Manic depression is touching my soulÂ
I know what I want but I just don't knowÂ
How to, go about gettin' itÂ
Feeling sweet feeling,Â
Drops from my fingers, fingersÂ
Manic depression is catchin' my soul
Jimi Hendrix
At a performance at the Winterland Ballroom in San Francisco, Jimi Hendrix was heard conveying to the crowd "I'd like to do a frustrating type of song for you, it's called Manic Depression, a story about a cat wishing he could make love to music instead of the same everyday woman." While Hendrix himself was never diagnosed with the infirmity, a great many people worldwide suffer from the intense mood swings and crippling depression that often characterize what is commonly known as bipolar disorder.
The incidence of bipolar disorder (formerly known as manic depression) in this country has increased in prevalence over the last ten years to where it currently affects over 2.6%, or over 5.7 million of American adults. Estimated numbers of affected children and teens vary in lieu of the fact that the criteria for those groups is seen as widely subjective and prone to some controversy amongst the scientific community. But according to the Child and Adolescent Bipolar foundation, at least three quarters of a million children and teens may be suffering the symptoms of bipolar disorder despite the fact that they haven't been officially diagnosed. This is partly due to the fact that symptoms can differ enormously between adults and children suffering from the disorder. For example, an adult may simply become depressed during the "low" cycle, whereas a child may be more prone to complain of physical types of symptoms including stomach aches, fatigue or what is known in the field as somatization (psychological symptoms expressed in physical form). Diagnosis in children is further complicated by the fact that the symptoms for bipolar disorder can look like other common problems often associated with younger populations like Attention Deficit Disorder and drug and alcohol addiction.
The incidence of bipolar disorder occurs virtually equally amongst males and females and symptoms begin to manifest themselves usually between the ages of 15 to 30 years of age. As is the case with many mental ailments, you are more likely to develop bipolar disorder if you have a close relative (i.e. parent, brother, sister etc.) suffering from it and those with a close relative are 4-6 times more likely to develop the disorder. But researchers in the field are finding that stress, trauma, drugs as well as other environmental factors can be the main catalysts to triggering the symptoms. In fact about 60% of all people who have been diagnosed with bi-polar disorder also struggle with some type of drug addiction although whether these individuals wrestled with their addictions before the onset of symptoms is yet to be documented. In other words, establishing causality between drug use and the onset of bipolarity has yet to be established in the general psychiatric community.
Bipolar disorder can be broken down into four distinct subcategories:
1. Bipolar 1 - This type of bipolarity can be distinguished by manic episodes (extended period of feeling elated, overly outgoing relative to one's routine state, agitated, jumpy, restless, impulsive) or mixed episodes (agitation, trouble sleeping, changes in appetite, suicidal thoughts; sadness and hopelessness can accompany highly energized periods in this state) that last at least seven days. Depressive episodes are also likely to occur that last at least two weeks.
2. Bipolar 2 - This type is likely to manifest itself in alternating forms between depressive periods and hypomanic (similar in form to manic state although with full behavioral functionality; creative flood, mild euphoria).
3. Bipolar Disorder Not Otherwise Specified (BP-NOS) - This diagnoses is forth-coming when the client's symptoms do not fit in with the accepted criteria for either Bipolar 1 or 2, either in terms of the duration or number of symptoms.
4. Cyclothymic Disorder or Cyclothemia - This is the mildest form of bipolar disorder characterized by occurrences of hypomania and alternating periods of mild depression (from the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR).
Keep in mind that the above definitions are specified in terms of the amount of time that symptoms last as well as their qualitative nature as delineated and reported by the client. This is an important point to recognize in lieu of the fact that manic states can be what the psychiatric industry deems "ego syntonic" or fitting in with one's needs or beliefs. Many sufferers of bipolar disorder have battled for years with the hopelessness and anguish of depression and find that manic states give them the strength and energy that they need to function. Subsequently they may be less likely to report those periods of mania or hypomania because they don't necessarily see them as abnormal or even pejorative in nature. This phenomenon contributes to many misdiagnoses that can hinder proper assessment and impede mental health professionals from creating effective treatment strategies for their clients. It's of the utmost importance that if you are concerned about your own mental state of well-being and wish to know whether or not you are indeed suffering from bipolar disorder, or something else altogether, that you are as honest as possible with your mental practitioner about your symptoms in order to get the most accurate assessment. Although the subcategories can be helpful to take a rudimentary glance at one's symptoms in hopes of gaining insight, they're constantly being updated and reorganized to accommodate the inscrutable anomalies of the human condition and are not intended as a means to self-diagnoses.
