I'm Finally Back!!!

The only reason I took such a long hiatus from this blog was the fact that I couldn't log in for nearly a year. I kept asking for my password and it never sent me anything until tonight. I am glad to be back, but not sure if I can continue to focus so broadly (narrowly?) on the bipolar experience. I am a creative writing major and I have the urge to write about everything else too.

However, in keeping with the spirit of the blog I am going to write about my personal experiences with bipolar a bit more.
Right now I am going through some rough times with my disease. When I began this blog I was unemployed, had withdrawn from university, and was hopping from one med cocktail to the next looking for "the one." After I found a magical concoction of pills that "worked" things changed. A year later I have returned to school, made the Dean's list in the fall, gotten a job and held it down for 8 months, remained completely clean and sober for over a year so far, made one new friend, and gotten reacquainted with some old friends.

These things are all huge! Unfortunately, I am at a real crossroads in this journey of mine. My medication is affecting my quality of life. I have early waking insomnia on one pill so after trying every sleep aid, I ended up on a benzodiazapene. These drugs are powerfully physically addictive. Withdrawal symptoms of benzos can actually cause death. I do not like being physically dependent on a drug. They also slow cognition and impair memory. The drug which caused the insomnia has helped pack an extra 20 pounds onto my already severely overweight body. I am also struggling with school and my depression.

I am glad that tonight I was finally able to get back on this blog. I really needed to write this. There have been successes, but there are new struggles. This disease does not manage itself...it tries to manage those of us suffering with it. We have to wrestle with the monster and try to push it back into its corner, wait is that a boxing or a wrestling analogy?

I have begun work with another new therapist (insurnace changes) doing social rhythm therapy. I need to research some more about it and will post on it soon. Our therapy is in its infant stage at this juncture. So for now just know that I am still plenty of steps from normal, but that I have made my way back here, and I certainly have something to say.

Dual Diagnosis: Bipolar Disorder and Addiction

As many as 60% of people diagnosed with Bipolar have some form of addiction as well, and these coexisting conditions are called "Dual Diagnosis." A good portion of people who struggle with Bipolar experience comorbidity, suffering from additional psychiatric illnesses. Some of these diseases include: Anxiety, Obsessive Compulsive Disorder, Borderline Personality, and Schizoaffective Disorder. A disorder is classified as something which interferes with your day to day quality of life, and your ability to function.
Addiction seems to co-occur even more frequently with those already suffering comorbidity. Many times people are undiagnosed or untreated, and they are self medicating their illness(es). Addiction is a disease which takes over a person's life, often changing their personality, ruining relationships, and resulting in legal ramifications. There are strong genetic ties involved, and many families contain multiple addicts. Perhaps these families consist of multiple members suffering from mental illness and that is why such a correlation exists; there is a bit of chicken and egg questioning when addressing addiction and mental illness.
One can become addicted to anything: alcohol, prescription drugs, illegal drugs, over the counter drugs, sex, food, shopping, etc. When one is diagnosed with Dual Diagnosis, and medicating their illness, sometimes the addiction heightens the parts of the disease that feel good like mania/hypomania. When the drug or other stimulant is removed there is a rebound of symptoms. A horrible, sinking depression can settle in and become severe enough to lead to suicidal ideation, parasuicide, or actual suicide. The drug of choice can also make symptoms of Bipolar much worse, from unmotivated depression and leaden paralysis, to rapid cycling and dysphoric mania (mixed state of mania with severe depression which is highly dangerous). The withdrawal of the drug and the resulting crash are what leads the addict to seek the drug again and again, regardless of the consequences. There is simply an obsession in the brain to continue using...as if their very life depends on it.
Dual diagnosis is particularly difficult to treat. Obviously both issues need to be fully addressed in order for recovery to happen, and often a third or fourth disorder also requires treatment. Dual Diagnosis also raises many questions. Did the addiction somehow cause the mood disorder by changing brain chemistry, or awaken a predisposition to psychiatric illness? Is the addiction a result of the mood disorder, or would it be there anyway? If one is self medicating will treating the underlying disorder(s) quell the ravenous beast of addiction, and if not why?
These are just some of the questions raised by this complex phenomenon which impacts so many of us with Bipolar Disorder, and we want the answers.

