Stigma makes disease worse

One day, when I was in the fifth grade, my mother - a decorous Irish Catholic - drew clown lips around her mouth with lipstick, took off her clothes, and wandered gibbering through the house. She smashed eggs on the kitchen floor, dumped flour and sugar on the goo, and splashed the counters with ketchup. My father came home, wrapped a coat around her, and bundled her off in the station wagon.

I didn't see her again for a month. I knew then why she'd vanished and reappeared before without explanation. We didn't speak of it, even within the family. It was a matter of shame.

That was my introduction to mood disorders, a group of brain malfunctions that have come out of the shadows again with the recent death of Robin Williams.

I gained an even closer acquaintance with bipolar disorder in the ninth grade, with the onset of adolescence. At night, about the time most people fall asleep, my brain would start revving like a Dodge Charger at a stoplight. My thoughts would make fast, acrobatic associative leaps. I might think of the color green and wind up contemplating the galaxy's lack of green stars. I'd think of mold, maybe, then frog legs, batteries, sparks, the odds of going to hell, how much I hated the Monkees, and on and on.

It was a fireworks show, and I was a captive spectator. I had to watch until my brain ran out of pyrotechnics, maybe at 2:30 on a bad night. The alarm rang at 6:30. I did a lot of yawning through my classes.

Manic depression - what Mom's bipolar illness used to be called - comes embedded in the genes. Her case was awful; as she got worse, she wound up in psychiatric hospitals once or twice a year. I was spared her psychoses. My version of bipolar disorder consists of mild to moderate depressions alternating with spells of "hypomania," an elated mood a couple notches short of mania.

Chronic insomnia and fatigue have been the worst of it. "Exhaustion combined with sleeplessness is a rare torture," wrote the novelist William Styron of his own depression. To this day, I need weapons-grade sleep meds to shut down my racing thoughts at bedtime, and even those don't always work. Much of the time, I have the curious sensation of wrestling with my own brain. Like most people with this sort of condition, I'm good at keeping it hidden.

Williams at one point denied suffering from either bipolar or depressive disorder. A lot of people have their doubts. On Mork and Mindy and in movies like Good Morning Vietnam, his machine-gun bursts of brilliant, instantaneous improvisation - and the wild joy in his eyes - looked like the quintessence of hypomania, mated with comic genius.

If this was hypomania, he may not have considered it a disorder. Many don't. In that groove, you can be prodigiously productive and imaginative, and the last thing you feel like is sick. Williams might also have wanted to avoid the stigma of the "bipolar" label, a term that covers a broad spectrum of conditions, some as concealable as my own, some as florid as my mother's.

The stigma is perpetuated by the way the term is thrown around so loosely these days. It's especially annoying that some people with explosive tempers proclaim themselves bipolar - usually without diagnosis - as if that were an all-purpose excuse for mistreating others.

Williams did suffer from depression, though he preferred to call it "bummed out." (Fear of stigma?) His suicide is evidence of a fall into the abyss.

Years ago, I suffered a bout of catastrophic depression. It is anguish almost impossible to explain. People who've never been through it say things like, "Cheer up" or "Go for a walk - you'll feel better." They equate it with one of their own down moods. The most clueless talk as if it's a character defect, a willful refusal to accept life's gifts.

People who have endured severe depression don't offer glib answers. They might say, "I know a good doctor." Or, "Cognitive therapy sometimes helps." Or, "I know it's hard to believe, but it's going to lift at some point." Or, "Don't make any big decisions right now."

Catastrophic depression is often fatal. Death comes in the form of suicide. Some sufferers kill themselves because the disorder itself prevents them from seeing an end to the pain. You stare at the wall or out a window for hours in a bleak trance. You feel 40 years older. Colors are washed out; nature is reduced to shades of twilight, gray and darkness.

You are certain you deserve the shame and the stigma. You feel exhausted, which means you are lazy. You dread taking your morning shower; it's an intimidating, monumental undertaking. You're a burden. Your loved ones would be better off without you. Nothing can change, because that's how the world is. You are merely waiting for your life to end.

Ultimately - if you hang on - things do change for the better. In some cases, even with good treatment, it takes months.

The key scientific insight into mood disorders is that they are driven by electrochemistry. The brain is an electrical organ. When moods go haywire, it's because the brain's neurotransmitters aren't firing enough or are firing too much. In Mom's case that day, they were firing way too much.

Sometimes the imbalances are triggered by something obvious: change of season, nightfall, extreme stress, childhood abuse. Often the cause is as mysterious as the weather. Regardless, this is largely a physical condition. It's not a moral state or a chosen frame of mind.

The brain is an organ of the body, just like a kidney or leg. If we knew a runner who had fractured his leg, we'd help him get professional care. We wouldn't urge him to fix it by running harder. We wouldn't stigmatize him, isolate him, or dehumanize him with labels like "crazy" or "head case."

Nor would society consign his fracture to an insurance ghetto deserving of less coverage than non-leg injuries. If he couldn't get his fracture fixed because he was poor, we'd scream bloody murder.

Yet much of society tolerates all that when the fracture lies in the brain. Robin Williams has put a face on these illnesses. How many successful celebrities must commit suicide before we recognize that marginalizing ordinary people with brain illnesses is a practice as medieval as burning witches?

ocallahan@thenewstribune.com