Friday, February 29, 2008

Mind-Body Connection (Part 2)

Although I plan to continue reading about Qigong, my interest in yesterday's post was about Dr. Larry's Dossey. If you recall, the symptoms he was experiencing in medical school included migraine headaches, and recurrent episodes of blindness, nausea, and incapacitation, which was compounded by anxiety, stress, and overwork.

Those symptoms are certainly worse than any I have experienced during a depressive episode. I wonder what label they attached to Dr. Dossey's symptoms. If his medical adviser had labeled him "mentally ill," I wonder how Dr. Dossey's life would have turned out. If his medical adviser had recommended that he leave medical school rather than staying, I wonder what Dr. Dossey would be doing today.

I wonder what effect biofeedback and meditation have on bipolar disorder. I'm sorry that I don't have the answer today. Over the next few weeks, I will research biofeedback and meditation as they relate to bipolar disorder.

If anyone who is bipolar has tried biofeedback or meditation, please let us know. You can write about it in your own blog and I will link to you.

I do know that meditation has been shown to have a impact on depression. Yesterday afternoon, I bought the book The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness by Mark Milliams, John Teasdale, Zindel Segal, and Jon-Kabat Zinn.

In the coming weeks, I will be discussing these topics and others. However, next week I need to edit my Ebook, Bipolar Depression Unplugged: A Survivor Speaks Out , which soon will be coming out as a paperback. So I will only be posting quotes--great ones no doubt--rather than longer posts.

Have a great week!

Thursday, February 28, 2008

Mind-Body Connection (Part 1)

I am reading a book called The Way of Qigong: The Art and Science of Chinese Energy Healing by Kenneth S. Cohen. In the book jacket, they describe Qiqong as "a gentle yet rigorous program for working with our life energy through breathing and relaxation exercises, massage, visualization, meditation, and other natural methods."

I have no idea whether Qigong works or not for bipolar disorder, although if you look at the Qigong Institute site on the page about scientific papers, they're studying it for other illnesses. What fascinated me was the foreword by Larry Dossey, M.D. I'm well aware of him because he has written a number of books I find interesting, including Prayer Is Good Medicine.

Here's what Dr. Dossey writes: "As a first year student I attempted to drop out of medical school because of chronic, classical migraine headache syndrome--recurrent episodes of blindness, nausea, vomiting, and insufferable headache, followed by periods of incapacitation....I was unaware at the time that my problem was compounded by anxiety, stress, and overwork."

Dossey goes on to say that his medical advisor convinced him to stay in medical school, but it wasn't until years later that he "discovered biofeedback and meditation, which for the first time allowed relief from the problem that nearly halted my career and made my life miserable."

(more to come)

Wednesday, February 27, 2008

The Placebo Effect

I just came across this quote from Love, Medicine, and Miracles by Bernie S. Siegel, M.D., (the famous cancer doctor) and thought it might have some application to the information JayPeeFreely provided on the Antidepressant Study post.

"One of the best ways to make something happen is to predict it. Pooh-poohed for some twenty years by the medical establishment, the placebo effect--the fact that about one-fourth to one-third of patients will show improvement if they merely believe they are taking an effective medicine even if the pill they are taking has no active ingredient--has now been accepted as genuine by most of the profession.

Dr. Howard Brody of Michigan State asserts that a positive placebo response occurs when three factors are optimally present: the meaning of the illness experience for the patient is altered in a positive manner; the patient is supported by a caring group; and the patient's sense of mastery and control over the illness is enhanced."

Antidepressant Study

Since JayPeeFreely left the following info as a comment on my post Bipolar Wellness Activity 5, I'm not sure how many of you read it. So I'm reposting it here. Thanks Jason! I appreciate the information. As I believe I've mentioned before, I can't get out of a severe depression without medication, but I believe it's primarily because I took medication for too many years. But who knows? Maybe my new exercise regimen will make a difference.

"Just today, another study pointed out that placebos were nearly as effective as depression medication. That most moderate depressions could be handled without prescribing Prozac or Seroxat.

Quote: "This means that depressed people can improve without chemical treatments.

"Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients unless alternative treatments have failed to provide a benefit."

The study, published in the journal PLoS (Public Library of Science) Medicine, looked at Prozac, Seroxat, Effexor and Serzone and found the drugs were only better than a placebo for some people with severe depression.

Kirsch's team said it was one of the most thorough probes into the impact of new generation anti-depressants or selective serotonin reuptake inhibitors (SSRIs).

But drug companies strongly questioned the findings.

What does that tell us? Maybe the meds route is not to be sought out as the 1st step to wellness. And our drug companies are hiding their less-than-stellar drug trials."

Tuesday, February 26, 2008

I Apologize

I've been so angry lately about the lack the treatment options; the lack of forward movement toward better results; the lack of insurance parity; the misinformation I feel I received the last 15 years; the lack of creativity in coming up with new treatment options; the pain and suffering experienced by bipolars everywhere; the tremendous influence of the pharmaceutical companies and the insurance industry on treatment; the years I've wasted when I pursued traditional treatments; the fact that no one assumes responsibility for medications that don't work, and a system run amok; the charlatans who propose alternative treatments that don't work; the lack of adequate funding for the right kind of research; the stigma; the suicide rate; the lack of leadership for looking at this illness anew; the lack of support for work-related issues, and everything else we face in this challenge...and so much more.