So how do you know if you indeed suffer from bipolar disorder or if you're simply having an off day, week, life? Keep in mind that we all have difficult periods in our lives and low-sad times are as natural as happy-joy joy. A bipolar diagnosis is more likely when extremes of emotion and extended periods of one or the other become predominant. The first step to take is to see an MD who will work to eliminate certain physical variants which may be causing your particular symptoms( i.e brain injuries, strokes etc). He or she will likely conduct a physical exam, take the necessary bodily fluids and ask some simple questions. If necessary the doctor will then likely refer you to a mental health professional who will take the reins from there and ask you a series of questions as to your particular feelings, thoughts and actions as well as their relative lengths and frequencies, over the last months.
Although bipolarity cannot be ascertained from a simple blood test, there are exciting new technologies on the forefront which are helping to pinpoint the causes and establish the presence of bipolar disorder. The use of PET (or Positron Emission Tomography) is now becoming an integral tool in the process of molecular imaging and the subsequent detection of Bipolar disorder. The use of PET scans has shown that in those individuals suffering from the disorder, Serotonin levels are measurably lower in the hippocampus (the area of the brain associated with stress regulation as well as other functions) than "healthy" subjects. The statistically lower levels of Serotonin in this area of the brain have been shown to lead to functional impairment in relationships as well as other problems commonly associated with Bipolar disorder. (http://www.nimh.nih.gov/science-news/2008/imaging-identifies-brain-regions-and-chemicals-underlying-mood-disorders-may-lead-to-better-treatments.shtml).
A Myriad of studies conducted involving information gleaned from the human genome (the combined entire genetic information of any given organism) have also helped scientists to better understand the genetic basis behind certain infirmities including bipolar disorder. One such study conducted in 2007 found that small variations in a number of genes work in combination to produce the physical and mental manifestations of bipolarity, although none are powerful enough to cause the disease by itself. One of the genes found to be associated with the disorder though is called DGKH which is active in the bio-chemical pathway through which Lithium is supposed to travel and mediate depression (Lithium is currently the most prescribed medication for treatment of bipolar disorder as well). The gene produces an enzyme which functions more efficiently and accurately than Lithium itself which gives scientists a specific genetic target to focus upon and emulate. This understanding of the brain's endogenous chemical interactions can inevitably help scientists to develop medications that are more effective treatments for bipolar disorder (http://www.nimh.nih.gov/science-news/2007/genetic-roots-of-bipolar-disorder-revealed-by-first-genome-wide-study-of-illness.shtml).
So, you have an inkling that you may actually have one of the varieties of bipolar disorder, what now? Well, the truth is there are numerous ways to treat the disorder ranging from a number of effective medications, to family therapy, to the power of music. Yes, that's right, music. A man by the name of Christian Huygens is known for (amongst other things) the discovery of the concept of entrainment which simply means that there is a "tendency for two oscillating bodies to lock into phase so that they vibrate in harmony" (http://www.soundfeelings.com/products/alternative_medicine/music_therapy/entrainment.htm). Huygen's insights were initially applied to his discovery that when two clocks were placed on the same surface, their pendulums would, within a short period of time, become synchronized. This observation culminated in the idea of entrainment which can be applied to various areas of science, including biology where the "two bodies" alluded to above can be two pulsing heart cells that when brought together will pulse in synchrony; or two women who live in the same household will sometimes have concurrent menstrual cycles or rhythms. In nature, entrainment can be witnessed in the synchronous chirping of crickets or the mutual and simultaneous flashing of fireflies. Examples of entrainment can be witnessed in virtually every facet of our world and indeed humans are no exception to this rule.
