Ma Yantao, a well-known emotional disorder expert, talks about bipolar disorder: disease? talented? Genius disease?

Reporter | Gao Jia

Edit | Liu Haichuan

The article "Our Gifted Son" recently published by Hangzhou Daily tells the story of his son Jin Xiaoyu who taught himself to translate foreign language books in the context of bipolar disorder from the perspective of a father. The story has attracted widespread attention on the Internet, the "chosen ones" have the ability to confront the world, and Jin Xiaoyu's "genius" traits attract a certain "romanticized imagination" of his experiences.

This story related to mental illness thus creates a social hotspot. After the article was widely disseminated, the media spoke with Jin Xiaoyu, who told his experience from his own perspective, which was not entirely consistent with the story told by his father, Jin Shengyong. Given their identity as bipolar disorder patients, discussions have emerged about when people with mental disorders will be able to leave the "told" role.

The topic of privacy protection for patients with mental disorders has once again been brought to the table, in this specific case, what will Jin Xiaoyu bear in the face of excessive exposure to the outside world? Perhaps it should become the problem behind the "carnival" of the story, which we should perceive.

Interface News had a conversation with Ma Yantao, head of the emotional disorder research group of Peking University Sixth Hospital and a well-known expert on emotional disorders in China, to observe the case of "genius son" from the perspective of a psychiatrist. It is hoped that this case will become an opportunity for the public to have a more objective understanding of the population of people with bipolar disorder.

Here's what Interface News had with Ma Yantao:

Interface News: Are people with bipolar disorder in a long-term "aphasia"?

Ma Yantao: I don't think so. In fact, the current state of patients is "polarized". On websites where young people gather, we often see videos posted by individuals, people actively describing their emotional problems, willing to expose privacy, and even willing to expose privacy. Many people don't mind referring to themselves as "depressed people" in public — some of these groups are bipolar, and their expository behavior has its own characteristics.

There are patients who present a sense of presence with overexposed disease, which we call "bluntness". Others are invisiblely exposed, exposing the "glory" that disease brings to themselves. For example, some patients think: "In the patient group, I am the top." When he exposed this understanding, he exposed "biased information."

Of course, there are also some patients who do not want to be exposed. "I don't want to talk to people" or "I have no place to expose" – this mentality is still prevalent among patients. Because the practical benefits of exposing a disease, such as more convenient health care, better job opportunities, and higher salaries, are not easy to see.

In real-world scenarios, the choice that more patients tend to prefer is indeed "concealment.". Including patients who have "overexposed" behavior on social networking sites, they often choose not to show the "side" of the disease in real life.

Interface News: What is "bipolar disorder"? How can we understand the behavior of patients?

Ma Yantao: Previously, we described bipolar disorder as a type of mental disorder dominated by repeated, prominent, intermittent episodes of emotional upswing and depression. Now we say that bipolar disorder is a chronic, prominent and subtle mood swing as the primary clinical manifestation of a disease. "Chronic" means continuous or repetitive, and "prominent" refers to the fact that the dominance of emotions causes some obvious changes in people, which in addition to subjective experiences , such as "I am not in a good mood" and "I am going crazy", are accompanied by objectively observable changes, generally that is, changes in behavior, including sudden impulses, which are also accompanied by suicide, attacking others or hurting themselves.

The disease is determined by emotions, not out of logical judgment, not based on delusions, but only on emotions. Emotions are unpredictable, maybe one second people are fine, the next second suddenly feel so depressed.

Emotions determine a patient's behavior. A lot of times patients will put up with the behavior, "I don't want this, I don't think it's good." "But there are also times when you can't help it, so patient behavior is characterized by suddenness and unpredictability." In essence, patient behavior is not deliberate, not purposeful.

When a person does things in an emotionally dominant context, he may not be judgmental. For example, we once communicated with patients: "When you were hospitalized, you said you would donate a building to our hospital and give us two hundred million." He wouldn't remember: "Is it?" Did I say anything like that? "After high levels of excitement, patients may develop selective amnesia.