Last night as I sat, overwhelmed by enormous feelings of loss and grief about the years I've lost even though I tried to do everything possible to get well, I thought that a blog that focused on the truths that are rarely discussed--would make me feel better, and bring the issue to the forefront. So, with little thought, I launched Bipolar Treatment Travesty. It was a mistake.

Dwelling on the negative makes me feel worse, and this morning I dreaded writing another post. I don't know what the answer is but it isn't this--at least for me. I do apologize. Any suggestions for forward movement?

Bipolar Treatment Travesty

In this blog, I try and concentrate on wellness. I've always said there are enough negative blogs on bipolar disorder out there and the world doesn't need another one. But today, I finally decided to start a blog that will list all the negative aspects about the treatment of bipolar disorder. It's not meant for the faint of heart and I'm not recommending that you read it. However, the message needs to be heard.

As far as I'm concerned, the treatment for bipolar disorder is an international travesty. And it's time for me to speak out.

My book, Bipolar Depression Unplugged: A Survivor Speaks Out will be published as a softcover book in a few months. It's a memoir of my personal experiences with this illness. While I feel that the only hope is wellness programs, I don't think that they can possibly be a reality without accumulating facts and figures about the way bipolar disorder is currently being treated.

Monday, February 25, 2008

Wellness Activity 5: Exercise

In yesterday's post, when I wrote about the studies mentioned below, I thought that walking was the only exercise involved, but I was mistaken. So I stand corrected. Still, I am stunned by the results...

According to Psychology Matters, an online publication of the American Psychological Association, in a 1990 study in which a research team did an analysis of 80 studies of exercise and depression, they found, among other things, that "Exercise was a beneficial antidepressant both immediately and over the long term." In this study, walking and jogging were the most frequent forms of exercise tested.

In 1999, psychologist James Blumenthal, PhD, and colleagues at Duke University conducted a series of studies of using exercise (a treadmill and stationary bicycle) and medication for patients who were clinically depressed.

Some patients did aerobic exercise only, some took Zoloft, and the third group took Zoloft and participated in exercise. "After four and a half months of treatment, patients receiving any of these treatments were significantly less depressed. About two-thirds were no longer depressed."

What is most amazing to me is that in a follow-up study six months after the original one, psychologist Michael Babyak, Ph.D and his colleagues "found that patients who had been in the exercise group were more likely to be partially or fully recovered than those who were in the medication or medication plus exercise group." (For more specifics on this study, see the article on McMann's Depression and Bipolar Web.)

Are we getting this? Exercise by itself was more effective than medication alone, or exercise plus medication.

Sunday, February 24, 2008

Wellness Activity: Walking (Part 2)

I'm reading two great books on walking. The first is Walking Magazine's: The Complete Guide to Walking for Health, Weight Loss, and Fitness by Mark Fenton. While Fenton, who was a member of the U.S. national racewalking team five times and has hosted two PBS shows on walking, discusses a number of benefits of walking, he says that "emotional well-being is one of the primary benefits."

He writes, " Walkers also say that their walk can be the most important time in the day. Whether mentally organizing for the day ahead, unwinding from work, or seeking a daily refuse with a friend or loved one, many walkers testify that their walks are often central to mental health and balance. Burn calories and build muscle all you want, but remember that your brain and soul may be the pieces of your anatomy that benefit most from walking."

Tomorrow, I'll discuss the results of a series of systematic studies at Duke University in 1999 in which participants who were suffering from a major depressive disorder either participated in a walking program, took Zoloft, or did both. I'll also tell you about some famous writers who loved to walk!

Saturday, February 23, 2008

Wellness Activity 4: Walking

If we bipolars believe it, walking is probably better for depression than medication. Dr. Robert N. Butler, President of the International Longevity Center at Mount Sinai Medical School in New York City, said, “If exercise could be put in a pill, it would be the number one anti-aging medicine and the number one anti-depression medicine.”

Given that, I have made a vow to start walking every day. I'll take my new digital camera with me, and if I ever learn how to use it, I'll post some of my photographs from my walks.

Needless to say, this photo on the left--featuring sheep at St. Paul's station--which comes from London Photos, is not something I'm likely to see in Los Angeles. But perhaps, Londoners were surprised as well.

Friday, February 22, 2008

Quotes on Motivation

I was looking for some quotes on motivation and found three that I loved from a woman I'd never heard of, but genuinely liked. Her name is Mary Anne Radmacher. She's a writer and artist, and her enthusiasm and joi di vivre made my day!

“Live with intention. Walk to the edge. Listen hard. Practice wellness. Play with abandon. Laugh. Choose with no regret. Appreciate your friends. Continue to learn. Do what you love. Live as if this is all there is.”

“Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow.”

“The jump is so frightening between where I am and where I want to be...because of all I may become I will close my eyes and leap!”

Have a good weekend! See you on Monday.

Wednesday, February 20, 2008

Bipolar Anger and Rage

Last night I found a book in my library that might be helpful to people who are newly diagnosed with bipolar disorder and need information. It's called the Bipolar Puzzle Solution and it was written by Bryan L.Court (a bipolar survivor) and Gerald E. Nelson, M.D. (a psychiatrist). They answer 187 questions posed by support group members.