The concept of rhythm comes into play here and fits in neatly with Huygen's theories. Human beings function in cooperation with a series of rhythms that are both physiological as well as psychological in nature, when those rhythms are out of sync we often experience problems ranging from simple moodiness to full blown pathologies like bipolar disorder. Circadian rhythms, or our 24-internal clocks which dictate when we should sleep and wake, are one excellent example of this phenomenon and research has shown that even simple organisms that lived billions of years ago had "fully functional Circadian clocks" (Menaker, M. (2002). Biological clocks at the end of the 20th century. In V. Kumar (Ed.), Biological rhythms (pp.1-4). Berlin: Springer-Verlag.) Circadian rhythms have much more complicated implications though to the welfare of the human organism including the balance of the endocrinal system and the mediation of body temperature. It follows then that when our Circadian rhythms are off beat, as a function of lack of sleep or other interruptions in our daily or nightly routines, other integral systems can also become maladjusted creating potentially disruptive pathologies and disorders like bipolarity.
Musical entrainment has many forms including the tendency for two or more musicians to synchronize rhythmically, or the idea that individual's every day movements like walking and running can become synchronized with the particular rhythms associated with their culture (ethno-musicology). More importantly for our discussion though is the tendency for brain waves to become synchronized or entrained to the rhythm of music and the potential for change in behavior as a result. Electroencephalograms or EEG's are the best tool that we have in measuring the amplitude of brain waves which also appear to exist in a rhythmic state as well . Countless studies have shown that lower amplitude Beta waves (14-30 Hz) tend to correspond to alert and active states of consciousness while Alpha waves with larger amplitudes tend to correlate with inactive, inattentive and relaxed states of consciousness. An early experiment done with EEG's discovered that brain waves themselves can actually be entrained and consequently synchronized to the frequency of a strobe light. Subjects exposed to the strobe reported feeling "...deep peacefulness, dream-like visions, and other unexpected sensations." (Walter, W.G. (1953). The living brain. New York:Norton). Later studies showed the relationship between particular rhythmic sounds and the same sort of relaxed states in the subjects, and a subsequent change in brain wave amplitude as well. This raises a series of questions the least of which is: what is the primary mechanism behind this change in brain waves and the accompanying change in sensation-feeling-emotion as well? Research is, as yet, unclear on the exact mechanism but studies to this day continue to show music's virtually unlimited potential to calm and even improve the conditions surrounding mental infirmities.
Many of these types of studies report very generalized findings though such as "the cause of change to the subject's EEG was due to the exposure of pleasurable stimuli" leaving the scientific community as well as the layperson to wonder if the study really has any significance to themselves or others suffering from a disorder. What then is "pleasurable stimuli?" One problem that hinders the application of generalized types of findings is the non-linear nature of human beings, at a behavioral as well as cellular level. Drug as well as therapeutic interventions are variable and need to be prescribed based on a number of factors including age, behavior, developmental level, gender as well as other factors of a subjective nature. One example of this is the use of stimulants to treat adolescents for Attention Deficit Disorders with the goal of calming the individual's behavior and helping them to focus. The same type of medication ingested in an adult patient could be ineffective or even dangerous. Because brain chemistry is markedly different from adolescent to adulthood and is in fact constantly dynamic and changing, different drug treatments will have different effects over time. Musical types of interventions will also have varying effects on different people and this is the primary reason why one person may be more likely to experience an improvement in their condition after listening to a Strauss Waltz in Eb while another might benefit more from the good 'ol twelve bar blues in E major. Further, a musical intervention will likely need to be tailor-made to the specific behavioral component demanding attention at that time and in the case of bipolar treatment, that could be a broad range of behaviors from deep depression to highly excited manic states. It's unlikely that one song, or particular type of music will re-mediate all of the symptoms of such a broad spectrum. According to some music therapists though, there are specific ways to match music with the individual's symptoms that are being targeted in an effective and palliative manner.
One study in 1998 delineated between three separate modes of musical entrainment with the goal of changing certain behaviors. They are as follows:
1. Primary Entrainment - "The music, or some attribute of it, is matched directly to the physical or cognitive behavior of the client. Once synchronized, modulation of the music causes change in those personal behaviors."
