Accepting Bipolar: Join the Club

They tell us that one in every hundred people has some form of manic-depressive illness.  My question is where are all these people?  The gays have come out of the closet, those with physical disabilities have the American Disabilities Act, but where the hell are all the basket cases?  Frequently, we're hiding it from the rest of the world. But on the other hand, many people just don't know why, or in some cases notice, a massive change in personality has happened.  To realize you have a mood disorder is tricky, to accept it is a struggle.  My struggle towards acceptance was probably a typical one, presenting challenges that most people with bipolar disorder (BPD) face, but it definitely is worth telling.

I was a pretty normal 12 year old boy; curious, hyper, unattentive, always looking to make a joke.  If you saw me at that age you wouldn't have concerned yourself much with my mental health future.  You would have seen a straight A student who was active in sports, had plenty of friends, was well-spoken to adults, and very independent.  What you wouldn't have seen were the subtle signs and the changes I was going to go through. 

I had a tenuous relationship with my father, he had lived 6 hours away from me since I was 3 and our interactions were limited to holidays and summer.  No matter the circumstances between us, I had a strong bond with my Dad which originated deep in my DNA.  Somewhere around the age of 12 my father and I lost contact, the particulars are rather unimportant, but what was important was the effect this had on me.  I thought I was strong and would be ok, so what if my father didn't want me, I didn't need his approval to feel good about myself.  But somewhere deep in my brain, forged through generations of fathers and sons, a disturbance happened.  Abandonment became my issue, one that follows me around to this day.  The knowledge that someone who is supposed to love you unconditionally has rejected you weighs heavily on the mind.  A boy searching for a father's love and coming to terms with his sexuality and transition into adulthood is not a pretty sight.

The changes weren't noticeable right away, the evolution towards recognizable bipolar disorder was a slow process which seemed to keep encroaching deeper and deeper into my life.  And although the trajectory of my life was changing I was blind to the process.  One person who did notice a change in me was my mother.  By age 17 she had seen enough of the inflated self-importance, high irratibility, striking independence, and disregard for consequences to understand that something was going on.  She took me to a psychologist who I met a total of one time.  As I walked out of the office I decided I would never see a mental health professional again.  I felt attacked, scared, insecure, and exposed.  How could this person observe me for one hour and pin me into this group of highly affected people?  Why didn't anyone else say anything?  The truth is that they either couldn't see it or if they could were scared to approach me.  How is it that you tell a friend/relative/co-worker that they need mental help without them feeling betrayed and judged?  Even having gone through the process I don't know that I can tell you a good way to go about it.  But regardless of my feelings about that meeting with the psychologist I walked away with a very important step, realization.

I may have fought it and not wanted to believe it, but I realized after a time that maybe the psychologist was right, everything I could put my hands on about bipolar disorder seemed to be a reading of my biography and inner thoughts.  But this didn't precipitate me doing anything about my disorder.  As with many people diagnosed with a mental health issue I thought I could control the effects on my own.  I simply would not accept that my brain did not function correctly in certain situations.  This was magnified by awareness of how intelligent I was.  I hate to blow my own horn, but I did very well in school and stood out in all subjects, competed for the top of my class, and was active outside the classroom.  How was it that the brain which breezed me through calculus had a problem?  Wouldn't I be a little dumber if my brain had a malfunction?  The answer was obviously no, and I learned over time that intelligence and mental health do not follow along the same path, many of the greatest thinkers of our time dealt with severe mental health issues.

So I began to believe that I had bipolar disorder at the age of 18, but still had not come to accept it.  This started to change my freshman year of college.  Two aspects of college life brough about a dramatic change in my bipolar disorder; freedom of schedule, and the escalation of relationships outside the boundaries of parents.  Suffice to say that my freshman year was a roller coaster in which I balanced the stressors of college life but also those of relationships.  I became very serious with a girl that lived in my dorm which brought me to the heights of ecstasy, a placed I relished and thrived in.  When things started to sour though I would deny and pretend everything was going to be ok just to get back to that mania, a short shot of that drug.  Eventually that plan won't work in a relationship and of course it failed.  Things got hard and the stress for both of us was continually mounting. 

