Psychology

Bipolar Disorder is a mental condition that affects both children and adults.  Bipolar Disorder is also co-morbid with other mental conditions that are depravities of and feed off oft the main diagnoses as well.  Some of these conditions are obsessive compulsive disorder, anxiety disorder, and Post Traumatic Stress Disorder. With these considerations taken into account, it is pertinent to know how an individual coping with Bipolar Disorder is able to function outside of a therapeutic setting.  This paper will examine the direct effects proposed by Bipolar Disorder and how it directly affects the personal life, social life, and environment life in conjunction of ones being able to perform in the workplace through the eyes of a mental health professional like a guidance therapist or a life coach.

CHAPTER 1
THESIS
Bipolar Disorder affects millions of Americans every year.  Bipolar Disorder is a mental disorder that affects the mental stability of a person with fulgurations of extreme excitability and feelings of grandiose or on the opposite end of the spectrum, feelings of extreme depression.  The onset of Bipolar Disorder can be early, as in children who are diagnosed with co-morbid conditions like Attention Deficient Hyperactivity Disorder (ADHD) or with Obsessive Compulsive Disorder (ODD).  In adults, Bipolar Disorder is often diagnosed with other disorders like ODD and generalized anxiety disorder. Bipolar disorder effects every facet of ones like including the personal life, the social life, and the workplace or school environment.
   
It is important to have a true understanding of what Bipolar Disorder actually is.  It is more than just periodic bouts of excitability or on the downside, periods of the blues.  Bipolar Disorder affects individuals suffer for irregular periods of mood activity predominantly focusing on the depressive state (American Psychiatric Association, 2003).  Most patients are treated with medications in order to level out the erratic moods, but this is a trial and error process.  Members of the psychiatric community have concluded that episodes of bipolar disorder are triggered by some underlying force or action (Belmaker, 2004).
   
For the purpose of this paper, the following case study will be used to reference specific items and reference and pertinent concepts and perspectives.

Case Study
Christine presents as a vibrant and otherwise healthy 24 year old woman.  She is not married, but has a young two-year old very active daughter.  Christine is not enrolled in school and admits
to having dropped out when she was in the 11th grade.  Her hobbies consist of watching television, sleeping, and hanging out at the local mall with her friends.  Her mother babysits her daughter whenever she needs a sitter.  Christine admits that she does not practice safe sex nor does she use any form of birth control.
   
Christine was raised by her father from the age of three.  Her mother and father were never married and her mother left the home due to domestic abuse sustained at the hands of Christines father.  A long and drawn out court battle ensued for custody over Christine and her younger sister, but due to lack of financial funds, her mother had to end the fight because she was financially depleted.  Over the past years, Christine tried to locate her mother, but her father informed her that her mother was dead.  When Christine reached the age of 11, she contacted the local Department of Social Services (DSS) to ask for help to find her mother.  She told DSS of her fathers drinking and drug use, and even told the social worker how her father made her perform sexual acts on his friends in exchange for her father getting his drugs for free.  Two years later, the DSS contacted Christines mother to inform her that the girls were in Child Protective Services custody.  Transportation arrangements were made to take the girls to their mothers home.  Christines mother made arrangements immediately for outpatient counseling for both of her daughters due to the anticipated trauma of the entire event.  Counseling continued with the girls for several months before any severe issues presented.  Christine began having
nightmares, refused to go to school, and became extremely withdrawn.  As a result Christines dreams continued to interfere with her sleep more and more to the point that Christine tried to
avoid sleeping at all.  In the end, Christine admitted that the dreams were of the sexual acts that her father made her perform on his friends.  Christine then became suicidal declaring over and
over that she wanted to die and she wished she was dead.  These statements prompted her mother to call the crisis worker on call.  The worker immediately came to her home and assessed Christine.  It was recommended that Christine be admitted to the hospital, and her mother agreed.          
   
