Sandy Hook

Sandy Hook

Wednesday, October 06, 2010

Sane Enough to Know I'm Not: Bipolar 101 (1)

MRI of the brain during "normal", manic and depressed moods

So I’m bipolar. So what? How does this make me an expert? It doesn’t. I’m no authority on the subject whatsoever. I can only write about what my experiences have been and about what I’ve learned while searching for answers to this very complicated multifaceted mental illness.

There are several stock responses when I tell someone I’m bipolar. “Oh, my dear, I can just imagine the hell you go through.” Or, “Oh sweetie, talk to me anytime. My great-aunt/mother/brother/wife/ daughter has it. I know all about it.” Well meaning but it’s pure horse hockey.

Another is: “We all get blue sometimes.” True, “we all” do just that. Someone dies, we lose our job or our kid gets sick. Or our house burns down while the firefighters stand there and do nothing. Any of these things alone is enough to depress anyone. But . . .

That is a situational depression. It is nowhere nearly as extreme in intensity or longevity. It isn’t so debilitating that you don’t want to get out of bed for weeks or months at a time. It doesn’t cause you to self-mutilate, or worse, to kill yourself. It may even last for a couple of years but not for a lifetime. And you can’t just talk yourself out of it.

Another is, “Well, gee, I have periods when I’m more energized than at other times.” Of course and that’s perfectly normal. You just got a raise, won some money, moved to that farm you’ve always wanted. Or, maybe it’s something simple like the sun shining and it’s a beautiful spring day.

But . . . This feeling of elation is thousands of miles away from the intensity and destructiveness of a manic episode. You don’t lose your judgment. You don’t make reckless decisions, spend boat loads of money you don’t have, or dance naked in a fountain, or self-medicate with drugs and alcohol.

Oh, there’s one more: “Well, I’m sure if you pray and talk to the Lord, you’ll be just fine.”

So what is this thing called manic depression anyway? What causes it? Is it contagious? Can’t you just take a pill to get rid of it? What are the symptoms?

According to the National Alliance on Mental Illness: “Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic and typically vary greatly over the course of a person’s life as well as among individuals.”

Too clinical. Too cut and dry says I. What are missing here are all the complexities of mood disorders, all the varieties which come in all sizes, shapes and even colors and the multitude of symptoms which overlap. There’s major depression. There’s manic depression. There’s schizophrenia. Each of them presents themselves differently and all of them have similarities, making diagnosis a complicated affair.

Even manic depression has variations on a theme. One is rapid cycling where moods go up and down like a roller coaster ride. The other is mixed states where mania and depression are experienced at the same time. Mixed states are bad enough. Rapid cycling is pure hell and they're both hard to control because just the tiniest dose of a medication, too much or too little, can send a person spiraling in the other direction. And there are even a few more, but that’s really getting too technical for this blog.

Scientists have been trying to find a genetic link to bipolar for decades, but so far it has eluded them. There was a huge study of the Amish about 15 years ago because they have such a high rate of bipolar and not a small amount of inbreeding. The study was a dud, unfortunately. But clinical trials continue at Columbia, John Hopkins, Duke and other major universities and centers. It is well documented that manic depression, and related mood disorders, is passed down through the generations.

A few cut and dry, but revealing, statistics from NAMI:

- Approximately 20.9 million – or 9.5 percent - of American adults over the age of 18 have some form of mood disorder.

- Manic depression affects about 5.7 million adults in America, or about 2.6 percent.

- The median age of onset is 32. (Note: children as young as six or seven are being diagnosed. More about this later).

- Ninety percent of people who commit suicide have a diagnosable mood disorder.

As mentioned earlier, bipolar is such a complex disorder that it is impossible to do it justice on a blog. What you’ve seen here and in my previous post (HERE) is a superficial look at best. But I think readers need this tiny bit of information to understand what follows.

Everything we experience is an extreme. There's no such thing as smooth sailing. It’s a stormy sea with periods when a body, mind and soul can be pushed to the depths, raised up in turmoil and only occasionally have peace and calm.

32 comments:

  1. Yes, I know all about bipolar/manic depression as my wife was diagnosed with it a few years back. I can go into detail about how it looks from the outside but I have yet to visual how the world looks to someone diagnosed bipolar/manic depression.

    My wife refuses to discuss it and basically we just kind of co exist with this 800lb elephant from time to time.

