Sane Enough to Know I'm Not: Conclusion

There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you're high it's tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one's marrow. But, somewhere this changes. The fast ideas are too fast, and there are far too many, overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friend's faces are replaced by fear and concern. Everything previously moving with the grain is now against.... you are irritable, angry, frightened, uncontrollable, and emerged totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.

 Kay Redfield Jamison, An Unquiet Mind

Not much of what follows is based on scientific evidence. It consists mostly of my own thoughts and opinions, arrived at through personal experience and observation over the years. It just so happens that several people agree with me, including a few mental health professionals, parents of bipolar children, and probably most importantly, bipolars themselves.

Doctors:

People generally devote more time and consideration to shopping for a car than they do for a doctor. If it’s been on the road for a few years, they want to know its history, how it responds in a crisis situation, how many times it’s been in the shop, and why its previous owner decided to chuck it. Potential owners kick the tires, blow the horn, take it for a test drive and check out other makes and models at other lots.

I don’t advise kicking a doctor or tweaking his nose, but I do advise checking him out and shopping around for different models. Just as different cars meet different needs, so do doctors. After visiting with a psychiatrist for a couple of years and feeling no progress has been made, there is nothing wrong with trading him in for a new model.

A diabetic wouldn’t see an OB-GYN for treating his high blood sugar. A cancer patient wouldn’t seek the services of a specialist in any field but oncology. A heart patient would be less than brilliant letting a podiatrist install a cardiac stint.

So, why do mental health patients seek the services of anyone other than a skilled and experienced specialist? I define a specialist as a psychiatrist who is trained and skilled in the treatment of the endless forms of mood disorders, one who can distinguish between bipolar and cyclothymia, chronic depression and dysthymia, and between schizophrenia and all the rest.

If possible, this psychiatrist should also have a Doctor of Pharmacy degree. After all, he is the person monitoring and prescribing medications, so I think it is wise to seek someone who has this additional knowledge and training.

I, and a growing number of professional and lay people, feel very strongly that medical doctors should not be allowed to diagnose, treat or prescribe medications for mood disorders, or any other mental illnesses. They have very little training in this field, resulting in undiagnosed or misdiagnosed cases of bipolar. Most primary care physicians recognize their limitations and refer patients to qualified mental health professionals, but unfortunately there are those few who do like to play God and the consequences can be truly disastrous.

The same strenuous search should be made for a therapist who is skilled in the dynamics of manic depression. Visit with several before making a choice. It is especially important that a child feel comfortable with and can relate to their psychologist or social worker. Whether or not mommy likes the mental health professional is irrelevant.

I teamed with psychiatrists for many years to treat bipolar illness. Bipolar patients were often the most rewarding for their intelligence, their eloquence, their creativity, and their fascinating life stories. They were also often the most frustrating, for their refusal to accept the boring mid-range of experience that successful pharmacological treatment had to offer . . . . And they were often the most heart-rending, for the sorrows their personal losses and disappointments handed them at the extreme points on either pole. Comment by Nance.

Medications:

“Experts Say Too Many Children Are Over Medicated.” “Experts Say Medication X Is Causing More Suicides.” I can almost mark my calendar with such old news headlines which appear with great regularity every two years or so.

Take a close look at these “experts.” See any psychiatrists? See the name of Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins who herself is bipolar?

Take a close look at the writer’s credentials. Most don’t even know that bipolar and manic depression is one and the same. It’s like sending a reporter to a horse show who has never seen a horse in their entire lives and who doesn’t know the difference between a trot and a canter.

Of course these claims are backed up with all kinds of statistics. “X percentage of people killed themselves while on the drug Pablum in the U.S. in 2009.” What they don’t say, because they don’t know or don’t do their research, is how many lives are saved by being on Pablum. What they fail to point out is that most, not all, of these patients lead more productive lives, perform better in school, and have much healthier personal relationships.

To deny a child needed medications is condemning the poor kid to a life of hell: to more hours in the principal’s office than in the classroom, to low academic achievement, to poor socialization skills, and very often, to a life of crime beginning at a very early age.

The days of medicating patients with bipolar or other mental illnesses to the point that they become zombies are pretty much over. Most psychiatrists prefer to start with low dosage amounts and then gradually increase it, if necessary.

Tragically, there are those cases where a patient simply doesn’t respond to treatment of any kind. Hopefully, in time, and as scientists learn more about this illness, this will be a thing of the past.

