highs. 

These expansive or irritable mood states are typically associated with a great deal of energy, decreased need for sleep, hyper-talkativeness, intrusiveness and an elevated sense of self-esteem. The person has an inflated view of his/her ideas and, as a result, may develop or pursue new projects that would be viewed by most people as being unrealistic and/or highly ill-advised due to the likely negative or harmful consequences.

Examples include the purchase of expensive items one clearly cannot afford, sexual indiscretions and highly risky, ill-advised investments.  These “highs” or irritable mood states are not characteristic of the person’s usual pattern of behavior or thinking and occur during discrete periods of time, lasting from several days to weeks.

Although the symptoms are similar in quality, the medical field recognizes two types of elevated or irritable mood states: mania and hypomania. During both mania and hypomania, the person’s mood, thinking and behavior are uncharacteristic of the person’s usual or natural self. The change in mood and behavior is noticeable to friends, relatives and colleagues.

During hypomanic periods, a person may be able to perform their usual occupational or social functions, sometimes at a faster-than-usual pace, whereas in manic episodes a person has a greater number of elevated or irritable symptoms and is clearly impaired. In fact, a person experiencing a manic episode may require hospitalization. 

Q: How common is bipolar disorder?

A: The combined prevalence of bipolar I and II is approximately 1.4 percent in the United States. The rate of bipolar disorder is generally the same in both men and women, although the prevalence of bipolar II may be a little higher in women. Childbirth may trigger hypomania, followed shortly thereafter by postpartum depression and subsequent bipolar II disorder.

Q: Carey has bipolar II disorder. What’s the difference between that and bipolar I disorder?

A: Bipolar I disorder is similar, but not identical, to the old classification of manic-depressive disorder. The person with bipolar I disorder experiences full-blown manic episodes, whereas a bipolar II person experiences hypomanic episodes.

While a person with bipolar I technically may not report a history of major depression, both bipolar I and bipolar II patients, in my experience, suffer from recurrent bouts of depression during their lifetime. Interestingly, even though mania in bipolar I is associated with a greater number of symptoms and lasts longer than the hypomania in bipolar II disorder, the impairment from depression is often greater in bipolar II disorder. 

Q: For years, Mariah Carey was in denial about having bipolar disorder. Is that a common reaction, and if so, why?

A: It is very common for people with bipolar illness to resist treatment, especially early in the course of the illness. This is particularly true if the primary reason for referral was hypomania or mania. After all, until one experiences and accepts the negative consequences and inevitable impairment associated with bipolar illness, it is understandable that a person might resist the idea of taking medications to reduce and/or eliminate feelings of being on top of the world or having unlimited energy, an enhanced sense of humor, being the life of party and self-perception of increased sexual prowess.

Q: A couple of years ago, MUSC hosted a screening of the movie “Touched With Fire,” which is about the gifts bipolar disorder can give and the huge toll it can take. Is there an association between this condition and being gifted artistically, like Carey is?

A: Although controversial, my scientific view and clinical experience is that individuals with bipolar illness are highly creative (i.e. more than in the general population). One of the reasons our department investigates the neurobiology of creativity is to develop more targeted treatments for creative artists.

The theoretical linkage between bipolar illness and enhanced creativity is another factor that contributes to a resistance to treatment. That is, creative artists are naturally going to be concerned about losing their creative edge as a result of treatment insofar as mood disturbances were a major source of creative inspiration.     

Q: How is bipolar disorder treated?

A: The pharmacological treatment of bipolar illness is highly effective and lifesaving. Nonetheless, additional research is needed to develop drugs with dual goals:

• The elimination of abnormal and destructive mood swings (both hypomania/mania and depression)
• The protection and promotion of creativity