One morning I sat on the fountain that had become my morning retreat, waiting for the bus to arrive so I could start my day of classes.  Suddenly an impressively clear thought crossed mine, "just walk out in the front of the bus, simple solution."  This image has stuck with me for over 7 years, and not just the vagaries.  I was wearing a yellow Brisbane rugby shirt as well as the Ralph Lauren jeans I hated, Ocean Pacific sandles were firmly glued to my feet and in my hand a blue folder with my research articles for my class.  The bus driver had very short blonde hair, a girl I hadn't seen drive the bus before, the number 7 seemed to be dominated by male drivers (possibly due to the fact it was the busiest busline and sometimes it became a little disorderly), she had on her 2001 Maroon Out shirt and a smile that doesn't belong on someone at work. 

Two people sat next to me on the fountain, regulars at the fountain who shared the same class with me.  I had introduced myself to them a week earlier which suddenly weighed heavily on my conscience.  If I step out in front of this bus these two people are going to see someone they know and had met commit the ultimate of mistakes.  Perhaps if I hadn't spoken with them earlier that apprehension to hurt those around me would have never stopped me.  I would have simply been a troubled stranger who they were unconnected to and could go on about there lives without wondering what they did or didn't do that caused my rash decision making.  As it was I stood up and froze, suddenly acutely aware of the thoughts running through my head.  An immediate rush of adrenaline shot through my body, my senses heightened, a light coat of perspiration seeped onto my skin and the urge to run came over me. 

My dorm was only 50 yards away but it seemed like an eternity, by the time I reached the door my excitement had turned into nausea.  Although the story ends with me vomiting in my bathroom and calling my girlfriend it could have easily ended with me flattened on the pavement and having the coroner visit a place I'm sure he would rather avoid.  I was lucky the way it turned out, a single thought had scared me, almost to death.  Acceptance became very much easier after that, a simple turning point with profound and eternal consequences convinced me that something needed to be done.

The next time I went to the psychiatrist I didn't feel attacked or insecure, but the feelings of being exposed and scared were still there.  But this was enough to establish a relationship with the psychiatrist and eventually my negative feelings towards the visits evaporated.  I learned a little then but was still rather arrogant about my situation.  My father came back into my life and I allowed this lull in tension to catch me off guard, and when he left again I had not prepared myself for a shock like that.  The depressive and manic issues I dealt with through that situation claimed another one of my relationships as I again buried myself deep in denial, far away from the acceptance that had brought me such progress.

Now the story is different, after sacrificing two different relationships due to my inability to accept my disorder I am facing it full force.  The pain of losing those close to you far exceeds that of personal deficiency.  Admitting and accepting those things that come with a mental health issue is a painful experience that leaves one feeling alone, stigmatized and exposed.  But this is a far cry from the pain of losing family, friends and significant others because you're scared to face your own problems.

So come on, join the club, I promise there are a few of us here that you wouldn't expect.  The club offers you peace for what is by definition an unpeaceful existence, but you have to want to join, you need to accept what qualifies you entry into the club.  Doing that is the only way you'll solve all of those other problems you have running through your mind.

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NYT Gives a Voice to Bipolar Disorder

The New York Times has an interesting audio piece about bipolar disorder. Listening will definitely help you feel a little less alone and help those who love someone with the disorder to get a better understanding of what it is like to live with it. It's pretty short and well worth the listen.

A few extreme cases in there but it is interesting to hear people living with the disorder speak about their experiences.

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My Life With Bipolar Disorder Pt II: The Allure of Mania

Almost every person I've spoken to who lives with bipolar gives the same account. Bipolar disorder, they say, is not all black and white. It' full of gray. At times, it's full of vibrant hues, all the colors of the rainbow. It can even be full of energy and laughter and excitement. Sure, there's depression. Bipolar depression is neither fun, nor vibrant, nor energetic. It's dangerous--lethal. So lethal that if you're bipolar, you're 10 to 20 time more likely to commit suicide than someone suffering from monopolar depression. But mania, the other side of the bipolar coin, has an undeniable upside. Even better is hypomania, which has all the fun of mania without its most serious consequences.

