It was only when a light bulb went off in my head right after reading a study about the mood spectrum that I realized I had a unifying theme for a book I had begun working on, one that would treat two illnesses within the context of one phenomenon. This was in the spring of 2004. That summer, I had a chance to sit down and talk to one of the co-authors of that study, Ellen Frank PhD of the University of Pittsburgh, who told me: "What we’ve been arguing is that even isolated symptoms that don’t cluster together to create episodes may be important."

Dr Frank’s study found that even one symptom can have significant repercussions. For example one manic item in a depressed patient increased suicidal thinking 4.2 percent. As I mention in my book:

"Although Dr Frank cautioned in our interview, ‘I don’t think we know yet whether [our findings have] treatment implications,’ and that ‘this is a new area of research, relatively speaking, and we don’t know exactly where it will lead us,’ she also advised:

"’I think patients need to be aware of what might be softer expressions of both hypomania or mania, and try to the fullest extent possible to get their doctors to listen to their concerns that there may be something more going on here than unipolar depression.’"

The middle of the mood spectrum is today’s hottest topic - and historically the most neglected. In a webcast of a grand rounds lecture delivered at UCLA in 2003, Trisha Suppes MD, PhD of the University of Texas Southwestern Medical Center in Dallas, gave me something to think about:

"I said, wait," she told her audience, "where are all those patients of mine who say they’re hypomanic and don’t feel good?" The common misconception of hypomania is of one feeling a little bit too good for one’s own good, but a study of hers identified a significant number of patients with "dysphoric hypomania," which can best be described as an "energized depression" overlooked by the DSM and most of the rest of psychiatry..

A year later, an outsider psychologist, John Gartner PhD, who teaches at Johns Hopkins, opened my eyes to the fact that hypomania (at least in its milder forms) should not necessarily be regarded as a pathology to be medicated out of us. In fact, it is often a significant advantage and for some of us may be a legitimate part of our personality. To quote from my book:

"Dr Gartner likens a patient with hypomania to the pitcher in Bull Durham, ‘the guy who has the 100 mile per hour fastball but keeps beaning the mascot.’ You want to give him just enough medicine to establish control, not slow him down to 50 miles per hour."

Unfortunately, nearly next to nothing is known about hypomania and bipolar II. As I mention in my book:

"In her UCLA grand rounds lecture, Dr Suppes observed that bipolar II is the object of only about 20 review papers. None of the treatment guidelines, in their recommendations, distinguish between treating a patient with bipolar I and bipolar II, as there is precious little research to go on. At the time of her talk, bipolar II was estimated to be 0.5 percent of the US population (now it is about 1.5). ‘That’s a lot of people,’ she concluded, ‘not to know anything about.’"

I attended my first psychiatric conference in 2001, feeling very much like a fish out of water. There, Robert Post MD of the NIMH cited new study findings that indicated I wasn’t alone, namely bipolar patients are depressed three times more than they are manic. For bipolar II, the ratio is much higher. Until then, I thought I was the only one with bipolar who was depressed practically all the time.

Mania gets all the attention, but, as numerous experts point out, bipolar depression is far more difficult to treat, is more incapacitating and potentially fatal, is what most patients relapse into, and is reportedly worse than unipolar depression (if such a thing is possible).

In 2002, at another psychiatric conference, I met S Nassir Ghaemi MD, now at Emory University, who very graciously answered my stupid questions and gave me valuable insights regarding treating this inexcusably neglected facet of our illness. Here, we find the enigma of the mood spectrum waxing most paradoxical: Bipolars and unipolars may be close diagnostic cousins, but when it comes to treatment we tend to be distant relations.

I had been doing my Newsletter for about a year when in 2000 I came across a study by Husseini Manji MD at the NIMH that found that lithium made brain cells grow. Surely, this is significant, I thought. Now what? If I email him to request an explanation, he’s going to think I’m some kind of idiot. I eventually overcame my anxiety and received a gracious reply, what would become the first of the equivalent of a series of personal master classes by leading experts into the workings of genes and cells and brain systems.

It was years before I was able to develop some sort of working picture in my mind. Then, at a conference in 2003, Robert Freedman MD of the University of Colorado told a symposium: "The DSM-IV was not designed with human gene function in mind and genes do not encode for psychopathology." Instead, "genes encode simple molecules in cells that alter cell function and brain information processing."

Hey, I almost know what he’s talking about, I thought, feeling like Eliza Doolittle after correctly enunciating, "The rain in Spain …"

This is why I love writing about brain science. The degree of difficulty poses an extreme challenge to my neurons, but when I get it right, I feel the same exultation as a gymnast who has stuck her landing. Not surprisingly, the brain science section is the favorite part of my book.

I confess to not knowing in which hemisphere of the brain the left prefrontal cortex is located, but that is neither here nor there. What I am attempting to convey is a sense of the atmosphere of discovery – equivalent to the early days of the space program - that is changing how we think about our illness. Hopefully, this appreciation translates into greater personal insight. To know thy neurons is to know thyself.

In the short time I have been doing my Newsletter, scientists have mapped the human genome, linked certain genes to behavior, identified a number of illness pathways in the brain, teased out gene candidates, discovered potential new drug targets inside the neuron, and developed theories that would have been unthinkable a few short years ago.