While I view this illness quite differently than Bryan, I recently realized that some people are visiting my blog because they have very specific questions. One of the issues is bipolar anger and rage. I've written about this subject, expressing my own opinion, but I think Brian provides some valid information, and basic solutions.

"An irritable mood is common in mania and hypomania. Sudden rage usually occurs when a person's "great" plans are ruined. I also have heard people describe the angry outbursts and ranges that they have while hypomanic or manic; sometimes anger is the most noticeable symptom of their hypomanic or manic episode. When I was either depressed or hypomanic, part of my anger came from frustration over my attempts to get help with the illness, and my irritable mood was a base on which to build anger. An irritable mood also can be present in the depressive phase of the illness.

"Irritability can be difficult to manage or control. Here are three things you can do that might help: (a) step back and recognize your irritability, (b) take time out from whatever you are doing, and (c) decrease sensory input, especially sound."

Question of the day: How do you handle bipolar anger, rage, and irritability?

Tuesday, February 19, 2008

Wellness Activity 2: Writing to Heal

According to Dr. James Pennebaker, one of the foremost experts on the subject of Writing to Heal, "Writing about emotional upheavals in our lives can improve physical and mental health." On his site, he suggests four topics to write about:

1. Something you are thinking or worrying about too much.
2. Something you are dreaming about.
3. Something you feel is affecting your life in an unhealthy way.
4. Something you have been avoiding for days, weeks, or years.

It's undoubtedly good advice and there have been long stretches when I've written about things that bothered me, and it did make me feel better. But for the last few months, I've decided that sometimes this kind of writing makes me feel worse. Lately, in my bleakest moments, I have wondered why I bother to write at all, and why I spend so much time doing it.

And then I picked up one of my favorite books, On Writing Well: An Informal Guide to Writing Nonfiction by William Zinsser. While this book is about the craft of writing, and at first I couldn't see how it related to my topic, when I reached the last page, I had one of those, "aha moments."


This is for you, JayPeeFreely...

"My favorite definition of a careful writer comes from Joe DiMaggio, although he didn't know that was what he was defining. DiMaggio was the greatest player I ever saw and nobody looked more relaxed. He covered vast distances in the outfield, moving in graceful strides, always arriving ahead of the ball, making the hardest catch seem routine, and even when he was at bat, hitting the ball with tremendous power, he didn't appear to be exerting himself.

"I marveled at how effortlessly he looked because what he achieved could only be achieved by great effort. A reporter once asked him about this and he said, I always thought that there was at least one person in the stands who had never seen me play, and I didn't want to let him down."

And I realized that sometimes I'm motivated to write because I feel there must at least one person in cyberspace who is reading my blog for the first time, and liking it, and I don't want to let him or her down.

Monday, February 18, 2008

President Abraham Lincoln and Depression

In the United States, today is President's Day, in commemoration of the birthdays of George Washington, the first president (who was born February 22, 1732), and Abraham Lincoln, the 16th president (whose birthday was February 12, 1809). From what I've read, their temperaments and lives were at opposite ends of the spectrum.

Washington was happy, outgoing, friendly, stable, and energetic. (Actually I'm linking to a site whether they suggest that Washington would have been an ESFJ according to the Myers Briggs Personality Test. How amusing is this?)

But Lincoln's depressions were legion, and as far as I can tell, his behavior would seem to be bipolar. Robert L. Wilson, who served in the legislature with Lincoln, wrote in 1836, "In a conversation with him...he told me that although he appeared to enjoy life rapturously, still he was the victim of terrible melancholy. He sought company, and indulged in fun and hilarity without restraint, or stint as to time. Still when by himself, he told me that he was so overcome with mental depression, that he never dare carry a knife in his pocket."

The most famous quote attributed to Lincoln about his "melancholy" can be found in a letter he wrote in 1841 to John T. Stuart, his first law partner, describing his mood after he broke his engagement to Mary Todd, whom he later married.

"I am now the most miserable man living," he writes. "If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I can not tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me."

And William Herndon, Lincoln's third law partner, wrote, "He was a sad-looking man; his melancholy dripped from him as he walked. His apparent gloom impressed his friends, and created sympathy for him - one means of his great success. He was gloomy, abstracted, and joyous - rather humorous - by turns; but I do not think he knew what real joy was for many years... The perpetual look of sadness was his most prominent feature."

What's interesting to me is that I can't imagine any presidential candidate today being elected should he or she have the melancholic personality that Lincoln embodied. And yet, when we think of President Lincoln's legacy, his accomplishments were quite extraordinary...either despite his illness or because of it.

[I found all the Lincoln quotes on the Abraham Lincoln Research site.]

Saturday, February 16, 2008

Wellness Activity 1: Music Therapy

Being bipolar means changing your mind frequently. Last night I was planning on stopping my blog for an extended time because of this depression. Today, I decided it's not all or nothing. So, I'm going to post on Bipolar Wellness Activities until I feel better. Some I utilize; some I've read about. I won't write a lot of text but will provide images and links.

