Calm Seas

Mental illness is an often negatively stygmatized, undertreated concern that impacts a huge part of our society. I have long felt that if we could remove the stigma and provide early intensive, high quality treatment, our country would have far less trouble from people suffering with mental illness. Calm Seas: Keys to the Successful Treatment of Bipolar Disorder by Roger Sparhawk, discusses one segment of this complex web of mental health. His book is almost bipolar in its nature. Some sections seem to target service providers, offering lots of research and best treatment ideas, where others seem to target patients and their advocates. It is written in a first person format, almost as a discussion with a peer. As such, parts of the book are easier to read than others. Case studies throughout the text showcase discussion points, but the manner in which they are included does not highlight their importance.

He highlights a few points. First is the importance of accurate diagnosis. Bipolar disorder responds very differently to interventions than unipolar depression, even though they share the affect of depression. He also notes that long term bipolar disorder's symptomology becomes increasingly similar to that of unipolar depression. Since there is usually a large gap between onset of symptoms and initiation of treatment, a thorough history is required to identify episodes of mania.

Second is the existence of sleep disturbances. People with untreated bipolar disorder have disruptive sleep patterns. In depressed times people sleep more than 10 hours a day and during manic times they sleep less than 5. Patients that present with sleep disturbances should be identified and interventions attempted. This could be adjusting medication times to be more at night so that they do not encourage daytime sleepiness, implementing good sleep hygiene, and/or adding sleep aid medications. When people have the correct amount of sleep they are significantly more likely to have better mental health.

Third is medication. Antidepressants help very few people with bipolar disorder. Older mood stabilizers have a far higher rate of successful results. These include lithium. People with a diagnosis of bipolar disorder should actively discuss medications with providers. Those unwilling to consider maintenance with mood stabilizers should raise a red flag.

Fourth is a concern about other tier one concerns: Organic brain syndrome, schizophrenia, substance abuse and severe anorexia. All tier one concerns need to be addressed in treatment if there is to be success. Since patients often self medicate mental health concerns with alcohol and other substances and often do not report use of illegal substances, careful consideration needs to be given to them. Comprehensive, multipronged therapy is effective whereas single issue therapy is doomed to failure.

Finally acknowledgement needs to be made that bipolar disorder is a life-long diagnosis. Monitoring and treatment need to continue for the long haul. Patients need to be aware that although they can be treated they cannot be cured. Comparing with a medical diagnosis like diabetes might be helpful. This book is an interesting read, but be prepared for lots of medicaleze intertwined with highly readable portions.