After a three day stay in the hospital, Christine was released and put on Zoloft.  The Zoloft, as indicated by the doctor, would help her to sleep better and keep her dreams at a minimum.  His theory was correct, but only for a few days.  Less than a week post-hospitalization, Christine began having the dreams again.  The school had contacted Christines mother to let her know that she needed to come to the school right away.  Upon arriving at the school, Christines mother learned that Christine had been caught by a teacher stabbing herself repeatedly with a lead pencil.  When asked where Christine was, she was told that she was in the nurses office.  The school official wanted to know if she should call for an ambulance.  Christines mother said no, and added that she has enough problems already and does not need to be made a public spectacle of.  Christine was admitted to the adolescent psychiatric unit a second time.
   
During Christines second psychiatric admission, she was given several psychological tests including the MMPI-2, although this test is still questionable in the use of children and adolescents (American Psychiatric Association, 2002).  Christine was also evaluated through blood tests, EEGs and a strobe test. In conclusion, it was determined by the psychiatrist that Christine did have a mental disorder, bipolar disorder.  Her mother sat in disbelief.  Christine asked what bipolar disorder was.  The doctor explained that bipolar disorder is also called manic depression, but it means that the moods swing from being extremely excited, or manic, to being extremely low, or depressed.  The doctor further added that there are medications that can level these moods, but that is very important to continue taking the medications even if the patient feels fine.  Christine was put on Depekote, Zoloft, and Clonodine. Upon being discharged, Christine continued taking her medications, but then became combative and refused to take the medications.  She became physically combative with her younger sister and hit her in the head with an alarm clock.  Her younger sister called 911, unbeknownst to her mother, and soon the police were at the door.  When their mother tried explaining to the officers that Christine was on new medications for her bipolar condition, the officers immediately arrested Christine and informed her mother that she was a risk to herself and to the public.  Christine was detained under a mental hygiene warrant, meaning that she would be held in a psychiatric facility for 72 hours and would then appear before a judge for a final determination.  Christine was bound over pending the appearance before the judge, who then ordered that Christine be held for six months at Highland Springs Adolescent Psychiatric Hospital.  During her stay at Highland Springs, Christines behavior worsened to the point that she was ordered transferred to Fox Run Hospital (Safer, 2009).  Fox Run Hospital is a long-term treatment hospital for children and adolescents who have mental disorders, have been sexually abused, and are declared encourageable by a court.

CHAPTER 2
LITERATURE REVIEW
Personal Perspective
Bipolar disorder is a mental disorder that produces episodes of mania or depression.  The client suffering from this disorder does not have the ability to recognize the bizarre behavior nor do they have the ability to see that their bouts of depression are more serious than that of a normal person. The American Psychiatric Association (APA) specifies treatment for bipolar disorder depending on which form of bipolar disorder the patient suffers.  Bipolar Disorder suffer from either Bipolar Disorder I, characterized by periods of depression, Bipolar II, characterized by periods of mania, and Cyclothymiac Bipolar Disorder which is characterized by rapid cycling. Rapid cycling is often present in children and adolescents.  Rapid cycling is defined by being manic one minute and then depressive the next minute.  The brain is constantly on overload from either symptom of the disorder.
   
Medications used to treat bipolar disorder vary from person to person.  The classic medication used is Lithium, although this medication can be very dangerous if it is not monitored frequently through blood tests (Maj, Adiskal, Lopez,  Sartorius, 2003).  Too much Lithium in the blood can be toxic to the patient.  Today, other medications are proving to be very effective without the harmful side effects like that of Lithium.  Depekote, Cymbalta, and Serequel are just a few. These medications must still be monitored by a medical professional as they can cause other reactions such as hives, swelling of the hands, face, lips, and in some cases, they have been known to cause blood clots.