One of the best books I know on the value of music therapy is The Mozart Effect by Don Campbell. It provides a lot of the reasons why playing music is healing. I play the Autoharp for fun. The photo in the upper left was taken at the California Autoharp Gathering, which I plan on attending in a few months. If you've got an instrument, you can start today. If you don't, in addition to the autoharp, drums, and the harmonica are easy to learn. The graphic in the upper right is a Sound Healing and Drumming Circle. I am learning to play the by listening to David Harp's CDs.

Thursday, February 14, 2008

Bipolar Valentine's Day Lyrics

This song is sung to Take Me Out to the Ballgame. (If you go to the NIEHS site to hear the song and lyrics, ignore the Nelly Kelly verses, which I'm not familiar with). FYI...I've recycled into another depression and thus the following sentiment is for my husband!

We're going to celebrate Valentine's Day,
even though I feel blue,
I'm going to buy you a gift and card,
Saying, "I so dearly love you!"
Sorry for my bad mood, hon,
I'm trying to 'will' it away,
For I can't, won't, shan't, let it ruin,
Our Valentine's Day!

Wednesday, February 13, 2008

Depression to Hypomania

Coming out of another depression has been exhausting once again. Today was a medication withdrawal day because when you take a stimulant as an antidepressant (like I do), you have to stop it the moment your depression ends rather than titrating off it. The reason for this is because stimulants can cause hypomanias—although I already seem to be in one.

How can I tell? It's the usual stuff: talking too much and too loudly, spending way too much time on this blog (literally hours spent redesigning the heading, changing the margins and the layout, adding other blogs), having too many ideas, and in this case, feeling somewhat irritable and annoyed.

For me, the best hypomania is when I feel good (actually a little too good), but I also feel this amazing sense of well-being and love for mankind. Although it sounds silly, I really do. It's like I have some sort of connection with everyone I see, and I feel so charitably toward them. It's not just opening doors for old ladies (which is what I guess I am to people who are 20 and younger). It's like the old AT&T commercial where I want to reach out and "touch someone." Actually everyone, although not literally, of course.

But this hypomania isn't one of those peak periods. I have more energy but it's not that amazing kind of energy. I'm not depressed but I'm not happy either. Over the years I've learned how to try and notice behavior that's "off." I could become easily annoyed but I'm aware of this symptom, and so I try to remember to breathe a few times, and it passes. When I noticed I was talking too much and my voice was loud--even to me--I stopped talking so much and lowered the decibel level. I've also learned not to act on my many ideas; a person can have grand thoughts without doing anything about them.

Questions for Today: What symptoms do you have during hypomanias and how do you overcome them?

P.S. Yesterday was the 18th anniversary of my father's death. I meant to note it in my blog. "Hi, Daddy. Can you read my blog in heaven? How are you and mom doing? I know you were thrilled to have her join you. I miss you both very much, and I love you dearly!"

Tuesday, February 12, 2008

Bipolar Disorder: Onset and Treatment

As many of you who read my blog with regularity know, the event that triggered my first depression almost 40 years ago was going away to college. In retrospect, I know it was too big of a change for me. The university was huge. It was 1968, and the buzz words were "sex, drugs, and rock 'n' roll."

Overnight I felt like a generational outcast. I suspected I was the only virgin on a campus of 40,000 people. I didn't do drugs, and I liked folk music.

While no therapist or psychiatrist ever paid attention to the triggering event, it was very important for me to understand the causal factor. And it was only within the last five years that I read that stressful life events can trigger a depressive episode. Had I been told this years ago, I probably could have stop ruminating on what happened and why, and moved on with my life.

It is only recently that researchers are asking people about the history of their illness. Dependent upon whom you believe, the average age of onset for bipolar disorder is either late teens or between 19 and 21. Yet, I have never read any explanation of why this is so.

When you think about it, most people's lives dramatically change between 18 and 21. They leave home for the first time--either to go to college or to work--and they have a host of new adult responsibilities. For many of us, this is the first real break from childhood.

If I were a bipolar researcher who knew this information, I would suggest that every health teacher in every high school in the universe teach a segment about the stresses that may be caused by the transition from high school to life. I would list depressive and bipolar symptoms, and provide basic information on how to seek help.

According to Dr. S. Nassir Gaemi, director of the Bipolar Disorder Research Program at Emory University, on average there is a 20-year-lapse between diagnosis and treatment. Most patients do not learn they have this illness until they are 40. In his practice, the divorce rate for bipolar disorder is 90 percent.

My feeling is that if more 18-21 year olds knew the causal factors and symptoms for these illnesses, they would seek help earlier (if there was no stigma attached to it). And I believe it's quite possible that if fewer people had to experience prolonged depressive (or manic) episodes without treatment, there would be a better outcome--in terms of their health and happiness.

Questions of the Day: What caused your first depressive or manic episode? How long did it take you to get a diagnosis? (Brevity will be rewarded although I'm not sure how.)

Monday, February 11, 2008

"Own Your Health"

In today's post, I would like to discuss a book that I found inspirational, Own Your Health: Choosing the Best from Alternative & Conventional Medicine by Roanne Weisman with Brian Berman, M.D., founder and director of the Complementary Medicine Program at the University of Maryland.

In 1995 Weisman had surgery to replace a failing heart valve. What was thought to a routine operation resulted in a stroke "that completely paralyzed my left arm and weakened my left leg to such an extent that my doctors thought I would never walk again."