"Mania is fun," my father once confided to me. "Being manic is fun. It may not be fun for the people who are watching, but it's fun for the person who's manic." And therein lies the paradox of bipolar disorder. Creativity, determination to succeed, the drive to love and live fully; some people insist these aspects of their life are driven by mania. And that's oftentimes true--to some extent. It's also true that mania, left unchecked, can lead to delusions, substance abuse, and impulsive, destructive choices that crush creativity, obliterate careers, and ruin relationships.

Part of accepting bipolar disorder is accepting the fact that the negatives of the disease coexist with the positives. Pretending the positives don't exist won't help. The top reason people with bipolar disorder give when they stop taking their medication--and each year almost one out of every two people with bipolar will do so--is that they feel the mood stabilization means deadening of thought, creativity, feeling and energy.

You're excited. You're interested in everything around you. Your mind is sharp as a tack. If there's a problem, you can solve it. You feel like you could squeeze beauty out of a stone. Mania. What's not to like?--aside from the irritabillity that starts to creep in and the voices you start hearing after your second week of no sleep, that is.

The cutting edge of mania is that no matter how bad it can get, it still hold that shining promise of a near-perfect you in a near-perfect world. The energy feeding into you opens your mind just a little wider and gets you moving just a little faster. It lets you reach a little farther for what was previously just beyond your grasp. The downsides are there, and if you've been there before, you know what they are. But that doesn't deny the beauty of the moment, the power that mania can hold over you.

Overconfidence

The creative impulses and relentless drive and energy of mania can serve, at least for a while, as a type of release. Those same impulses--plus the natural grandiosity that can be part of being bipolar--can turn a shy, retiring type with a few interesting ideas into a true leader. These are the sort of people--men, at least in the earlier part of history--who seemed to possess a sort of cult of personality. People were drawn into their sphere and seemed to be led effortlessly. Some of the most prominent leaders in history had (or at least were suspected to have) bipolar disorder and reads like a Who's Who of military and political history. Alexander the Great, Napoleon, Winston Churchill, Teddy Roosevelt, Oliver Cromwell, all dealt with bipolar disorder. In more recent years these dynamic types have been driven to the boardroom. Take Ted Turner, the founder of Turner Broadcasting, has openly talked about his diagnosis with bipolar disorder. He reportedly once quipped, "If I only had a little humility, I'd be perfect." Never before has there been such a concise, if unintentional, definition of manic grandiosity.

Impaired Insight, a Predicament

Denial is wanting not to hear what you're hearing; it's refusing to see what you're clearly seeing. Denial requires you to actively work against what you know to be true--to deny it access to your life or your plans or your consideration. In bipolar disorder, denial is the tip of a largely dangerous iceberg. One of mania's most insidious side effects is called impaired insight. Impaired insight goes way beyond your desire not to see what's happening or being unable to recognize that mania is bad or destructive; it's not being capable of seeing it. It is, says Nassir Ghaemi, M.D., director of the Bipolar Disorder Research Program at Cambridge Health Alliance, an actual, biological phenomenon. In about half of all case of mania, you literally can be physically incapable of knowing if and when you're manic. In fact, there's even a name for it: anosognosia.

The brain's frontal lobe is the culprit in the impaired insight mechanism. The physical link between stroke, Alzheimer's disease, and bipolar disorder lies in this area, the seat of both thinking and emotions. Certain changes to that area of the brain might make it impossible for you to logically asses what's going on around you, yet you need just that sort of process when you're becoming manic so you might have a chance to pick up on the mania before it gets out of control. Instead what you get is severely impaired insight--so impaired that when someone suggests to you that your behavior has turned somewhat manic, you begin to rant and rave, convinced that your friends are turning against you. You won't even consider the possibility that your friend might be right, that you might be becoming a bit manic, because you actually are unable to see what the friend is talking about, unable to recognize that anything is wrong or off.

