BAD MOODS : Manic-Depressives Worry About Violence Giving Ailment Bad Name

A month ago, police led Joseph Peter Lynch out of his Santa Ana apartment, handcuffed and with only a blanket around his waist to ward off the post-midnight chill.

Inside the apartment, police had found the body of Lynch’s wife, Helen, still holding the couple’s badly beaten and unconscious infant daughter in her arms.

Within 2 days, 13-month-old Natalie Lynch was declared brain-dead.

The next day, Lynch was charged with beating his wife and daughter to death with a champagne bottle.

As the public recoiled at the brutality of the attack, Lynch’s relatives asked for understanding for the accused man, saying he suffered from manic-depressive psychosis. They said his wife called his doctor the day before she was killed, saying that the symptoms of Lynch’s illness had recurred. The doctor, Richard Rose, told reporters after the deaths that an appointment was not scheduled immediately because Helen Lynch did not express urgency. Instead, an appointment was scheduled for Tuesday, Jan. 17. Sometime during the night, Lynch allegedly attacked his wife and baby.

The weekend after Lynch’s violent outburst, about 50 people met at St. Joseph Hospital in Orange for their regular Saturday morning get-together. For this group, all diagnosed as manic-depressives, the Lynch news was particularly troubling. Aside from their revulsion at the crime, they knew that their hopes for increased public understanding about the nature of their illness had taken another blow.

That Lynch was identified as manic-depressive and then linked to the assault was but another scary image added to the public’s awareness of the illness. Last year, actress Robin Givens attributed heavyweight champ Mike Tyson’s alleged violent household tirades to the illness. More recently, a Connecticut psychiatrist said condemned serial killer Ted Bundy probably was manic-depressive.

Three men. Three violent tales.

But mental health experts and victims of manic depression say the violent episodes, which commonly occur during the manic phase, are a misleading indicator of the illness, which often is controllable by medication and whose victims often lead normal lives.

That is not to say that manic depression--or bipolar affective disorder, as doctors more commonly refer to it--does not present a fascinating look at how the brain can malfunction. Although researchers know that there is a genetic link to manic depression, no one is certain what misfires in the brain.

The search for answers has become increasingly alluring to researchers. At UC Irvine’s Brain Imaging Center, researchers soon will begin a study of manic depression, comparing the brain activity of 16 manic-depressives with that of known schizophrenics. The center is looking for volunteers willing to go off medication to participate in the study.

The common perception of manic depression is that of a cyclical mood swing in which patients ride an emotional roller coaster from frenzied activity to depression. While those are the classic symptoms, many sufferers exhibit only one side of the mood swing, most commonly the depressive side. The person showing only manic tendencies is rare and probably shows some depression that may not be easily recognizable, experts say.

But it is the manic side of the illness that distinguishes it and that produces behavior that can be so excessive that it torments friends and relatives as much as it exhilarates the patient.

People who have come out of manic episodes, which can last for hours, days or weeks, describe it as a near-constant state of euphoria.

“The typical manic has very inflated self-esteem and feels much more self-confident than others,” according to Himasiri DeSilva, chairman of the psychiatry department at St. Joseph Hospital and co-founder of the Manic-Depressive Assn. of Orange County. “They feel that what they think is right and what they do is right. Most of the problem we have in treating them is saying, ‘Hey, slow down a bit, change your mind.’ ”

But as doctors and patients alike know, it is often impossible to penetrate the sense of omnipotence and energy that someone has when experiencing a full-blown manic episode.

A few years ago, Linda Olsem was spending her lunch hour in the Mall of Orange, finishing off a hot dog, when she spotted a jewelry store. For the next 30 seconds, she recalled, all she could think of was that she really wanted a 1-carat diamond ring. That she did not need a ring was immaterial. Olsem went into the store, filled out the necessary forms and walked out with a $7,000 diamond ring.

