It’s the story told round the world (Google has 3,058 stories on their site today).

Crazed lady astronaut tracks and attacks another lady astronaut over a third male astronaut.

Yum. We love gossip about perfect people, and astronauts are too often portrayed as perfect cardboard saints. So let’s hear the dirt.

But to a doctor the story sounds like more than stress. It sounds like more than jealousy. It sounds more than paranoia. It sounds bizarre. It sounds like mental illness. Or drugs.

But my bet is she has Acute Manic psychosis due to bipolar illness.

Jealousy and love triangles are not new, and taking a gun out and arranging carefully to confront a rival with a gun is not new. Usually it’s men, but with women’s lib, we have become an equal opportunity violent society.

But you get more hints of something wrong in the story. She is married with three kids. She was organized enough to survive Astronaut training and psychological evalustions.

But then you read the incident.
This “well organized” person didn’t take a 44 special with her, or a tazer. She took pepper spray, a hammer, and a bb gun. Duh.

And then we read this: “Nowak, accustomed to wearing astronaut diapers during the space shuttle’s launch and return to Earth, wore them on the drive from Houston so she would not have to make bathroom stops”.

Guess she never heard of Ditropan XL or Detrol.

This is getting bizarre…and when we were in medical school, we were told the “taxi driver rule”. If a person’s actions would sound crazy to the average taxi driver, you are probably dealing with psychosis, i.e. mental illness that puts you out of touch with reality.

But the clue is that it is a one thousand mile drive…you HAVE to stop to sleep and eat and do other things…Unless you are manic. Unless you are suffering from Bipolar disorder and are in an acute Manic psychosis.

Bipolar disorder AKA Manic Depression, is quite common. I am not talking about emotional moodswings (which are probably a mild form of the disease) where people get mildly depressed sometimes, and at other times are cheerful and happy. I’m talking about mood swings where in the manic phase people forget to eat, stay up all night partying, spend money, have affairs, write books, and have brilliant ideas for days on end…ideas that are complete nonsense when examined carefully. And that might be the only clue that this is mental illness, not normal energy.

You see, the judgement gets cloudy. A Baptist deacon spends his life’s savings on gifts and has an affair. A good Amish farmer starts wearing red shirts. A judge parades around his office in shorts and offers to show his “family jewels” to his elderly secretary. A college student runs down the street naked in November shouting he “loves fagots”. These people were not “nuts” they were manic, and all patients of me or my collegues, and all needed hospitalization.
But milder cases are often shrugged off as high spirits. But then the person goes into a deep depression, where they have no energy, hate everything, and see their doctor. Or alas commit suicide.
The dangerous part as a family doctor is that some people we docs see who we think have run of the mill mild depressions are bipolar, and when placed on the anti depressant, get manic or suicidal. This is one of the reasons for the bad reputation of Prozac.

Without a history, you miss it. And in between the mood swings, you may be normal.

So it is likely that this lady never was diagnosed, but the stress of her marriage breaking up and the stress of overwork and being an astronaut may have lit the fuse that spun her into a full blown manic cycle.

WebMD has a good site for information on Bipolar illness.

Sean Astin also sponsors a webpage on Bipolar illness that is geared to the lay public. Astin, best known as Sam in LOTR or as RUDY in the movie Rudy, is the son of Patty Duke, who was diagnosed as bipolar.

The important thing to remember is that this is a biochemical disease, just like Diabetes, and not your fault.

The second most important thing to remember is that most people can be treated with medicine. However, the treatment is subtle, so usually I recommend a psychiatrist to treat my patients who are bipolar.

Lithium keeps down the moodswings, but now a lot of docs prefer to use medicines for seizures, which also work and easier to take since you don’t have to worry about doing blood levels as often. Often “poly pharmacy” is needed. And counselling for controling life stresses and for family relationships often is also helpful.

The ironic thing is that unlike many forms of schizophrenia, bipolar disease is often found in productive people, and when treated, most (but not, alas, all) can continue their lives.

So if you have a question, go to the sites, and then ask your GP and say you worry you might have bipolar illness, and he or she will find a mental health expert to check you out.

After all, if you suspected your blood sugar was high, you’d check it out. Same here. It’s an illness.

One note of caution in all of this: We might not know all the facts about the case, so making a diagnosis without seeing a person is not always accurate. And another note of caution: certain drugs –both medication (e.g. steroids, anti depressants) and “recreational” drugs (e.g. cocaine, meth)–and some medical illnesses (e.g. hyperthyroidism, brain tumor, Cushings disease) can cause similar symptoms.

A good doctor may diagnose bipolar or depression or mania, but will always do the lab work.

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Nancy Reyes is a retired physician working in the Philippines. Her webpage is Finest Kind Clinic and Fishmarket and she often posts medical essays on Hey Doc Xanga site

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