Social Perspective
With reverence to the bipolar condition as viewed in society, patients are under much scrutiny.  This stereotyping contributes to many patients not taking their medications (Spears,
1997). Clients already are told that they have a condition that they themselves cannot really see or understand.  Clients feel just fine and view themselves as being like everyone else.  It is a hard pill to swallow to see yourself as being different or ill, especially when you feel fine.  Clients have reported feeling indifferent when asked what the medication is for.  Some have reported lying about what the medication is for, or even telling someone that it is for a sinus infection rather than revealing the truth that it is a mood regulator.  Society has developed a stigma where psychiatric drugs are concerned (Kassin,Fein,  Markus, 2008)
   
Bipolar Disorder generally affects more women than it does men (Burn, 1996).  This correlation is also in conjunction with the number of adolescents and children who have been diagnosed with bipolar disorder as well. On average, women are diagnosed with bipolar disorder at a median age of 27.2 years of age and. men are generally diagnosed with bipolar disorder at a median age of 22.4 years of age (Maj, Akiskal, Lopez,  Sartorius, 2003).  Despite that latter onset of diagnosis in women, the symptoms are often present long before the diagnosis is made.  This is due in large part because women experience many mood swings during pre-menstrual syndrome (PMS), pregnancy, and general reactions to stressful situations.  It is charismatic of women to be more emotional than men therefore, the underlying bipolar condition may be ignored until a life threatening situation or suicidal tendencies present (Healy, 2006).  Symptoms of bipolar disorder often present by irrational displays of depression combined with intermittent periods of mania. Both men and women will verbalize suicidal ideations due to one reason or  another, but those that intend on following through with the suicidal threats will ultimately not verbalize their intentions to anyone other than through a journal, letter, or suicide note (Belmaker, 2006).

Environmental Perspective
Environmental and workplace conditions play both a positive and negative part in the bipolar disorder behaviors.  Environmental, workplace, and academic settings can create stressors that create bipolar disorder episode breakthroughs despite medication regimens designed to level the patients moods.   Individuals in society that are unaware of ones mental status may trigger an episode by repeating rumors or by poking fun at one having been hospitalized in order to stabilize an episode of bipolar disorder.  This pertains to the manic part of bipolar disorder in most cases. Manic episodes can cause a patient to become violent not to mention displaying behaviors that are not normally characteristic of the patients normal behavior.  Patients in a manic episode have been known to engage in criminal behavior such as incredible spending resulting, writing bad checks, and theft (Aaronson, Wilson,  Akert, 2002).      
The environmental influence often intermingles with the social perspective in that peer influence is more prominent in one who is currently suffering from a manic episode of bipolar disorder.  Bipolar disorder does not seem to produce erratic behaviors in one who is clinically depressed as a result of bipolar disorder.    The depressive side of bipolar disorder makes the individual more apt to sleep or just simply not have any energy required to be active in any way.  The patient may not even take note of their own personal hygiene.  Certain other medical factors may interfere in the treatment of bipolar disorder.  It is common for patients with bipolar disorder to be treated with mood regulators like Depekote and others, but these medications are usually prescribed with antidepressants like Zoloft, imipremine, desprimine, and others however, when a patient has a medical condition like hemiplegic migraines, the treatment course of antidepressants cannot be used because these medications will produce a migraine in the patient that could become life0threatening (Personal communication, January 14, 2010).  Other physical conditions like high blood pressure, cardiac conditions, diabetes, and autoimmune disorders may also alter the regimens of medications used to treat the bipolar condition in the patient.  Each patients medication regimen must be altered to fit the psychological needs of the patient, but the physical medical conditions must be taken into consideration as well (Gilbert, Fiske,  Lindzey, 1998).  
   
Other environmental factors that are rarely mentioned have to do with allergies.  Certain allergies to things like dust, pollens, trees, foods, and chemicals may have a significant factor in the diagnosis of bipolar disorder.  If a patient is suffering from an allergen, then their behavior and demeanor may be different during the initial assessment phase of testing and may produce a result that is inaccurate due to the variable of an allergen being present.  These factors must be taken into account before an assessment is performed in order for the accuracy to be confirmed (Healy, 2006).

