Wednesday, April 30, 2008

Bipolar Lyrics 3

One important aspect of healing that is often overlooked is laughter. Perhaps Norman Cousins said it best when he wrote, "Hearty laughter is a good way to jog internally without ever having to go outdoors."

One of my favorite activities--that makes me laugh--is writing lyrics to songs, and playing them on my guitar or Autoharp. The following lyrics are from My Favorite Things, from one of my favorite films, the Sound of Music (music and lyrics are by Richard Rogers and Oscar Hammerstein II). You can find the "real" lyrics and music on this National Institutes of Health site devoted to music for kids.

These Darn Side Effects
(My Favorite Things)

Dry mouth and nausea, sweating and rashes,
Heart palpitations, hair loss with hot flashes.
Cognitive mem'ry loss, flatulence too,
I hate these side effects, really I do.

Increased urination, headaches and confusion,
Drowsiness, lethargy, tremors, delusions.
Sleeplessness, dizziness, blurred vision too,
I hate these side effects, really I do.

Anxiety, slurred speech, increased agitation,
Nervousness, restlessness, and constipation.
Changes in appetite and sex drive too,
I hate these side effects, really I do.

When I’m happy, but not manic,
When I’m free from pain,
I always remember these darn side effects,
And wish I were well again.

Tuesday, April 29, 2008

Is There a Bipolar Personality?

In yesterday's post, I wrote that during a person's diagnosis for bipolar disorder, I feel he/she should take tests for temperament, and also personality (which I didn't mention). Within psychological circles, there's a lot of discussion about the differences between temperament and personality, which I'll try to explain briefly--just so I can make my point.

The easiest way to explain it is that temperament is a set of traits you're born with. It appears early in childhood, and while it's not measurable, observed over time it suggests a certain pre-disposition toward a "particular configuration of habits." According to Dr. David Keirsey, co-author of Please Understand Me: Character and Temperament Types, there are four temperament types: Guardians, Idealists, Artisans, and Rationals.

Your personality is formed by your temperament and character, which may be influenced by your environment, socialization, education, birth order, siblings, interpersonal pressures etc. The most popular test for this is the Myers Briggs Personality Tests, and they define 16 personality types.

Finally, my point is this: In every book I've read about bipolar mood disorder, psychiatrists talk about the bipolar personality. And in books on depression, they talk about the "depressed" personality. And none of their descriptions have ever resonated with me. Of course, I always feel they're trying to find some way of "blaming" me for my illness.

But, what if they gave bipolar people (BIPs) temperament and personality tests? And what if they found that the majority of BIPs are highly sensitive? Or that according to the Keirsey Temperament Sorter, BIPs tend to be Idealists? Or according to the Myers Briggs Personality Tests, most BIPs tend to be INFPs or ISFPs and "live in an intently personal fashion, they strive to adhere to their own high personal moral standards, and they are deeply empathetic?"

I have no idea whether BIPs have any similar temperament and/or personality traits, but it would be interesting to find out. It would also be important to know how well we deal with stress. Was our adjustment from adolescence to adulthood more difficult than most? There are numerous other questions that would have value.

Why? Because, if we share certain temperament and personality traits, and if we have similar problems dealing with stress, or if we tend to have difficulties dealing with change, then it should be relatively easy to develop a skills-based program to help us, rather than having every single one of us try to seek help on our own.

And rather than "blaming" us for being different, we could be taught certain coping skills, or we could be praised for our sensitivity, or encouraged to pursue occupations that would take advantage of our unique perceptions and sensibilities.

It's just a thought...

Monday, April 28, 2008

Highly Sensitive People

I've often wondered whether I feel things more deeply than other people I know, or if at this stage in my life I have a great need to express my feelings, and other people I know don't.

Perhaps the reason is because I spent decades keeping my feelings to myself. From my earliest remembrances (maybe in kindergarten), I used to get my feelings easily hurt. For some reason, I tried to "toughen up," although I don't remember ever discussing this with my parents--or having them give me this advice.

Although I could certainly express happiness, love, affection, joy, and other positive emotions, I wonder why I never thought it okay to express sadness, unhappiness, disappointment, or anger. And now that I'm in my late fifties, I can't (or won't) keep these feelings to myself.

What's interesting is that I'm not a highly sensitive person (HSP), as defined by Elaine N. Aron, author of Highly Sensitive Person: How to Thrive When the World Overwhelms You. Actually if you go to her website, you can take a self-test.

In Aron's definition, HSP have a nervous system that is more sensitive to subtleties (which I do). According to Wikipendia, "This means that regular sensory information is processed and analyzed to a greater extent, which contributes to creativity, intuition, sensing implications and attention to detail, but which may also cause quick overstimulation and overarousal."

While I have the former characteristics (creativity, intuition, sensing implications and attention to detail), I don't have a problem with overstimulation and overarousal. However, what's interesting about all this to someone who's bipolar is that this HSP temperament may correlate to high cortisol levels, something I wrote about at the end of an earlier post.

The point I'd like to make is that I believe temperament is a very important area of study for bipolar researchers. When I was talking about bipolar diagnosis last week, one of the tests I think people should be given relates to temperament.

(more to come)

Friday, April 25, 2008

Inspirational Quotes

Thanks to everyone who commented this week. It's been a lively discussion on some important topics. I thought I'd end the week with a few quotes that make me think, smile, or inspire me.

