Wednesday, May 28, 2008
If I've learned anything about stress and relaxation in the past few weeks, it's to take time off when I need it. Thus, I won't be posting until next Monday. In answer to Coco's question, my dog isn't sick; he's just old. But Murphy, his companion (and ours) for the last nine years, died in December--two months after my mother.
Anyway, for a number of reasons, I am stressed out, which is only a bit ironic given that I'm writing a series on stress and relaxation techniques. I need a bit of breathing room, and I need to practice the techniques I've been learning.
So...I'm going to take off the next two days. And since I don't usually blog on the weekends, I'll be back on Monday.
I will keep the comments moderation "off," but please be gentle with each other. I believe that one of my responsibilities as the "comments moderator" is to make sure I support everyone's right to have his/her own opinion. In my absence, I would appreciate it if you would all moderate yourselves.
Finally, I will be offline, so I won't be reading the comments until the weekend, or visiting other blogs online. See you on Monday!
While I have finally realized that the initial triggering event for my first depressive episode 40 years ago was stress, others agree that this is what happened to them as well. And Naturalgal wrote something that confirmed a central hypothesis of mine, which is that labeling people is far less helpful than providing support. What follows is taken from her comment.
"If someone had said, 'Hon, you are perfectly normal. It's just that your body and mind can only handle so much stress. Here we will show you how to get back to health.'The authors of The Relaxation & Stress Reduction Workbook write that stress comes from four sources: your environment, social stressors, physiological problems, and thoughts. They write: "How you interpret and label your present experience and what you predict for the future can serve either to relax or to stress you...
"I was told this but I was also told I had a chronic mental illness. No. I was a normal person with too much stress."
"Stress researcher Richard Lazarus has argued that stress begins with your appraisal of a situation. You first ask how dangerous or difficult the situation is and what resources you have to help you with with it. Anxious, stressed people often decide that (1) an event is dangerous, difficult, or painful, and (2) they don't have the resources to cope with it."
What's ironic to me is that if many of us believe our symptoms are stress-related, then how much more stress do we feel when our doctors say, "You're bipolar--which is a form of mental illness--and the only thing I can do for you is give you medication."
Following Naturalgal's lead, think of how much better we'd feel if our doctors said, "You seem to have difficulty dealing with stress, but that's okay because it's a learned skilled, and we have great resources to help you."
Tomorrow, I'll describe some of the tools these authors recommend for dealing effectively with stress. I'd also recommend that you read the comments from yesterday's post because a lot of people provided great examples of the methods they're already using to to promote relaxation and reduce stress.
Tuesday, May 27, 2008
Years ago, the biggest break for me came when I stopped reading bipolar and depression books, which I find singularly depressing, and moved on to other topics. But even then, I still couldn't figure out what continued to cause my depressions. And I monitored them again and again to see what the triggers were.
What caused me to quit the job with the writer whose book I edited almost two years ago and spiral downward into a five-month depression? What caused me to deal with my mother's illness so well and even handle her death, but spiral into another five-month depression after repeated arguments with my siblings? What caused me to feel so distressed over my son's difficult adjustment when he went away to college that I felt a low-level depression for the entire semester he was gone?
The answer, plain and clear, is stress. And when I read Neural Path Therapy by David Harp, M.A., and Matthew McKay, Ph.D., which has truly made a difference in my life, and saw that McKay is the co-author of another book, The Relaxation & Stress Reduction Workbook, I bought that as well.
As I began reading the table of contents, I thought, "Why didn't I pursue this avenue years ago?" It has been obvious since I was a teenager that stress is the cause of so many of my problems. I remember that even in middle school--which was the first time in any school where I had flexibility in my daily schedule--I arranged my classes to minimize the external stress. Rather than taking as many difficult classes as my friends, I took one more elective like chorus or glee club. Why?
Because it was clear to me that I could only absorb so much material. I knew I needed a lot of time to study, and I only liked to push myself to a certain level. And that has remained a constant throughout my life.
One of the things I have liked best about a career in writing--which I began in 1989 after many previous careers--is that writing never stresses me out. It is the one thing I do, other than pursuing hobbies and interests, that has never felt like a burden (except when I was very depressed and had medication-induced cognitive impairment issues). Or maybe, there is a level of stress in writing, but it's internally generated and that's always been okay with me.
What is interesting about McKay's book, which he co-authored with Martha Davis, Ph.D., and Elizabeth Robbins Eshelman, M.S.W., is the very definition of stress. They write:
"Stress is an everyday fact of life. You can't avoid it. Stress is any change you must adapt to, ranging from the negative extreme of actual physical danger to the exhilaration of falling in love or achieving some long-desired success. In between, day-to-day living confronts even the most well-managed life with a continuous stream of potentially stressful experiences.(to be continued)
"Not all stress is bad. In fact, stress is not only desirable but also essential to life. Whether the stress you experience is the result of major life changes or the cumulative effect of minor everyday hassles, it is how you respond to these experiences that determines the impact stress will have on your life."
Monday, May 26, 2008
My father and his three brothers served in World War II. My dad was accepted into flight school, and once he arrived it turned out he suffered from motion sickness and couldn't be a pilot. He was terribly disappointed, but he served our country in the United States teaching radio to other soldiers, while his brothers fought in Europe. As it turned out, my father's entire flight squadron was killed in WWII, and my dad survived only because he wasn't a pilot.