CHAPTER 3
DISCUSSION
Anyone who has been diagnosed with Bipolar Disorder must expect some changes to their entire life in the areas of personal life, environmental life, social life, and workplace environment.  In relation to the personal life, there are adjustments that have to be made in the aspect of the patient remembering to take their medications on a regular basis.  These medications are a must and a major part of treatment.  Some patients may go into a period of denial and feel that they do not need the medications and will quit taking them altogether.  This is a dangerous decision as some medications cannot be stopped at once, instead, they must be tapered off of the medication otherwise the physical body will go into shock from the level of medication taking such a dramatic drop (Safer, 2009).  A patient may suffer convulsions, heart palpitations, irregularities in blood pressure, and possibly a stroke or death.  The medications used to treat bipolar disorder are designed to synthetically replace chemicals in the brain that are not produced properly or are non-existent.  Patients may also experience depressive stages where personal hygiene goes ignored for days or weeks at a time, housework becomes irrelevant, and the patient will ultimately quit a job.  The depression takes over every aspect of their life.
   
Family intervention is the only means for seeking treatment for the patient at this stage, if family is involved in the patients life.  Family members, including spouses, parents, and even adult children, will step in and take over the household chores of cleaning and doing laundry.  The patient may appear to have no appetite, refuse to take medications, or pretend to take the medications and then flush them down the toilet later.  Family members functioning as caregivers often feel overwhelmed but obligated to care for their ill family member.  They offer the excuse that the patient, family member, cannot help that they are like this, or that this is just part of the illness.  Only part of this is true.  It is true that the family member cannot help having the illness, but it is the patients responsibility to do their part to combat and keep the illness under control.  Caregivers often times sacrifice their own health and well-being as a result of caring for a mentally ill family member who would benefit more from a hospitalization.
   
The Social Perspective as it relates to bipolar disorder is equally important in a patient with bipolar disorder.  A patient may have a good level of self-esteem, but through the duration of treatment, the same patient may develop a lower sense of self-esteem as they begin to see themselves as different.  They may feel that there is a tattoo accros their forehead reading bipolar.  Their inner self-esteem and inner view of their self may change and create depressive conducive feelings related to the diagnosis of bipolar disorder.  While it is natural for a patient to go through periods of understanding and coming to terms with their illness longer onsets of this depressive phase can be detrimental to their overall treatment.  It is most important that a patient be involved with a cognitive behavioral therapy, a group therapy, or a client-entered therapy.  Therapy is vital for bipolar patients.  Group therapy is highly recommended for a patient with bipolar disorder as it would allow the patient to hear from others what they have experienced.  Sharing obstacles, triumphs, new medications, and good experiences may offer hopes to patients attending who have been recently diagnosed and feel caught in a fog of confusion.

Critique
Every patient deals with Bipolar Disorder in a different way.  There are different levels of Bipolar Disorder.  Some bipolar patients are high-functioning while others find it difficult to function at all.  High functioning bipolar disorder patients take their medications regularly, go to work every day, have families, and no one would ever be the wiser to their mental disorder.  Their periods of mania or depression are mild at best.  The periods of mania are characterized by sudden bursts of energy needed to clean, mop, or do laundry.  Then as soon as the work is completed, they are satisfied and continue doing other things like watching a television program or reading a book.  Their periods of depression are characterized by rare episodes of crying.  This may happen if something hurtful is said to them or when trying to balance a checkbook or work on yearly taxes.  These episodes of mania and depression are not really out of the ordinary, but are still indicators of their form of bipolar disorder.
   
Not every episode is a full blown manic or depressive one.  Not every person with bipolar disorder goes into mania by talking unstoppably or by irrational thoughts that run into one another.  This is conclusive with bouts of depression as well.  Not every depressed person lies in bed for days on end in a catatonic state, staring blankly into thin air, watching re-runs of Jerry Springer.  Depression can be an internal feeling that is not outwardly expressed.  Many people with bipolar disorder have learned how to develop a personality for work and one for home.  At work, bipolar patients often pretend that everything is alright so that no one will be suspecting of a problem, but when the patient goes home, they let it all go and act however they fell.  This is not to say that the patient has a multiple personality condition, but rather to suggest that the work-face and the home-face are simply acts to fit the part being played at the time.   In other words, it is a coping mechanism of sorts designed to protect their job.
   