"For all sad words of tongue and pen, the saddest are these, "It might have been."
~John Greenleaf Whittier

"Forget past mistakes. Forget failures. Forget about everything except what you're going to do now, and do it."
~Will Durant

"I have made it a rule of my life never to regret and never to look back. Regret is an appalling waste of energy...you can't build on it; it's only good for wallowing in."
~Katherine Mansfield

"I have had dreams and I have had nightmares, but I have conquered my nightmares because of my dreams."
~Dr. Jonas Salk

Thursday, April 24, 2008

The Disease is Not the Person

I was reading about mania and hypomania today, hoping to answer naturalgal's question about why people do things that are against their moral code when they're manic. I couldn't find the answer. However, I do want to share a most interesting observation on bipolar disorder from E. Torrey Fuller, M.D., co-author of Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families, and Providers.
"It should be clearly stated, however, that the disease is not the person. The symptoms of manic-depressive illness are merely symptoms and are distinct from the person's underlying personality. Manic depression is an equal opportunity disease: It may affect those whose underlying personality is shy or outgoing, altruistic or narcissistic, responsible or spoiled, kind or cruel.

The symptoms of mania and depression then interdigitate with the person's underlying personality to create a unique medley that differs not only from person to person but even from day to day within a single person as the disease process evolves. It is this interaction of disease symptoms with underlying personality that makes manic-depressive illness so difficult to comprehend for most people."
While Dr. Fuller is one of the foremost researchers of bipolar mood disorder, it is this kind of a statement that I completely disagree with. When I read his book years ago, and he is a true advocate for the mentally ill, I felt there was no hope for me to become well.

In the intervening years, I've totally changed my mind, and it's one of the reasons why I no longer read books on bipolar disorder. If I truly believed that the strength of my personality couldn't affect the outcome of this illness, I'd be devastated. If I believed that my illness would change from day to day independent of my behavior, my resolve in seeking to control it, and my willingness to utilize a wide range of wellness activities to feel better--it would mean that I was powerless to heal myself.

While Dr. Fuller has done so much for so many, his mindset about bipolar mood disorder is in total opposition to my own. I've asked this question before and I will ask it again.
Why is it that some of the foremost oncologists who deal with people who have terminal cancer believe their patient's attitudes can affect the outcome of their illness, but none of the foremost psychiatrists who deal with bipolar disorder feel similarly?

Wednesday, April 23, 2008

Dealing with Mania and Hypomania (Part 1)

Years ago, when I was first diagnosed as bipolar II, and I was reading everything I could find about the illness, I quickly learned there was a lot written about mania, but every little written about hypomania. In my local library, I picked up a video about being bipolar, and when I started watching it I began crying.

The interviews with four bipolar people were so depressing that I was overcome with sadness. As I remember it, and I'm not sure this was all on the same video, one bipolar man talked about some sort of money scam he'd run when he was manic. A married woman talked about buying an entire living room of furniture (in one day) that put her family in financial jeopardy. A mother discussed how she'd strike out at her children for no apparent reason. And a married man talked about taking a woman he barely knew (not his wife) on a trip to another country.

Years later, I read about Sol Wachter, the Chief Judge of the New York State of Appeals, stalking a former lover (he was married at the time), by writing a series of explicit letters and making menacing telephone calls, and ending up in prison. And there have been so many other stories about uncontrolled mania, and the havoc and heartbreak it causes.

The bipolar people in the video, Judge Wachter, and so may others seemed to suggest they had no control over their behavior, and their bipolar illness was to blame. I, who had only experienced hypomanias, found it difficult to believe.

When Wachter's prison memoir came out, I remember being so upset about it that I discussed it with my psychiatrist. "Do you truly believe that Judge Wachter couldn't help himself?" I asked. "He's writing that everything he did was against his moral code and yet he blames his undiagnosed illness, for which he didn't seek help, and self-prescribed medication."

All these years later, I don't remember my psychiatrist's exact words, but he reassured me that he didn't believe Wachter's bipolarity was to blame. And neither did I.

Since I've only experienced one "manic episode" that was medication-induced, and my doctor immediately took me off Zoloft and put me on lithium (which didn't work but I still returned to "normalcy"within a few days), I don't have any idea what full-blown manias are like.

During my brief manic episode, all I remember is that I had too much energy, which I tried to dissipate through exercise, I diligently cleaned my house, played a lot of video games with my son (who was about five years old at the time), and flattened two tires on my mini-van because my judgment was slightly impaired, and our driveway is narrow and steep and has a concrete lip off the fireplace that is problematic at best (although I'd never hit it before). There was some other slightly "off" behavior, but I did nothing that was inconsistent with my morals and values.

What I decided early on was that unlike the bipolar people who blamed their untoward behavior on their illness, I would take personal responsibility for mine. (more to come)

Tuesday, April 22, 2008

Three Things I Dislike Most About Hypomania

While there are some aspects of hypomania I enjoy--the boundless energy, great enthusiasm, joi di vivre, and a interest in talking to a wide range of people--there are other qualities I despise. The following are three things I dislike most about hypomania.

1. A lack of patience. While I'm ordinarily patient with people--and have gotten increasingly so since my illness, when I'm hypomanic I have very little patience. I try to overcome it by recognizing it's a problem and consciously trying to count to 10 before I speak.

2. Talking too much. I used to feel that talking too much during a hypomania wasn't so problematic because, after all, I went through long periods of depression when I didn't talk at all. So, it kind of evened itself out.

I have since realized that excessive talking is unappealing to others, and I work hard to control this. If I'm with my husband, we have a sign when I seem to be dominating the conversation with others. He kind of nods at me, although it's my decision whether to quit talking or not. I wish I had figured this out years ago. I'm still not great at dealing with this when I'm alone, although my mantra is "Less (talk) is more."

3. Increased irritability. I wish I could say that I've got this under control, but I don't. I recently had a fight with a dear friend. I can't seem to truly apologize or empathize with her position, because I can't get beyond my own hurt feelings (which came out as anger) at something she emailed me. (Please no more lectures on forgiveness, but if you've got other advice, I'm willing to listen.)