Olsem, now 46 and president of the county’s manic-depressive association, said that was one of her final manic episodes but not necessarily the most bizarre.

That came a year later when she went into a manic phase after having been depressed for many months. “I felt I had missed so much that I wanted to make up for it,” Olsem said. “I wanted to do everything and take care of everyone, so I took a perfect stranger into my home because I rationalized she really needed some help and needed someone to believe in her and help her.”

Olsem rejected her husband’s attempt at rationality. “I wouldn’t listen to him at all. He said, ‘Linda, you’re not bringing this person into my home.’ And I said, ‘Robert, this is my home, too, and I will bring her in.’ ”

The stranger stayed for 8 months, Olsem said.

That sense of benevolence is not uncommon, Olsem said, recounting the story of a manic-depressive patient who was under a doctor’s care at a hospital but somehow got off the grounds. While gone, the overly grateful patient bought 44 color television sets, Olsem said, one for every room in the hospital.

Olsem has not had a significant manic episode since opening her home to the stranger. She attributes her now-normal behavior to faithfully taking the lithium that her doctor prescribed for her.

Sometimes a patient will run into problems by deciding to quit taking medication. Joseph Lynch’s mother-in-law, Joan Stuart, said he had been off his medication, but she was not sure how long. Experts say patients may decide to stop because of a false sense of security, since episodes can be spaced years apart, or because of side effects. Doctors say that lithium can cause a mild weight increase and that some patients may feel a slight tremor while under the medication.

But Olsem, DeSilva and others stressed the importance of remaining on medication. Otherwise, DeSilva said, a manic-depressive patient will “almost certainly” have recurrent episodes.

Olsem acknowledged that her episodes--both her big spending for the diamond and the irrational generosity to the stranger--took a toll on her family.

“It’s horrible for family members,” she said. “In mania, the patient is having a great time and the family is pulling their hair out, trying to decide what to do, what not to do, what to say and not say. They don’t want to upset you any more than you are. They’re just sitting around waiting for the person to run out of steam.”

The manic’s burst of energy can be fraught with disaster and embarrassment, experts say.

DeSilva said he once treated a patient who, without notifying her husband or children, bought a motor home and parked it in the driveway of the family home.

Partly because the family had the money, “the family members said, ‘Fine,’ ” DeSilva said. “The next day when they came home, they found a motor home identical to the first one parked in the driveway. She had bought a second one. Her husband said, ‘What are you doing?’ and she said, ‘You liked the first one so much that I knew you’d like a second.’ ”

Besides the danger of spending themselves into bankruptcy, persons having an uncontrolled manic attack typically become sexually hyperactive, experts say.

Terri, a 46-year-old volunteer at the national Manic Depressive-Depressive Assn. in Chicago, experienced such behavior.

“You have a much stronger sex drive,” said Terri, who did not want to give her last name. “Normally, I’m normal. I normally wait for a gentleman to walk up to me, but I wouldn’t do that if I were manic.”

Her escapades, while enthralling at the time, eventually became self-defeating, Terri said. “I felt terrible because another person who was a friend of mine told someone that she used to like me and thought I was a nice person, but that I had changed.” What the friend had seen was Terri’s seemingly promiscuous behavior.

But even had someone told Terri about her behavior while in her manic phase, she probably would not have listened.

“Once a manic episode is in full bloom, insight disappears, and they don’t recognize they’re making a fool of themselves,” said Douglas Schiebel, service chief of the Mission Viejo and Laguna Beach mental health clinics.

“In other words, they don’t realize they’re being quite crazy. In this swept-up sense of omnipotence, of sitting on top of the world, it’s hard for friends and family to persuade them to go to the hospital. . . . When the euphoria has reached a certain pitch, it completely blocks out any kind of reservations and self-critical kind of capacity and, of course, they go totally overboard. And when a relative comes along and says they’re not acting right and haven’t slept in ages and they’re not eating, they dismiss it all. They’re apt to say, ‘What do you mean? I feel perfectly OK. I can handle this. You just don’t like it when I’m feeling good.’ ”

While some manic-depressives may enjoy the manic phase--or more commonly, the somewhat-less-frenzied state known as hypomania--it is the depressive cycle that they fear. In that state, they can become so morose and inactive they can barely function. In its most serious form, the cycle can make people feel suicidal.