While the surgery had saved her life, "...after a few months of occupational therapy for the stroke... My therapists told me that I had 'plateaued.' I could walk but slowly and without good balance. I could use my left arm to pick up larger objects, but it was still very hard to pick up a vitamin pill or a penny, button a shirt, turn a doorknob or a faucet, or manipulate a fork. They suggested I should now turn my attention to 'adapting' to my limitations."

There's so much more to Weisman's story, which is included in the introduction to this book. Weisman is an award-wining author specializing in science, medicine, and healthcare, and this book has been thoughtfully and fully researched. There are hundreds of interviews with a host of experts, patients, and alternative practitioners who are involved in a wide array of disciplines, including meditation, bodywork, Ayrurvedic Health, craniosacral therapy, guided imagery, self-hypnosis, and so much more.

When I first bought this book, which was a few years ago, I was struck by how many patients and doctors were turning to alternative treatments (in addition to conventional ones) for wellness.

I was depressed that so little was being done for so-called mental illness. But I resolutely went ahead and identified a few alternative practitioners with great credentials. In every case, they offered alternative treatments that were very expensive and helped me in no way whatsoever. Worse, I was devastated by their promise of wellness, and their unwillingness to assume any responsibility for treatments that didn't work. Finally, I gave up and lost hope that this arena has anything positive to offer.

But, I've realized that you don't throw out the baby with bath water. I need to learn to differentiate between the false healers and the true ones. Most importantly, I need to have a Wellness Manager who can help me choose options and participate in the process with me.

In terms of Roanne Weisman, her Harvard Medical School-trained cardiologist, Eugene Lindsey, M.D., assumed that role. She writes, "His openness to other healing modalities, combined with his and (my family's) belief in my recovery, helped give me the strength and will that I needed."

To me, Roanne Weisman is a hero of the highest order. You should visit her at her blog, which I will link to and thoroughly read.

For me, the path is clear. Please join me on the journey.

Sunday, February 10, 2008

Poems about Mothers and Children

Yesterday, I wrote about the guilt and sadness I have felt about being a bipolar mother. My hope is that my son has always known how much I love him and that my love will transcend some of my inadequacies. Today, I'd like to share some poems about mothers and children.

Life began with waking up and loving my mother's face.
~George Eliot

"Who ran to help me when I fell,
And would some pretty story tell,
Or kiss the place to make it well?
My mother."
~Jane Taylor

"You may have tangible wealth untold:
Caskets of jewels and coffers of gold.
Richer than I you can never be
I had a Mother who read to me."
~ Strickland Gillilan

"The mother-child relationship is paradoxical and, in a sense, tragic. It requires the most intense love on the mother's side, yet this very love must help the child grow away from the mother, and to become fully independent."
~Erich Fromm

"Children are the anchors that hold a mother to life."
~Sophocles

"A mother is the truest friend we have, when trials, heavy and sudden, fall upon us; when adversity takes the place of prosperity; when friends who rejoice with us in our sunshine, desert us when troubles thicken around us, still will she cling to us, and endeavor by her kind precepts and counsels to dissipate the clouds of darkness, and cause peace to return to our hearts."
~Washington Irving

Saturday, February 9, 2008

Bipolar Mother

I usually don't post on the weekend, but I think my bipolar depression may finally be over. I've spent most of the day thinking about its impact on my 18-year-old son. As you undoubtedly know, when a depression ends (and I'm hoping this one is truly over), everything changes. As a parent, while you want to focus on your children's needs (no matter how old they are), it's very difficult when you're struggling to survive.

I wasn't diagnosed until my son was four years old, and for the next six years, the medication made me so sick that I felt I missed so much of his childhood. Yes, given the circumstances, I did the best I could, but it wasn't enough--no matter what anyone says.

And things didn't change. There were new doctors, new medications, and a steady stream of depressive episodes followed by hypomanias. This current depression hit in November--another holiday ruined--and has hopefully ended but it is now six weeks after my son has left for college. Because I was so sick, when I think of the isolation of those last few months, and how stressed I was about helping him prepare to leave--it truly makes me ill.

I'm sure he's experienced difficulties I can't imagine although we never sought family therapy because I didn't want him to feel like we were a "mentally ill family." In my experience, everyone has such a negative view of bipolar disorder--doctors and therapists alike--that they've lost the ability to approach it from a problem-solving perspective and to help provide answers and services rather than a lot of meaningless conversation and ineffective medication.

In fact, my family didn't need therapy as much as accurate information, a treatment protocol that worked, and support services. What I could have used were psychiatrists who actually admitted they had no idea how to treat bipolar depression but were spending as much time as I was trying to find the answers, psychologists who understood common behavioral patterns and symptoms and could provide helpful advice, an insurance policy that actually covered the costs of the treatment, and a Wellness Manager to help oversee the illness and aid in evaluating the care, as well as a host of other services.

When it comes down it, the best thing I could have achieved for my son would have been to get well. My mistake wasn't that I didn't try hard enough. No one tried harder. It was that I felt like I couldn't speak up because of the stigma of the illness.

But, today, as I thought about my son and how much I love him, I realized that it's time for one last huge effort. Medically, I have strong ideas about how to heal myself and it's time to find the people who can truly help me. Morally, it's time to speak out about the travesty of bipolar treatment.