On the positive side, over the years I have reduced or eliminated the following hypomanic symptoms:

Inflated self-esteem or grandiosity. I try to listen to myself and stop behaving this way. I realized that I used to talk about "big plans" because I felt so bad that I wasn't achieving anything positive during my depressive episodes. But these days I try to focus more on who I am than on what I achieve.

Decreased need for sleep. This was always a medication-induced problem for me. Still, since my doctors made it very clear that a lack of sleep fuels a hypomania, I'm careful to get eight to nine hours of sleep a night. If I can't do it naturally, I take sleeping pills (which I stop taking the moment I'm no longer hypomanic.) Getting off the pills is always a problem, but staying on them is far worse because I know they contribute to depressive episodes during low energy periods or during the fall and winter months.

Flight of ideas. This still creeps up on occasion, but I've gotten much better about refusing to pursue ideas during a hypomania that don't interest me when I'm normal.

Increase in goal-directed activity. Again, I try to watch my behavior and identify problems before they occur. While I consider it okay to garden for long periods, or do home improvement chores, I only start one project at a time, and I finish it before I move on to the next one.

In years past, I would spend months working on book proposals that didn't interest me when I was well (This can still be a problem although I try to disengage myself more quickly.). I try to stay off the computer (which was a problem when I spent years researching this illness and downloading reams of materials that I diligently filed).

When this symptom seems like it's rearing its ugly head, I get out my Day-Timer and start accounting for my time in 30 minute segments so I can record how I'm spending my days--and make appropriate adjustments.

So, what hypomanic symptoms do you dislike the most? What tips do you have for diminishing their impact on your life?

Monday, April 21, 2008

Continuing to Blog about Bipolar Issues and More

Dear Friends,
I just received another comment about my decision to stop blogging about bipolar issues and move on. I have also received a few ideas about ways to continue this blog but include it in a larger site. That's what Danielle did with the Bipolar Diaries, which is now a part of My Name is Danielle. It makes sense. So...I'm noodling all this in my brain--which is how I make decisions--and thinking about options. But it seems likely it will work. Thanks for your support. I'll keep you posted.

Susan

P.S. Tony--I haven't heard from you and I'm concerned. Let me know you're okay!

Friday, April 18, 2008

Bipolar Diagnosis (Part 2)

When I reread what I'd written about bipolar diagnosis yesterday, I realized that what I recommended only should be considered a small part of the larger diagnostic process. In fact, what I wrote was short-sighted, and I apologize.

What I should have said (and this is my personal opinion) is that while the process of mental illness diagnosis has degenerated into matching symptoms to the Diagnostic and Statical Manual of Mental Disorders (DMV IV) criteria, that's a huge disservice.

In traditional medicine, the best doctors have always known that diagnosis is an art. In The Lost Art of Healing: Practicing Compassion in Medicine, Bernard Lown, M.D., writes: "Practicing the art of medicine requires not only expert knowledge of disease, but an appreciation of the intimate details of a patient's emotional life usually presumed to be within the province of the psychiatrist."

And yet, how many psychiatrists really do effective diagnoses? No matter how many psychiatrists (and psychologists) I talked to, none of them really listened, and thought outside the box. If they had, things might have turned out differently, because I unknowingly had provided them with critical information, which they ignored.

At every first visit, I said: "My first depressive episode occurred when I was at Cal, and I think that while I was there something broke inside me that could never be fixed." Yet, none of the psychiatrists ever considered that to be an important piece of information, although I am one of the few people who believes that the initial trigger is extremely important.

I also said, "For 25 years I had these semiannual six-week periods of unhappiness (undiagnosed depressions) in April and October." Yet, no psychiatrist ever asked: "Is there anything significant about those months?"

If they had asked, I would have said, "April is my birthday and for years I used my birthday as a period of reflection. Every year I would ask myself over and over again, "What happened at Cal that caused such an enormous shift in my orientation to life, and these periods of such unhappiness?"

If my doctors had followed this line of inquiry, they would have understood that what I actually was doing was "rumination," which is thinking over and over about a negative experience. In my case, I didn't realize this was a bad thing to do. I thought I was using my critical thinking skills to try and heal myself.

The other significance of April is that it is the anniversary of the month I started college. A few years ago, I read that many people suffer depressions on the anniversary of a traumatic life experience. Thus, both the rumination and anniversary of starting college were viable reasons to experience the April depressions. And had a doctor uncovered them during the diagnosis, I might have been able to end the cycle.

The causal factors for the October depressions are less clear. There may have been a seasonal element to them. Yet, only one psychiatrist suggested the possibility that the fall depressions might be related to Seasonal Affective Disorder. Also, I returned to Cal in October of 1968--my second quarter--which was the very worst part of my experience there. Again, this is an anniversary of sorts.

My point is that these questions aren't rocket science. Each of us may have incidents in our lives that trigger depression episodes. The problem is that psychiatrists believe that while the first depressive episode may be triggered by a life event, subsequent ones are not. They are caused by brain kindling, which means that after a few depressive episodes, our brains become rewired and automatically switch into a depressive mode.

However, like much else related to bipolar disorder, this theory is conjecture. The fact is that our brains have elasticity. And if we know that a specific event is causing a depressive episode, it may well be that if we meditate, do guided visualization, or learn self-hypnosis, we can prevent this recurrence.

But the key to taking charge of our illness is to have a doctor ask questions during the diagnosis--or in subsequent meetings--which will uncover information to help heal us. Instead, once I was diagnosed as bipolar II, in every subsequent consultation with a new psychiatrist (and I've seen 5 different psychiatrists in the last 15 years), all they did was confirm the original diagnosis.