Bipolar Disorder and Social "Normalcy"

During my last hospitalization I was struck with how comfortable I felt. I was on what I would jokingly refer to as "the bipolar ward," where 90% of us seemed to be suffering from bipolar disorder. I was surrounded by people who battled some of the same things I struggled with and usually, like myself, had at least one or two co-occuring illnesses like anxiety disorders or addiction.
I got along with everyone. We talked about our similarities, our differences, the doctors we didn't care for, the ones who listened, and we witnessed the ascent or descent of one another's moods from afar. Respectfully distant, unless called upon, we saw ourselves and knew when to back away.
I could live like this, I thought, feeling slightly deranged at the prospect. Not locked up in an airless, stale hospital building, but surrounded by my "own kind." Granted, the hospital is designed to keep stress at bay, to keep the patients occupied with "activities" and engaged in meetings, but alot of it is hokey. Only the conversations with other patients kept me from coming unmoored.
Socially, this disorder can be devastating, particularly when one is vocal about suicidal ideation; it scares people away. Social malfunctions such as the withdrawal of depression, or the forced speech of mania, are off putting to those who do not understand. I have few friends and family who truly stick by me through these rough patches. They either suffer from mental illness, or just care enough to have empathy.
Sometimes I ask myself how I can be expected to function in a world that demonizes mental disease, or that just doesn't understand me. I have to hide my dirty little secret or become a pariah at worst, or at the least have every odd thing I do attributed to bipolar. I have trouble in groups and meeting new people due to my illness and the social withdrawal it has brought about. I also have trouble with social norms. I tend to violate them unconsciously.
One of the aspects of "recovery" is "psychosocial skills building." I see the relevance and necessity of this, yet at the same time I wonder if it needs to begin with the "well" among us. I would like to think that I am very accepting of all types of people who violate social norms, not rude people per se, but unconventional folks. I miss many of the people I have alienated and wonder if it was something I did, or if they just got caught up in their own personal lives. I try to soothe and quiet my paranoia and move on, but I don't want to miss out on the friends I haven't met yet. I want to get out there and show the world just how eccentric I can be.

Bipolar Poetry

This is a poem I wrote 4 years ago, it is about my suicide attempt at 16. Don't worry, I am not suicidal right now, this is just a glimpse into the past. This is the first of my bipolar poems that I am sharing on this blog. I only have a few, but I do have poems on many more subjects...some of which I will probably share at some point.

The Procession to the Misplacement of a Mind, and Halfway Back, in Two Parts
By Christina
I.

Walking to that long winding bridge,
Teetering over salt flat, marshy waters,
Bottle of pills grasped in fist,
One, two, how many taken now?
His slap still burns my cheek,
Ten, eleven, how many left now?
The sulfur odor washes over me
To float in the James River,
Released, I will drift like refuse,
Lungs becoming waterlogged, weighted down,
My hand has started shaking,
Harder now to open pills,
Antidepressants are supposed to heal,
Hate myself, going to kill,
Steps tripping faster toward edge,
Can not wait to fall,
Welcomed back by, water’s embrace,
Missed me from the womb,
So easy to let go,
My feet are heavy,
Hands can hardly fumble,
Twenty seven, Forty three....
Blurring vision smears sky,
View is almost gone,
Sun nearly does set,
Nothing more to watch,
Stinging slap comes back,
Where am I?
Will they come?
Stop and stare,
Incomplete overdose-done.
Whole body convulses,
Jerking head, twitching,
can no longer,
see the bridge,
losing my sight,
heavy breath,
pounding heart,
swaying drunkenly,
ground shifts,
spilling pills,
into stomach,
Sixty. “Gulp.”
Better now.
Licking lips...
Who...
passes...
on...
the...
road...
coming...
to...
take...
me?

II.