Society has attached such a stigma and stereotype with the words mental disorder, that it is often times uneasy to discuss it with peers, members of the medical profession, and most of all in the workplace.  Mental illness and mental disorders are views by society as a taboo.  It signifies that there is something critically wrong with someones brain and creates the stigma that the patient is insane, crazy, or on the verge of a mental break that coud end up in a massive homicide.  Most of this is due to made for television movies and the way that the media portrays serial killers or wanted criminals.  One of the first things mentioned in the profile of these criminals is their mental conditions like schizophrenia, bipolar disorder, antisocial personality, and the like.  Society has not respect for the human behind the illness, when in fact it should be the mental illness behind the person.

Parallels
There are many commonalities between the research performed on bipolar disorder with relation to the workplace, academic settings, personal, and social life and how the individual with bipolar disorder truly functions.  A person with bipolar disorder is just like anyone else except that certain chemicals are either overproduced or not produced enough.  A bipolar person does not just get excited, but rather they usually get overly excited and go over the top with their emotions.  The same is true for feelings of depression.  A bipolar person with depression becomes extremely depressed.  Depressive episodes can last for days, weeks, and even months without intervention from a mental health professional.  From a personal perspective, an individual wants to be treated just like everyone else and not looked at differently.  This does not sound like much, but once their personal information has been revealed, they feel ostracized and like they are the oddball out.  This feeling is normal in the fact that everyone has experienced this feeling at one point or another in their life.  Some things are better left kept private unless the patient feels comfortable revealing the information.
   
The personal and social perspectives intermingle for the most part as far as parallels are concerned.  Society does offer empathy to patients with bipolar disorder in the respect that it is acknowledged that it cannot be cured.  It is also understandable that there are medications and research constantly being performed to better a patients ability to cope and function within society.  It is estimated that 25 of society has undiagnosed bipolar depressive conditions (Maj, Adiskal, Lopez,  Sartouius, 2003).  The most common diagnosis for Bipolar Disorder is Bipolar II, which is characterized by depressive moods, but it is the most difficult to treat because of its unpredictability (Safer, 2009).
   
The environmental perspectives are most parallel with everything stated within this paper insofar that medications are a normal regimen of treatment coupled with therapies. However, it has been stressed repeatedly the importance of the patient continuing to take the prescribed medications on a daily basis in order to keep the synthetic chemical in the bloodstream in order to regulate the mental mood.  Without the medication or with intermittent ingestion of the medication, the full effects and benefits of the medications will not be achieved and the treatment will be unsuccessful.  Hospitalizations will be repeated over and over to stabilize the patients mood, but upon release, if the patient is unwilling to continue the medication regimens, the treatment will fail again.    The psychiatric nurse in a clinical setting plays an important role in the treatment of a patient with a mental disorder as he or she has the opportunity to observe the patient in a controlled environment, the hospital (Shives, 2008).  He or she can offer the treating psychiatrist suggestions and explain observations that have been made in reference to behavior changes or aggressive behaviors observed. This information is pertinent for a doctor to know as they play a key part as to what medications should be stopped or what medications should be added in order to keep the patients mood regulated.  Organic medications can have a devastating effect when used with prescription medications.  Some organic medications are not meant for ingestions and can produce symptoms similar to that of bipolar disorder, but they can also produce hallucinations and aggressive behaviors.  Much research is still being done on organic substances and their purpose in the psychiatric community, but so far, none have been approved for treatment of bipolar disorder.
     