I believe this is medicine at its worst. As Dr. Lown says, "Doctors focus on the chief complaint (which in my case was always depression) mainly because medical schools do not train students in the art of listening. Obtaining a careful history, while emphasized, is not actually taught... Furthermore, the history provides soft data while a doctor craves solid facts... Limiting history-taking to the chief complaint often initiates fruitless pursuit of irrelevant matters that are quite tangential to the main problems.

(to be continued)

Thursday, April 17, 2008

Bipolar Diagnosis (Part 1)

During the 14 months I've written this blog, I've vacillated back and forth. Sometimes I love writing it and sometimes I don't. Lately, I've begun thinking that once again I need to broaden my interests and move on with my life. I learned more about being bipolar from writing this blog and reading other people's comments than from all the doctors I've met with, and research I've done--for almost 15 years.

But I'm suddenly feeling like the blog is "holding me back" from moving on with my life. In a way that's good because it means that I'm truly healing. Prior to being "the bipolar wellness writer," I was a writer--without any qualifiers. And maybe it's time once again to write about a wide range of interests rather than remaining so narrowly focused.

During this transition--which is what I feel I'm experiencing--I'll continue to write this blog until I decide upon a new direction to pursue. And I've decided to devote my final posts to information and advice for bipolar newbies. In years past, I often have asked myself, "What if...

What if...I had been given better information or had been able to find better information when I was first diagnosed? How would that have changed things for me?

Obviously, I can't change the past, but perhaps I can provide a better future and an easier present for others. So...my posts until the end of the month--which will probably be my last posts on this site--at least for now...will answer some of those "what ifs," and I'll also provide some information and advice that I wish I'd been given.

Caveat: As you all know, I am not a doctor. If I'm providing medical information, I will site different resources. If I'm expressing my personal opinion, I'll let you know. Understand that the very nature of the items I'm including in these final posts represent an opinion of sorts.

Make sure the diagnosis is the correct one. There are sites where you can take tests for mania and depression. I'm including a Depression Screening Test from the Department of Psychiatry at New York University (There are plenty of others, which you can find online.) and a Mania Screening Test from the DBSA (Depression and Bipolar Support Alliance). Read about manic and depressive symptoms. Understand that it takes some people years to get the correct diagnosis, and some people are misdiagnosed.

In terms of a diagnosis, what doctors are doing is trying to do is to match your symptoms to a disease that is quantified in their psychiatric bible, which is called the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Bipolar I is described as "characterized as one or more manic or mixed episodes." Bipolar II is characterized by the presence or one or more major depressive episodes, and one or more hypomanic episodes. The Massachusetts General Hospital Bipolar Clinic and Research Department also discusses Cyclothymic Disorder, and Bipolar III (which is not a true category but which they find to be helpful in their research and in dealing with patients).

If I were starting out, I'd read what different organizations and people have to say about this illness. When I was researching the nuts and bolts of bipolarity, I frequently visited the following sites: PsychEducation.org (founded by Jim Phelps, M.D.), Dr. Bob, Ph.D. (he's a pscyhology professor from the University of Michigan), Internet Mental Health (founded by Phillip Long, M.D.), Depression Central (founded by Ivan Goldberg, M.D.), the Black Dog Institute, and the National Institutes of Mental Health (actually I don't agree with a lot of information they provide nor with the way they spend their mental health budget, but within the United States, this is where my tax dollars go), The Stanley Medical Research Institute, and NARSAD.

If anyone has other resources on this topic, other points of view, or other experiences to share, I welcome your input. (I will respond to comments, but I won't answer any medical questions on this series for obvious reasons.)

Wednesday, April 16, 2008

Online and Offline Friends (Part 5)

Yesterday's rant made me and a few others feel good, although I realize this isn't the kind of post that most of you probably like. Still, as I wrote in my response to various comments, since I seem to be one of the few people in this blogging circle who feels that my treatment made me worse rather than better--I believe it's important to share my point of view (Yes, I know I tend to dwell on it, but it's part of my healing process. Maybe when I'm 90, I'll feel like I've written it out of my system).

Today, I was planning on writing more about friends--the "real world" kind--and say that one of the true difficulties of my bipolarity is that I like different kinds of people--dependent upon my moods. But, then I received four comments--one on each post in this series from Paula Joy, who's a bipolar newbie. And she asked a question, which I can't adequately answer, so I'm going to ask for your help in responding to her.

She said she likes blogging because she can honestly talk about her illness (she was only diagnosed four months ago, and started blogging about it a month ago), and she's not able to talk about it with "real-world" friends and and wondered why. (However, I just read her blog and she did talk about it with someone today and felt much better.)

I'm not really sure that I have a good answer for her. I believe there may be many reasons it's difficult for friends to discuss bipolar disorder, but here are a few: 1. They may feel like it would be an invasion of your privacy to ask about it. 2. Because it's a so-called mental illness, they may feel uncomfortable talking about it. 3. They may be waiting for you to broach the subject. 4. They may worry about what you're going to say, and be concerned that they won't know how to respond.

Does anyone else have more insight on this than I do? Or can you make suggestions on how Paula Joy might encourage them to talk about it?

Paula...I've actually got a more pressing issue to advise you on, and perhaps it will affect others as well. In your blog, you said that you have a thyroid problem. And I recently read that there is a "clear connection between the process of thyroid hormone regulation and bipolar disorder."

A really good article on this is on the website PsychEducation.org. Jim Phelps who runs this site is an M.D. If I were you, I would download this article and show it to your doctor. It's possible that you're not bipolar, but that your thyroid is causing "bipolar symptoms." Before I would be willing to be labeled "bipolar" and continue with your current treatment of Topomax (which isn't working), I'd find the best specialist I could find who is really knowledgeable about the studies that Dr. Phelps mentions.