As the mother of a son who is almost 19, I pray that with a new president in office in November, we will work to resolve international problems with diplomacy rather than weaponry, so that mothers the world over will no longer have to commemorate the deaths of their sons and daughters. Amen!
P.S. Since Memorial Day for me is also a time for contemplation and gratitude because I realize how lucky I am that my father wasn't killed in WWII (of course he couldn't have been my dad since I was born in 1950), perhaps it should also be a time to think about our fellow bloggers who aren't feeling well.
In visiting a few blogs this morning, I see that Nancie is having health problems and family issues and has stopped posting for awhile, and Coco hasn't been feeling well either. I'm sure there are others, but I need to go offline now and can't check them out now.
Today, I'm sending positive thoughts to Nancie and Coco, and I'm sure they'd love to hear from you. Also, I want to send prayers of safety to all service people (men and women) throughout the world, especially Syd's daughter Lindsey, who's in Iraq.
Saturday, May 24, 2008
In this case, my action is to share my final thoughts about what Dr.Frank wrote, to discuss what bipolar wellness means to me, and to provide a few inspirational quotes.
To me, bipolar wellness (as a frame of mind) means thinking positively about bipolarity rather than negatively. When psychiatrists, psychologists, or other mental health professionals say, "Bipolar disorder is 'like a death,' or it's a lifelong illness, or we need to grieve for our 'lost healthy self,'" I sometimes need to acknowledge what has been said, refute it, and move on.
Unlike earlier periods in my life, I don't allow other people's negative perceptions of bipolarity to depress me. One of the greatest values of writing this blog has been to meet other bipolar wellness seekers. Before my blog, I'd never talked with one person who had been labeled "bipolar." Now, I have more than 44,000 hits on this blog, and I have read comments from hundreds of people, and responded in kind.
What I've learned is that we all approach our bipolarity differently. We have different symptoms. Some of us come to this illness from unipolar depression, others from mania, and still others from psychotic episodes. But I believe the reason we have come together as a "virtual support group" is because we all seek wellness.
When I started Bipolar Wellness Writer in February of 2007, it was because I wanted to share the information I had learned, and the wellness activities I had developed, and learn new ones. I wanted to discover people who were "more than their illness."
I felt that if we could tell each other what was working for us, it would help us in our quest. If we could share disappointments, it would make them less difficult to deal with. And if we could provide hope for each other--when it's so lacking within the mental health professional community--we would strengthen our collective resolve in seeking wellness.
And I believe that has happened in a significant way. So, rather than ending the week on a negative note, I wish to end with some life-affirming quotes about hope.
"I believe that imagination is stronger than knowledge,
That myth is more potent than history.
I believe that dreams are more powerful than facts
That hope always triumphs over experience
That laughter is the only cure for grief
And I believe that love is stronger than death."
~Robert Fulghum, Storyteller's Creed
"Become the change you seek in the world."
"Your hopes, dreams and aspirations are legitimate. They are trying to take you airborne, above the clouds, above the storms, if you only let them."
Friday, May 23, 2008
I also think there's a big difference between people who try a few medications, stabilize, and feel good within a reasonable time frame--and those of us who don't. And maybe sometime in the future, I'll be able to say there's a difference between those who are diagnosed, begin an exercise program, participate in neural path therapy, change their diet, receive insightful counseling, and stabilize--and those of us for whom it took a much longer period to reach the same outcome.
For me personally, unipolar depression turned into bipolar disorder after many years of undiagnosed episodes combined with antidepressants. When an illness is medication-induced (and perhaps even when it's not), I don't think it's unusual to mourn our "lost healthy self," which was the topic of yesterday's post.
While Ellen Frank, Ph.D., author of Treating Bipolar Disorder: A Clinician's Guide to Interpersonal and Social Rhythm Therapy, and her colleagues may have found that mourning our "lost healthy self," is unique among bipolar patients, her reasoning why this is so, astounds and infuriates me!
She writes, "Some of our colleagues who are experts in IPT for unipolar disorder have argued that this problem area is more appropriately thought of as a subset of the role transition problem area, but we have found that presenting it to patients as a form of grief has a very profound impact and tends to motivate them to work on this issue in a way that presenting it as a role transition does not. Perhaps this is because 'becoming bipolar' has a kind of unalterability that is more like a death than the loss of a job or even a divorce."And it's this very paragraph, which represents everything I despise about the psychiatric profession's attitude toward bipolar disorder. To present a bipolar diagnosis as a form of death is exactly what so many psychiatrists do--either knowingly or not. In one fell swoop, they destroy a patient's hope for achieving wellness, and their dreams of living a life with any possibility of normalcy.
One only has to substitute any other illness for bipolar disorder to see just how ridiculous it is. What if a diabetes researcher wrote, "Perhaps this is because 'becoming diabetic' has a kind of unalterability that is more like a death than the loss of a job or even a divorce."
I can guarantee you that researcher would be publicly condemned--within the medical and diabetic communities. What's so strangely awful is that Dr. Frank has a wonderful reputation and has done some excellent research in the bipolar field. But if she doesn't really have a clue what a huge disservice it is to tell bipolar patients that their illness is more "like a death than the loss of a job or even a divorce" than it's no wonder the suicide rate for bipolars is so high.
