In the mood

Manic depression is touching my soul.

It is a peculiarity of the modern American temperament that spiritual and mental health, no less than shoe styles or skirt lengths, are subject to fashions and fads.

So it seems with bipolar mood disorder, which lately appears to pervade popular culture.

Catherine Zeta-Jones, Demi Lovato, and Russell Brand have spoken out about their struggle with the illness. Michael Angelakos, lead singer of indie rockers Passion Pit, stunned the music press last summer when he came out as bipolar, while Sinead O'Connor canceled her tour last spring, citing the illness.

Commonly known as manic depression, bipolar mood disorder manifests itself in severe mood shifts from depression to the heights of mania, an elated, if frenzied and sometimes psychotic state of mental disorder. There is no cure, but it can be managed with medication and therapy.

First diagnosed 100 years ago, the condition has long been associated with creativity, more common among artists and writers than among the general population, and has been rare. That is, until the 1990s, when it began being diagnosed more than ever. Some therapists have criticized the trend, believing the illness is overdiagnosed.

Bipolar disorder is a major thread in the Golden Globe-nominated romance, Silver Linings Playbook, which stars Rydal native Bradley Cooper as a bipolar man trying to put his life back together after an eight-month stay in a mental facility. (The film's director David O. Russell recently revealed that his son is bipolar.)

The disorder figures in Showtime's spy thriller Homeland, which stars Claire Danes as a CIA officer whose judgment is sometimes clouded by her mood swings.

Juvenile bipolar disorder, a diagnosis that didn't exist 20 years ago, is a hot topic in medical circles. And it's making inroads in teenage culture in a big way, says Amy Reed, 33, a young-adult author whose latest novel, Crazy, is a love story about a bipolar high school senior and her understanding, if baffled, boyfriend.

"Teenagers are hearing a lot about it but from the medical point of view," she says from her home in Seattle. "They don't feel they hear a lot about how it affects them."

Harvard University psychiatrist John Sharp welcomes the attention. "This exposure is a good thing, because it reflects decreasing stigma when it comes to psychiatric disorders," says Sharp, part of the medical team on Drew Pinsky's reality show, Rehab With Dr. Drew. "It helps reinforce the fact that we treat psychiatric disorders the same as any other medical disease."

Zeta-Jones, 43, recently addressed the issue. "With my bipolar becoming public, I hope fellow sufferers will know it's completely controllable [and] seek help," she says in InStyle magazine's December issue.

The pop-culture attention reflects a noticeable rise in bipolar diagnoses. Bipolar disorder affected less than 1 percent the American population in 1980, says science writer Robert Whitaker. "Today, you will see numbers like 1 in 50 [2 percent]; sometimes studies say it's up to 4 percent."

Numbers are up in part because more sufferers are seeking help, explains Michael Edward Thase.

"About 40 percent of people with bipolar disorder aren't receiving any kind of treatment," says Thase, director of the Mood and Anxiety Program at the University of Pennsylvania.

Thase thinks that social factors also may contribute to the increase in bipolar diagnoses. "Our brain chemistry is melded by the culture and the times we live in," he says. Modern urban culture, he suggests, tends to lead to an increase in all mood disorders.

Our media-saturated, busy, plugged-in culture, marked by intense competition and an equally intense appetite for excitement, does seem to have a manic element. TV, movies, video games, music, thrill rides, extreme sports, drugs, illicit sex all feed it. And when the high from those activities dissipates, a depression may seem inevitable.

This may help to explain why America has the highest rate of bipolar disorder in the world. India has the lowest, with 0.1 percent of its population.

Another reason that bipolar disorder seems so interesting to the lay person is its century-long association with artistic genius.

Some of our civilization's most creative people have been bipolar: painters Michelangelo, Paul Gauguin, and Jackson Pollock; poets Charles Baudelaire, William Blake, and Emily Dickinson; novelists Mark Twain, Joseph Conrad, and Virginia Woolf.

Kay Redfield Jamison has written a classic study of creativity and bipolar disorder, Touched With Fire: Manic-Depressive Illness and the Artistic Temperament.

"There are a lot of studies that suggest a higher rate of creativity in bipolars than the general population," Jamison said from her office at Johns Hopkins University, where she is professor of psychiatry.

Jamison says a milder form of mania called hypomania, which precedes full mania, is an especially provocative and productive state of mind. Hypomania imparts confidence and an increased capacity for lateral thinking.

Cartoonist Ellen Forney says she felt charismatic and brilliant when hypomanic. "Hypomania is awesome," says the Philadelphia-raised artist. "You feel really productive and kind of satisfied and you can still sleep and you just feel really on top of everything, but it's also a dangerous place, where I know I'm slipping away."

Forney, whose critically acclaimed graphic memoir, Marbles, released in November, recounts the decade it took her to come to terms with bipolar disorder, says some artists treasure their illness as a source of their genius.

Norwegian painter Edvard Munch claimed the disorder "was where his inspiration came from," says Forney from her home in Seattle. "Who am I to say that he'd be better off if he was stable?"

Jamison, who documents her own bipolar illness in An Unquiet Mind: A Memoir of Moods and Madness, says artists often resist treatment. "It's common for artists to fear that if they are treated, they will lose their creativity," she says.

It was inevitable that the public would start romanticizing the illness.

Forney did, at first. She says she felt singled out, special. She saw the illness as an invitation to join "the van Gogh club. . . . a group of people who are wounded and yet creatively brilliant."

While Forney has experienced the spectrum of bipolar disorder, from suicidal lows to uncontrollable mania, others have much milder symptoms. Critics contend they are misdiagnosed as bipolar.

Connecticut psychologist Gary Greenberg says overdiagnosis has reached epidemic levels.

"For a hundred years, bipolar disorder . . . was a well-established, stable diagnosis," he says. "The criteria for diagnosis never changed, nor did the percentage of people affected by it."

Everything in psychiatry changed with the Prozac revolution of the 1990s, says Greenberg, whose books include the social critique Manufacturing Depression: The Secret History of a Modern Disease.

Drug treatment became the norm and more people began using powerful psychotropics to deal with problems ranging from mild discontent and social awkwardness to obsessive-compulsive disorder.

Greenberg says this growing demand for a quick fix has led the medical community to loosen the criteria for psychiatric diagnoses. Half a century ago, he says, a patient would be counted as bipolar if his symptoms were severe enough for hospitalization. Today, a hearty upswing could get one labeled hypomanic.

In 1994, the new edition of the psychiatric guide the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) introduced a new diagnosis, Bipolar II, to account for people with milder symptoms.

Critics see it as a made-up label. Allen Frances, who chaired the DSM-IV committee, has since repudiated it. "We made mistakes that had terrible consequences," he told Greenberg in 2010. "Diagnoses of . . . bipolar disorder skyrocketed."

More and more people are encouraged to see themselves as bipolar, says Whitaker. He says even people with very mild cases are often treated with powerful drugs.

"The treatment is lifelong and can be life-altering," says Whitaker, author of Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.

To complicate matters further, a growing body of literature suggests that people taking antidepressants may begin experiencing hypomanic episodes.

Whitaker says in such cases the effect is permanent and can't be reversed by refraining from the drug. It's a stunning development, considering that since the early '90s, a generation of Americans has grown up on antidepressants.

"People find identity through these diseases," says Greenberg, "and they get a sense of belonging to a group that shares their problems."