People ask why so many more people are being diagnosed with bipolar these days. My answer is simple: doctors and scientists are learning more about it as each day passes and there are better and better diagnostic tools at their disposal. Polio was first identified in 1789 but it wasn’t until the late 1950s and early 1960s that the Salk and Sabin vaccines proved effective in fighting this deadly disease.

But the brain is still the most mysterious organ of all.

My (bipolar) friend often wrote about the unspeakable cruelties of history and taught these subjects at a local University … genocide, the Holocaust, and torture. Survivors of torture, she used to say, remain tortured. Sometimes she used these as a metaphor to describe how she felt inside. Revolt, she used to say, is how one responds to unspeakable cruelties. At some point, she used to say, one must resign oneself to life’s cruelties because if you dwell on your mortal wounds, it will drive you mad. Revolt and resignation … that is how described her struggle. Comment by Octo.

While creating havoc in a person’s life, and making it pretty miserable for their loved ones, bipolar doesn’t have to mean the end of the world. I often wonder what my own life would have been like had I been diagnosed earlier. Would I have dried out sooner? Would I have had a happier or more content life, used better judgment, found success in the creative or performing arts, hurt and disappointed fewer people? Would I have been a better wife to my first husband, who is still my greatest friend?

Would I have been able to keep my head during those frequent turbulent moments when my second husband used me for a whipping post? Would I have been able to defuse his anger had I remained calm? Not if I had been an angel on steroids.

Would I have been a better mother? God, I hope so.

Sadly, I can’t turn the clock back nor can I keep beating myself over the head for what did or didn’t happen. But due to the exceptional mental health teams on both sides of the Mississippi River, and to appropriate medications, I have been able to rebuild my life, brick by brick by brick.

It goes on and on, and finally there are only other's recollections of your behavior.... your bizarre, frantic, aimless behaviors..... for mania has at least some grace in partially obliterating memories. What then after the medications, psychiatrist, despair, depression, and overdose? All those incredible feelings to sort through. Who is being too polite to say what? Who knows what? What did I do? Why? And most hauntingly, when will it happen again? Then, too, are the bitter reminders..... medicine to take, resent, forget, take, resent, and forget, but always to take. Credit cards revoked, bounced checks to cover, explanations due at work, apologies to make, intermittent memories (what did I do?), friendships gone ordained, a ruined marriage. And always, when will it happen again? Which of my feelings are real? Which of the me's is me? The wild impulsive chaotic, energetic, and crazy one? Or the shy, withdrawn, disparate, suicidal, doomed, and tired one? Probably a bit of both, hopefully much that is neither. Kay Redfield Jamison, An Unquiet Mind

Be a name dropper - famous people who were or are bipolar:
http://www.pendulum.org/information/information_famous.html

Professional Organizations:
National Alliance on Mental Illness
National Institute of Mental Health

Books for the layman:
Although a clinical psychologist and a Professor of Psychiatry at Johns Hopkins, Kay Redfield Jamison sits at the top of the stack. She is bipolar and has done more to educate the public and professionals about bipolar than a twenty volume encyclopedia could do. And her writing is much more enjoyable - moving, clear, lofty at times, profound at others. I had the privilege of hearing her speak at a Colorado Mental Health Association luncheon in Denver one time. She is a remarkable woman and I am a devoted fan.

Her An Unquiet Mind can be read in one evening. It has done more to give hope to bipolars like me than any other single book. It is about her own struggles with this illness and is beautifully written.

She also wrote Touched with Fire: Manic-Depressive Illness and The Artistic Temperament. This was my first introduction to Jamison (before I was diagnosed), is quite a bit longer and absolutely fascinating. I could not get my nose out of it. She explores how bipolar disorder can run in artistic or high-achieving families.

Others she has written include Exuberance: The Passion for Life; Night Falls Fast: Understanding Suicide; Nothing Was the Same. I honestly cannot recommend any of these books enough.

HERE is a list of books for significant others.

Internet Sources:
One could spend a month of Sundays visiting bipolar pages and still not get to all of them. And many of them are filled with mythologies of their own, so beware.

Pendulum has been around since the days of L-servs. I used to participate and think it's pretty reliable. There are all kinds of sources there for those who are bipolar and for friends and family.
Depression and Bipolar Support Alliance is another but I am not as familiar with it.