Psychology

Putting puzzles together is a pastime of an acquired taste. Some people enjoy the complex nature of figuring out what pieces should be connected with others in order to get the full, beautiful picture.  For many individuals, family members, and medical personnel, solving the puzzle connected with the ailments of mental disease is an on-going reality, and, at times, it can be difficult to see any beautiful picture in sight. In 72 Hour Hold by Bebe Moore Campbell, Trina, an eighteen-year-old, African-American young woman, is diagnosed with bipolar disorder. Keri, Trinas mother, tells a realistic account of the symptoms, treatments, and changes in their lives after the introduction of this disorder. There are specific things that can be done to avoid the dreaded 72 hour hold, but knowing them and affording them has proven to be another lost piece to the puzzle for many.

Trina is young, beautiful, confident, and bipolar. Her mother did not see the signs in the beginning, but they soon clearly manifested themselves as Trina progressively lost control of her moods. Keri was in a stage of denial at first as she believed that the reason Trina talks so fast is because she is excitable, emotional, and the reason she couldnt sleep at night was because she was so wound up from studying (Campbell, 2006). (24) Beyond these signs other symptoms persisted, such as, the loss of friends, the excessive speeding tickets, and the out-of- character outbursts (Campbell, 2006). (24) Throughout the entire novel, there are numerous symptoms displayed that directly connect Trinas behavior with category II, mood disorder (Dziegielewski, 2002), primarily because of her disturbance in mood (Dziegielewski, 2002). She goes through frequent mood episodes that occur during the same time period (Otto, Reilly-Harrington, Knauz, Henin, Kogan, Sachs, 2008). Keri remembers a particular night in August when Trina seemed to be floating on a jet stream of hallucinatory energy that punctuated her every word (Campbell, 2006) (26). Later on, that same night she woke to Trinas footsteps, kitchen cabinet doors slamming shut, music playing in her room, and television voices that were way too loud around 3 AM (Campbell, 2006) (26). These are all symptoms of mania.

Most people consider mania as simply extra energy however, mania is a serious condition that is diagnosed when a person experiences several symptoms associated with an elevated or high mood that go beyond what most people experience (Otto et al., 2008). For the most part, people do not encounter the floating on air feeling that Trina was experiencing. Some of the distinct symptoms with mania include increased energy, racing thoughts, inflated self-esteem, a decreased need for sleep, abnormal irritability, extreme happiness, poor judgment, and over participation in risky activities (Otto et al., 2008). After a heated argument, Trina was in her room for hours, then they heard the clicking of high heels on the stairs, and Trina appeared along with the odor of way too much perfume (Campbell, 2006) (24). Beyond the overbearing smell of her perfume, she was wearing a micromini red leather skirt, a transparent white blouse, and, underneath, a black bra (Campbell, 2006). Trinas behavior was quickly spiraling out of control. The concern is, what shows atypical behavior from normal teen rebellion

For proper diagnosis, there are symptoms that must be present during a period of at least one week to be considered mania (Otto et al., 2008). Just given the descriptions of her persona during this short time frame, it is clear that severe moments of mania were beginning to take over Trinas life. For the diagnosis of bipolar disorder there are other symptoms that present themselves as well. Hypomania refers to a clearly abnormal mood state with mild to severe symptoms of mania that may last for at least a few days or may persist for many months (Otto, et al., 2008). Although, they are similar, hypomania is not to be confused with manic state. Hypomania typically lasts for at least four days with high, happy, euphoric, expansive, irritable behavior and being easily distractible, risk-taking, and racing thoughts (Otto et al., 2008). Within an extremely short time frame, Trina experienced mood episodes connected with both of these symptoms. On the opposite side of this ranging mood disorder are moments of severe depression with periods of low, sad, and disinterested moods lasting at least 2 weeks (Otto et al., 2008). The depression stage also causes sleep disturbance, diminished interest, low self-esteem, decreased energy, appetite loss, psychomotor retardation, and suicidal ideation (Otto et al., 2008). Trina demonstrates this severe side as she stays up many nights and at some points yells out that she wishes she were dead to a group of men (Campbell, 2006).