If I were in your shoes, my next step would be to go through a battery of physical tests to ensure that I was getting the right diagnosis. I would be very cautious about taking a drug like Topomax without conclusively knowing that what you've been experiencing isn't caused by your low-hormone regulation.

And since I know you're religious, I would pray to God that your problem is hormone related and that you're not really bipolar.

P.S. You can still read our blogs (smiling face), but this would be great news.

Tuesday, April 15, 2008

Online and Offline Friends (Part 4)

For my second to last post in this series, for now, I think I need to correct a false impression I inadvertently may have created. I'm not saying I don't have "offline" friends; I just don't have as many friendships as I used to. And for the past few years, I haven't tried very hard to develop new relationships.

I retreated because I was embarrassed by my own erratic behavior (when I was really sick and taking so much medication), and hurt by the responses it elicited. And I didn't know what to do. At the time, none of the books talked about the bipolar symptoms I was experiencing, or if they did, it was in a blaming mode. And I was tired of being blamed for being sick.

If I'm being honest, I know that a part of me didn't care how my behavior was affecting others. What I truly wanted to say to people during this period was this: "I'm fighting every day to stay alive. You can't possibly imagine how extraordinarily difficult this is. Each day when I awaken, I feel like I want to die and yet...I push myself to live. And I would never kill myself because I love my son more than life itself.

"But let me tell you this, I don't really care if I talk too much because I go through months where I can't talk at all. I'm sorry if I'm irritable and get easily annoyed, but walk in my shoes for a few days and tell me how it cheerful you are when you wake up every morning feeling nauseous, and you've either got diarrhea or you're constipated, and all of a sudden you get head sweats for no apparent reason and you're drenched (and look sloppy even though you looked fine when you left the house), and you feel like you're going to vomit a half-dozen times a day (and sometimes you do), and suddenly you experience such a frightening shortness of breath that you're terrified.

"Most of all, describe how you feel when you tell your doctor about the side affects that have gotten increasingly worse, and you figure he should be sympathetic because you've been a trooper for so many years and have barely complained when you think about how truly awful you've felt--but he says nothing.

"Tell me how you try to remain civilized and choke down your rage, anger, and disappointment when what you really want to do is scream at him and say:
Why didn't you think about all this because you put me on this medication merry-go-round from which I can't get off? Why didn't you admit that you knew nothing about the short-term or long-term effect of these drugs? Why won't you and your colleagues admit that you have no idea what you're doing so you keep on prescribing more and more medication in different combinations and different dosages, and I'm now living in this nightmare from which I can't get any relief?"
In fact, this is what I wanted to say to my friends, to the people who were turned off by the way I looked and acted, to the psychiatric establishment, and to anyone else who would listen.

But I didn't...until now.

(one final installment tomorrow)

Monday, April 14, 2008

Online and Offline Friends (Part 3)

I think the problem with being bipolar and dealing with "real life" friends is that it's inconceivable for them to understand what this illness feels like. When I'm depressed, I'm not able to explain it at all. If fact, I can barely speak, and have no desire to. From past posts, I know there are others who feel differently and want to be surrounded by people when they're depressed.

Personally, during my worst depressions, my best companion is my dog Spike. (Yes, my husband is a saint, and he's been totally supportive throughout, which makes me one of the lucky ones, but I truly wouldn't have wanted him to remain by my side for a year.)

During my first year-long depressive episode, which was caused my medication (I know I sound like a broken record but I guess it's my prerogative since it's my blog), Spike never left my side (that's my husband in the background; my digital camera skills still leave something to be desired). And it's now 15 years later, Spike and I both have gray hair (although I dye mine, and thus look younger), and he is still a wonderful companion.

When I'm well, I always felt that I should try not to dwell on my illness because of my long absences. Still, I know that over time, some friends feel I've talked about it too much. Some are more tolerant, but I guess they feel helpless to help me. Some have always been there for me. Others have chosen to keep me in their lives, but they have marginalized me by not sharing their own problems and concerns.

And I guess, when all is said and done, it's difficult for most people to feel I'm trying to get well--when I've remained sick for so long. If they have any questions in that regard, they could always read my blog. Does anyone find it just the least bit odd that we write these public blogs and share our innermost thoughts about this illness and our attempts at wellness, and few of our friends or relatives read them? I guess it's just another indicator of our self-absorbtion...or is it?

Maybe, it would be helpful to write a Bipolar Primer for Friends and Relatives. But again, would we be writing it for an audience who is so sick of this illness that they don't want to hear it mentioned one more time? I'm not sure.

What do you think? How do you deal with your "real life" friends? How many people feel their illness has left them feeling isolated? How many have figured out a way to appear less self-absorbed?

Sunday, April 13, 2008

Online and Offline Friends (Part 2)

Actually, if I'm being honest, if anyone came up to me, introduced herself and said what I wrote in yesterday's post, I'd run away as fast as my legs could carry me. While I have purposely become more "blunt" in my dealings with others, I usually don't "spill my guts" upon first meeting people. I like to get to know them a bit more slowly than that.

And while my good friends all know about my illness, it isn't something I would spring upon someone new--before we developed some level of trust. I usually try to put myself in the other person's shoes. If I just met someone, and they began sharing their most intimate secrets right away, I would feel uncomfortable.

What's interesting is that the concept of "online friends" is an entirely new entity to me. This blog--which I've been writing for a little more than 13 months--is my first sustained online presence. And while there have been a number of faithful readers, and a few who truly have become friends, unlike some other bloggers, I can't sustain online relationships with a large group of people.