When I think of my husband and son and the heartbreak and disappointment we have had to endure, I don't want that to happen to other children and their parents. It is my love for my son that enabled me to survive the darkest days of my depressive episodes. It is my love for my son that will help me chart a new course as a bipolar advocate.

Friday, February 8, 2008

Cycling In and Out of Depression

Perhaps it is important to note that with bipolar disorder, depressive episodes are not the same. Not only do they differ in terms of duration and pain, but some continue for weeks or months and end abruptly from one day to the next. Others go on interminably. Some cycle on and off.

Yesterday, I thought this episode had ended. I felt well, I accomplished a lot, and my sense of humor had returned. But, today was as dreadful as it gets.

As some of you know, my mother died at the end of October. And this morning when I awakened, I started sobbing because I missed her so terribly, and I was sad and tearful all day long. I was grateful that my son is away at college, so that I could shed my tears with abandon.

Today I felt like I was crying for a lifetime of depressions...for the first one when I was 18, for this one--almost 40 years later--and every single one in between. I didn't ruminate about prior episodes, but I felt entitled to cry for so many reasons: for trying so hard to achieve wellness and failing, for trying so hard to remain positive despite abundant suffering, for causing so much pain to those I love, for being judged and found lacking by those I used to love, for persevering when it would have understandable to have quit, and because I miss my mother, who was my anchor throughout my life. In the depth of my sorrow, I wrote the following poem.

Mama, Can You Hear Me?
I am 57 years old
and the mother of a teenage son.
And this morning when I awakened,
I started sobbing because my mother is dead.

I suddenly realized
that for the rest of my life,
no one will answer me
when I say the word "mama" aloud.

No one will look at me and see
the laughing happy child of years ago.
No one will think I'm perfect
despite my recognizable flaws.

No one will hold me the way
that only a mother can,
And promise me I'll be okay
because to her I am invincible.

"Mama, I love you deary," I weep.
"Mama, I miss you deeply," I whimper.
"Mama, I still need you," I whisper.
"Mama, can you hear me?" I wail.

"Maaaaamaaaaa," I bawl,
like a small child who is lost in a crowd.
"Maaaaamaaaaa," I bellow,
praying that my voice will reach her in heaven.

Thursday, February 7, 2008

Coming Back from a Depression (Part 2)

Reemerging from a depression sometimes feels like going from Edvard's Munch's The Scream to Leonardo's da Vinci's Mona Lisa.

According to Wikipedia, the former is "said by some to symbolize the human species overwhelmed by existential angst." Actually, it's just one painting in a series in which Munch explored the themes of life, love, fear, death, and melancholy.

I must admit that I wasn't surprised when I read that Munch was often ill, and at one point went to a hospital where he underwent electroshock therapy.

Of course, the universal question always asked about the Mona Lisa is "Why is she smiling?" Well, as far as I'm concerned, it's because she's extraordinarily relieved that her last depressive episode is over. She was so tired of feeling bad, exhausted by the pressures placed upon her by her husband, a wealthy Florentine silk merchant, and quietly pleased that once she recovered, she could spend a few weeks sitting for her portrait--which was a low-stress activity.

All right, I'm just kidding but who really knows?

Wednesday, February 6, 2008

Coming Back from a Depression (Part 1)

When I was younger, it was much easier for me to bounce back from a depressive episode. No matter what the duration or how awful I felt, once I began feeling well again, I used to call all my friends and say, "I'm back." And then I would arrange luncheons or dinners so that I could catch up on their lives--the milestones I had missed when I was ill. There were years when I was a good listener, and I truly was interested in whatever they wanted to share.

As the years progressed, gradually I stopped making most of those telephone calls. In some cases, after so many episodes of absence, we grew apart. In other cases, I just didn't have the energy to hear about everything I'd missed. It's not that I didn't care. It was just that I had spent so many days, weeks, or months--trying to survive--that I found it difficult to return to the rhythm of daily life.

And when they would ask me, "How are you?" I would say, "I'm okay now," and let it go at that. I think some of my friends and family members felt like I was shutting them out. I truly believed I was doing them a favor.

How can you describe what a depression feels like to someone who's never experienced one? Could I feel comfortable saying, "For the last four months, every day I felt like I was dying. Each morning when I awakened, I had to force myself to get out of bed, brush my teeth, shower, dress, and pretend that I could feel joy about anything. Yes, I love my husband and I love my son and there are others, but aside from loving them--I can't feel anything but sadness, grief, sometimes terror, and an overwhelming sense of loss."

Would they feel comfortable hearing these words? Would it make me feel better to say them?

I didn't think so then, and I don't now. How could I ever explain to them that from one day to the next, everything changes for me. Suddenly, after months of such debilitating psychic pain that I don't how I will stand it for one more minute, I'm myself again, and I feel the enthusiasm and optimism that is a central part of who I am--when I am well.

(to be continued)

Tuesday, February 5, 2008

Bipolar Wellness Pilot Program (Last day)

This is the final day of this post. If you have thoughts, ideas, or suggestions about the Bipolar Wellness Pilot Program that I proposed on Sunday, I'd love to hear from you! Whether you do or not, I'll share two quotes I particularly like.