And, we who disagree with "the death knell analogy" need to find some way to voice our disapproval so loudly and so publicly that our voices will be heard from Washington D.C. to Ottawa to London to Canberra to Manila to Moscow to Beijing and beyond!
P.S. While I'm focusing on Ellen Frank in this article, I don't truly mean to single her out. As far as I'm concerned, her attitude typifies every bipolar researcher in the field who preaches despair rather than hope, and dwells on illness rather than wellness.
Thursday, May 22, 2008
"After many years of working with patients who suffered exclusively from unipolar depression, we began a major program involving those with bipolar I disorder. We were immediately struck by the tendency (which we had never observed in the unipolar patients we had treated) of the people with bipolar disorder to divide their lives in two: before their diagnosis and after their diagnosis.
"We soon realized that in this new group, a patient often saw him- or herself almost as two different people: the person he or she had been before developing bipolar disorder and the person he or she was now. We began to talk about the idea of grief over the 'lost healthy self' as another form of unresolved grief that was common among people with bipolar disorder."
I'm hoping you'll share your thoughts about Ellen Frank's observation. I'll tell you how I feel about it tomorrow.
Wednesday, May 21, 2008
"Unfortunately, most of us have never been taught how to focus--or not focus--on mental objects, like thoughts, emotions, or neural pathways," they write.
So, if a particular person triggers a particular emotion, we respond the way we always have. If that means we ultimately become depressed by the exchange, then most of us believe our doctors who say, "It's an automatic response and you can't change it." But, McKay and Harp believe we can change our neural pathways.
They believe all of our emotions are based on the "fight or flight" syndrome. That just means that our brains have not really evolved since we were cavemen or cavewomen. If something frightens us, we automatically respond...like people did thousands of years ago when they saw a lion or a tiger coming at them.
In our contemporary world, we (like the cavepeople who preceded us) don't have time to think when we see a car in an alley headed toward us, or we see our child running away in a busy department store. Instead, we instinctively respond by running away from the car, and running after our child before we lose him/her in the crowd.
McKay and Harp liken our thought processes to the automatic response patterns we use if we or our kids are in danger. If someone triggers an emotion like anger, fear, or jealousy, we automatically respond. But...and this is the key to their theory...if we anticipate our response to a common stressor or we stop the "fight or flight" syndrome by relaxing rather than stressing out, we can change our response.
The way we do this is by breathing. But, instead of making the breathing process difficult by suggesting we have to sit in a lotus position on the hard floor, or go to a mountain retreat and remain silent for eight hours, McKay and Harp believe that if we only have a few minutes a day to practice our breathing, it's enough.
Each time we anticipate an emotion, and breathe rather stress out, we're strengthening our "mental muscle," which they define as "our ability to keep the power of our brain focused on an object or move it to another object." Eventually the neural pattern we no longer use will disappear, and a new pattern will evolve.
I can't really explain their breathing exercises without quoting too much from their book. But they chart out different exercises. Basically what you're doing is just inhaling, holding the breathe, and exhaling. Or you're quickly inhaling and exhaling. Or you're taking shallow or deeper breaths.
What you're also doing is focusing on the breathing rather than focusing on the emotion. So, for example, if you notice your spouse/partner always makes you feel powerless when you're at a low energy level, by saying--"Are you sure you can't go out to dinner tonight? I was really looking forward to it"--rather than focusing on the words and feeling worse, the moment you anticipate what he/she is going to say, you start breathing, and begin releasing the tension rather than building it up.
The process they're recommending works with everything. If you get angry because someone writes a comment you don't like on your blog, rather than writing a quick and angry retort, start breathing and calm down. If you feel "angst" every time your best friend mentions that you're talking too fast or straying from one subject to another, rather than feeling hurt by her judgmental tone, start breathing.
And if you get depressed every time your doctor says, "It's not a good idea to remain off medication because you could experience another mania or depression," don't feel down about it, just start breathing.
So far, breathing is the most effective depression antidote I've ever tried. And Neural Path Therapy is one of the best wellness books I've read. I highly recommend it.
P.S. I just learned there's a Neural Path Therapy site, which provides a lot of additional information.
Tuesday, May 20, 2008
While I've only read about half the book, it's already had a huge impact. The point they make, which is critical to me, is that you can change "automaticity." This is such an important concept that I need to explain it further in relationship to bipolar disorder.
One of the key arguments psychiatrists use when they say you can't "cure" bipolar disorder is "brain kindling," which I've discussed before. Basically it means that after a few depressive episodes, whenever you get stressed, your brain automatically will respond the same way to the same triggers.
I've always found this argument to be depressing, because what they are suggesting that even if you change significantly, your brain won't change. But Harp and McKay disagree. They write, "The crucial mental skill is to be able to focus attention onto--or away from--the thought, or neural path of your choice."
What they believe is that you can learn how to observe neural pathways and change them. They say that if you stop using the same neural pathways (i.e. your supervisor always demeans you and as a result you feel powerless, or your sister pushes your hot buttons and as a result you get angry), they will fall into disuse.
Thus, if your supervisor says, "I don't like the copy you've written or the way you edited this article," rather than feeling powerless (and becoming depressed), you can anticipate she will say this, identify that it always makes you feel powerless, and stop feeling depressed.
What this means is that you can train your brain to stop kindling! How do you do it? By breathing exercises. While it sounds simplistic, it's truly a powerful tool. I've already begun using it, and it works!