Interface News: After "Our Genius Son" received attention, the media communicated with the "genius translator" Jin Xiaoyu in the article, and Jin Xiaoyu's subsequent experience told from his own perspective was not completely consistent with the story told by his father Jin Shengyong. How can people with mental disorders fade from the role of "narrator"?

Ma Yantao: All human activities are seeking or creating some kind of meaning, but the meaning is not the same. In the family of a patient with bipolar disorder, the family caregiver and the patient themselves feel differently about the same facts, and the meaning they want to create and express is also different. In this case, the father and son have translated many books over 10 years, and they have "conspired" to do something, and they agree with each other on the meaning of doing it, but the specific feelings may be different.

When we take patient histories, we often hear that there are differences between the stories told by the patients themselves and the stories told by the family. The important point of disagreement is the evaluation of the patient's own performance on the social network architecture. For example, in this case, Xiaoyu said to himself: "I am not suitable for school and work. The father said: "Xiaoyu suddenly said, I don't go to college, and I don't want to go to high school... He really lives at home every day. It can be seen that Xiaoyu at that time did not want to have more connection with society, and his tendency was self-satisfaction.

But his father and mother wanted to give him a job. "Let a friend help, introduce Xiaoyu to the Xinhua Bookstore on Jiefang Road as a salesman... He also introduced Xiaoyu to the exhaust fan factory as a worker..." In the "arrangement", we saw the word "society". "How do I arrange a normalized, socialized life for my children?" This is the role of the caregiver (father, mother).

In fact, when I saw the photos of the Kim family's room, I was very touched. They moved into that house in 1988, and we lived through that era, knowing that the people who lived in that house in the '80s, most of them later improved their housing conditions. We follow the so-called "normalization" and earn money by going to work and raising the material level. But the family's space stopped in the 80s, why did it stop in the 80s? Among them are the factors of the disease. From this point alone, can the father's feelings be completely ignored? No. He carries the burden of supporting his family.

Simply put, if conditions permit, the child lives in a personal castle and has a creative talent, and there is nothing wrong with it. However, in the socialized background, the child does not adapt to the social situation, and even has a degenerative performance, parents encounter such a problem, can only feel from their own identity and perspective, he also hopes that the child lives freely in the castle, but the reality may be very cruel.

We hear different voices of fathers and children, two different voices that are not relationships that should prevail over whom, they are both part of the truth. Whether it is Xiaoyu's current calm expression, or the seemingly unbelievable sudden violence he presents in the story; whether his father is an intellectual in public, a hard-working image, or an image of sometimes anger in the eyes of his son, these are real life, and if we do not accept this reality, we will not accept the real experience that disease brings us.

Interface News: What do you think of this story related to mental illness creating a social hotspot?

Ma Yantao: I think it is very interesting that my father recounted a story between "illness" and "creativity". In the past, mental illness was even seen as a "disability", what is there to say about disability? But this father created a "light" in the "disability". Everyone will hope that in the imperfection of "I", there is a creative existence, and it is this "light" that touches everyone.

A mood disordered person, when we look at him badly, he is sick. But there is creativity implicit in this disease. I have a patient who is 16 years old, who was also a bully, who was studying in a key high school, and suddenly became in a bad mood. He also has very special feelings, when he is depressed, he picks up an iPad to draw, and every time he comes to the doctor, I see his paintings. He said, "Once you've cured me, I won't paint." I said, "I'm really sorry we made you a mediocre person." ”

This correlation between creativity and emotion is indeed relatively prominent in this group, which is also the appeal of the story of "Genius Son". If Xiaoyu hadn't been sick, he had nothing to do, stayed at home for 10 years, translated 20 books, and probably no one would have heard the story. But a patient, 10 years of translating many books, is remarkable. It is somehow in line with the needs of society, and people with emotional illness still have productivity, which is a very intense story.

Interface News: Should we also be wary that romanticizing individual experiences could lead the public to form an unreal romanticized imagination of the entire population of people with bipolar disorder?

Ma Yantao: Beautification is an instinctive expectation of people, and at the same time, beautification also means singleness. In the story of "Genius Son", it is both beautiful and ugly. For example, the disease trapped the whole family in 1988, the family should have improved the house, the old couple can often go out and play, the child has a stable job and a happy little family. No. This is the "ugly" part of it. But "beauty" bursts out of "ugly". He (Xiaoyu) even had such a creative ability. Beauty and ugliness coexist. Put aside the ugliness to talk about beauty, or put aside the beauty to talk about the ugliness, that is not real, the truth is all there.