When the mania disappears, however, so does your insight impairment. After the fact, you'll usually be able to recall most of what went on while you were manic. You'll be able to gain some insight into your disorder.

By then, however, it might be too late. It's these excesses that make bipolar disorder so very fascinating to so very many people. Face it: depression is not fun to watch. But mania...mania can be titillating. Mania can be exciting. Mania can be fun. And that's just from the outside. From the inside, it's equally exciting--at least while it's happening. But when the ride is over and the music stops, you're the one left holding the bag. You're the one who has to put the pieces back together, to try to make your life whole again. And you have to do it despite not always being quite sure what really happened in the first place.

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Manic Moments

Awake! What time is it? 8:15, maybe if I hurry I can only be an hour late to work. Time for breakfast, 100mg of Sertraline, a multivitamin, now wait for it. There it is, that tingling in the back of my head that slowly creeps forward until it reaches my eyes. My eyelids close just slightly and a sense of calm and drowsiness cover me. There it is, that little bit of motivation I have stuffed somewhere in the back of my head. I feel that little blue pill pulling it out of the deepest crevices of my psyche. I've got to get to the car before the full effect reaches me. The drive to work is a blur, bits and pieces of a road I drive everyday, overpasses, exits, traffic, I am a passenger on this journey.

Ok, safe at work, the hardest part of my day is over, lets get to my office so I can lay my head down. Spinning, spinning, stop.

Awake! What time is? 10:30, I wonder how many times Season has come in to get me to finish something for him? Two more hours until I can walk out of here and wipe the guilt from my conscience. The clock doesn't have numbers now, just a countdown until I take those three small yellow pills. Curved just so perfect from the factory that you can feel the machine that pressed them. The machine churns out pill after pill of mind altering bite sized snacks.

Is that machine my new owner? Its hard to tell which thoughts are mine now and which are visions of the pill. Seroquel, what a cute little name. As calm and smooth of a pill name as I've ever heard. But to me it screams bipolar disorder. A constant reminder of the fight I put up with myself, of the efforts and winnings lost to a vicious cycle of self-hate and torment. What else will I sacrifice today in order to fulfill the appetite of discontent? Whose feelings will I feed to the whirlwind of uncertainty and anger? Its sad that I can anticipate these thoughts, once they were simply my reality. My grasp of this cycle continues to fail me.

Here it comes again, that sinking feeling in my chest, the irresistible urge to stay in the sheets. I rather like these black ones, they reflect my mood very well. Of course I know in 6 hours I'll bitch about having to look at these glum, empty, black-as-night sheets and wonder why the fuck I bought them. But right now they offer tranquility, a peaceful break from the anger I'll feel towards them later.

Maybe that's the hardest part, knowing that nothing will ever be comforting to me all the time. Something that enhances me and brings out the best is only doomed to fall in the path of my temper at a later date. I set the dominoes up everyday just so I can walk in and knock them down before I retire. These tiny pillars of self-esteem, confidence, satisfaction, motivation, calm; they all stand on the slightest of edges waiting for me to exhale hard enough to send them crashing to the ground again. And I will...

Breathing is so simple, such an effortless endeavor on the outside, but such a battle on the inside. The cycle is so fine tuned, so right, that it functions even outside of my conscience. I breathe in: hope, certainty, love, like a flood rushing over my mind. But I know that I can only hold that breath for so long. The fresh oxygen that brought so much ability will degrade and my body will expel the waste, exhale: wrath, anxiety, fear, jealousy, like a flood pours out from me.

Why this cycle? It is so easy, breathe in, breathe out, breathe in. Friends fail to see the depth of my heartache, I want to sail on smoother water, know that tomorrow I can reach out and love, not fear waking again to fight back the uncertainty that is myself. But this is the body I was born with. For as much as I cherish my mind and the sharpness and ability it has given me it has cursed me, sent me on this course of ever changing horizons. Time passes in a straight line, but not I, my path is crooked everyday. Its sad to recognize such deep problems, it means I have been but a witness instead of a participant in my time on Earth so far.