P.S. I just learned there a Neural Path Therapy site, which provides a lot of additional information. So I've listed it on both posts on this topic.
(more to come)
Monday, May 19, 2008
To finish my own story, the bottom line for me was that lithium didn't work and neither did any of the other 25 drugs I ended up taking. Eventually Zoloft "pooped out," and I had to survive horrific depressions with medications that made me feel physically worse, and emotionally erratic.
I changed psychiatrists four times within a decade. A big mucky-muck psychiatrist, who is also a professor of psychiatry at a major university, wouldn't take me as a patient (because I'm not a psychiatrist, a famous person, or a celebrity, which was his clientele) but he did consult on my case because I had become a bipolar II medication-resistant rapid cycler, which is considered the most difficult cohort within the bipolar community. And even he kept on saying, "Everything your psychiatrists are doing is right."
But, it wasn't right for me. It only would have been right if I had been a guinea pig in a lab. What infuriated me then--and now--was when I was at my lowest ebb and had absolutely no hope left, the only suggestions my psychiatrist made were, "You can do ECT, or you can be hospitalized, and you should certainly start therapy with me."
I nixed the last idea because I knew it wouldn't make me feel better to pay him double his current fee so that I could tell him (in therapy) how angry I was with him for prescribing drugs that made me feel worse. Besides, I'd already been in therapy with someone else who never diagnosed this illness or clinical depression despite classic symptoms.
I knew that ECT might "cure" the depression I was in, but it wouldn't help the next one on the horizon. And, for me, hospitalization was not an option. I'm not opposed to it on principle, but it wouldn't have made me feel better.
I did say to one of my psychiatrists, "If I'm depressed now, why would you think I'd find it uplifting to go to a mental hospital where people represent a spectrum of illnesses that scare me? At least at home, I'm with people who love me."What I can say is this: For 25 years, I was depressed a total of 85 days a year. And for much of that time, the depressions (which remained undiagnosed) weren't bad enough to stop me from working every day, and living a "normal" life. However, I knew I was feeling down compared to how I felt the rest of the year, and the depressions had become more severe.
The first year I began taking medication, I was sick for 365 days, and so it went for six years, which means 2,190 days. Then I started taking Adderall, a stimulant (a controversial choice for someone who is bipolar), which is the only medication that can relieve my depressions. But I didn't realize how erratic it made my behavior, or how much it intensified the highs and lows until 2003, ten years after I started the medication merry go-round.
When I think of the depth and breadth of side effects (not on Adderall, but on all the other medications), I am amazed and grateful I survived. On Lithium, I had such terrible headaches I could barely stand the physical pain. When they finally began to dissipate, I started seeing floaters (in my eyes) and worried I was going blind. On Depakote, I felt like I had a low-grade fever all the time. On Wellbutrin (they used to prescribe it at much higher dosages than they currently do), I lost a third of my hair, and when it finally came back it was curly and gray. It took three years to grow a new head of hair, which was straight and brown again.
On other drugs, I experienced cognitive memory loss where I didn't just forget words, but entire paragraphs. I had hand tremors that were so terrible, I figured the only job I could qualify for was conducting an orchestra. I had diarrhea and constipation for so long that I figured I'd never have regular bowel movements again. It seemed like I spent years vomiting multiple times a day--and in truth I did. And I gained weight, which I'm just now beginning to lose because I've begun a regular exercise program.
I could go on and on, but I won't. I've written about it in my eBook, Bipolar Depression Unplugged: A Survivor Speaks Out. For me, all of this represents a past I'd like to forget. When P.J. who was recently diagnosed, wrote a comment asking what to do so that she doesn't have to experience what some of the rest of us have, other than giving her resources, I truly didn't know what to say.
The truth is that I still take Adderall when a depression hits. And I still take Ativan at night to sleep when I'm taking the Adderall in the morning. At one point I was taking 80 milligrams, which is a very high dosage, and it still wasn't working. Now, I take 10 milligrams, and it's usually effective; at most I take 20 milligrams. Adderall doesn't make me "happy," but it enables me to get out of bed. My strength is that I won't give up--although I would be less than honest unless I admit there have been times when surviving has been a huge struggle.
None of the alternative remedies work for me either, and I've taken tons of it. I've also seen a doctor of Acupuncture (13 sessions), a doctor of naturopathy (12 sessions), and a holistic psychiatrist, among others.
For those of you who are recently diagnosed, you'll find that every person you talk with will have a different take on this. I wish there was an easy answer, but I'm not sure there is. What I do know is this, and I can only speak for myself.
I believe that whether or not bipolar disorder is biochemical in nature (and to me that's not been proven beyond a doubt), whatever treatments you pursue will only work if you resolve the underlying issues that made you ill, and if you figure out a way to deal with the stress in your life.
No matter what others say, I don't believe this illness happens in a vacuum. In my case, I don't handle stress well, and never have, although I'm working on it. I used to have difficulties dealing with life transitions, and I'm working on that. It took me a long time to find my life's work, and until I did, I changed careers a lot, and that made me unhappy.
Despite years of therapy in which my therapist tried to turn me into someone who views life in shades of gray, I still don't. But, I finally realized I'm not a "gray" person, and it's okay. I've got very strong morals and values, and they are sometimes at odds with the popular culture. And that's okay too.