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  2. I cry for you, TAO. No, you can't know the internal turmoil, but I've often said that this illnes may be harder on the loved ones than the patients. Does she see a psychiatrist? Does she take meds? I feel for both of you.

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  3. Yep, sees a psychiatrist every month and meds are a daily routine...

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  4. I feel extremely sad for anyone who suffers from depression or bi-polar or even monthly severe PMS, which was me. It is very debilitating and complicated, and I think the person living with the inflicted person has a really hard time coping as well.

    I hope you are well my friend, and You too TAO, I hope you and your wife are doing well!

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  5. It's not my job here to dispence advice, but - if you haven't already - you might try getting her to a psychiatrist with a pharmacology degree. Some of them do only evaluate meds but they do not "treat." Probably you'd have to go to a larger town?

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  6. Thanks, Ms Sue. I manage better than most, I think, at least when I take my meds. : )

    That last post was in reponse to TAO, btw.

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  7. Tell us more please! I do think it is hard on the family members because we don't understand it, we lose patience, and ultimately we give up. Most of that comes from ignorance.

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  8. I just sit here feeling so very thankful for my health. I would be curious to know from persons like Annelle (who commented on your introductory post) and TAO, who have loved ones who are bipolar: do they feel “guilty” because they themselves are healthy? I ask that because I feel guilty to an extent when others around me are suffering.

    My older son committed suicide in 1982 at age 17. I will always feel guilty that I might have done more. So that’s where my feeling of helplessness come from when I know of others’ suffering and know I can do nothing about it.

    The thing I – or anyone – can do is to stay informed.

    Leslie, how very courageous you are to share this insight with us. I look forward to each of your posts.

    BJ

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  9. Viki: I do think family members have an obligation to read up on it and learn as much as they can. Until they do that they don't have the necessary tools to be of much help.

    There is plenty of info on the Internet at NAMI and the Mental Health Assn. sites. Plus there's one called Pendulum, which has been around for 20 or so years.

    http://www.pendulum.org/

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  10. BJ: I had an aunt who committed suicide after eight years of excruciating back pain. I lived with her for a time. I think all of us feel guilt when that happens. I also think that when it is your own child it has to be a thousand times worse. I'm so sorry to hear about this. Teenage suicide has grown to epidemic proportions and it's a heartbreaking travesty.

    Thank you BJ and yes, we must become and stay informed.

    Nance: Thanks. I hope it helps someone.

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  11. Guilt is not the first emotion....at first you want to find a cure or a fix. You expect everything to get better then.

    Then you have anger, anger because you feel that they are not working hard enough to get better.

    Then you begin to wonder why is this happening to me?

    What did I do to deserve this?

    It becomes personal because you are the loved one and you are the one that they will lash out to first and foremost. They will for a time blame you for their situation....you let this happen to them.

    Then you realize that there is no "better" you realize that the one you love will never be the person that they once were.

    Then you experience grief. In that grief you find compassion and strength. You grasp not only your loss but their loss too...

    Yes, BJ you do become more compassionate and more concerned about doing more....you do look back and think of all the times that you should have done something differently....

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  12. TAO: I don't think I've ever read anything from the "other side" as poignant as what you've written here. "you are the one that they will lash out to first and foremost." This resonates with me. I admire you, TAO. A lot of men would have escaped through the back door rather than deal with this. Your love and compassion is very evident. She's a lucky lady, and deep down, she knows it. Trust me.

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  13. I applaud the courage you must have to take on this topic, and thank you for enlightening us. I'm sure we'll all learn a great deal.

    My own brush with bipolar disorder involved my first husband. It was his brilliance and enormous appetite for excitement that attracted me to him as much as his creativity, which generally involved days and days of brooding followed by gigantic explosions of energy and accomplishment. When you're 18, nothing could be more exciting than being around someone who really throws himself into life! By age 30, you realize how debilitating it is for the individual, as well as the marriage.

    Unable to hold down a job or maintain a friendship for any length of time, my young husband attempted suicide more times than I could count. (I wrote about this briefly in one post in a series on 1960s sit ins.) As you say, we could be living on air but he would buy himself an expensive stereo component, or motorcycle. Any untoward glance or inadvertent slight could turn into a monstrous roadblock ending a perfectly good friendship. There was no consistency, no logic but his own. Eventually, I could spot depression triggers. Over time, the creative part of his mania turned to plans for self destruction or (worse!) plans for my destruction. He refused help, and I eventually ran away.