"I have spread my dreams beneath your feet.
Tread softly because you tread on my dreams."
~W.B. Yeats

"All men dream but not equally. Those who dream by night in the dusty recesses of their minds wake in the morning to find that it was vanity; but the dreamers of the day are dangerous men, for they may act their dream with open eyes to make it possible."
~T.E. Lawrence

Monday, February 4, 2008

Bipolar Wellness Pilot Program (Once More)

I'm letting Sunday's post, which focuses on my Bipolar Wellness Pilot Program, maintain its prominence on my blog for a few days. Originally it was entitled Dear Senator Clinton because I was prompted to write it by an email I received from her campaign. However, I've changed the title because my opinion about bipolar treatment has nothing to do with politics.

I am most interested in hearing how you feel my ideas, your opinion about the quality of treatment you've received, and/or your ideas about the services you need in order to achieve wellness.

Sunday, February 3, 2008

Bipolar Wellness Pilot Program

Dear Presidential Candidates:
One of the key issues for me in the upcoming presidential campaign is mental health. I am only interested in supporting a candidate who will establish mental health insurance parity, support a comprehensive and innovative Bipolar Wellness Program, and will listen to bipolar consumers who are not affiliated with mental health organizations that are funded by pharmaceutical companies--as well as those who are.

(As an aside, I am not anti-medication although I am medication resistant. However, I strongly believe that medication--even when it works--should only be part of a larger wellness program.)

The participants in the Bipolar Wellness Pilot Program I am proposing--which certainly could use tweaking--should be the most successful and motivated bipolar consumers. The theory behind this is that most programs are provided for the sickest people who are in psychiatric hospitals, and/or those suffering from alcohol and drug addiction and/or other psychiatric conditions in addition to bipolar disorder. So, the results are rarely valuable to those of us who are just bipolar, have been highly disciplined and have worked terribly hard to get well, and still suffer from severe depressions for months at a time.

I've spent more than 12 years researching this illness, trying to cope with the fall-out of being so ill, trying to be remain hopeful and upbeat for my son and my husband, and trying to survive when the psychic pain of these continual depressive episodes has been overwhelming. The Bipolar Wellness Pilot Program I'm recommending is intended for people like me. If you could just give us a chance to get well, then perhaps we could finally learn something significant that could help others.
Bipolar Wellness Pilot Program
1. A complete physical examination with all possible blood work to determine whether there are physical reasons for this illness.

2. A complete psychological examination.

3. Personality and temperament tests to determine whether there are common behavioral patterns that could be addressed in a skills-based class.

4. Providing a Wellness Manager (WM) to oversee each case, discuss the treatment the consumer has received, and the treatment she would like to receive. The WM will help consumers choose a counselor or a therapist, a psychiatrist, possibly a psychiatric nurse, and any other medical team members. In conjunction with the medical team and the consumer, the WM will help the consumer determine whether she needs person-to-person visits, telephone conversations, or online visits, and how often they need to be scheduled. The WM will help the consumer decide whether she wants to participate in a cognitive therapy program, an interpersonal therapy program, and or an educational skills-based program.

5. The WM will help set up adjunctive treatment options, including including art therapy, music therapy, biofeedback, acupuncture, neurofeedback, hypnosis, light therapy, writing therapy, massage, horticultural therapy, and stress management (among others), and allow consumers to participate in a reasonable number of programs.

6. Every consumers' medication history will be entered into a computer program to determine what medications she has taken, in what combinations, and what dosages, and what the outcomes have been. This data will be evaluated by a highly skilled doctor who specializes in psychiatric medication and who will make recommendations to the consumers' psychiatrist.

7. The consumer will meet with a nutritionist to determine whether her dietary needs are being met and to develop dietary recommendations.

8. The consumer will participate in a yoga program and/or meet with an exercise/movement specialist to develop an exercise program, which will be provided free of cost at a local YMCA or Bipolar Wellness Center.

9. The consumer will participate in a weekly mindfulness-meditation program.

10. The consumer will be provided with a computer generated mood chart that she will fill out on a daily basis, and which will be fed into a program so that mood charts can be analyzed on a daily, weekly, monthy, and yearly basis.

11. To launch each program, consumers will spend five days in a Wellness Center so that all the medical tests and lab work can be done, psychological evaluations can be completed, medications can be evaluated, and they can develop a relationship with their Wellness Managers, meet with medical staff members, and wellness team members, and begin participating in wellness activities.

12. The length of the program will have to be determined and a method for evaluating progress determined. As with any relationships, some teams members will have to be replaced over time, and adjunctive therapies adapted or changed. As various needs arise, new program elements including career-related advice will be provided.

I have no idea what kind of budget we're talking about but if one compares the Bipolar Wellness Pilot Program I am proposing with the $16 million National Institutes of Mental Health Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), one would have to conclude that my program cannot help but be more effective, less expensive, and of far greater value to the bipolar population.

Begun in 1998 and concluded in 2005, the STEP-BD researchers treated 4,360 patients. In 2006, Roy M. Perlis, M.D., one of the chief investigators of the study, told Jim Rosack from Psychiatric News, "We still have a lot to do." The results he was focusing on at the time were based on 1,469 patients who participated in the program for at least two years.