What I've been doing for years--mostly on my own, but now with the help of people who read this blog and share their experiences--is working hard to figure out:
- who I am and how to once again feel proud of my accomplishments (as I define them);
- what stresses me out, and how to stop allowing it to do so;
- what deeply matters to me, and how to write about it so that I feel I am making a difference;
- how to deal with disappointment so that I don't view it as a setback, but rather as an event to redirect my path (I want to credit Bernie Siegel's book 101 Exercises for the Soul for the words to explain my goal);
- how to change my neural pathways so that I don't repeat life patterns that used to paralyze me,
- and how to move beyond the label of "bipolarity" so that the symptoms and behavior I exhibit are only a part of who I am rather than my defining characteristics.
I disagree. I believe bipolarity is neither better nor worse than cancer, diabetes, or high blood pressure--all of which can be "cured." My mission is to "cure myself" so that I can help others achieve wellness. And, for me, that's truly an important life mission.
P.S. I've changed the Comments section so that I no longer accept anonymous comments. If you have trouble leaving a comment, I'll find that out tomorrow, and try to fix it. If you spend a lot of time writing your comment and worry about losing it, then write it in WORD, and copy it to comments.
Friday, May 16, 2008
But, there are other bloggers who are writing about their own experiences with medications, or are explaining why they believe they became ill, and how they're trying to become well. I just read a very interesting piece by Jazz about the relationship of aspartame (it's in diet drinks) and her onset of bipolar disorder. Last February, Gianna wrote a piece called Undiagnosing Myself on the genesis of her illness. Naturalgal has written Who Told You That You Needed a Psychiatrist?, and I'm sure there are more.
If you've written something on this topic, let us know. I've got dozens of errands to complete today so I'm out and about, but I'll get back to you as soon as I can, and try to include your post on this page.
Hope everyone has a Wellness Weekend!
P.S. Two people have written to say they've sent comments but I haven't posted them. But I never got them. So...if that's happened to you, try sending it again. This has never happened before so I'm not sure how to fix it.
P.S. Don't miss my earlier post on Medication-Induced Mania. I know it's rare for me to post twice in one day, but I think this is such an important topic.
But, as I mentioned in yesterday's post, in 1994 I had a third depressive episode and I was emotionally exhausted, so I agreed to remain on Zoloft for six months. I was now taking Klonopin as a sleeping pill because no matter how busy my days were, I couldn't fall asleep or remain asleep at night.
Even with the Klonopin, one night in February I was awake until 5:00 a.m., fell asleep for two hours, and got up at 7:00. The following material is excerpted from my eBook, Bipolar Depression Unplugged: A Survivor Speaks Out (This is copyrighted material; please do not reproduce it).
At 8:30 a.m., I dialed Pasha's (Ice Maiden) beeper number. She returned the call within moments. When I told her the problem, she said, "Stop the Zoloft. It has pushed you into a mania. You must begin taking lithium immediately. I will call in the prescription to your pharmacy. You need nine to ten hours of sleep each night because sleep deprivation feeds the mania."
"I can’t imagine feeling tired with all this energy‚" I said‚ fairly gushing into the phone.
"Susan‚ listen to me. You need sleep. How much Klonopin are you taking?"
"How many milligrams?"
"Double it. If you don’t fall asleep within the hour, take one more. If you are still unable to sleep, call me and I will prescribe a stronger medication."
"Okay," I answered in a subdued tone, somewhat concerned because she sounded worried.
"You will need to take blood tests for the lithium," Pasha said. "Make an appointment with Dr. Abcarian’s lab technician on Friday; I’ll fax the order to his office. The medication must be in your system for four days before we can get an accurate reading. I’ll see you on Monday at 3:30 If you need me before then, dial my beeper number."
Pasha’s tone suggested that our conversation was over so I hung up the telephone although I had no idea what the blood test was for. After taking two milligrams of Klonopin, I slept for a few hours, did some errands‚ picked up the lithium, returned home, and drove my minivan up our driveway and flattened the right front and rear tires against a small protruding lip of concrete that I’d circumvented for fifteen years. Within a half-hour, the Automobile Club tow-truck driver delivered my van and me to a tire store where they replaced the tires with new ones, and I returned home in less than an hour.
After a play date at a friend’s house, Alex (my son) came home from school. I had cleaned the house, done laundry, straightened his bedroom and had dinner cooking in the oven. We spent the next few hours playing Nintendo. He was pleasantly surprised by my increased energy level. Bernie (my husband) was delighted by my newfound interest in domesticity and we had a Norman Rockwell-like evening.
I slept five hours that night. The next day I bicycled in the morning‚ met a friend for lunch‚ went to the library, and had a manicure and pedicure at my favorite neighborhood nail salon. For dinner, I cooked roast chicken with mashed potatoes and creamed spinach. I made chocolate brownies and smothered them with ice cream‚ chocolate sauce, and whipped cream. Bernie was glad I had cooked, but was surprised by the high caloric content of the meal. Alex was thrilled. So was I.
By the third morning‚ after Alex and Bernie left the house‚ I crashed. That night and the next morning I had a terrible headache. I was nauseous, had diarrhea, and couldn’t stop urinating. I called Pasha’s beeper number.
"How many hours have you slept last night and the night before?" she asked.
"Five each night."
"Why didn’t you call?" she asked with reasonable annoyance.