Perhaps the main reason is that I don't spend a lot of time online. Staring at a screen doesn't make me feel well. I don't read a lot of blogs--bipolar or otherwise; I prefer reading books. Unlike others who are bipolar, I'm not interested in the entire field of mental health. For the most part, I try to focus on aspects of bipolar recovery, depression recovery, and wellness because that's what I'm interested in, and that's why people read this blog.

But my personal interests are wide-ranging. If I look at the books surrounding my bed--which is mostly where I read--right now I'm reading about photography, music, walking, woodworking, adjusting to college (I'm trying to help my son), the mind and the brain, playing the electric guitar, and color theory. I just finished reading Steinway & Sons, and a half-dozen murder mysteries (that's how I relax). I'm also reading Ordinary Women, Extraordinary Lives: How to Overcome Adversity and Achieve Positive Change in Your Life, Creating from the Spirit: Living Each Day as a Creative Act, and The Story of Elderhostel.

So, what am I saying? I genuinely like the community I've created here. Having never talked to one bipolar person before I started writing this blog, it's been gratifying to find kindred spirits. In a world where there's so much negativity about being bipolar, I like the fact that people who comment on my blog have such a positive outlook. I have learned that seeking wellness with others is easier than trying to do it alone.

On the one hand, developing online relationships has been a tremendous growth experience for me. As I've become more isolated in the "real world," I find it very satisfying to share my deepest thoughts about illness, wellness, and other important life issues in cyberspace.

On the other hand, developing online relationships has made me realize what I've been missing offline. On Monday, I plan to write about why it's been so difficult to maintain "real world" friendships, how my bipolarity has affected those relationships, and what steps I plan on taking to reenter the world once again.

Saturday, April 12, 2008

Online and Offline Friends (Part 1)

I'd like to thank everyone who wrote during my computer meltdown. It's comforting to know I was missed. Perhaps, returning from an enforced absence online is like returning from a depressive episode--without all the angst. Still, there are some important issues to address. For a long time I have recognized that I have become socially isolated. But that point was driven home when I realized that more people have missed me online in the last week than miss me in "real life."

Sometimes I feel bad about my reclusiveness and sometimes I don't. I certainly have justification for my behavior. Over the years, there have been so many depressive episodes, so many canceled plans, so many birthday cards left unsent, so many milestones ignored (because my main concern was survival), and so many relationships damaged by my erratic behavior that was medication-induced--that many friendships have fallen by the wayside.

And during a decade of severe illness, I had to adapt to the restrictions it placed on me. Initially, it wasn't by choice. But perhaps after years of going forth into the world--and pushing myself to fit in--maybe my depressions caused me to reclaim my original personality type, which is introverted. In fact, many of my personal traits can be explained in the Myers Briggs Personality Test. An introvert has the following qualities:
  • Think/reflect first, then act.
  • Regularly require an amount of private time to recharge batteries.
  • Motivated internally. Mind is sometimes so active, it is closed to the outside world.
  • Prefer one-to-one communication and relationships.
When I'm hypomanic--and this has been greatly exacerbated by medication although I've worked hard to diminish its impact--I become an extrovert with all the Myers-Briggs defined qualities (although it's not as dramatic a shift as it seems):
  • Act first/think later.
  • Feel deprived when cutoff from interaction with the outside world.
  • Usually open to and motivated by outside world of people and things.
  • Enjoy wide variety and change in people relationships.
I'd like to have a few close friends who live nearby who would understand this bipolarity and not feel like it's "bad" or "negative." (My dearest friends are mostly spread out throughout the country.) But how would I explain myself to new friends?

"Hi, my name is Susan Bernard. I 'd like to be your friend, but my personality does not remain constant these days. I need periods of solitude, although I sometimes enjoy interaction with the outside world. Sometimes I can be there for you--and sometimes I can't (although I will always respond to your emails if you let me know they are important.)

Sometimes I have bursts of energy, but sometimes I don't. I'm extraordinarily loyal although it may not seem so, given my absences. I can be outgoing, but usually I'm more quiet than that. My feelings are easily hurt. When there are problems between us, I cannot let them fester. I need to resolve them, and I will tell you how I feel (in writing because it's so much easier for me to express myself). And I hope you will do the same. My goal is to talk or write things through so that we can understand our differences and remain friends.

(more to come)

Sunday, April 6, 2008

Computer Meltdown

Both my laptop and desktop computers crashed a few days ago. I can use my husband's computer, but I'm feeling a bit overwhelmed by the meltdown. I'll be back in a few days. I'll check for comments and email once or twice a day--but I won't be online other than that. Yikes! Maybe this is a message from the technology god telling me to exercise more, garden more, and get on with my life! Who knows?

Friday, April 4, 2008

The Search for Meaning (Part 2)

I first read Viktor Frankl's book, Man's Search for Meaning, more than 38 years ago when I was suffering a depression in college. I felt that someone who had survived the Holocaust, and could develop a school of psychotherapy dealing with finding meaning in one's life, must have something to say that would help me.

At the time, what impressed me was that Frankl was able to live such a fruitful life, and help so many people--despite losing his entire family (only his sister survived) in concentration camps. But I didn't really see what logotherapy could teach me.

According to Frankl's book, we can discover meaning in three ways: 1. by creating a work or doing a deed; 2. by experiencing something or encountering someone; and 3. by the attitude we take toward unavoidable suffering.

He writes that the first point, which is about accomplishment or achievement is obvious. The second, whether it is experiencing goodness, truth, beauty, nature (or something else)--or loving another human being, enables a person to actualize his own potentialities.