Generally, a common symptom of a mood disorder is related to feelings of depression, but there are additional mood episodes that extend far beyond most individuals definition of depression. These episodes are not just linked with feeling sad, blue, or down in the dumps these patterns reflect consistent patterns, signs, and symptoms such as manic, hypomanic, major depressive, or mixed episodes (Dziegielewski, 2002). Before this latest storm Keri notices some signs, yet again, that lead to other symptoms that affect her daughter. During the quiet before the storm, Trina started talking in a baby voice that kept reoccurring. Then, when they went to get flowers Trina vanished. After Keri searched frantically for her she spotted her talking to an unknown, mentally challenged man. Trina says, See you later, and shoved her hand inside her pocket. It was a movement that didnt register until later, when every detail mattered (Campbell, 2006) .

Diagnosis of symptoms can be extremely difficult, but it can be an exceptionally daunting task while treating someone with multiple symptoms. Research suggests youth with bipolar disorder often have other disorders as well (Otto, et al., 2008). At first, most of the treatment provided to Trina dealt with one of her demons, bipolar disorder. Keri accounts the first time it is confirmed that something is wrong with her daughter. At UCLA, a Russian doctor tells her, your daughter is bipolar (Campbell, 2006) (24). Keri notices that the statement is definitive. The doctor does not say your daughter has bipolar disorder (25), and she does not every remember anyone saying you are cancer, you are AIDS (Campbell, 2006) (25). By the end of the novel, though, Trina is bipolar, and also deals with paranoia and drug addiction. Many mentally ill patients sing duets more often than solos where they harmonized with self-medication that temporarily hit their notes (Campbell, 2006) (51). The feelings that come with medication can vary from patient to patient therefore, many patients turn to self-medicating themselves which leads to more episodes.

There are several different supports available in the Los Angeles area, but in Keris neighborhood, there is a lack of support for mental illness treatment and awareness. Throughout the novel, there are a number of different support groups mentioned. These support groups all focus on various concerns, but they generally act as a meeting place to share frustrations, feelings, and, at times, new treatments. Trina is a part of the Weitz Center at Beth Isreal Hospital which is renowned for innovative patient care and VIP rooms (Campbell, 2006). Keri soon realizes that the thoughts she once held about hospitals being places to mend bodies is now just a constant reminder of the broken mind that rampaged through her life (Campbell, 2006). The program at this facility is a partial program, outpatient therapy for people with psychiatric disorders (Campbell, 2006). With all the help available, Trina kept relapsing. She had five hospitalizations within two years. She was then introduced to a dual program for people with mental illnesses and addictions (Campbell, 2006) (273).  The social circuit provides two things for family members. On one hand, it is a place to build friendships, but on the other hand it is a breeding ground for the frustrations that the family members are experiencing. Keri and some of the other mothers critique the system as they share a meal after a support group meeting. They wittingly say, some day support groups will replace family (Campbell, 2006) (52). With all the support, there are still concerns with their children relapsing and the cost for treatment. One of the mothers says that she is glad her daughter is locked up in jail because it is less expensive than A Caring Place (Campbell, 2006) (52). She is still paying off the six thousand dollars for a four week stay covering room and board, group sessions, private counseling, and family counseling (Campbell, 2006) (52). The disappointing part is that the insurance company is only paying half, and it took about twenty phone calls and I dont know how many letters to get them to pay anything she adds out of frustration (Campbell, 2006) (52). The psychosocial measure introduced through the characters experience all lead to a relapse with most of the patients. By the end of the novel, Keris family of mothers in support groups come together and create a new type of group at Crenshaw Baptist Church. This program is activities based with some meetings with sharing, but most meeting focused on life skill enhancements and creative outlets, such as writing and performing plays with one of their activities (Campbell, 2006) (314). This is the best resource for Trina and others because it allows them to see that there is life after being diagnosed with bipolar disorder.

