(Click here to listen to the radio piece)

Introduction: Bipolar disorder, or manic depression, is a devastating mental illness that affects more than 2 million Americans. It can cause suicidal depressions and whirlwind manias that shift from a seductive euphoria, increased energy, and little need for sleep to deep fear and misery, paranoia and sometimes frightening hallucinations. It can start in childhood or later in life, but usually first appears in adolescence or early adulthood, There is no cure for this lifelong illness. And researchers don't know exactly what causes it. But they do know it runs in families. The problem is it often takes years for a correct diagnosis. And in the illnesses' storm, marriages can be destroyed, jobs and schooling lost, and lives shattered.

With proper treatment, however, those with manic depression can live fruitful lives without anyone even realizing that they have a mood disorder. Laurie Udesky traces the journey of one family as it battled and learned how to cope with this complex illness:

(Ambient sound of teacher Diana Grippo teaching her class)

Laurie Udesky: Thirty-nine-year-old English teacher Diana Grippo reads an excerpt from Harry Potter to her 10th grade students in Atherton, California, near her hometown on the Northern California peninsula. It's one of the many sources she draws on to teach media literacy. In September 2003 she helped her students with a video project interviewing homeless people in San Francisco. Grippo has more than a passing knowledge of that life. Looking at the petite teacher who has radiant green eyes, well-coiffed blonde hair, and flawless skin, you'd never guess that the very streets that she covered with her students had been her own home in the late 1980s.

Diana Grippo: I started hearing what sounded like a baseball game on the radio. I don't know why that's what it sounded like, but it was sort of the cadence and then there were cheers. And then it would be like voices, and it sometimes became a chorus, and I didn't know if it was me or other people, because I had never heard voices before. I had had a real normal life ... At some point they told me to go to San Francisco. And I would just leave whatever I was doing and go to San Francisco, because you really can't hang out on the Peninsula if you're going crazy, you're just too noticeable.

Udesky: The voices she heard were part of so-called manic episodes that first hit Grippo in her early 20s after she had earned high marks and a bachelor's degree in economics from UCLA. Grippo said that she'd had insomnia for some time before she swung into this full manic episode. In fact, lack of sleep is one of the triggers for debilitating shifts in brain chemistry, says Kay Redfield Jamison, PhD, an expert on the illness and professor of psychiatry at the Johns Hopkins University School of Medicine. Jamison, who wrote about her own struggle with manic depression in her remarkable memoir, An Unquiet Mind, explained the role of sleep in this illness at a recent conference of the Depression and Bipolar Support Alliance:

Kay Redfield Jamison: If you start to find yourself not sleeping well ... get some medication for it. Because there's no question that the underlying pathology of the illness is tremendously beholden to sleep and extremely important.

Udesky: Besides sleep, proper diagnosis, treatment and medication are key. Diana Grippo had not been correctly diagnosed. Before she ever had a manic episode she had felt inwardly miserable and depressed for years, but kept it to herself. While she studied hard, she began using alcohol to drown her despair. And, says Grippo, the last thing she wanted to do was tell her parents how much pain she was in.

Diana Grippo: They'd always been so supportive and they paid for my college. And though I got an academic scholarship, they were paying the difference and wanted me to do well, and they were excited for me and were happy. I just thought that they'd be sad if they knew I was sad. So I was protecting them.

Udesky: Despite Diana's reticence, Nancy Grippo realized her daughter had problems after the university notified her that she had been kicked out of her sorority for passing out drunk in front of her door. Grippo took a quarter off, went sober, saw a therapist at the urging of her parents and returned to school. Nancy Grippo says she didn't realize the full extent of her daughter's illness and what danger she was in until she failed to come home one night after a Grateful Dead concert. None of her friends knew where she was.

Nancy Grippo: Finally, we got a call from Nordstrom in San Francisco who said we have a woman in the store who's behaving bizarrely, but she had I.D. on her, and it identified her as living in Los Altos. I said, "That's my daughter." So my husband I drove to San Francisco got her in the car, she was just incoherent, and as we're driving along at a pretty good clip, she opened the door and tried to jump out. So we knew we were dealing with an illness that had just taken over.