I can feel it now, my right leg won't stop bouncing, its only a matter of time before it reaches my head. Those black sheets scream of failure now to see what's good in my life. Creeping slowly up my back, I need to go run around outside and have a cigarette, come on dog, get your frisbee.

What time is it? Only 7, that means I have to wait 3 more hours before my cute little yellow pills can be taken. Seroquel, damn I can't believe it sounds so charming, but every one of them packs a sinister little secret. Nasty fuckers, you hide it so well to. Am I me or are you me? What exactly is it that you do up there in my head? Fucking assholes.

Shit, what time is it? 11? Take 'em now before its too late, they're already gonna knock you out til 9, what will work say? Can you even tell people at work? Fuck 'em, they'll just judge, everyone does. I'm a crazy person, right? At least I'm a damn good looking crazy person, that's gotta count for something. I'll be sure to cash that in on my next downward spiral. Seroquel, what a cute name.

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My Life With Bipolar Disorder

I have a confession to make. I live with bipolar disorder, a category of psychological mood disorders. You may recognize it by its former name, manic-depressive disorder. So some recent news that a startup company is now selling a bipolar genetic test ($399) startled me. In my years of dealing (and not dealing) with my disorder I have learned a lot regarding the physiology and progression of the disease and a claim like this scares me.

Dr. John Kelsoe is the designer of the test and after researching for years he identified several gene mutations closely related to the disease. These breakthroughs are no doubt very significant for the identification and treatment of bipolar disorder but they do bring up some very serious questions that the medical profession must answer.

Many public health officials, medical ethicists, and doctors are troubled by the proliferation of such tests. They receive almost no government oversight, and even though many are being sold as tools for making serious medical decisions they are built on thin data. It really is a double edged sword as openness and sharing are very powerful paths down the road to medical discovery, but at the same time a premature test preys on individuals' deepest anxieties.

Kelsoe himself acknowledges that bipolar disorder probably results from a combination of genetic factors and life experiences, and that the presence of these gene variations does not at all mean that someone will, in fact, develop the disease. He admits, too, that his findings about the genetic basis of the illness are far from complete.

But he said his test is a vital starting point toward moving away from the notoriously tricky practice of diagnosing bipolar disorder based purely on a person's behavior.

"The goal of this is to try and help doctors make an accurate diagnosis more quickly so the patient can be treated appropriately," Kelsoe said. "Anything is going to help, even if it just helps a little bit."

This diagnosis help is very useful but should be performed by licensed medical professionals who are capable of making a diagnosis on observation and testing. Making these kits available for home tests only raises fears and self-diagnosis problems. And unfortunately this is a very serious disorder to be putting people at fear of having.

Through my years I've learned the effects of the disease and learned, through medication and diet, how to manage my cycles. Unfortunately this is not the case with many people and realizing you have a problem is very hard. The feelings that you have and urges and emotions that drive them are so ingrained in the being of a person that it is hard to tell if you are outside of the universal consciousness of the population. I didn't realize my own self-destructive behavior until I really sat down with a friend and discussed how we felt and observed things and I began to realize that I process things differently.

As with any psychological disorder, bipolar is a powerful and all encompassing problem. You can never escape your inner thoughts and you must train yourself to see through the eyes of normality and push away a lot of the noise that your brain creates. Racing thoughts and delusions are just a part of my life that I must live with and then learn how to incorporate that into the "real" world. All of my interactions, from friends, girlfriends, parents and strangers have been influenced by my disorder and I have thrown many a good relationship to the curb under the pretenses that I would be better for it, only to find out I was running from having to deal with these problems.

It is a problem that I do not wish on anybody and something I will have to deal with until I squeeze the last breath from my body, but until we learn more about the disease lets keep the diagnosis with the professionals.

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