"I took all the Klonopin you prescribed."
"We’ll switch to Ativan. I’ll call in a prescription to your pharmacy."
I described my other maladies.
"These are all medication-related and will go away in a few days," she said. "I will see you Monday."
After a brief nap‚ I felt great again. I caught up on some phone calls and joined a friend for lunch. After I came home‚ I gardened for a while before I was hit by the most severe headache I’d ever experienced. I spent the rest of the day in a semi-comatose position wondering anew why this illness was preying on me and whether it would ever end.
(to be continued)
Did your antidepressant medication cause your manias or hypomanias? Is there any antidepressant that's really worked for you? Did your doctor put you on a mood stabilizer before trying an antidepressant?
Thursday, May 15, 2008
After I was diagnosed as atypical bipolar II in 1993, the psychiatrist whom I've long since thought of as Ice Maiden (given her lack of empathy), prescribed Zoloft. Despite how horribly depressed I felt, she told me the medication would take two weeks to "kick in" if it worked at all.
When I asked her for information on Zoloft, she said she was out of the pharmaceutical brochures. When I asked her to recommend books about bipolar disorder, she said all her books were too technical, and she had no suggestions.
The next two weeks were the longest ones in my life. Perhaps William Styron describes it best in his book, Darkness Visible: A Memoir of Madness, when he writes:
"In depression this faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come--not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow. It is hopelessness even more than pain that crushes the soul."It was truly a miracle when the Zoloft kicked in. You have to have undergone this yourself to know what it's like to feel alive again after feeling so melancholic that it was not only difficult to get up each day, and to pretend to feel "normal" so I could be with my husband and son, but even to physically "speak."
The Zoloft continued to work. While my doctor wanted me to remain on it all the time, I chose to go off it after each six-week semiannual depressive episode ended. My reasoning made sense to me. I wasn't comfortable taking psychiatric medication. And even with Zoloft, I could feel the depression beneath the surface, and thus I knew when it was over.
In 1994, in addition to having a depressive episode in April and another in October--which had been my pattern for 25 years--I had a third depressive episode in December. This time I agreed to remain on Zoloft for six months, but in February it pushed me into my first and only full-fledged mania. Stay tuned!
A Word of Explanation: Many of you probably know that ordinarily psychiatrists are supposed to prescribe mood stabilizers before antidepressants because the latter, by itself, can and usually does lead to manias or hypomanias. In retrospect, it was fine for Ice Maiden to have prescribed the Zoloft first because I was so terribly depressed, but she certainly should have known that after the depression ended, she should have prescribed a mood stabilizer. It was bad medicine not to have done that, and it had frightening consequences.
Wednesday, May 14, 2008
How do I write a series on psychiatric medication without offending those who can't survive without it and those who can't survive with it? Maybe it's important for me to say I'm neither pro- nor anti- medication. I do have a lot of issues with the heavy handed way in which it's prescribed, the lack of testing on its clinical applications (particularly before STEP-BD), and the emphasis on medication to the exclusion of other treatment options. But I do take medication when I need it, and I'll discuss that in future posts.
The difficulty of writing on this topic is that each and every one of us may have started using medication for different reasons. Some people heard voices. Others didn't sleep for days. Some were speeding so fast they were out of control. Others may have been exhibiting grandiose behavior, spending too much money, or having sex with strangers. Some were so depressed they couldn't function. Others were suicidal. Some were self-medicating with alcohol or drugs.
Or perhaps like me, it was none of the above. In my case, I had undiagnosed depressive episodes for 25 years, and they were getting progressively worse. Maybe, like me, you tried therapy (with a number of different people with different credentials) over a period of years, and it didn't help. Perhaps you sought psychiatric help because you were feeling so depressed or manic that you couldn't stand it for one more day.
Maybe you didn't seek help at all because you didn't feel there was a problem. Perhaps your loved ones felt your behavior was harmful and recommended treatment.
I can't possibly cover all the possibilities of why you sought help, nor do I know how long it took for you to get a diagnosis, or whether it's the right diagnosis. Also, I don't know if you come from a healthy family in which you were loved (like I was), but had a major life stressor (in my case, going away to college) that caused the first depressive or manic incident. I don't know if you come from an abusive family, and/or have suffered abuse later in life.
I mention all these factors before delving into the topic of medication (tomorrow) because I disagree with the current bipolar treatment protocol with its emphasis on medication, and the supposition that you must take it for the rest of your life.
I believe that who we are, what our backgrounds are, what kinds of lives we've lived, how committed we are to healing, and how actively we're willing to pursue wellness, should factor into the treatment process. Among us, there are people who passively accept their treatment (I would imagine this is a small percentage of those who read this blog).
Among us, there are also "exceptional patients." This is a term I learned about from Bernie Siegel, M.D., an oncologist and author of Love, Medicine, and Miracles. He defines them as people who take charge of their illness. "Exceptional patients do indeed want t0 be educated and made 'doctors' of their own cases. One of the most important roles they demand of their physicians is that of teacher."
Among us are those who may or may not be taking medication, but also are participating in important adjunctive treatments, which have become an important part of our lifestyle, whether it's exercise, spirituality, expressive writing, nutrition, meditation, art therapy, music therapy, movement therapy, talk therapy, biofeedback, neurofeedback, and a wide array of other possibilities.