Udesky: Nancy Grippo teaches psychology, so she suspected then that her daughter probably had bipolar disorder. The greater challenge was finding the right doctor. The suburban psychiatrists she consulted refused to treat Diana without her consent. Similarly, since Diana was an adult, she couldn't be involuntarily hospitalized for more than three days, unless it was clear she would harm herself or others. There was a revolving door of arrests, and corralling Diana at home in a manic state, while looking for a psychiatrist to treat her. But she'd invariably escape.

(Ambient sound of the Tenderloin)

Udesky: With untreated manic depression, Diana spent the greater part of the next two years in San Francisco's Tenderloin district, a bustling mixed neighborhood of restaurants, theater, immigrants, flashing neon signs offering pay-by–the-hour rates at hotels, and homeless people.

Diana Grippo: I would go manic, and I would do something and be on the streets and steal or do whatever I had to do, because by that time my parents didn't know what to do and I didn't want to deal with them for some reason in my sickness ... And then in my depression, I'd not only be chemically depressed, but then I'd be trying to clean up the wreckage that was in my wake after having been manic. So while manics are psychotic, meaning you're out of touch with reality, depressions you really know what's going on you're fully lucid and feel the whole thing ... and so it's awful.

Udesky: Nancy Grippo did not give up. She remembers days and days of cruising the Tenderloin looking for her daughter, and endless nights of pacing her living room in worry. She eventually found a support group of similarly affected family members who gave practical advice. They told her to bring photos of her daughter to police and describe her symptoms to them. They also recommended doctors and hospitals and advised her to write up careful notes about her daughter's illness. The notes, she says, are critical, since it's not easy for medical staff to diagnose and correctly treat a patient who is incoherent. Ultimately, such advice helped Grippo get her daughter back. When police called and told her that they were taking Diana to a hospital, Nancy Grippo jumped into action and had her moved to a recommended facility.

Nancy Grippo: And she stayed there a number of days and I found a psychiatrist who would finally listen, the first one I ever had who would listen. ... The patients very often don't know their own history, the parents often do ... I would write down where she'd been spotted, any medication she'd taken. I'd write down how long the manic had lasted, how long the depression was lasting, symptoms, anything that seemed relevant to the illness. So I could put that out to the psychiatrist and I said to him, "She's going to crash. I know she looks like she's wired but I know this. I've seen the cycle." He was very nice to me but he said, we'll see and called me the next day and saidyou were right I want you to come in. Then we went through her history very, very carefully, and he prescribed medication according to that and it worked ...

Udesky:: What do you mean it worked?

Nancy Grippo: It's like seeing somebody who's been on a long journey. I mean it's like they've been gone and suddenly they're back. I always knew she was inside there, but I couldn't get to her and she just looked at me and she said, "Hi, mom" and I thought oh my god, this is the first time in so long. It wasn't the perfect medication and medication isn't absolutely the only answer, but to get a person rational enough to deal with their own illness, that's often the only thing that brings them around.

Udesky: Professor Kay Jamison agrees that medication is essential to treating the illness.

Jamison: The consequences of not treating the illness are infinitely worse than the consequences of the medication…It's not benign to have mania. So in the same way you may have a child with leukemia, nobody's going to say the treatments for leukemia are pleasant treatments but the question is what are the alternatives.

Udesky: For Diana Grippo, proper treatment and her own determination helped her get her life back.

(Ambient sound of Diana Grippo giving homework assignments to her students)

Udesky: It took time for Diana Grippo to work her way back into the functional world and get the right balance of medications for her illness. She waited tables, spent part of the 1990s working in the computer industry and returned to graduate school for her teaching credential.

Diana Grippo: I feel like I want to be an example to teenagers that you can be a happy adult. I just feel like that's when everything in my world went to hell was in adolescence. So wouldn't it be nice if just one adolescent had an example of one person who is happy in their job has chosen the job ... and I was in industry, and I thought you know, it would be a good idea to give back and be a teacher…

Udesky: Grippo was initially worried about how people would react when she first started telling people about her past, but she has no regrets.

Diana Grippo: It's actually been really encouraging. I expected some fallout, some parent complaints. I didn't know what to expect, but I thought it would be bad and nothing bad has ever happened from me exposing the fact that I'm mentally ill and on medication ... Only bad things happened when I spent all my time denying it and censoring half my life and trying to figure out what to tell people and what not to tell people.

Udesky: For Consumer Health Interactive Radio in San Francisco, I'm Laurie Udesky.

First published December 31, 2003
Copyright © 2003 Consumer Health Interactive