Shivers
Uncontrollably
Forced to the hospital doors,
It will be different here.
White walls close in.
“Were you lovers?” she asks again.
I drank the charcoal,
Rocks of tar in my belly,
Yum.
I met a boy there,
who put a knife through,
his entire hand
What a scar
After striking me
the other one
played the guitar
Was it cold?
I don’t remember Newport News,
Virginia, I hate the state,
but wanted to drift,
Like Woolf in a river,
River of James,
Edge of swamp and city,
I am dry above your waters
Life claimed me that day,
But I was never the same
Ever since that time
Ever since the fall I had,
the one I took,
When I misplaced my mind.

Book Review on Bipolar Disorder Demystified By Lana R. Castle

I have to admit that I have a special fondness for Lana R. Castle's, Bipolar Disorder Demystified: Mastering the Tightrope of Manic Depression. It was the first book I read about bipolar disorder. This book is somewhat overlooked in the bipolar "canon," yet it contains many fundamental teachings about psychology and psychiatry.
Castle struggles with bipolar herself, and she experienced the loss of her sister to suicide. Her personal experiences add depth to her heavy consultation of many experts in the field of psychiatry. She also revisits, for the psych 101 student, some of the fields' historically well known contributors. One aspect of the book that really stands out is her open-minded approach to treatment modalities. So much bipolar literature pushes an agenda of "you must all take meds, that is the only real treatment for this disease." Despite her belief that they are, "integral to my own recovery," she doesn't write in black and white terms. She posits that "most" of us do need the meds, but without condescending to those who cope without them. She uses her own life stating, "Had I not discovered the ease with which I could lose my life, nor experienced the loss of my sister, I might have tried to make it some other way (Castle 194)."
The ease of using this book is also great for people who are unfamiliar with the topic of bipolar or mental health. There are bulleted "Caution" sections, charts, a glossary, exercises, and affirmations. Much of her advice is extremely pragmatic, from tips on "fighting fair," to a chart entitled, "potential ways to help someone in a depressive episode."
It is her lack of condescension and her warm, empathic voice that made this book so easy to read from cover to cover. Many books by experts without the disorder contain case studies, and sometimes those books are cold and clinical, creating an "us and them" mentality. There is only so much one can say about this disease, it is how it is said and the depth one goes into which help paint an ever more intricate picture of what it is like to live the bipolar life.


To buy this book online visit:
http://www.amazon.com/Bipolar-Disorder-Demystified-Mastering-Depression/dp/1569245584/ref=sr_1_1?ie=UTF8&s=books&qid=1242812799&sr=8-1

The Treatment Team

Another aspect of treatment for mental illnesses like bipolar disorder, is a good treatment team. In a perfect world someone with mental illness would have a supportive family and friend base, a good general practitioner, a nutritionist, a therapist, a psychiatrist, and a naturopath. All the books say so.
However, in the real world most of us cannot afford to have all of the above practitioners, we may have frightened many family members and friends away, and our insurance companies would just say "Naturopath?" laugh, and hang up on us. Finding "good" practitioners is also about as easy as finding the long lost friends who bolted when they learned your diagnosis. They changed their phone number.
I have had some really messed up experiences with practitioners: the hypnotherapist who lied to me to get me out of her office but had the nerve to hug me on my way out, the male psychiatrist who picked at his scabby face and head with his bitten-down nail nubbins, while twitching slightly and staring at my breasts, the stoned female psychiatrist who kept drifting off in mid sentence (having double dipped one too many times into the sample closet), and the psychoanalytical psychotherapist who I wasted 4 years with; he encouraged me to stay off meds and use marijuana, and ignored threats of suicide, all while encouraging me to wallow in the past, and that I was never wrong, even while manic and semi-delusional.
Yup, I've had some real gems on my team.
My current psychiatrist (or pdoc as we refer to them in cyberspace), forgot to write the prescription for the main drug we discussed yesterday. He also refused to take me off a drug that is making me physically unhealthy, encouraged me to try an over the counter weight loss supplement, told me to use my benzodiazepene for sleep (a no-no, especially for someone with addiction), and after informing me that I might need a sleep aid the rest of my life, due to side effects from the aforementioned ill-making med, told me to cut my sleeping pills in half...all while getting paid $150 for spending 15 minutes with me.
My general practitioner looks concerned and clueless and says "They sure have you on a lot of stuff." Poor guy. He also tries to give me meds and advice to counteract the devastating effects that psych meds and my mood disorder have had on my body. Most general docs do not treat a complex illness like bipolar, letting "the experts" treat it. I feel he may do better than them at this point.
My therapist is pretty great. She does Dialectical Behavior Therapy which teaches skills for emotion regulation, social skills, mindfulness, and coping mechanisms. The point of DBT is to relearn emotional intelligences which have morphed due to mood disorders or past trauma. It was created for people with borderline personality disorder, but can be useful for other psychiatric maladies as well. I can rarely afford to see her though, even though it is a $25 copay, I am spending all of my money on meds and seeing the semi-incompetent pdoc every two weeks.
In my dream world scenario I'd have a naturopath, a nutritionist, an acupuncturist, etc. If only I had the cash for a complete team of professionals to repair my head.
I do have several supportive family members, especially my indomitable husband, and a friend or so. It is hard to let myself rely on them due to massive amounts of guilt. They are few, but they have been integral to surviving my imperfect world.

