About the Authors
When I started my practice 15 years ago, Prozac was becoming a household word. I became a champion of finding and treating depressive illness and teaching others to do the same. But despite Prozac’s fabulous track record, there were patients it could not help. There were patients nothing seemed to help.
One such patient had been to four psychiatrists and multiple primary care doctors before she came to me, and none of them had been able to resolve her problems. In desperation I tried her on an antipsychotic sometimes used to treat bipolar disorder. Her positive, almost miraculous, response to this treatment became a watershed event in my life. Since that moment I have made it my business to learn everything I can about bipolar disorder. Like most other doctors, I had relegated bipolar disorder to my list of rare and unusual diagnoses. I did not expect to come across it in my practice. It certainly did not exist in my framework of understanding depression. But finally I had seen it and it was not what I thought it was.
I now know that innumerable cases of depression and anxiety have been misdiagnosed and wrongly treated based upon a myopic view of bipolar disorder just like mine. Research has shown that bipolar disorder is more common, more complex and more varied than previously thought and that many of the patients we have been treating for depressive illness have a form of bipolar disorder rather than unipolar depression. Understanding this has changed my approach to mental illness.
Once I developed a new template for recognizing bipolar disorder, I realized I had been seeing it every day in my practice, but attributing its symptoms to something else. Now that I know what it looks like, my exposure to patients in a clinical setting enables me to see firsthand how bipolar disorder manifests itself in the general population. I know how to detect it in cases of intractable depression. I know how it might be the hidden problem behind other psychological disorders, chronic migraines or drug abuse. In addition, as a family doctor I have been trained to treat illness in families. Bipolar disorder is highly hereditary and often affects many family members.
Unlike a psychiatrist, I see patients who do not know yet they have a mental illness. These are people who know something is wrong with them, but they do not know what, and they are at least marginally functional. Most of them I will be able to treat without referring them for specialized care. Psychiatrists see the most extreme cases, and those who are already aware of their need for psychiatric help. Psychiatrists and family doctors see two very different groups of people, and while the facts about the disease do not change, psychiatrists and family doctors have decidedly different perspectives on the problem.
Our goal in writing this book was to provide an explanation of bipolar disorder that will interest my own patients and others like them, while containing enough information to be useful to primary care doctors. We wrote the book around my kitchen table, Laura taking down my ideas and understanding and putting them into writing, then both of us revising, back and forth. Her job was to make sure the material was accessible to people who do not have a medical background; mine was to make sure it was accurate. We interviewed many of my patients at length; Laura transcribed their life histories, and distilled from them that which shed the most light on the experience of being bipolar.
I graduated from Adelphi University and the Medical College of Virginia and was trained in family practice at Washington Hospital. I have worked in private family practice in western Pennsylvania for 19 years. For 5 years, I have been speaking to groups of physicians about bipolar disorder. My co-writer, Laura Edwards, is a writer and a graduate of Bryn Mawr College. Dr. Suzanne Vogel-Shabilia, president of NAMI, the National Alliance on Mental Illness, also contributed to the book.