The third, which was the most confusing years ago, is explained this way: "We must never forget that we may also find meaning in life even when confronted with a hopeless situation, when facing a fate that cannot be changed. For what then matters is to bear witness to the uniquely human potential at its best, which is to transform a personal tragedy into a human achievement."

Although I have read this book at least three or four other times during various stages of my life, it wasn't until today that I suddenly thought, "Viktor Frankl is right about this, and it applies to everyone who's bipolar."

While I'm not suggesting that being bipolar is hopeless, what I am saying is that our ability to speak out about this condition (bear witness to it), and to transform our illness by writing about it and helping others, is truly an achievement. And when I look at the passage I quoted yesterday, it makes even more sense to me.
"One should not search for an abstract mission in life. Everyone has his (or her) own specific vocation or mission in life to carry out a concrete assignment which demands fulfillment. Therein he cannot be replaced, nor can his life be repeated. Thus, everyone's task is as unique as is his specific opportunity to implement it."
As I read that quote, again and again, I realized that I needn't feel bad about all my suffering. I needn't feel that if only things had been different--if the medication had been better or the doctors more competent--I would have lived a more productive life.

Rather, I can say that suffering from bipolar depression and surviving more than 120 depressive episodes is my unique mission. For whatever the reason, I had to spend 40 years of my life "struggling" with this illness. But, as I approach my 58th birthday on Sunday, perhaps I don't have to "struggle" any longer.

Despite how "lost" I sometimes feel during a depressive episode, the truth is that I know a lot about coping with depression. In the last ten years, I've learned a lot about wellness. It's finally time to implement what I've learned as a cohesive plan and practice it on a daily basis. If anyone has the self-discipline and will to "overcome" bipolar depression, it's me.

And perhaps it's time to feel proud of what I've accomplished rather than sad because of my losses, or angry because of a litany of things (many of which I've expressed in this blog). First and foremost, I am a Survivor, and always have been. As I approach this birthday, it truly is time to let go of the past and delight in the future.

To my friends and long-term readers, I want to thank you for spending the last year with me. Since February 2007, I written 315 posts. I feel blessed to have received so much support from so many. As we move forward, I hope that we'll all begin feeling a renewed sense of hope and purpose!

Thursday, April 3, 2008

The Search for Meaning (Part 1)

Since it might not have been obvious how my earlier post relates to the topic of wellness, I will post once more today. The real issue for my son--and for all of us--is how to find meaning in our lives. In his book, Man's Search for Meaning: An Introduction to Logotherapy, Viktor E. Frankl, M.D., a psychiatrist and Holocaust survivor writes: "According to logotherapy (a type of psychotherapy that Frankl founded), this striving to find a meaning in one's life is the primary motivational force in many."

"...What matters, therefore, is not the meaning of life in general but rather the specific meaning of a person's life at a given moment...One should not search for an abstract mission in life. Everyone has his (or her) own specific vocation or mission in life to carry out a concrete assignment which demands fulfillment. Therein he cannot be replaced, nor can his life be repeated. Thus, everyone's task is as unique as is his specific opportunity to implement it."

(I'll write more about this tomorrow.)

A Mother's Lament

Since my son began college two months ago, I've been feeling bad that I haven't been as insightful as I'd wished in providing advice for him, and helping him put things in perspective. During his recent break, we talked a lot about the problems he's been encountering, with the hope of finding solutions.

Now that my son has returned to school, he's been trying to stop focusing on what he's going to major in, and begun thinking about where his true interests lie.

It's difficult because that's not the orientation of a major research university, although it certainly should be since the majority of students are undergraduates. In most of the workshops my son has attended, and in individual meetings with advisers, I believe the focus has been too narrow and the information too pedestrian.

Except for commencement speeches, few educators and administrators talk with students about the big picture. What is the true purpose of a college education? Aside from specific curricular information, what are faculty members hoping to teach their students? What do they hope their students will learn?

Of equal importance, how are faculty and administrators helping students understand the relationship between the big picture, and daily campus life?

From the get-go, students are pressured to pick a major, decide upon a career path, and achieve at all costs. And yet in many institutions, the importance of vocation as a calling isn't discussed by faculty or woven into the curriculum. Rather it's left to the purview of career counselors and advisers. And perhaps the entire concept of choosing a college major and its relationship to larger life issues should be rethought.

"Life itself is a whole, not divided into majors," writes Robert Harris, an author and college educator. "Most jobs, most endeavors, really require more knowledge than that of one field. We suffer every day from the consequences of not recognizing this fact. The psychologist who would fully understand the variety of mental problems his patients may suffer will need a wide-ranging knowledge if he is to recognize that some problems are biological, some are spiritual, some are the product of environment, and so on. If he never studies biology, theology, or sociology, how will he be able to treat his patients well? Shall he simply write them off as hopelessly neurotic?

"The doctor who believes that a knowledge of cell biology and pharmacology and diagnosis will be all-sufficient in his practice will help very few patients unless he also realizes that more than eighty percent of the typical doctor's patients need emotional ministration either in addition to or instead of physical treatment. The doctor who listens, and who is educated enough to understand, will be the successful one. A doctor who has studied history or literature will be a better doctor than one who has instead read a few extra medical books."

I couldn't agree more. And now that my son has changed his focus and broadened his scope, I am feeling a great sense of relief and hope--for him. As the mother of an only child (and a former college administrator), I only wish that I'd thought this out more clearly months ago, and had provided my son with better advice.

Wednesday, April 2, 2008

Helping a Friend During a Depression

Thanks to everyone who's commented in the last few days: JayPeeFreely, Mariposa, Meredith, Danielle, Gianna, Nanci, Tony C., KJ, and Pixie. It's been nice coming back from an absence and having such interesting discussions.