The personal, social, and environmental perspectives all work conjunctively together to form a biopsychosocial diagnosis of a patient with bipolar disorder.  Everything must be taken into account from the physicalhealth background, the psychological background, and the social perspective past and present. This new form of diagnosing is proving to be most helpful for patients receiving any treatment, whether it be medical, psychological, or social psychology.

For someone entering the profession of a guidance counselor or a life coach, it is most important to know exactly with whom they are encountering.  Their past in many perspectives plays a huge part of how they should presently be treated as it would be easier to focus on what treatments in the past have failed and why they have failed.  A guidance counselor and a life coach bear the responsibility of helping someone to develop new skills for coping and making decisions in their lives.  Guidance counselors should always focus on a client-centered therapy and allow the client to feel some sense of control, but this should also be coupled with the use of cognitive behavioral therapy as teaching the client how to rethink a situation or to re-evaluate why they had the feelings experienced during a specific incident may offer some insight and shed a new light on the issue.  These are essential techniques to possess as a guidance counselor or a life coach in order to be successful in their craft.

CHAPTER 4
DISCUSSION
This paper focused on the personal, social, and environmental perspective aspects of Bipolar disorder and how the illness affected each facet of the person.  The case study mentioned in the introduction of the paper discussed an young woman named, Christine, who had been diagnosed with bipolar as a young teenage child.  Through different areas of her life, she was medicated and then others where she refused to take her medications at all.  In the aftermath of not being medicated, she ended up paying a very high price.  She ended up pregnant by someone who wanted no part of her, her father ultimately kicked her out of the house, and she went to her mother.  Immediately following the birth of the baby, the attending obstetrician had a psych consult done at the hospital since some women who give birth and are diagnosed with bipolar, have a higher tendency to develop post partum depression.  Christine seemed to be okay at the time.  Several days later, Christines mother took her to the local mental health facility for an evaluation due to the fact that Christine was going ballistic over the color of the nipple ring on the bottle that her mother had used.  Christine insisted that on Tuesday, the blue nipple rings were supposed to be used and no other color.  Christines mother feared that something else was going on and convinced Christine to go see the counselor and at least talk to them.  It was determined that Christine did in fact have bipolar disorder, but that she was now dealing with obsessive compulsive disorder and generalized anxiety disorder.  Christine was hospitalized for a period of eight months, and then transferred to a long-term care facility, all of which she was willing to go and did not have to be involuntarily committed.

The effects of the bipolar disorder illness, at least in Christines case, made school unbearable.  She could not sit still in her classes and always felt that someone was talking about her.  She had been engaged in more than one physical altercation with other students, suspended on several occasions, and was expelled once.  Christine did not seem to care nor did she seem interested in getting her GED.  From a social perspective, it was odd to observe that Christine did not seem to have the natural instinct that most mothers have with their babies.  Christine treated her baby like it was just in the way.
     
The environmental factors, which did include medication, also included environmental influences on her life.  Her only influences came from the television or her poor choices in friends.  None had any goals in life other than getting drunk or staying high.  Berar in mind that these behaviors were much encouraged by her father as he was an alcoholic and a drug addict himself, and misery loves company.  Children apparently do learn what they live because she has fit into his shoes perfectly.
     
A community should take a more active role insofar as checking on one another.  Mental illness affects more people than originally thought.  Children and adults alike are striving to make recoveries from bipolar disorder, but without community support, it is a difficult task to be overcome.  While medications and therapy are the psychiatric norm for treating bipolar disorder, it is necessary to incorporate the community as part of the recovery process.  A simple phone call, dropping by for a visit, saying hello in a grocery store can do a lot more for a person than just a sixty-minute session with a therapist.  A workplace is another place to offer support.  Employers can discuss privately with an employee the understanding of the illness and express the companys support by offering to allow the employee days or times off for appointments if needed.  Although this is just common courtesy, but an employee might be fearful to ask for time in lieu of being fired. Bipolar Disorder affects the personal life, the social life, and the workplaceacademic life of anyone who has been diagnosed with the mental disorder.