In other words, music is matched based on the particular behavior that the subject is exhibiting at the time: slower paced (for example) to depressive states; faster-paced to manic states, then the music is changed, modulated to effect a change in behavior. This is similar to EEG biofeedback (which we'll be discussing shortly) in that the subject begins with music, or sound that matches their current state, and is then gradually modified to a more natural state reflecting "normal" or comfortable states of being.
2. Secondary Entrainment - "The music is synchronized with the material, skill, or concept to be learned. Many of the mnemonic uses of music utilize this process."
This type of entrainment simply looks to match the type and/or quality of the music to the skills one desires to acquire. An example of this might be to play soothing music (Mozart?) while studying or attempting to learn relaxation strategies or anger management in the grips of a manic state.
3. Tertiary Entrainment - "The music is matched to the individual's functioning or preference level to cause a change in an unrelated behavior..."(Rider, M. S. and Eagle, C.T. (1986). Rhythmic entrainment as a mechanism for learning in music therapy. In J.R. Evans and M. Clynes (Eds.),Rhythm in psychological, linguistic, and musical processes. Springfield, IL, U.S.A.: C.C. Thomas.)
This type of entrainment is directed towards individuals having lower functioning skills such as those suffering from mental or behavioral defects (i.e. severe retardation, autism) and in an effort to break through to them on a therapeutic level.
One important note here is that entrainment is found to be most effective as a behavioral modification tool when the individual first synchronizes to music that matches their current state. This is an important point to recognize especially in lieu of the fact that many sufferers looking for solace from their symptoms may not experience any changes in their condition simply by listening to music. Primary entrainment addresses this element and is likely the most valuable level of entrainment in terms of treatment effectiveness and symptom modification in bipolar disorder.
Other types of interventions using sound and video seem to be helping individuals cope with the sometimes debilitating effects of bipolar disorder. EEG biofeedback training is one example of an intervention that has helped a number of people suffering from the disorder to live ordinary lives away from the shackles and often draining effects of medication.
Here's how it's done: an initial consultation is done with the clinician to establish health and family history, and the first EEG measurement is often done as well. Measurements are taken by placing sensors on the scalp as well as on each ear to establish "baseline" or brain wave patterns that seem to be normal for the individual. The biofeedback process itself is done in the same fashion although the patient is able to see the brain waves displayed on a video screen. The feedback appears in the form of a video game along with audio signals and the subject is asked to "make the video game go with his brain ."
(http://www.eegbiofeedback.cz/english/english.php?menu=faq). As brain wave activity corresponds with "desirable" wavelengths the game moves faster or rewards the subject in another way. As wave activity moves in less desirable rhythms the game slows. Eventually the brain alters, or entrains its overall wave activity and "learns" to resemble the desired patterns, patterns which more closely resemble EEG's of non-sufferers.
A study done in 1995 used EEG biofeedback training incorporating low beta wave frequencies (12-18 hertz) and tailor-making the frequencies to align with the particular state of the subject at the time of the biofeedback. The subject underwent treatment intensively to recover from acute depression but after a long series of treatments (over 100 in this case) the assessment of bipolarity was no longer applicable to the subject, and he no longer relies in Lithium for symptom alleviation. Keep in mind that the number of treatments that this particular subject underwent is not typical and symptom alleviation is usually achieved through significantly less exposure to the EEG biofeedback. (http://www.eegspectrum.com/Applications/Depression/EEGBipolarDisorder/)
Although there is no guarantee that EEG biofeedback will help to modify the negative effects of bipolar disorder, there is an enormous amount of evidence supporting the curative nature of the treatment and about 90% of subjects who undergo the process see some improvement in their symptoms. In fact, EEG biofeedback has been found to be effective in treating a number of disorders including ADHD, alcoholism, certain anxiety disorders, sleep disorders, depression, epilepsy, chronic headaches and may also lead to improved test performance for school-aged children.
Bipolar disorder can be a crippling and life-changing malady, but there's hope on the horizon for sufferers. Through the use of modern miracles like PET scans and genetic mapping, scientists can gain a better understanding of the chemical interplay that underlies the disorder and learn to treat the disorder more effectively. On other more holistic fronts is the application of concepts like entrainment which can teach us the power of becoming synchronized with the world around, as well as ourselves through the power of music and sound.