The bipolar affective disorder is a mental condition that results in abnormal shifts in an individual’s energy, moods, concentration, and activity levels. In the film “Silver Linings Playbook” written by David O. Russell and released in 2012, the main character Solitano Jr. “Pat”, is an excellent example of a bipolar affective disorder patient. Although the exact cause of the disorder is yet to be established, several researchers point out biological genetics and psychosocial elements as possible causal factors. Simultaneously, research reveals that alteration of neurotransmitter signalling due to the damage of the limbic network is the disorder’s central pathophysiology. Genetics, brain structure, and environment are the commonly known risk factors for developing the disorder, with racing thoughts, irritability, and lack of sleep as the significant symptoms. Low resilience level, impaired psychosocial functioning, and lack of family cohesion and adaptability are ways the disorder impacts an individual, family, and community. Conducting Cognitive Behavior Therapy (CBT), Interpersonal Psychotherapy (IPT), and mindfulness-based therapy are vital roles nurses play in mental nursing’s non-pharmacological interventions.
The exact cause of the bipolar affective disorder is yet to be discovered. Still, research suggests that a combination of factors, such as psychosocial and biological genetics, contributes to the condition. Notably, the bipolar affective disorder is one of the most likely conditions that can be passed from a parent to a child with a 10% chance (Coombes & O’Connell, 2021). Simultaneously, the chance increases to 40% in cases where both parents have bipolar disorder. In reference to Pat, it is clear the condition is hereditary because his father suffered from Obsessive-Compulsive Disorder (OCD), an illness comorbid with bipolar affective disorder (Albert et al., 2020). Although psychosocial factors do not cause the illness, symptoms of bipolar affective disorder can be triggered by stressful circumstances such as the breakdown of relationships.
The pathophysiology of bipolar affective disorder is mainly the limbic network’s damage that leads to alterations of neurotransmitter signalling. While such damage can result from heterogeneous conditions, the primary pathophysiological mechanism is traceable to an inflammatory/immune-mediated change of white matter that involves connections of the limbic network, destabilizing the signalling of serotonin and dopamine molecules (Magioncalda & Martino, 2021). As a result, there is a repetitive and phasic reconfiguration of inherent brain activity, from variations in network activities to abnormal subcortical-cortical due to changes in neurotransmitter signalling. Hence, researchers can develop hypotheses based on the current information on bipolar affective disorder to better understand the illness.
Not a single risk factor leads to an individual’s development of the bipolar affective disorder, as scientists suggest that multiple factors can lead to the illness. Genetics is one of the common risk factors because the condition tends to run in families (Bergen & Robinson, 2021). Specifically, children with a sibling or parent with the illness have an increased chance of developing the condition than those with zero affected members in the family. Brain structure is another risk factor due to chemical imbalances resulting from traumatic head injuries and concussions. To identify if there is a chemical imbalance in an individual’s brain, positron emission technology (PET) and functional magnetic resonance imaging (fMRI) are two types of scans that can provide brain images (Bauer et al., 2019). Finally, the environment is a risk factor because significant life changes or stressful events can trigger an individual’s bipolar affective disorder. As witnessed in the film, Pat’s illness was triggered when he found his wife with her lover in the bathroom, bringing about a manic episode that made him attack the man. Therefore, stressful or adverse events brought on by the patient’s environment are strongly associated with subsequent mood episodes.
Like other mental illnesses, bipolar affective disorder is identified with various signs and symptoms that can trigger the search for medication. Lack of sleep, racing thoughts and irritability, and talking incessantly are common symptoms of bipolar affective disorder. We can see several examples of such behaviours in Pat throughout the movie. One of the classic scenes is when Pat stays up reading Ernest Hemmingway’s book rather than sleeping, and there is no happy ending because he gets upset, throws the book outside through the window and storms his parent’s bedroom (Biggio et al., 2021). Hence, individuals diagnosed with bipolar affective disorder get unusually irritable, euphoric, or full of energy when their moods shift to hypomania. However, they feel hopeless or sad and lose pleasure or interest in most activities when they become depressed.
Individuals with bipolar affective disorder are likely to experience family dysfunctions, leading to inferior psychosocial functioning through psychological and environmental factors. Lower resilience levels and impairment of psychosocial functioning are the most common psychosocial impacts of bipolar affective disorder on an individual. Notably, resilience is significant in an individual’s ability to adapt to challenging situations such as trauma, family tragedy, and stress (Cai et al., 2022). A bipolar affective disorder patient fails to keep functioning both psychologically and physically when events that trigger their mania episodes occur. For instance, Pat cannot resist the thoughts of attacking her wife’s lover in the film due to his lower resilience level. Better psychosocial functioning is associated with high resilience levels, as suggested by research performed on stable bipolar effective disorder outpatients.
Simultaneously, impaired psychosocial functioning implies that the patient’s ability to engage in relationships with others and perform daily activities is affected by the cognitive, physical, and emotional dimensions of depression. In bipolar affective disorder, improving family conflict through psychosocial functioning is significant for moderating family adaptability and enhancing cohesion (Bonnín et al., 2019). Although psychosocial function researches are rare, the correlation between them and family calls for further investigations to analyze its effects on bipolar affective disorder patients.