Why do I mention all this in a prelude to a series about medication? Because every psychiatrist I saw--but one--believed none of this mattered. They focused on medication, they didn't believe in adjunctive treatments, and they never considered utilizing my strengths and insights as part of the healing process.
To me, nothing matters more. After taking such highly toxic medication for so long--and getting sicker and sicker--I must admit that this illness almost destroyed me. (Despite my strengths, the suffering, grief, and loss still have a residual affect.) And I finally realized that if the medication and treatment (and I use the word loosely) could affect me this way--a lot of other people don't have a chance.
This is not to say I don't believe that some people require medication. They certainly do, and as I said before, I use it as well. And I certainly don't believe that those of us who need medication for survival are any less determined, skilled, talented, intelligent or motivated than those of us who don't.
But I do believe we are all different, and until the psychiatric and mental health establishment includes us in the decision-making and healing process, we will continue to see higher and higher levels of unprecedented suffering that is sometimes medication-induced.
After a lot of thought, I've decided I don't intend to focus on specific medications other than to include them if they played a prominent part in my own journey. But, if you need an unbiased look at medication from the consumer's viewpoint, you might check out Dr. Bob's (he's a psychologist from the University of Chicago) website, and Crazy Meds.
P.S. This is a slightly edited version of the piece I posted at midnight. As I reread it, I felt it needed editing and clarification.
Tuesday, May 13, 2008
Over a period of ten years, five psychiatrists prescribed 25 different medications in different combinations and different dosages, including Abilify, Adderall, Ativan, Buspar, Celexa, Concerta, Cymbalta, Depakote, Effexor, Geodon, Klonopin, Lamictal, Lexapro, Lithium, Neurontin, Parnate, Prozac, Seroquel, Strattera, Tegretol, Topamax, Trileptal, Wellbutrin, Zoloft, and Zyprexa.
And I experienced the attendant side effects, including anxiety, blurred vision, confusion, cognitive memory loss, dry mouth, hair loss, exaggerated response to stress, hand tremors, headaches, insomnia, irritability, a severe rash, shortness of breath, slowed mental functioning, slurred speech, weight gain, and so much more.
Tomorrow, I'll talk more how I feel about having been on the medication merry-go-round.
(The graphic isn't a photograph of my pills, but since I've saved all the bottles, I'll show you what I've taken tomorrow as well.)
P.S. I highly recommend Gianna's post on Bipolar Overawareness Week!
Monday, May 12, 2008
Because of the sound of its name when he was a boy.
And when he was a man he went to Penang
And found it an enchanting, a Malayan place.
He was not at all disappointed, he told me.
Plymouth, Massachusetts--where people visit--
Have once with a most definite satisfaction
Walked in the streets of Springfield, Illinois.
More than names, then? Nothing is more than names.
~Poetry, December, 1962.
Penang (top of page) and Springfield, Illinois (above), which is "Nothing is more than words."
Of course, that isn't true. And yet, I believe the difference between someone who's named Bipolar and someone who's named a Thoughtful Humanist is everything.
Sunday, May 11, 2008
This is the first Mother's Day I'm not spending with my son. He's away at college, and I know he doesn't read my blog so I can write this without embarrassing him.
I love you completely and unconditionally. And I believe that's the greatest gift I can give you. When you were born, my entire world changed. When I looked at you, suddenly I felt a love that was greater than any I had ever known before. It's difficult to describe, but I hope some day you'll have a child (or children) and know what I mean.
I realize it's not easy to be a college student these days. There's so much external pressure (not from us) to fit in with your peers, to figure out what you want to be, to get good grades, and to succeed in a chosen profession.
Yet, somehow and somewhere, things got turned around in academia, and in life. What's important is who you are, not what you do. Fitting in with your peer group matters far less than finding a few good friends who you truly care about and who care about you.
At 18 years old (almost 19), you don't need to worry about what you want to "be." You are who you are, and you need to let your vocation speak to you. While there is tremendous pressure to figure everything out now, it's an artificial expectation. That's not how life works; over time, people evolve. Everyone doesn't "find themselves" at the same age. At this stage in your life, what's most important is to identify and pursue your passions--and hopefully that will ultimately lead you to find your life's work.
Most of all, be true to yourself. When I look back, I feel that perhaps my depressions started at your age because I tried to accommodate other people's morals and values, which were so different from my own. Rather than speaking out when I disagreed with my fellow students and professors, I remained quiet. Rather than fighting for what I believed in, I steered away from confrontation. And years later, rather than writing my books the way I wanted to, I changed them so that my agent could sell them.
In the last few years, I have recognized that my illness was caused by my choices--not by my biochemistry. So, don't worry about it being genetically passed on to you.
What I hope for you is that you will make your own choices, pursue your own dreams, and stop worrying about what others think. Our lives are what we make them. I hope that yours is creative, loving, satisfying, and fulfilling. But know--that whatever you do--your father and I love you completely and unconditionally, and we always will.
On a Sad Day
Don't cry for me.
I have loved and been loved
with more sweetness than most.
I promise to be a gentle ghost,
with only a reminder here and there...
an off-key song...a steak that's rare...
an ice cream cone...a silly poem.
So, smile awhile and think of the stories I'd tell,
then remember me...and laugh like hell!
You taught me how to laugh, and love, and cry. You also taught me to end every story with a good punch line, so I wrote my own small poem for you.