In fact, we have spent many years discussing bipolar disorder, is bipolar disorder a disease? Or genius? Or is it a genius disease? We have come a long way in medical research, and later learned that it is both "genius" and "disease", or that "genius" and "disease" are actually the same thing, both "biased" in the crowd. There is always a group of people who are biased to the left point, a group of people to the right point, and most of the people standing in the middle are called ordinary people, ordinary people.

The bias is actually the same in terms of "disease" and "genius" bias, and in terms of probabilistic events, it is the same. Interestingly, when it condenses on a person, when we use such contradictory labels on a person, when we give too much meaning to a person, we can't see anything clearly, and we just look for a bunch of words in the meaning to "generalize".

What we're doing now is breaking the meaning, breaking the label, breaking the framework. In an intuitive way, using the carrier of art to let people directly perceive and experience emotions, experience the so-called good and bad, here, the most important work is not only "de-stigmatization", in fact, "de-aliasing".

Interface News: In recent years, what kind of clinical progress has been made in the treatment of bipolar disorder?

Ma Yantao: In 2015, the second edition of the "Guidelines for the Prevention and Treatment of Bipolar Disorder in China" was released, and in the past 8 years, China has done a lot of work in promoting the standardization, standardization, systematization and long-term treatment of bipolar disorder.

Non-pharmacological therapies such as light therapy, transcranial magnetic stimulation, and vagus nerve stimulation use light and electricity stimulation to stimulate specific targets of the brain more precisely and quickly eliminate symptoms. The trend of clinical application of this type of physical therapy in recent years has become stronger and stronger, and everyone still hopes that there will be more accurate and faster treatment methods to break the deadlock of drugs.

Interface News: Can we foresee how the sudden and intense attention from the outside world may affect Jin Xiaoyu?

Ma Yantao: We look at this story and create a kind of carnival, which actually belongs to the "social self-congratulation". I tend to understand that my father was in a state of despair when he told the story. If we really want to focus on what we can bring to this family, it should be to bring some substantial help to this family. If social institutions can help the child, if he can have a more stable environment and income, I believe it is very important for this family.

In this case, how Xiaoyu will continue to live, we have no way to predict this matter. In the past, it may have been his family who bore more, but this time, the real reaction of society was presented to him, allowing him to experience and take responsibility for the first time. As a social person, he and his father view this social phenomenon on an equal footing.

From the doctor's point of view, if the patient's parents come to ask for help: "Now our family is touching this kind of thing, what to do?" "I think there is one of the most basic principles — the principle of rights as human beings. If Xiaoyu is 4 years old this year, I suggest that you quickly call the police and drive away the people who disturb the normal life of the family. Xiaoyu is now an adult, and adults need to learn to face it independently, and he should not be exposed to these things.

We don't know what he thinks, what to do? If he can have the opportunity to listen to his thoughts in a particular situation, it is the best healing for him. As a friend or family caregiver, you can observe his state change in this rapidly changing environment.

Interface News: In daily life, people with mental disorders, how should we treat them correctly?

Ma Yantao: Pay attention to others, like pay attention to yourself. Focusing on emotional disorders is like focusing on your own emotional problems. This should be a basic principle.

Professionally, one technique we usually employ is called empathy. The core idea of empathy is not to ask about cause and effect. "Why are you sick?" "Why can't I get sick?" We don't ask this. What we have to do is be aware, I see you sitting there, I see you're uncomfortable. I saw that, and that was the first step.

Not only seeing, being able to hear better, being willing to listen to others is the second step. "Seeing" and "listening" are our basic instincts. Then, the most difficult thing for us to empathize with is that it's hard not to make judgments about the information we've gained. As long as you don't make evaluations and don't do "meaning wars", your "empathy" will be very strong.

To "see" and "listen" is to have done very important work and have done a great job. Professional things are left to doctors, but we are all experts in companionship, care, understanding, and listening.