INTRODUCTION

It has been a passion of mine to help educational institutions such as schools, colleges, and universities implement evidence-based strategies to stop dangerous acts in their environment such as bullying. My genuinely commitment to this calling has culminated in the publication of books and online curriculum on bullying and hazing to name a few.

Having discourse with SJ Hart and reading her book on "Lies in Silence," I was inspired to write this book on "Your Answers to Bipolar Disorder: A Guide For Every Individual and Organization."

This experience added to my curiosity about how some of the research on best practices to address bullying (such as the ecological-system by Bronfenbrenner) might relate to strategies to support the needs of individuals diagnosed with bipolar disorder.

• The book "Lies In Silence" gives readers an in-depth look at bipolar disorder, and how it runs rampant in the family. It gives examples of how the disease lies in silence in people through symptoms such as high energy level, loss of touch with reality and reduced need for sleep. Hart explains in the book how the genetically transmitted disease will destroy a person. Without a cure, the bipolar disease will take over the brain and will drive you to do something bad.

Having suicidal thoughts is a symptom of bipolar disorder. In her book, Hart describes this symptom as a "picture or suicidal movie theater" in a person's mind. The images are very scary, bloody, horrific and traumatizing. As the images linger in the person's brain, he or she will do anything to make the pain go away.

Hart pursued a bachelor and master's degree in Therapeutic Recreation. She understands the importance of providing people with bipolar disorder more useful information on the symptoms of mental illnesses and suicidal ideation. Hart is an advocate for suicide management and she helps people of all types who are suffering silently from the disease.

At a time when our country is wrestling with horrific murder and an epidemic of suicide often but not always due to mental illness, Hart's book will highlight the importance of providing counseling and treatment and understand mental illness as a brain disease.

Realizing the seriousness of bipolar disorder and how it impacts an alarming number of people in the U.S. and abroad, I decided to attend the 2018 Young Gifted & @ Risk Symposium (YGAR) in Austin, Texas; and the 2018 Crisis Intervention Team (CIT) International Conference in Kansas, City Missouri to supplement the writing for this book. The YGAR Symposium seeks to promote awareness among families, students, faculty members of higher education, mental health professional, etc. about the risk to mental health such as imposter syndrome, microaggressions, discrimination, marginalization, and isolation experienced by college students of color.

The CIT program is a community partnership of mental health, addiction professionals and law enforcement, persons who live with mental illness and/or addiction disorders, their family members and other advocates. Additionally, CIT program "is an innovative first-responder model of police-based crisis intervention training to help persons with mental disorders and /or addictions access medical treatment rather than place them in the criminal justice system due to illness related behaviors."

The CIT conference was most informative and meaningful. One key highlight of the conference was when Keynote Speaker Paton Blough talked about his struggle with bipolar disorder and how he managed to overcome a divorce, altercations with police officers, six arrests, and imprisonment with the support of organizations such as the National Alliance on Mental Illness. Another key highlight was when Session Speaker Thomas Hemert led a humbling and powerful discussion on understanding mental illness by having the participants to listen to an audio and hear the experience of what individuals with psychiatric disabilities are challenged with on a daily basis.

Thus, this book will discuss useful and resourceful information about bipolar disorder and particularly "what to know" to assist individuals living with bipolar disorder and organizations working with individuals diagnosed with the brain disorder. Since bipolar disorder is a mental illness, this book will start with the critical question, what is mental health?

What is Mental Health?

Mental health represents a person's social, psychological, and emotional well-being. It has an impact on how a person acts, feels, and thinks. Mental health also helps assess how a person makes decisions, relates to people, and handles stressful situations (Mental Health.gov).

According to Mary Giliberti, chief executive officer of the National Alliance on Mental Health (NAMI), 44 million people in this country live with mental illness; and one out of every five people struggle with a serious mental illness such as schizophrenia and bipolar disorder. As posted on NAMI's website, the following are additional statistics highlighting the prevalence of mental illness:

• In a given year, approximately 1 in 5 adults in the U.S. (43.8 million) experiences mental illness.

• In a given year that substantially interferes with or limits one or more major activities, approximately 1 in 25 adults in the U.S. (9.8 million) experiences a serious mental illness.

• At some point during their life, approximately 1 in 5 youth aged 13-18 (21.4%) experiences a severe mental disorder; the estimate is 13% for children aged 8-15.

• In the U.S., 1.1% of adults live with schizophrenia and 2.6% live with bipolar disorder.

• In the past year, 6.9% of adults in the U.S. (16 million) had at least one major depressive episode.