Rosack reports the following, "The researchers found that slightly more than half (858 patients, or 58 percent) of this group achieved recovery, defined as having no more than two symptoms of the disorder for a period of at least eight weeks during the two-year follow-up period."

"Within that two-year window, nearly half of those who achieved recovery (416 patients, or 48.5 percent) relapsed; almost twice as many patients who relapsed suffered a depressive episode (298 patients, or 34.7 percent) than those relapsing to a manic, hypomanic, or mixed episode (118 patients, or 13.8 percent)."

As far as I'm concerned, these results are dismal. I'm hoping that whomever becomes president will appoint a blue-ribbon committee to determine the following:

1) Why the STEP-BD, the first real study to determine the "best treatment methods for bipolar disorder," wasn't begun until 1998 despite the high rate of suicide for bipolar disorder and the large quantity of psychiatric medication that is prescribed for it;

2) Why STEP-BD was such a pedestrian study and focused so heavily on medication and a "core psychosocial intervention" as opposed to other treatments options;

3) Why the researchers were so surprised to learn that the depressive side of this illness is more likely to occur than the manic side (despite the fact that you could search hundreds of online sites and have consumers tell you this without spending $16 million); and

4) Why the pharmaceutical companies have a lock on this illness and why funding is so heavily focused on pharmaceuticals rather than other treatment options. One would also have to ask why there aren't better medications with fewer side effects, and how doctors determine which medications to prescribe in what combinations and dosages. Finally, someone should be asking consumers whether the medication has worsened their condition rather than improved it.

As you can see, there are so many issues to discuss about the STEP-BD and the treatment options in general. The problem is: Who's in charge of bipolar disorder within the federal government? Who's accountable? Who decides what programs to fund?

Perhaps I would know more if I belonged to a mental health organization but I don't. The issue is that I don't consider myself "mentally ill." I believe that label is stigmatic and self-defeating. I look at illness from a mind-body perspective and don't understand why being bipolar is worse than being diabetic, having high blood pressure or heart disease, or cancer.

In closing, I guess my point is that I don't want to die from this illness, but I am finding it increasingly difficult to withstand any more depressive episodes. If 50 percent of the diabetic population tried to commit suicide, the American people would would be appalled. But manic-depressives are killing themselves on a regular basis and no one seems to care.

At this point in my life, I feel that my only legacy is the pain and suffering I have endured...needlessly. And I need someone to care. More than that, I need someone to help me implement a Bipolar Wellness Program that I believe would work--for me and for others who live with this debilitating illness.

Sincerely,

Susan Bernard

Saturday, February 2, 2008

Saying Thank You

I just noticed that Danielle from The Bipolar Diaries thanked everyone who commented during the last month. I've decided that's a very nice thing to do. So here goes. In addition to Danielle, I would like to thank the following people for participating in my blog in January:
Merelyme from Multiple Synchronicities & Schlerosis
JayPeeFreely from No More Mr. Nice Guy
Pia from Courting Destiny
ariadneK from Weird Cake
The Individual Voice
Patricia from Nuts R Us News and Alternative Views
Dirk from Dirkmonster
Syd from Bipolarity
Howard from Mead on Manhattan
Edward J. Renehan, Jr.
Sandy M.
Iris
Lynn
Kwana Aminata Oliver from Excuse me? I'm Still Here
Dr. Deb
Marja from Roller Coaster
Polly from polarcoaster
Carrie from This Crazy Idea
Roomalone

I must say that while it took a lot more time to put together this list than I expected, it was really nice to review people's comments. If I left anyone out, I apologize. Where I've given a name and no link, none was provided.

Cheers to February!

Friday, February 1, 2008

Bipolar Wellness Activity

When I'm feeling depressed, I try and think of accomplishments--big and small. Just one a day will suffice. Since I've had a rapid cycling depression for months, this exercise currently requires fairly low standards and a high level of creativity. But last night, I came up with a big winner: kickball. Yes, kickball. When I was in elementary school, I was probably the best, if not one of the best, kickball players in my class.

As a sort of a baby boomer visualization exercise, I lay on top of my bed, closed my eyes, and visualized the blacktop diamond at my elementary school. As I remembered my childhood friends with whom I used to play, I felt a smile beginning to form...the first one in days. As I visualized what it felt like to stand at the plate looking for holes in the outfield as I waited for the pitcher to release the ball, I felt a small surge of happiness.

As I saw myself standing at the plate and waiting for the ball to come towards me, I could feel a slight increase in my heart rate. When I visualized my left foot solidly connecting with the ball, and kicking it so hard and high that it sailed through the air beyond our diamond, I unintentionally clinched my fist with pride. Finally, as I saw myself running so fast around the bases that I felt like I was flying, I was jubilant--if only for a moment.

When I opened my eyes, I sighed deeply, and felt like part of the darkness was lifting. Moreover, for the first time in weeks, I came up with a plan of action. I decided that if this depressive episode doesn't end within one week, I'm going to return to my elementary school, which is only five blocks away, and see if I can find a "pick-up" game of kickball. While I'm not sure that beating ten-year-old kids will make me feel better, it certainly couldn't make me feel worse.

P.S. I just read that kickball is a popular retro sport. So, perhaps I can join a team of adults.