John Dierking of Tustin has been married for 18 years to a manic-depressive, although his wife, Gloria, seldom shows the manic cycle. “Her idea of manic is that the house gets real clean,” Dierking said.

But her depressive cycles have been deep and, until she was diagnosed about 8 years ago, seemingly untreatable. She had been treated for depression alone, but nothing worked, Dierking said. “Finally a guy said, ‘Let’s try lithium because she may be manic-depressive,’ and it was the magic bullet,” Dierking said.

Dierking said that had his wife, now 37, not been diagnosed, he is not sure whether their marriage would have survived her depressive bouts. Her depression became so severe that she would not speak to other family members, would not want to get out of bed on some days unless her husband physically removed her, and occasionally had to be led by the hand to the dinner table.

“If she hadn’t been diagnosed, I can’t really tell you how long our marriage would have survived,” Dierking said. “I was getting real burned out and even though we had a young child (they now have two), it was not real pleasant and it was becoming less tolerable. She was OK about half the time, and the rest of the time she was depressed, irritable, critical and agitated. . . .”

The Dierkings now divide their lives together into the “pre-lithium and post-lithium” years, Dierking said.

Trying to detect manic depression in loved ones can be difficult, Dierking said. “It’s a real personal decision to decide where the line is between normal mood swings and what becomes an illness,” he said.

“But when it comes to the point where it interferes in the activities of daily life, and I’m talking work, family, taking care of one’s self, when it starts seriously interfering with the normal things like family finances, sleeping schedules, you just have to look at them closely and make a decision.”

Spouses have a particularly difficult time because an untreated manic-depressive in the midst of an episode can make life hell.

“We deal with guilt feelings, inadequacy, pent-up hostility and frustration and anger,” Dierking said. “A person married to a manic-depressive knows they can’t help it, but over an extended period, if you’re not getting what you want or need, it can get frustrating. You want to lash out or get a divorce or run away or whatever.”

Dierking is among a group of 10 to 25 people who meet monthly to discuss life with manic-depressives. The group includes spouses, parents, siblings, children and even girlfriends and boyfriends, Dierking said.

The Manic-Depressive Assn. sponsors 2 other support groups for manic-depressives and their friends and relatives. Besides the group that meets Saturdays at 10 a.m. at St. Joseph Hospital in Orange, a new weekly support group at CPC Laguna Hills Hospital meets Thursdays from 7 to 8 p.m.

It is in the brain--where all those decisions about spending and sexual activity occur--that the answers to manic depression may lie. “It has been estimated that 80% of the brain’s activity is inhibition, turning things off,” said Monte Buchsbaum, director of UCI’s Brain Imaging Center.

“In most people, they decide they can’t afford the new Ferrari. . . . That takes a lot of brain work. It’s the same with sex. The drive is there all the time. It may require more work inhibiting the sex drive than carrying it out.”

Therefore, Buchsbaum said, if researchers can discover why those inhibitions break down for a manic-depressive, they may be on the trail of better treatment of the illness.

Compounds of lithium, a light metallic element, are the standard treatment for manic depression, but not even doctors know why it works. Breakthrough success in treating manic depression with lithium was reported about 40 years ago, after an Australian psychiatrist discovered accidentally that it had a calming effect on laboratory animals.

DeSilva said 50% of manic-depressives “respond very well” to lithium alone. Other patients take it in combination with other drugs to combat either the mania or depression.

Researchers still theorize about manic depression. Buchsbaum said there may be a connection between separate parts of the brain that “communicate” with each other in ways that affect inhibition.

