Bipolar disorder and gout


Empty chair at Baroon Pocket Dam – Photo by Bob Wilson

This may seem an odd way to approach an essay about bipolar disorder, but I had forgotten that lithium was at one time prescribed for gout. Not that I’ve ever had gout, but a couple of relatives who do have it tell me it is not something you would wish upon your worst enemy – or even Donald Trump. Gout is a painful inflammation of joints caused by an excess of uric acid which forms needle sharp crystals in the joints, hence the pain.

The conventional solution is medication and avoiding rich, fatty foods. Traditional medications are allopurinol and colcochine although some GPs and naturopaths recommend low doses of lithium combined with vitamin C to make uric acid soluble and easier to expel from the body.

The point being, very few people would stigmatise gout-sufferers for taking medication to ward off the acute pain that comes from an attack. Yet lithium is the drug of choice dispensed by psychiatrists when diagnosing someone with bipolar disorder. The latter is very much a stigmatised condition. However, as we will see, some famous people are working to ‘normalise’ it through documentaries and speaking tours.

Author Edward Shorter traced the history of lithium in an article published by PubMed Canada and archived by the US National Library of Medicine:

A London internist, Alfred Baring Garrod, recommended lithium treatment for gout after discovering uric acid in patients’ blood. This was in 1847, 12 years before Garrod wrote The Nature and Treatment of Gout and Rheumatic Gout.

Lithium, a naturally occurring mineral, was used to treat mania in the 19th century, particularly in Denmark, but did not emerge as a mainstream treatment until 1949, when Australian doctor John Cade was credited with re-introducing lithium to psychiatry.

Despite the development of pharmaceutical alternatives (valproate, lamotrigine, carbamazepine), it is still regarded as the ‘gold standard’ for mood stabilisation and treatment of major depression.

The gout sufferer, meanwhile, simply has to cut down drinking beer and avoid purine-rich foods (such as red meats, offal, some seafood and Vegemite). His or her sanity is unquestioned. If asked (say at a barbecue with friends and neighbours), they will freely talk about their swollen joints; knobbly elbows and inflamed big toes may even be shown.

No such empathy for the approximately 727,300 Australians (about 3% of the population), with some form of manic depression/bipolar disorder.

In 1980 the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), changed the classification system to bipolar disorder, a more clinical and less emotionally loaded term than the stigmatised ‘mania’ or ‘manic’.

Stigmas die hard. There are hard-to-shake myths, worst-case scenarios magnified in the press and on current affairs TV, which focus on the tragic cases that fell through the cracks in the system. We form fixed ideas about the mentally ill, shying away from people we see as ‘odd’.

I started exploring the subject (it’s Mental Health Week after all), after watching Stephen Fry’s Not So Secret Life of a Manic Depressive 10 Years On. Fry, originally diagnosed with the less disruptive form of bipolar (cyclothymia), made a controversial documentary series a decade ago where he interviewed well-known bipolar sufferers including actor Richard Dreyfuss. The psychiatric profession was generally dismayed with Fry’s (then) stance against taking medication.

In this update, Fry is diagnosed with bipolar 1 (the more serious type in which sufferers may have psychotic episodes) and he starts taking medication, although confessing to self-medicating (as many sufferers do); in his case with alcohol, diazepam or sleeping pills. In the hour-long ABC documentary, a range of people with bipolar disorder are interviewed and the nature of their disorder is laid bare. There’s a young woman who became a paraplegic after jumping from a balcony (in her manic state she thought she could fly). There’s a chef whose wildly swinging moods are endangering his job and his home life who finally decides to stick with lithium.

Although bipolar disorder afflicts only 3% of the population, the odds are that only 50% of these people will be able to hold down a job.

People who plainly don’t understand mental illness may react badly on seeing an apparently healthy 20-something man wandering around in the middle of a working day. Because he is taking medication to quell the various strands of his illness, he is not talking to himself, acting oddly or accosting people. But he is still (invisibly) unwell.

“He’s got two arms and two legs hasn’t he? Tell him to get off his arse and find a job,” some might say.

Ah yes, so he’s a ‘leaner’ not a ‘lifter,’ a polarising notion recycled in 2014 by former Treasurer Joe Hockey (borrowed from the lexicon of Liberal Prime Minister Robert Menzies).

As Fry’s documentary shows, some bipolar sufferers have ‘normal’ friends who support them through the worst of their illness and stick around during the well times.

Others not so fortunate retreat into their own heads while their friends may drift away. Fortunately, there are support groups which can help people struggling with the feeling they are on their own.

It is easy enough to find long lists of famous people who have ‘come out’ and declared themselves bipolar and one would hope this helps to push stigmas and myths into the corner.

Surrealist painter Edvard Munch (who painted “The Scream”), is on this list, so too Beach Boy singer-songwriter Brian Wilson. The late Spike Milligan owned up to it, as did former NRL star Andrew Johns and a long list of composers, writers, comedians, actors and celebrities.

Margaret Trudeau, mother of Canadian Prime Minister Justin Trudeau travels the world speaking out against the stigmas and myths surrounding this admittedly confronting disorder. If you are my vintage, you may remember reading about Margaret in the popular press, hanging out at nightclubs with famous rock stars and generally not living as one might expect of the first lady of Canada (then married to Prime Minister Pierre Trudeau). In hindsight, those florid 1970s reports of Margaret jiving at Club 54 with Mick Jagger and the Stones typify a person in the throes of a typical bipolar manic phase: disinhibition, impulsive behaviour, risk-taking, spending sprees and so on.

In a lengthy interview with Will Pavia in the Sydney Morning Herald, Trudeau, now 68, at one point began to talk about her passion for bringing mental health issues into the spotlight. From February to June she travels, campaigning about brain diseases, depression and her experiences of living without the medication she now takes. Trudeau says she is helping to break the last great taboo – “The thing people are most afraid of talking about”.

At which point Pavia observes: “She is certainly not afraid to talk about it. She talks at a rate of knots…if this is Trudeau on mood stabilisers, what must she have been like, for all those years, when the mania struck?”

Great question, Will, one which reminds me of an older chap I know who was diagnosed with bipolar in the 1960s.

“I took the lithium and after a few months I felt great so I said, Doc, I don’t need to take this anymore. At which point he looked at me and said: “Don’t be a f***’ng idiot!”

(What I wrote last year):                    

rainbow-lorikeet-02And on an entirely different note, Bird Week starts on Monday 17th October- you’re invited to spend 20 minutes one day next week to count (and name, if possible) the birds in your backyard- check it out at this website. To get you started, this is a Rainbow Lorikeet – common, now that the Bottlebrush is flowering. (Ed.)


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October 15, 2016 2:20 pm

Interesting Bob – but off the mark in one respect. I have suffered from gout since I lived in India. It comes on when I am dehydrated (I always drink beer, red wine, and eat rich food and red meat). It is, as you correctly say, incredibly painful. I know I have it when the pain does not go away when weight is taken off the afflicted joint. Where you are wrong is that there are a few people to whom I would like to pass it on to – starting with the Trump, and going onto the ex-presidents Bush,… Read more »