• In the U.S., 18.1% of adults experienced an anxiety disorder such as obsessive-compulsive disorder, posttraumatic stress disorder, and specific phobias.

• In the U.S., among the 20.2 million adults who experienced a substance use disorder, 50.5% (10.2 million) adults had a co-occurring mental illness.

• In the past year, only 41% of adults in the U.S. with a mental health condition received health services.

• In the past year, approximately 50.6% of children with a mental health condition aged 8-15 received mental health services.

• By age 14, half of all chronic mental illness begins; by age 24, three-quarters.

• Students with a mental health condition age 14-21 and older who are served by special education, drop out of school at a rate of approximately 37%; among other disability groups, this is the highest drop out rate.

• In the U.S., suicide is the 10th leading cause of death; the 2nd leading cause of death for people aged 15-24; and the 3rd leading cause of death for people aged 10-14.

• In the U.S., over 9% of children who die by suicide have a mental health condition; and each day 18-22 veterans die by suicide.

• In the U.S., approximately 26% of homeless adults residing in shelters live with serious mental illness; 20% of state prisoners and local jail prisoners have a reported history of a mental health condition; and 70% of youth in juvenile justice systems have a mental health condition (NAMI).

While this book will focus on bipolar disorder, other mental illnesses include schizoaffective disorder, ADHD (attention-deficit/hyperactivity disorder); PTSD (posttraumatic stress disorder, borderline personality disorder; dissociative disorders; anxiety disorders; obsessive-compulsive disorder; eating disorder; and depression. The glossary section provides a definition of these mental illnesses.

What is Bipolar Disorder?

According to the National Institute of Mental Health (NIMH), bipolar disorder "also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks." Approximately 5.9% of adults age 18-29 experience symptoms of bipolar disorder and over 3.9% of the nation's adult population has experienced symptoms of bipolar disorder within their lifespan (NIMH cited in Dentzau, 2017). In adolescents aged fifteen to nineteen worldwide, the World Health Organization estimated in 2011 that pediatric bipolar disorder is the fourth leading cause of disability, "accounting for a total of 5 percent of disability in this age range" (Mondimore, 2014).

Bipolar disorder varies in four basic types as discussed in the next section (NIMH).

Types of Bipolar Disorder?

In the United States, the Diagnostic and Statistical Manual of Mental Disorders, outlines the diagnostic clinical criteria for bipolar disorder and its four basic types. They include Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Bipolar Disorder Not Otherwise Specified. Each of these "involves clear changes in energy, mood, and activity levels in a person. The moods range from periods of extremely "up," elated, and energized behavior (known as manic episodes) to very sad, "down," or hopeless periods (known as depressive episodes). Also, less severe manic periods are known as hypomanic episodes" (NIMH).

According to the NIMH, Bipolar I Disorder is defined by manic episodes that last at least seven days in a person or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur in a person as well, typically lasting in the person at least two weeks. The proceeding chapter on "A Parent Story of her Bipolar Son" provides a real-life example of a person's episodes of Bipolar I Disorder.

Bipolar II Disorder is defined by a pattern of depressive and hypomanic episodes characterized by a person, but no full-blown manic or mixed episodes.

Cyclothymic Disorder is defined by numerous periods of hypomanic and depressive symptoms in a person lasting for at least two years. The symptoms, however, do not meet the diagnostic requirements for a hypomanic and depressive episode.

Bipolar Disorder Not Otherwise Specified is defined by bipolar disorder symptoms in a person that don't match the criteria for Bipolar Disorder I and Bipolar Disorder II. Also, they are out of the person's normal range of behavior.

Stages of Bipolar Disorder

Although the illness of an individual with bipolar disorder can begin in early childhood or as late as the 40's and 50's, the median age of onset for bipolar disorder is 25 years. Men and women equally develop the disorder and it is found in all races, ages, social classes and ethnic groups. Children of parents who have bipolar disorder are more likely to be affected by the disease. When one of the children's parents has the bipolar disorder, the risk to each child is from 15% to 30%. When both of the children's parents have the disorder, the risk increases from 50 to 75% (NIMH).

Signs of Bipolar Disorder

The signs of bipolar disorder include manic and depressive episodes. Individuals having a manic episode might experience feeling elated, have a lot of energy, increased activity levels, trouble sleeping, become more active than usual, talk really fast and quite often about different things, become irritated or touchy, have reckless sex, feel wired or jumpy, and think they can do a number of things at once.

