The baby in Joan Fisher’s arms looks perfect: full cheeks, a corona of wispy brown hair and wide, happy eyes through which she seems to take in the whole world. Gazing at her granddaughter in their Darien, Ill., home, Fisher can see no trace of the legacy that has run through their family for generations. But she knows it could be there, hidden in the girl’s DNA, waiting to emerge.
The baby in Joan Fisher’s arms looks perfect: full cheeks, a corona of wispy brown hair and wide, happy eyes through which she seems to take in the whole world. Gazing at her granddaughter in their Darien, Ill., home, Fisher can see no trace of the legacy that has run through their family for generations. But she knows it could be there, hidden in the girl’s DNA, waiting to emerge.
The inheritance is bipolar disorder, a mental illness that afflicts up to 6 million Americans. It can be tricky to diagnose, hard to treat, devastating to live with.
Much remains mysterious, but its genetic nature is clear. The baby’s mother has been diagnosed with the disorder and the father might have it, too. While that does not guarantee it will someday show itself in the girl, it boosts the odds.
But as the next chapter of this difficult family saga begins, there are good reasons for hope.
Researchers are getting closer to identifying the genes that cause bipolar disorder. They’re using brain imaging to track the illness in a person’s neural pathways. And they’re zeroing in on triggers that might cause it to flare up.
These developments, some experts say, suggest that children born today with a predisposition toward bipolar disorder will have easier lives than their parents. The illness could be detected earlier, managed with more effective medications, perhaps even prevented with therapy and lifestyle changes.
Medical advances, though, are only part of the equation – and maybe the simplest part.
Advocates for people with mental illness say stigma is still rampant despite growing efforts to combat it. They say those who suffer from it are frequently mistreated, while others are shamed into denial.
“There’s still all that negative talk, the way people used to talk about handicapped people or children with Down’s syndrome,” said Susan Resko of the Evanston, Ill.-based Child and Adolescent Bipolar Foundation. “We’re still in that space with psychiatric illness. We don’t understand it. It’s scary to us as a society.”
Hope and fear have been at war for decades in Joan Fisher’s family, and she is prepared to face that struggle again as her granddaughter grows up.
“There are many people with bipolar disorder who live a wonderful life,” she said. “I believe that is possible. … At the same time, I do not believe that society is ready to embrace the idea that for the greater good we must support those that need support.”
Bipolar disorder, also known as manic depression, affects an estimated 2 percent of the population, and can be one of the hardest mental illnesses to endure. A severe manic state can cause people to spend money wildly, throw themselves into high-risk sexual encounters or lose their grip on reality. When depression takes over, they can feel exhausted, even suicidal.
Though Fisher has never been diagnosed with the illness, its shadow has always hung over her. Several relatives spent time in institutions, displayed erratic behavior or committed suicide after trying to soothe their brains with drugs and alcohol.
But she didn’t see the disorder’s full power until the early 1980s, when her older sister, Nicole, got sick.
Nicole, then a 26-year-old architecture student attending school in Minnesota, was diagnosed with manic depression after she became convinced that her parents and the FBI were conspiring against her. During her first breakdown, it took three police officers to get her to a psychiatric hospital.
Nicole went on lithium, a mood stabilizer that even today remains the most popular treatment. But she didn’t tolerate it well, leading her doctors to try many other drugs in the years that followed.
They never found the magic formula. Though Nicole was stable enough to have a successful career as an architect, she confessed to Fisher that psychotic thoughts frequently bobbed through her mind.
Despite this family history, Fisher said, she was determined to have children of her own.
“I was really quite confident I knew how to deal with it if it showed up,” she said. “It didn’t frighten me, and I was quite confident that whatever treatments we would need would be available. I even knew I was marrying a man who had bipolar in his family. I thought, ‘Well, he managed to skirt it and I managed to skirt it. Maybe we’ll be lucky.'”
For years after her two daughters were born, it seemed as though Fisher had gotten her wish.
But things changed dramatically when the girls entered their teens, the family said. Many scientists have come to believe that stress can trigger dormant mental illnesses, and as the girls approached adolescence they were hit by trauma after trauma. Their parents divorced. Their Aunt Nicole died suddenly from a heart ailment. And in 2004, they moved to a new town.