Some of the psychopharmacological treatments provided for Trina were provided to try to stabilize her mood. The first doctor prescribed a mood stabilizer and an antipsychotic (Campbell, 2006) (30) (289). However, this physician did not try to provide any other alternatives for treatment. She reached for the small bottle of pink pills that was between the salt and pepper shakers. She took out one, placed it carefully in her mouth, and swallowed it with the hot liquid. For the last three months, I hadnt had to remind her (Campbell, 2006) (6).  While on the medication, Trina is able to function in society, and although less is known about the effects of these medications in youth, research suggests that they can be very helpful in reducing mood symptoms (Otto et al., 2008). Keeping her on the medication was the main task for Keri. Finally, after being hospitalized at Light House for a few months, the psychiatrist stopped her old medications and introduced two new ones, slowly titrating the dosage until it reached optimal therapeutic level (Campbell, 2006) (316).

Similar to what happened with Trina, current treatment for bipolar disorder is  characterized as polypharmacy, even in the best treatment centers a patients typically receive three or more psychotropic agents (El-Mallakh, R. and Ghaemi, S., 2006). However, there is a desperate need for alternative options. With the current state of affairs new approaches in the treatment of bipolar disorders are needed (El-Mallakh, R. and Ghaemi, S., 2006). Given the time period these patients spend in the depressive phase, new modes and novel approaches to treatment are especially necessary for lifelong benefits (El-Mallakh, R. and Ghaemi, S., 2006).  In some cases, it has been suggested that typical antipsychotic increase the severity of depression or the number of depressive episodes in long-term maintenance treatment of bipolar patients (El-Mallakh, R. and Ghaemi, S., 2006).

In recent years, there are novel approaches being tested to treat bipolar disorder in  ways that are not psychopharmacological. Electroconvulsive therapy (ECT) is an effective treatment for bipolar depression. However, these authors reported that 39 of their patients developed mania while treated with ECT (El-Mallakh  Ghaemi, S., 2006). There is also, Transcranial Magnetic Stimulation (TMS) which is being studied as a novel method of stimulating brain neurons in conscious humans(El-Mallakh  Ghaemi, S., 2006). With this therapy, it is proposed that stimulation over areas of the brain such as the prefrontal cortex might lead to emotional changes of possible therapeutic value in psychiatry  however, there are not enough completed studies to demonstrate the direct effects on bipolar disorder (El-Mallakh  Ghaemi, S., 2006). Within the psychosocial realm other therapies have arisen. For example, Vagus Nerve Stimulation (VNS) is an interesting procedure in which a pacemaker-like device is attached to an electrode that wraps around the left vagus in the lower neck and there is periodic stimulation of the vagus which alters functional activity in multiple regions of the brain (El-Mallakh  Ghaemi, S., 2006). In a single study of 30 patients with bipolar disorder, patients who never received ECT were four times more likely to respond with VNS. Leading researchers to the conclusion that VNS appears to be most effective in patients with low to moderate, but not extreme, antidepressant resistance(El-Mallakh  Ghaemi, S., 2006).

For younger adolescents another psychosocial therapy introduced in recent years is cognitive behavior therapy (CBT) to target distorted thinking patterns, develop coping skills, address anxiety, and improve social skills in order to decrease high-risk behaviors such as alcohol or substance use and abuse (Otto et al., 2008).  If the symptoms were seen earlier, it is a possibility Trina would have less hospitalizations and holding periods in the years covered by the novel.

Although there is a need to understand specific triggers for these mental defects, there is no distinctive cause for bipolar disorder. Dr. Ustinov, in the novel, tells Keri that there is no rhyme or reason for the development of bipolar disorder, but sometimes there are triggers such as drugs, alcohol, or a traumatic event (Campbell, 2006) (29). The best understanding from studies suggests that there is a certain genetic precursor that some individuals hold to make them more prone to such mental disorders.  Keris mom comes back into her life near the end of the novel and talks about her demons with Trina. She says that she has to make sure she takes her medication as well. Possibly, a traumatic event such as her father leaving could have triggered this within Trina or the death of her brother, but there are limited studies to definitively show causes for bipolar disorder directly linked with traumatic experiences.