    Fortunately for him, he experienced longer and longer periods of peace later in life -- even though he had cut himself off from almost all family and friends -- so I imagine he got some of the help he needed. When he died, I mourned for all the pain I knew he endured, and for the life (and lives) that could have been.

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  14. First, Leslie- this is a very courageous and educational act on your part, baring your soul to try and tell us what it's like to go through life with a diagnosis of being bipolar.

    My fraternal grandfather, a retired cop, had a mood disorder most of his life. In the late 1950's he received electro-shock therapy to relieve the symptoms. On the Sunday after Thanksgiving, 1958 he hanged himself while my grandmother attended Mass. I was very little at the time and barely remember him. Years later, we found out that grandpa's father was also a suicide, and also a man prone to depression. I'm no expert on genetics, but scientists say that in our DNA there are switches that trigger changes, like how we age, how we grow, how we develop. So count me in on those who believe there is some sort of genetic link or predisposition regarding mood disorders.

    TAO- reading your comment made me think that you experienced all of the aspects of the Five Stages of Grief. Usually it happens at the death of a loved one, but can be experienced in the death of a relationship, or realizing that a loved one will never be the same due to illness, or as in your case, an emotional disorder. Though most of us cannot truly relate to what it's like to be bipolar, nearly all of us have dealt with the grief of the survivor.

    Thank you both for sharing.

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  15. Paula: I can identify with all of that. Not only am I bipolar, it's a sure bet that my second husband was as well. Apparently bipolars are attracted to each other for the same reasons you were attracted to you husband. Imagine having two in the same household. When one is up, the other is down! I felt the same way you did when my ex died but because of my own demons I've had an extremely hard time dealing with the dynamics of our relationship. Very eloquently written, Paula.

    Hugh: Thanks. Nothing like running naked across the football field in front of thousands of spectators! Except I don't have 1000s of readers.

    The hunt for the elusive gene fascinates hell out of me. I used to have some stats on what the chances are of a child inheriting it if one parent is depressed or bipolar but I've lost them. Of course, if both parents have a mood disorder the the chances of a child having it increase just that more.

    Interestingly, in those stats I quote from NAMI, more men commit suicide but women try it more often.

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  16. TAO, I knew there was something we have in common besides an extreme dislike of political idiocy...

    I could have written, albeit not as well, your comments too...

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  17. Thank you for this very important post, Leslie. My daughter thinks she is bipolar and I tend to agree with her. She has been diagnosed as having clinical depression. She has been to two different psychiatrists, but a divorce meant that she lost her medical coverage. She was on a medication that stabilized her, but can no longer afford it. She is taking some medication for the disorder and seems to be functioning quite well.

    It is very difficult to spot when it first appears. I always thought my daughter was a drama queen as a child because she exaggerated the good and the bad episodes in her life.

    After she got married and had children she would take them to school and go back home and go to bed. She slept a lot and was very depressed. She would have periods of manic cleaning followed by doing nothing. I became worried at this point, but I knew nothing about the illness. She was married to a grade A jerk who was not sympathetic and thought she just needed to "pull up her socks". He was manipulative, controlling and demeaned her so much that her self esteem was zilch. She started medicating herself with liquor and that made her husband more scornful, although he was an enabler. He had her convinced that she was a bad mother and she finally tried to commit suicide because he had convinced her that her girls would be better off without her. She almost succeeded.

    After that suicide attempt she became angry and kicked him out. (He actually physically punished her.) Now she has a job she loves and perhaps being bipolar is an asset right now. Although she is on a low salary and does not get overtime pay she works from 45 to 60 hours a week setting up an entirely new office system for a small company. Her self esteem has returned and she is happy for the first time in years. I pray she remains stabilized and she seems to be so. Her emotions are no longer manic.

    Your post is the best one I have ever read on the subject and I am forwarding it to my daughter now.

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  18. Dave: Good to see you here. Yes, TAO's comment is very profound and I've saved it.

    Darlene: Some pdocs will charge on a sliding scale. The problem is finding a good one - preferably someone with a pharmacology degree. This is something I can't stress enough. Failing that, she might check out city or university services. I have a friend who wrote the necessary pharmaceutical companies and provided them with documentation to prove she couldn't afford her meds and they give them to her free.

    I'm sure she feels empowered since she kick the bastard out. Good for her. I've been there, done that and it ain't no fun.