Buchsbaum believes brain research is on the verge of the kind of breakthrough marked in previous scientific eras by the development of the telescope, the microscope and vaccines. “Suddenly, this is a moment for scientific exploration,” Buchsbaum said. “In the last part of the 20th Century, we are really going to unravel something about the brain. It’s a historic moment.”

For manic-depressives like Olsem, that’s encouraging news. After the Lynch incident, she said, “we (in the support group) were all really angry. That’s the only kind of press we get. That’s not the majority of us, by far. That’s what makes the news; that’s what gets printed. How many articles are there about manic-depressives who lead nice, normal, quiet lives?”

MANIC DEPRESSION: EXTREMES IN MOODS Manic depression is a form of mental illness that can be characterized by cyclical periods of extreme mood swings from euphoric highs to numbing depression. The high or low periods may last for days or weeks or months and then may or may not recur. There is a genetic predisposition to the illness, and doctors generally agree that some specific stress can trigger an episode. THREE VARIATIONS IN MANIC-DEPRESSIVE ILLNESS In its most classical form (Graph A), depressive or low moods alternate with abnormally high feelings. Sometimes the high phase precedes a depression. Graph B indicates depressive episodes may recur with no high. Graph C shows cycles of high episodes recurring with no depression periods. Variations are shown by dotted lines. A. MANIC-DEPRESSIVE (Cyclic) B. MANIC-DEPRESSIVE (Depressed) C. MANIC-DEPRESSIVE (Manic) MANIA CHARACTERISTICS: Feelings of near-unrestrained energy Power Self-confidence and euphoria Spending excesses Decreased need for sleep Heightened sexual drive In its most troubling forms, a loss of rational judgment Delusions about self-worth or importance DEPRESSIVE Feelings of worthlessness Helplessness Lack of energy In the most extreme cases, suicide TREATMENT: Lithium is the standard treatment for manic depression. It is effective for combatting both the highs and lows of the mood swing and is helpful both in preventing recurrent episodes or tempering their severity. During more acute episodes of either mania or depression, other medications may be used. Source: “Up From Depression” by Dr. Leonard Cammer, M.D., 1969, Pocket Books UNDERSTANDING MANIC DEPRESSION: POSITRON EMISSION TOMOGRAPHY One way to understand manic depression: PET scans conducted by UCI researchers show energy metabolism in the brain of normal volunteer (left) and patient with manic-depressive illness (right). The colors show brain metabolism on the rainbow scale, with red and orange indicating high activity and blue and purple indicating low activity. The frontal lobe (top of brain slice) shows high activity in normal brain but is markedly diminished in the patient. This brain area is important in personality and in the organization and, perhaps especially, inhibition of behavior. Source: Monte Buchsbaum, M.D. UCI Brain Imaging Center FAMOUS MANIC-DEPRESSIVES Thomas Eagleton, U.S. senator One-time vice presidential candidate had past bouts with depression. It became an issue in the 1972 U.S. presidential campaign and ultimately resulted in the Democratic presidential candidate, George McGovern, dropping him from the ticket. George Frederic Handel, composer Wrote “The Messiah,” his most famous work, during a 3-week period while in a manic frenzy. Some advertisements for lithium, the drug most often used to treat manic depression, feature a drawing of Handel. Honore de Balzac, French author It is thought Balzac was in a manic state most of his life. He spent money recklessly and was always in debt. When he wasn’t spending money he was writing, frequently staying up all night. Others include: Buzz Aldrin (astronaut), Sir Winston Churchill ( British statesman), Charles Darwin (scientist), Sigmund Freud (psychoanalyst), Ernest Hemingway (author), Howard Hughes (industrialist), Edgar Allan Poe (author), Dylan Thomas (author), Vincent van Gogh (artist), Virginia Woolf (British author) Source: “Holiday of Darkness: A Psychologist’s Personal Journey Out of His Depression,” by Norman S. Endler. Research by Kathie Bozanich