Culture plays a large role in mental illness. Throughout the entire novel, there is an explicit view of the denial and lack of resources available in her community. Mania has often been negatively associated with the irrational, out-of-control, overly emotional, racially marked, nonwhite person, yet  there is little acknowledgement of mental illness in certain communities. Mental illness had a low priority on my side of the city, along with the color cast and the spread of AIDS (Campbell, 2006) (49). The lesson in the novel, though, shows that mental illness can touch anyones life. The people in the varying support groups had different family structures, socioeconomic backgrounds, education backgrounds, and ethnicities. Although, one of the major critiques in the book is that people living in certain parts of the Los Angeles area had to travel far to get the support needed. However, the characters took action at the end and assisted with creating a program that is not only closer to the community, but one that focuses on the specific needs of their community. Instead of becoming an addict on the street, they created a special group to help their mental ill community members to succeed in life.

Words have power. They have the power to entertain, to explain, and to educate. 72 Hour Hold is a gripping novel that holds the power to entertain while also educating the public about mental illness. Especially in the African American community, there are extreme misconceptions, and, at times denial about mental illness. The clever diction used allows readers to understand the thought processes of people dealing with mental illness either directly or indirectly. Campbell provides a much needed critique of the treatment options affecting patients and their families. Many people dealing with these disorders and their families come to a point when they feel completely out of options. Through the honest characterization of Keri, Trina, Curtis, and other families affected by these same kind of ailments, readers begin to understand that some sort of change is needed in order to provide the care that is required to help these people live a productive lives with bipolar disorder.

One of the main biases that any professional has to deal with are expectations. This is a challenging disease that deals with the unparallel universe of the brain and there are many possible treatments available however, the main need is for individualized care. A bias that many professionals hold is that if one treatment worked for one individual, it will automatically work for someone else. Also, for someone like Trina that is still young, there is a common feeling that those patients need to catch up with life agendas that have been disrupted (Otto et al, 2008). However, this approach just adds to more stress that can trigger feelings of defeat. It is important to constantly remember that a person experiences life, and life events can always take a linear, planned life and make it more unexpected, more curvilinear, more like a zigzagged course toward goals (Otto et al., 2008). This is an important concept for professionals to keep in mind as adolescence dealing with bipolar disorder are requesting more guidance to help them achieve their goals. Additional biases to keep in mind centers around categorizing people. One of the most intriguing aspects of 72 Hour Hold is that it focuses on middle-class African American family. It is important to ensure that any thoughts of black or white or any other categories are not connected with the treatment options introduced to families. One way to decrease this bias is to have each patient create a personal portfolio of their dreams, thoughts, moods, and aspiration. This way they will be connected with their goals rather than their categorization.

Despite her obvious afflictions, Trina has many positive traits. At the end of the novel, Trina is able to put her acting skills to the test. She focused her energy on something positive. Also, prior to the storm, Trina was planning to attend Brown University. Once she gets her medications completely stabilized, she can still pursue her academic career at that university. She is a part of a new activities-based support group, which will help her better focus on her future and all the things she can still accomplish.

Bipolar disorder is not a death sentence. It is an extremely complicated puzzle that require time, research, and patience in order to solve however, once the pieces to that puzzle start coming together, a beautiful life can be continued. In 72 Hour Hold, Bebe Moore Campbell cleverly educates a global community about mental illness and ways to get the proper treatment. The puzzle given to Keri and Trina might have been difficult, but with the proper education and intervention methods, there still can be a beautiful picture even with bipolar disorder. There need to be more aspects of individualized treatment to ensure that the proper treatment is being provided for all patients.