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  19. TAO, Paula, everyone: I am so impressed by your willingness to open up and share your own thoughts and experiences. Leslie, this openness is so refreshing. You have done a good thing, my friend. Your posts and all the comments are a much-needed book in the making. I recently listened to Beautiful Boy: A Father's Journey through His Son's Addiction by David Sheff amd couldn't imagine how any man could be so brave as to share his innermost angst just to help others. BJ

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  20. Leslie,
    Although I don't have direct experience with being bipolar, I've had similar issues with alcohol and drug abuse - sober 35 years!

    Without going into detail I understand how people will unintentionally minimize, often for well intentioned reasons or to show solidarity.

    My heart goes out to you, Tao's wife and others. Addiction is insidious, I know firsthand. But from what I've learned here so far in your series, I am so fortunate because thru the grace of God and dumb luck and many other things I am OK. I could easily fall back again should I make some mistakes, but barring that life is pretty good.

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  21. L.P., thanks for more insight, again so well written.

    Psychiatrists are M.D.'s and have full prescribing authority. As I understand it, some psychologists have limited prescribing authority while others have none.

    "“Well, I’m sure if you pray and talk to the Lord, you’ll be just fine.”

    DIY, huh? How much better to have someone who genuinely cares squeeze your hand or give you a hug and say, "You're in my prayers."

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  22. Thank You for sharing this info, never took time on this subject, just heard alot of folk's had it. Leslie .... reading your stuff as long as I have been ... I would have had no idea whatsoever you have any kind of disorder. Like I said, I known a few (3) acquaintence's over the year's ... who told me they had problem's with this, and I reckon I didnt understand and just thought, they were coached into believing they had something wrong with them .. and I know this may sound narrow minded to you or perhap's, not being understanding enough ... I just thought that Leslie. I had, had some contact with a few death row inmate's that are labeled as "serial killer's" (I dont want to mention their name's here, cause they are fairly well known) and of course, they are termed I reckon by the public as having some kind of mental disorder's, but they dont seem to have had anything like this, or seem to kill out of anger, more like an addiction in some cases, one thinking it was a mission from some deity type archetype, yet could be very sensible and likable in a one on one conversation actually ... we even talked football game's, told joke's, love/ romance, etc .. you name it ... but it was indeed an experience. I am not sure what their disorder would be though ... but yeah ... they were in regular prison's ... only one was on med's, who had vision's of sort, and he commited some gruesome act's (I prefer not to elaborate, out of courtesy to ya'll), when I was visiting with him though, he would get really shakey, couldnt hold his hand's still, and seemed to stay in a state of paranoia, thought at once that some spirit sent me to him for a reason even, so it was an experience.

    But this was very informative ... seem's like though you have a good handle on at least understanding this ... wish I could say something beneficial to you, but frankly cant, I simply dont know enough. I appreciate you sharing though, I learned something.

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  23. BJ: You are too kind. I've been thrilled with, fascinated with and enlightened by all these wonderful comments. I am the one benefiting from all this.

    Oso: Addiction can be a byproduct of bipolar, whether or not we know we have it. Often, it's the only way - or so it seems - we can shut off our brains which are racing a mile a minute and making it impossible to sleep. Or it may be an attempt to ease the emotional pain we may be feeling. I commend you for being dry and clean for all these years. Good for you.

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  24. SW: Psychiatrists are the only ones who have the authority to prescribe "mood altering" meds. I very, very vaguely recall something about a few psychologists having limited authority to prescribe such meds, but they shouldn't. Nor should MDs. But I'll get into this in my final post.

    I don't mind people sympathetically saying that I'm in their prayers but the other b.s. is what chased me away from AA. I could write another series on that experience.

    RC: This is going to sound very contradictory. The average person can't tell just by looking at someone or reading their posts that they have bipolar - just as you can't tell someone has diabetes. But, and this is going to sound like Parsley's Voodoo, a person who is bipolar can often pick up on it simply because they recognize the "signs" - patterns, traits, etc. Maybe someone with a spouse who is bipolar can see it, but not so much. I'd be willing to bet that every single one of those prisoners has some sort of mental illness. I'm glad you feel you're learning something. That's what this is all about.

