Cigarettes and alcohol are also glamorous.
Cigarettes and alcohol are also glamorous.

Philip Seymour Hoffman is dead. Another junkie entertainer. Another rehab failure. Another statistic. Ho hum.

But what if that’s not the whole story? What if Hoffman’s drug addiction wasn’t really a drug addiction?

Drugs are chemicals. They change the way your body operates, the way your brain issues commands to the rest of the system that is you. They can make you happy or sad; sexually responsive, or not; alert or sleepy. Drugs, including alcohol, can be used recreationally or medicinally.

So what if there are some people whose bodies can’t hold a charge? By that I mean, what if they wake up one morning and feel they’re in a hazy, indefinable, limitless, grey-black pit with oiled walls? They can’t find the source of their ennui. There is no trigger event (grief, heartache, defeat). But the feeling is real and unrelenting. They reach for a pill or a drink. Soon the chemicals kick in and the malaise subsides for a while. Then it returns. They reach again what alleviated the pain. Another short-lived relief is followed by a return to lethargy.

Then, suddenly, just as quickly as the ennui arrived, it disappears, replaced by a sunlight-glinting-off-snow, daffodils-in-bloom, Maria-spinning-atop-the-mountain happiness. No reason. No relief. No sleep. Brilliant thoughts come one after another in ceaseless succession. Productivity soars—well, actually, activity soars; productivity is often an illusion. Exuberance extends to spending lots of money, and everything is fun, fun, fun. Exhaustion eventually settles in, along with a sense of dissatisfaction about anything and everything, but there’s no way to rest. The body just pushes ever onward. This generates the need to fix everything. Reach for the sleeping pills or alcohol to slow down, get some rest. Brief relief. More pills or alcohol. Brief relief.

The grey-black pit reasserts itself, and the cycle starts again.

This is the life of an undiagnosed, untreated, self-medicating person with bipolar disorder. What causes bipolar disorder is still being researched, but doctors believe it to be a genetically disposed biochemical imbalance in the brain that results in swings between depression and euphoria.

There is no evidence that Phillip Seymour Hoffman suffered from bipolar disorder. However, one of the hallmarks of people who do is that they fail repeatedly at rehabilitation. They fail because rehab treats the physical addiction, and most rehab examines psychological factors that maintain that addiction, but few programs examine the biochemical factors that contribute to bipolar disorder.

Alvin Ailey, Robin Williams, Catherine Zeta-Jones, Demi Lovato, Kurt Cobain, Jim Carrey, Ted Turner, Buzz Aldrin, Brian Wilson, and a lot of other famous people have struggled with the disorder. Many of them try self-medication as a strategy, always unsuccessfully. Once properly diagnosed and treated, many of them have gone on to lead successful, healthy lives. Some, like Cobain, do not.

There are several medically-recognized subtypes of bipolar disorder including: Bipolar 1, the most severe type; Bipolar 2, less severe but manageable; Cyclothymic disorder, least severe. In reality, the disorder is a continuum and one can fall anywhere along that continuum, depending on the mixture and severity of individual symptoms.

Treatments for bipolar disorder have changed over the years. Up until the 1990s lithium was the only successful drug treatment. For some people it worked. For others, it caused a feeling of listless disconnection from their bodies. Newer drugs have been added as options, though lithium remains the standard. As with any lifelong drug treatment, dosages must be prescribed after evaluation by a psychiatrist. This takes time to get it finally right. While psychological treatment may help someone deal with the behaviors associated with bipolar disorder, it takes medication to give them the balance and tranquility to do so.

I don’t know whether Phillip Seymour Hoffman struggled with bipolar disorder. But his death will stir lots of talk about drug addiction and drug abuse over the next few weeks. It’s important that the subject of self-medication for bipolar disorder also be discussed.

There are people in our community, in the arts, sciences, politics, religions, who are struggling to manage bipolar disorder on their own. They appear to drink too much, be way too exuberant, never sleep. They find nothing gives them joy. We need to be vigilant. We need understand that, for these people in our lives, theirs might not be an addiction, but rather an attempt to subdue their internal biochemistry. Helping them requires our own willingness to step outside of “Seattle Nice.” It requires that we ask them right out, “Have you considered that you might have a natural chemical imbalance, maybe bipolar disorder?” And we need to provide them with resources.

Here are a few:

The Mayo Clinic
National Institute of Mental Health
Washington State Psychiatric Association

Most important of all is just to have the conversation. Suggest they see their primary care physician for a referral to a psychiatrist for evaluation. Remind them that you love them and want to support them as much as possible in their treatment and recovery. And if you are someone wrestling with the twin blades of bipolar disorder, know there are treatments available to give you relief. Talk with your close friends and trusted family members to let them know about your challenges. Then go see your doctor for a referral.

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