People having a depressive episode might experience feeling sad or hopeless, have very little energy, decreased activity levels, trouble sleeping and concentrating, forget things quite often, eat too much or little, feel tired, worried and emptied, feel they can't enjoy anything, and think about death or suicide (NIMH).

Studies of Bipolar Disorder

There are a plethora of research studies regarding bipolar disorder. Bipolar disorder is a brain disorder found in all races, ages, social classes, and ethnic groups. The following are some studies identified in the literature.

In the Ancona (2013) study, the author sought to understand, among other things, the life experiences of six women living with bipolar disorder as college students. Through the research process, the author identified several commonalities from the women who shared their life stories with her. One of the findings was that bipolar disorder for these women was at its worst during the hormonal cycles. A second finding was that puberty and/or childbirth for these women seemed to be the trigger for the onset of bipolar symptoms.

A third finding was that all the women were high achievers as youngsters putting them at a greater risk for later adult onset bipolar disorder. A fourth finding was that low self-esteem and feeling of worthlessness were factors for several of these women. Also, the presence of childhood abuse was part of most of the women's past, and they all resulted to substance abuse.

Another finding was that all the women, when they felt overwhelmed, were reluctant to talk to their academic advisors and college professors about their bipolar disorder because of social stigma. For students with bipolar disorder, this could lead to onset of a manic or depressive episode with serious outcomes.

In the Dentzau (2017) study, the author sought to discover the experiences of four college students who experienced the onset of bipolar disorder during college. Through the research process, the author identified five main themes and 27 sub-codes under each theme. Figure 1 provides a breakdown of the five main themes and examples of the sub-codes for each theme that was reported by each participant in the study.

Under Theme 1, for example, the author indicated that "anger" was noted by all of the participants during a manic episode. Under Theme 2, the author indicated that the participants were confused about the onset and did not realize they were manic at the time. Under Theme 3, the author reported that all the participants used campus resources to improve their academic studies. One participant used the counseling center to get his symptoms under control and plan his life.

Under Theme 4, the author noted that the participants' relationship with various people changed once they shared their mental health disorder with them. People thought differently of them and this stigmatization resulted in the loss of opportunities as experienced by the participants. Under Theme 5, the author reported that all of the participants used "self medication" to deal with the symptoms of bipolar disorder. One participant noted that he drank alcohol almost daily to cope with stress.

In the Kim (2015) study, the author sought to explore and describe the perspectives of six parents' experiences of living with their children's who were diagnosed with bipolar disorder. Through the research process, the author identified a number of themes from the mothers who shared their experiences. The mothers expressed feelings of isolation, embarrassment, exhaustion, struggle, guilt, fear, hurt, worry, and being protective daily of raising their bipolar children who exhibited behaviors of temper tantrums, destruction, verbal and physical aggression, threatening statements, night terrors, sleep walking, and impulsivity. For several of the mothers, the adult interaction, socialization, and martial and family relationships were negatively affected and limited as a result of being embarrassed by their children's behaviors. Thus, the mothers dealt daily with their struggles and emotions through coping skills such as praying, crying, shopping, isolating, and interacting with other adults.

In the Reed (2009) study, the author sought to explore the perceptions of 10 college students diagnosed with bipolar disorder on their personal transition from high school to college in the areas of student development, student-focused planning, family involvement, interagency collaboration, and program structure. Through the research process, the author noted several findings from the study. One finding indicated that the counselors, teachers and district administrators were not adequately addressing the needs of students with bipolar diagnoses. Another finding reflected that collaborative and coordinated planning in the educational setting was not taking place. The majority of the students in the study, for example, were not aware of transition services to college until they attended college. In order to avoid potential worry, humiliation and negative views associated with bipolar disorder, the students did not disclose their disability in high school. This contributed to their having little or no awareness of transition services in college. Also, the majority of the students in the study reported that they did not gain support from their teachers. They expressed that their teachers misunderstood their behaviors and made no effort to determine the reason for their behaviors. The students also expressed that they did not gain support from their counselors. They felt the counselors did not care about them.

In the Watts (2014) study, the author sought to explore the experiences of 10 mothers diagnosed with bipolar disorder that had school age children living at home with them. The author focused the study on questions related to parent-child relationship, parenting stress, etc. Through the research process, the author found that the bipolar mothers significantly experienced parenting stress as a result of worrying about what other people thought about their parenting skills. This subsequently created self-doubt and interfered with the mothers' parenting decisions on a daily basis. Other parenting stress experienced by the mothers included worrying about how to take care, protect, and provide for their children. Their parenting became more difficult and their symptoms exacerbated during experiences of trauma or loss in family members such as siblings and grandparents.