As I've been visiting a few blogs in the last few hours, it seems like depression (and mania) have hit a few dear readers and friends. Trying to help people who are despairing is a difficult task even for those of us who have been there ourselves, and feel that our own pain and suffering should give us the insight to provide comfort or counsel. If we can't help our fellow sufferers, who can?

I read the most amazing example of someone who "can," not in a book about depression, but rather in Parker J. Palmer's book, Let Your Life Speak: Listening for the Voice of Vocation.

Palmer wrote that when he was depressed, most of his friends who visited (and many didn't) made him feel worse. They would either recommend that he do activities, which he couldn't; tell him what a good person he was, which pointed out the disconnect between how he felt and how others perceived him; or try to "fix" his pain, which was not possible.

He writes, "Blessedly, there were several people, family, and friends, who had the courage to stand by me in a healing way. One of them was a friend named Bill, who having asked my permission to do so, stopped by my house every afternoon, sat me down in a chair, knelt in front of me, removed my shoes and socks, and for half an hour simply massaged my feet. He found the one place in my body where I could still experience feeling--and feel somewhat connected with the human race.

"Bill rarely spoke a word. When he did, he rarely gave advice but simply mirrored my condition. He would say, 'I can sense your struggle today,' or 'It feels like you are getting stronger.' I could not always respond, but his words were deeply helpful: they reassured me that I could still be seen by someone--life-giving knowledge in the midst of an experience that makes one feel annihilated and invisible. It is impossible to put into words what my friend's ministry meant to me. Perhaps it is enough to say that I now have deep appreciation for the biblical stories of Jesus and the washing of the feet."

I must admit that this is the most extraordinary story I've ever read about receiving help during a depression. When a friend or family member is unhappy, I, who should know better, always try to "fix" the situation. On the one hand, it is inconceivable for me to think about being there and feeling so helpless. On the other hand, I think that we would all hope to have a friend like Bill and be a friend like Bill.

Tuesday, April 1, 2008

Medication-Resistant Bipolar II

Although I was initially diagnosed at atypical bipolar II, within a few years of taking medication (which, as my regular readers know by now, didn't work for the most part), I was labeled medication-resistant.

Lately, I've been thinking a lot about how I felt about that designation, which, of course, was the most disturbing of all. Why? Because, all the information I read confirmed my worst nightmare: there was no hope for me whatsoever.

Imagine how you would feel if you were medication-resistant and read the following: "Fifteen percent of the bipolar population is medication-resistant, and this is the most difficult group to treat. It often takes years to find the right combination of medication (if we can find it at all), and this group has the highest suicide rate." It's not exactly uplifting.

What truly bothered me was the dispassionate nature of the analysis. Somehow, I always thought that when you take away a patient's hope--which is so critical to their ability to survive--you should do it with great fanfare. I would have preferred dramatic drum rolls and clashing cymbals, rather than mere words on a page. It was disappointing to be utterly devastated in such a non-dramatic way.

Of course, optimist that I am, the only way to continue to persevere was to stop reading bipolar books, and stop visiting bipolar sites. The best attitude for me was to think outside the box. And recently, I asked myself: What if psychiatrists looked at the medication-resistant cohort from a different perspective?

In fact, let's use the diabetic population for comparison. When people with diabetes I (and sometimes diabetes II) are given insulin, it controls their blood sugar. But if you give insulin to people who aren't diabetic, it makes them sick.

When you constantly give psychiatric medication to people whose body won't accept it (like mine), perhaps it's like overdosing someone on insulin. The side effects for insulin overdose are headaches, irregular heartbeat, increased heart rate or pulse, sweating, tremor, nausea, increased hunger, and anxiety.

In fact, these are all side effects I've experienced and so many more. But unlike "regular" doctors who might have done a series of tests to see why I kept on having these side effects, my psychiatrists just piled on more medication. And unlike insulin, psychiatric medication affects your brain, not just your pancreas.

Years ago, I found statistics about how many people who originally suffered from clinical depression became bipolar after they were given antidepressant medication. I'm unable to find the info in my research folders (which I finally threw away because they depressed me), but I seem to remember that the number was around 37 percent.

What if...giving bipolar medication to people who truly may not have been bipolar when you prescribed the medication...caused them to become sicker and sicker? Perhaps those of us who suffered from untreated depressive episodes for many years needed a different type of treatment altogether.

Maybe our problem has to do with cortisol. On a site called All About Depression, I read, "Of those individuals who are clinically depressed, about one-half will have an excess of a hormone in their blood called cortisol. Cortisol is secreted by the adrenal glands...Cortisol may continue to be secreted even though a person already has high levels in his or her blood."

The fact is that high cortisol can cause depression. And some adults with depression or chronic stress have high cortisol. A few years ago, when I asked my psychiatrist about this, he said something like, "There's no way to measure cortisol or you can't use cortisol as a marker."

But that's not true. In fact you can measure it. And it's quite possible that people who have had untreated depression for years might have high cortisol.

My point is this: Since bipolar depression was largely ignored until 2003, and psychiatrists were prescribing medication without any idea how it affected us, the truth is that they may have been entirely wrong about what they were/are prescribing.

And since psychiatrists and endocrinologists don't work in tandem, it's quite possible that those of us with untreated depression should have had our cortisol levels checked, and it might be that if these levels were checked during a depressive episode, doctors would find that it's the increased cortisol that's causing the depression--and if it's suppressed--the depression will go away.

What bothers me is that there has been so little thought given to the so-called biochemical causes of depression. If a person is depressed, but not psychotic and has no other psychiatric symptoms, perhaps the underlying cause is not psychiatric in nature. And perhaps, all along, people like me should have been seeing specialists who are endocrinologists rather than psychiatrists. It's just a thought.

What do you think about that?