Severe problems began to emerge. The elder daughter became sexually active with older men, some of whom would call the house from jail. She drank and abused drugs, and fought with her mother. Fisher said she had to learn martial arts in order to subdue her daughter.
“We would spend half of our time screaming,” said the older daughter, now 20. “I was a terror from age 13 to 18.”
The younger girl said she developed her own issues. When she was manic, she would write poems until her handwriting blurred. Her thoughts raced and became obsessive, and she sometimes tumbled into panic attacks. When her depression set in, she would sometimes think about killing herself.
Fisher took her daughters to one psychiatrist after another in search of help. But because the girls’ symptoms didn’t fall into clean categories, it took years for each to receive a diagnosis of bipolar.
The hit or miss approach to medication produces some of the keenest frustrations for people with mental illness. But some research efforts dedicated to alleviating that problem are starting to bear fruit.
At the University of Illinois at Chicago’s Pediatric Bipolar Research Program Dr. Mani Pavuluri and her colleagues have used functional MRIs to examine the brain operations of children who have bipolar disorder. They have discovered that when these kids are exposed to distressing words or images, the part of their brains that regulates emotions is underactive.
That shows up in an MRI scan as a vivid blue blob. Though the technology is still developing, Pavuluri said it could help to distinguish people who have bipolar from people who have attention deficit hyperactivity disorder.
The two conditions are frequently confused, especially in children, and that can lead to serious mistakes in prescribing medication, she said. The stimulants used to treat ADHD can drive mania to frightening heights in someone with bipolar.
Scientists are also having some success identifying genes that increase the risk of bipolar disorder. While much work remains, some say the discoveries promise to make selecting the right medication, or even creating new ones, a much easier job.
“You find the genes primarily with the hope of developing novel drugs that we hope will work better,” said Dr. William Byerley, a psychiatric geneticist at the University of California San Francisco. “We might be able even to prevent the onset. By knowing the gene, we’ll know the neurobiology and know some of the pathways of the disease.”
In high school, after years of trial and error, Fisher’s daughters finally got on effective medications. The older daughter said her meds helped her become “a completely different person,” though she hopes for further improvement. While her sister has improved, she said her medicines haven’t stopped her from occasionally slipping into mania.
Fisher was confident enough to loosen her grip, effectively putting the girls in charge of their own lives.
“Their response was very positive,” she said. “They appreciated me backing off. I was no longer the enemy but more of a friend, someone who is just trying to make things work.”
Their symptoms soon diminished. Both graduated from therapeutic high schools and have gone on to higher education, the eldest daughter in pursuit of a criminal justice career, the younger in the hope of becoming a hairstylist.
Four months ago, the elder daughter gave birth to a baby girl. The baby’s father said a doctor has told him he might have bipolar, too, creating a stronger chance the girl will inherit the condition.
Dr. Kiki Chang, director of the Pediatric Bipolar Disorders Program at Stanford University, said recent research has focused on the idea that treating children early can keep bipolar from emerging in those who are genetically predisposed toward it.
In one experiment, children who were showing only mild signs of the disorder were given a drug used to treat mania. It helped with all of their symptoms, even depression, suggesting it might smother the illness before it can bloom.
Dr. Herbert Pardes of NARSAD, an organization that funds mental health research, said that as science clarifies the biological origins of mental illness, he expects more public sympathy and understanding for people who are afflicted with the disorders.
One recent study, though, has punctured such optimism. It found that while the public increasingly recognizes the biology of mental illness, it is, if anything, less accepting of those who have one.
“We need to see difference as part of the human condition,” said Bernice Pescosolido, the Indiana University sociologist who led the study. “Really, we have to stop making generalizations that there are perfectly healthy people out there. Everyone struggles with something – this is just one more thing.”
Fisher said she will help to raise her granddaughter with that in mind. She’ll use yoga to try to keep the stress level down around the house, and be keenly attuned to any changes in the girl that might call for early treatment. She will continue her work in organizations that try to increase public and family understanding of people with mental disorders.
Whatever comes, she and her daughter say they will be ready. And who knows? Maybe they’ll be lucky. Maybe this baby, so perfect in Fisher’s arms, will never face the illness.
“It’s my job,” Fisher said, “to be hopeful.”