Yes, we have a long way to go, but how far we have come can be best summed up from this passage in my book:

"In a lecture at the 2004 APA annual meeting, Jack Barchas MD of Cornell University and a pioneer in the field of how biochemistry and behavior interact, recounted how as a student a half century earlier he proposed investigating neurotransmitters. He was told: ‘If you want to research biochemistry, study the liver. Nothing is going to happen in the brain for years.’

"So out of touch was psychiatry with medical science back then that an early mentor actually challenged one of his ideas on these grounds: ‘How is this justified in the writings of Freud?’

"Fortunately, Dr Barchas paid the man no attention."

Ever since I started my Newsletter some seven and a half years ago, readers have been emailing me, and fruitful correspondences have developed. Similarly, readers have posted on my Website. The result is a fountain of insight and wisdom that amply complements the knowledge of the expert clinicians and researchers.

"Please," writes Brian, "may I have my life back and start over again."

You want to know what our illness is really all about, simply ask my readers, some 200 patients and loved ones cited in my book. Says Dove:

"Crying up to God to please take me home. I see friends pass and envy them, or at least wish I could give them my time. I go to the doctor and he will say ‘well how are we feeling today.’ If I was feeling good or happy enjoying life I would not be in his office. I want death so bad, but what stops me from doing it myself is how will God see what I've done. I feel trapped, damned if I do damned if I don't. So life goes on trapped in a world and body I wish to have no part of."

Says Marcy:

"Come, join me as I take six medications. Watch me as I enter a manic mood and decide that I will try to go to college and live a happy, normal life. Watch me as, hours later, I lay sobbing and crumbled on the floor because I am depressed now and have just been brought back into the realization that college isn't going to happen for me right now. Watch me as I call my sister and talk about her college studies and friends. Watch me as I watch ‘Friends.’"

Throughout the book, my readers offer the kinds of insights borne of living with this illness day after day. Nowhere does this come through more loud and clear than in my chapter on behavior.

In early 2003, I asked my Newsletter readers to take an online personality test and email me the results, along with their diagnosis. I was amazed to discover that 83 percent of us were introverts, almost the exact reverse of the general population. A search of the literature revealed that my unscientific poll was not far off the mark. Further research revealed that our tendency to isolate sets us up for future depressions.

One of my respondents, Carol, offered this advice: "If I may draw a conclusion, those of us who can break through isolation and make contact with others, could be better able to keep the depression at bay."

In an article on my Website, I concurred, noting: "This is generally easier said than done, given the nature of our illness, but the stakes are enormous in what could very well be the most important aspect of our treatment."

But another reader, Mel, challenged me: "As an intelligent and creative artist, visionary, thinker and compassionate human, I find most extroverts obnoxious, self-centered narcissists who have little respect for topics which do not serve them in some way. … We ARE NOT like others and do not want to be. The advice that we would be better off somehow by getting out more often and mingling with the very people we can't relate to makes no sense at all."

Definitely food for thought. Is there a middle way? Avatar found it in a monastery, among fellow souls: "There I was in a true community, no longer alone, eating, prayer, and working, no longer isolated, but alone together. I hope this makes sense. Community is vitally important to sanity."

In a similar vein, I asked my Website readers for their take on spirituality, which struck a deep chord. As Katie describes it:

"To have lived (and survived) the highest elation and lowest depression has been an awakening of my spirit I would not otherwise have known. Persons not affected can not imagine nor will they ever be able to understand how this affects our spiritual lives as much as it controls and twists our physical lives."

And from the spiritually sublime to the sensationally sublime, I switched the conversation to sex. From Anonymous: "When I was in a relationship, I would wear my poor partner out. To me sex was like potato chips, once you started you couldn't stop until you ate the whole bag. I couldn't stop until the poor guy was begging for mercy, he couldn't perform anymore. Then I would go home and get out the trusty vibrator."

Here, my readers are the experts. Says Eric:

"It is a daily war against giving into the darkness. The impulses, and constant voices in your head saying how unworthy to be here, how unworthy of life push into you. But, each day we win, we survive, and those who have not these forces pushing them have no concept of how strong you are, we all are, for winning a war daily against things that would immobilize any of them."

Says Jane: "Bipolar is not the problem. The problem is the problem. If you suffer with bipolar, you will suffer. If you merely cope, you will merely cope. If you live with bipolar, you will live."

Ultimately, with acceptance comes healing. In the context of our illness, healing is more of a personal transformation than a cure. Here is where I enter the picture. Nearly eight years ago, a suicidal depression resulted in my family taking me to the emergency room, resulting in my diagnosis as bipolar. As I describe it in my book:

"One brutal cold day in early 1999, a psychiatrist confirmed what I had known but what I had been afraid to face up to all my life – that I wasn’t like the other 96 or 97 percent of the population. I wasn’t normal. Never was. I had been lying to myself all these years."

I could have swallowed my pills and pretended everything was fine, or I could begin to face up to reality. It didn’t take me long to decide my life would never be the same. I could still do the one thing I was good at, but the terms and conditions were about to change. A short time later, I sent out my first Newsletter. My life was about to take a turn for the better. Fittingly, the last words in the book serve as the final word here:

"Writing is what helped bring me back from the dead. For me, it is a healing activity. If I were a basketball player I'd be shooting hoops, if I were a gardener I would be out with the petunias. Healing is about finding something that makes you feel alive and doing it. When I'm in full flight there is no time and space. The sun takes its leave, booming music falls mute, and the steaming hot cup of tea by my side is stone cold when I pick it up a minute later.