The absence of family adaptability and cohesion, high levels of expressed emotions, and inadequate family interpersonal relationships are some of the psychological impacts of bipolar affective disorder on the patient’s family. They are both features of a bipolar affective disorder family, associated with difficulties in creating intimate relationships and lower perceived social and family support from the surroundings. In particular, family functioning significantly impacts the life of a bipolar affective disorder patient (Dai et al., 2019). In reference to the film, Pat developed poor mood symptoms in episodes when there were increased conflicts between him and his father or mother regarding medication. Simultaneously, lower family adaptability and cohesion lead to jovial moods in Pat’s life, as seen when his parents mutually agreed to lie to him that Nikki would attend the dance competition. Therefore, emotional stability is essential in families with bipolar affective disorder patients as it enhances communication and problem-solving through effective family functioning.
In addition to individuals and their families, the community is not excluded from the psychosocial impacts of bipolar affective disorder. Remarkably, the condition is considered one of the leading causes of disability worldwide. The world health organization (WHO) claims the condition has affected approximately 45 million people. At the workplace, coworkers are likely to carry the labour burden because bipolar affective disorder patients will likely miss workdays due to severe symptoms (Depp et al., 2021). Besides, the community’s efforts in supporting bipolar disorder patients are affected by the stigmatization attached to the condition. As a result, the patients are discriminated against in society due to their struggles in starting a family, living everyday life, and holding down a job. Finally, an increase in bipolar affective disorder patients makes it difficult for a community to manage its treatment, resulting in a tense environment due to an increased feeling that the condition cannot be controlled.
In mental care, mental health nurse plays several roles in providing non-drug interventions to build healthier relationships with the consumers of mental health services. One of their central roles is implementing standard psychological therapies such as (CBT), one of the most effective psychological treatments for depression. CBT aims to help individuals to break down their problems into smaller parts that can be effectively dealt with (Amani et al., 2020). Notably, mental health nurses are well-trained with diverse techniques to engage with patients and build strong relationships with them. As a result, they enable the patients to explore their own problems and empower them using the Socratic approach, a questioning technique based on thoughtful and disciplined dialogue.
Moreover, their main goal is to get the patients to reflect on their unhealthier behavioural patterns and form healthier approaches to their emotions. For instance, Dr Patel employs the Socratic questioning technique during therapy sessions with Pat, as we can see him asking questions such as “would you like to be the guy who goes back to jail or to hospital?” As a nurse or a therapist in CBT, he ensures that Pat can develop healthier behavioural patterns by reflecting on his thoughts and emotions (Himle et al., 2022). Hence, a mental health nurse helps the patients prioritize their objectives during CBT by degrading problems and developing a hierarchy of small goals to achieve.
Performing less formal supportive therapies is another role a mental health nurse plays in non-pharmacological interventions in mental health care. Mindfulness-based therapy is an example of less formal supportive therapy. In mindfulness-based therapy, mental health nurses help patients under mental illness treatment to better understand physical sensations associated with their cognitions and how to address their emotions (Khoury et al., 2019). In particular, the nurse guides the patients to direct their focus on the contemporary moment to help them maintain a sense of control during emotionally overwhelming experiences. Accordingly, helping patients better understand their physical agitation and emotions associated with their cognitions is crucial in mental health nursing career.
Finally, mental health nurses are crucial in implementing interpersonal psychotherapy (IPT) for patients with mental disorders. As a form of psychotherapy, IPT improves patient’s interpersonal functioning by focusing on relieving their mental health symptoms. During therapy sessions, mental health nurses focus on helping the patients to address their current relationships rather than developmental or childhood issues (Holmqvist et al., 2019). However, the nurses should ensure they are non-neutral, active, hopeful, and supportive during IPT therapy sessions to offer effective change options to the patients. In reference to a scene from the film, Dr Patel asks Pat to reflect on his relationship with Nikki, his ex-wife, to help him solve interpersonal issues to relieve his symptoms and improve his life. During an IPT session, a mental health nurse helps patients to mobilize social support and improve their interpersonal relationships by understanding their thoughts as social signals (Correa & Rocha, 2020). Consequently, improving self-esteem, restoring morale, and reducing psychological symptoms are vital roles of mental health nurses in improving the client’s interpersonal relationships during IPT.
In conclusion, genetics is one of the leading causes associated with bipolar affective disorder, as most researchers suggest that the condition runs across families. Although not a single gene is accountable for the condition, family members of bipolar affective patients are more likely to develop the condition. Concurrently, serotonin and dopamine are the most significant neurotransmitters in the pathophysiology of bipolar affective disorder due to the limbic network damage that results from their alteration. The existence of first-degree relatives with bipolar affective disorder, traumatic life events, and chemical imbalances in brain structure increases an individual’s chances of developing the condition. As a mental issue, medics can identify bipolar affective disorder patients by examining their ability and rational thoughts and irritability events by the patients. It undermines an individual’s ability to adapt to life challenges, the family’s emotional bonding, and the community’s productivity because bipolar patients cannot carry out their day-to-day activities. In particular, mental health nurses play a critical role in non-pharmacological interventions such as CBT, mindful-based therapy, and IPT by helping patients identify their emotions and behaviour regarding their life, surroundings, and relationships to solve their interpersonal issues by developing healthier behavioural patterns.
References
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