May Madness: How Many Pills From Normal?

Hopefully as the month progresses my readers will learn more about bipolar disorder and its treatment options. Although I appreciate that Mental Health Awareness month includes awareness of other mental maladies I have the most expertise on bipolar. Soon I may choose to move on to different subjects, as my interests are varied and unpredictable, much like my mood. Today's subject: "Crazy Meds" is a term I first saw at this great web site devoted to the topic: http://www.crazymeds.us/ .
I have conflicting opinions on whether these meds cause more harm than good. Are they creating a world of moodless, overmedicated zombies trying to keep up the status quo, or are they saving lives (including my own). Furthermore, are they really necessary and effective for everyone with bipolar?

Two questions I have been asked as someone with bipolar: "Is there a pill for that?" and "Can't you just do some yoga?"

Good questions... The answer to the first one is an almost definite no. For most of us there is no magic pill, but "cocktails" of four all the way to--I don't know that there's a limit to how many pills they will prescribe. I am 5 pills or so from normal, and several of those pills are to counteract the side effects of others, which include, early waking insomnia, weight gain, and oddly, depression. Each pill has a veritable encyclopedia of side effects, some of which can be dangerous or deadly.
Being on no meds and trying yoga and positive thinking has its own drawbacks. If one's mood in unstable, beginning positive work on one's body or mind can be severely hindered. Suicidal ideation may creep up, or hypomania or mania can rear their ugly heads. Mania and its slightly less severe sibling, hypomania, can lead to anxiety, anger, irritability, elation, hypersexuality, and a level of hyperactivity that can burn a person's mind and body into ash. Bank accounts can be emptied, credit maxed out, relationships ruined, and lives endangered. At worst suicide or psychosis can occur. The crash from mania can be a devastating plummet into despair and depression. I don't think yoga or positive thinking can begin from those extreme emotional states.
There are theories about an effect called "kindling" which may occur in the bipolar brain. This theory posits that when a bipolar brain experiences stress, the stress reaction continues long after the event. The brain literally smolders with past stresses. For me stress is the biggest trigger that I face, and its effects are long lasting. Medication is supposed to prevent this reaction.
The trouble with these flawed medications is that they don't work for everyone, the side effects can be terrible, the combos have not been safety tested, and the adjustment of dosages and drug types are a fine pseudo-science; some people require an almost constant tweaking of their meds to remain stable.
There is also an enormous amount of stigma attached to taking psychotropic medications. Yet who would judge a diabetic for taking their insulin?
As a person who takes these medications I can attest to the fact that I hate taking them. I'd like to believe if I stopped them I could deal with my haywire emotions or the burning fires in my brain. Maybe one day I will be able to deal without them. For now though, I am scared of the mercurial nature of my brain, the way the neaurotransmitters dopamine and serotonin teeter totter back and forth, in a sickening motion beyond my control. The illness is real, the treatment imperfect, and the question of the lesser of two evils is right there: staring back at me in the mirror every day.