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  25. I just felt I would notice something different in writing, because I feel a person's writing, also reflect's their feeling's, emotion's, mood's, etc ... at least when I write, I have emotion's in my writing ... as far as anger, happy, sad, love, etc ... you know what I'm saying(?) I kind of like write like I talk I reckon in person. I was in close contact with 4 prisoner's who have been convicted of these offenses ... oddly ... they all have different personalities, though can be fairly straight up and honest and likable ... and certainly functioned at a time normally in society. What I had noticed though ... is they had really weird chldhood's and were subjected to alot of "abuse" it seemed like. I mean ... they had some weird parent's/ familia's, who acted violent with them, and were forced to do thing's that normal parent's dont do to their kid's, even sexual stuff, which was unheard of in my familia. I mean ... I came from a familia myself that were not all upstanding citizen's I reckon (like mom's brother's, racket's, number's running, dad worked in the casino business at a time (60's Vegas), and indicted on tax evasion, etc)... however ... I never was abused as a child actually, or beaten or whatever, you know(?) (just seen quite a bit of crooked shit I reckon) I wonder sometime's if that has something to do with some of their action's too.

    Thank You Leslie ....

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  26. RC: I think it's more a case of output, or lack of it, that can be very telling. When I'm "up," I can't stop writing and posting. When I'm down nothing interests me and I can't put two words together. Remember, this is a matter of extremes. There are some other little signals that, added up altogether, indicate the possibility of a mood disorder - at least to me.

    I think we all have a few horse thieves in our closets. Google "murderers" or "convicts" or "serial killers" and "mental illness." You might come up with some interesting articles.

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  27. Great post and I am living with someone who is also bipolar.

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  28. Beach: I hope you read TAO's comment above.

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  29. suicide? Suicide? SUICIDE? Tiny felt like that big sign was nailed to her chest like being in stocks. No self-esteem or self-worth taught in and reinforced every time the church doors were opened. Lower than worms in the dust. Not good enough for heaven, but you better be or you burn in hell FOREVER! Afraid to go to sleep for fear you won't wake up. Afraid to wake up for fear you will still be here. Tiny thinks that was the first upper step on the stairs down to the utmost pit of hell.

    Age twelve, first attempt. Thoughts, almost daily. Religious confusion, constant. Social life, non existant. Church-Work-School and in that order. No school activities. Sunday School and school teachers were the same who taught no self worth or self esteem.

    Married alcoholic who constantly reinforced that Tiny was insane and her fault he drank. In 1965 a doctor knocked Tiny out and sent her to hospital with another patient being sent for surgery due to lung cancer.

    Hospital doctors kept her knocked out for a week. When allowed to come to a man was sitting by her bed and said, "Good morning.
    My name is ... ... I'm a psychiatrist."

    Tiny raised up on her right elbow laughed and said, "Well, I am crazy," relieved to finally know for sure. But all good things end ...

    Rapidly,he announced, "No! You are not."

    Confusion turned to shock when he told Tiny she was being tormented to death by her alcoholic husband, which Tiny knew she had not told and knew her alkie hubby would never admit. How did he know such things, accurate things?

    Back then doctors were allowed to give,without permission sodium pentothol, commonly known as truth serum.

    The question remains, is Tiny crazy or not? Depends on who you talk to.

    Leslie this is an excellent post. It shines a light into the corners of our minds and causes us to take stock of ourselves.

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  30. Tiny- Thank you. My God. How very, very sad. No, you are not crazy but I know too well how someone can drive you to think that way. Maybe landing up in that hospital was a good thing? Maybe saved your life?

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  31. I encountered a guy on OS who is bipolar. He has EXTREME mood swings. He's incredibly intelligent and writes some fascinating stuff to read. He's got a cool name - James M Emmerling. Every once in awhile he disappears for a long time, returning to write again about his stay in the "hospital."

    http://open.salon.com/blog/james_emm

    His writing reminds me of some of the early philosophers, sometimes very difficult to follow, but when he explains them to you, his words make perfect sense.

    You know there's been much discussion related to bipolar disorder and whether or not it should be singled out as a disorder. The problem with the discussions is that those with bipolar don't always know how to manage it and it is most certainly a disorder at that point. If the discussions become too philosophical, there's a chance that our friends in the gubnit would disqualify it for ADA benefits, robbing them of much needed resources.

    BUT! The creativity of many bipolar individuals is phenomenal - check out David DeRosa at http://www.artprimadonna.net/figurative_gallery.html

    He's an extreme cycler with a wife who is his soul mate and helps him through his very dark times. His art is awesome and his writing on OS is just as good.

    I'll comment more on your following posts

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