Oh mama, I love you so!
I'm so sorry to see you go.
I know it's time to say goodbye
but I'll love you dearly until I die.
Saturday, May 10, 2008
Balance and Bananas (mother of four).
Beyond Blue by Therese J. Borchard is featuring an interview with Cooper Munroe and Emily Mckhann, creators of the website The Motherhood.
Dark Day Thoughts (mother of three).
Spin Original (mother of two).
KJs Perspective (mother of four).
My Name is Danielle (mother of one).
Quotidian Light (mother of two).
Spanglemonkey (mother of two).
And of course, one of the most popular mom's blogs on the web is Dooce by Heather Armstrong. There's also finslippy.com by Alice Bradley, and Mini Smartypants, among others
If you want to find out more about mom's who blog, check out these sites:
Mamablogga, Mommy Bloggers, Mother's Day Central.
I'd also like to take this opportunity to announce that my friend Syd, who writes Bipolarity, just launched her new blog Soulful Abundance, and wrote a post on 8 Creative Mother's Day Gifts.
Thursday, May 8, 2008
I could discuss in detail all the reasons I dislike these books--their initial supposition that bipolarity is a lifetime illness, the negative prognosis, lack of success stories, and chapter after chapter about all of the "challenges" we face, the burden we are to other people, the bad behavior we exhibit, and the hourly vigilance we must maintain to control our moods, deal with our anxiety, withstand our depressive episodes, and so forth and so on.
In short, what a crock!
No wonder I was ill for the entire decade I researched this illness. And despite the value I think there is in discussing bipolar behavior and working with you to develop wellness strategies, I must say that there is an alternate way to deal with bipolarity.
It is to ignore everything*** that is written about manic-depression, and do what every other survivor does--develop our own wellness techniques, pursue our life's mission, maintain relationships with people who are nonjudgmental, loving, upbeat and positive, and pursue activities and interests that are pleasurable and give our lives meaning.
Tomorrow I intend to provide some inspirational quotes from a book I'm reading and loving, A Big New Free Happy Unusual Life: Self-Expression and Spiritual Practice for Those Who Have Time for Neither, by Nina Wise. Stay tuned!
***I'd like to qualify this statement and say I believe there are some important things we all need to know--and you probably feel that way too. I'll discuss my opinions on this subject next week, and perhaps you'll share yours as well. We can also find out: What books have really helped you and why?
Wednesday, May 7, 2008
One of the foremost researchers on writing to heal is James W. Pennebaker, Ph.D., who wrote the book, Writing to Heal: A Guided Journey for Recovering from Trauma and Emotional Upheaval , and also Opening Up: The Healing Power of Confiding in Others. In the latter book, he asks: What should your writing topic be?
"It is not necessary to write about the most traumatic experience of your life. It is more important to focus on the issues that you are currently living with. If you find yourself thinking or dreaming about an event or experience too much of the time, writing about it can help resolve it in your mind. By the same token, if there has been something you would like to tell others but you can't for fear of embarrassment or punishment, express it on paper.One of my favorite sites for exploring this topic is One Year of Writing and Healing. It's hosted by Diane Morrow, M.D., the doctor we probably all wish we could see. Her interest is in how the act of writing can benefit healing, and her site is chock full of activities, books recommendations, and research on writing and health. Enjoy!
"Whatever your topic, it is critical to explore both the objective experience (i.e. what happened) and your feelings about it. Really let go and write about your very deepest emotions. What do you feel about it and why do you feel that way?"
Tuesday, May 6, 2008
In their seminal book, Manic-Depressive Illness, written by Frederick K. Goodwin, M.D., and Kay Redfield Jamison, Ph.D., they write, "Research on mood symptoms in mania demonstrates that most patients are depressed, labile (liable to emotional change), or expansive as often as they are euphoric; they are irritable even more often."
In a section entitled Learning to Discriminate Moods, they write: "Problems in learning to discriminate normal from abnormal moods are common throughout the psychotherapy of bipolar patients...Many common emotions range across several mood states...For example, irritability and anger can be a part of normal human existence or alternately can be symptoms of both depression and hypomania."
They may explain why irritability is a symptom of depression and hypomania (in this 939-page book; I have the first edition), but it's too difficult for me to go to all the different sections where it's listed to try and distill it. However, they do quote Emile Kraepelin, M.D., who defined the term "manic-depressive psychosis" in the 1920s in Germany, and he does write about irritability and rage in hypomania.
"Mood is predominantly exalted and cheerful, influenced by the feeling of heightened capacity for work. The patient is in imperturbable good temper, sure of success, "courageous," feels happy and merry, not rarely overflowingly so...If irritability, anger, and rage are such prevalent symptoms of bipolarity, then why aren't they more prominently discussed in bipolar literature? And more importantly, why aren't we taught specific skills for identifying this behavior and changing it?
"On the other hand there often exists a great emotional irritability. The patient is dissatisfied, intolerant, fault-finding...he becomes pretentious, positive, regardless, impertinent and even rough, when he comes up against opposition to his wishes and inclinations; trifling external occasions may bring about extremely violent outbursts of rage."
When doctors write about specific behavioral symptoms as part of bipolarity, but also write, "Bipolar mood disorder is the result of a chemical imbalance," to me it suggests we aren't responsible for our own behavior, nor can we change it. But, in my experience that isn't true.
What do you think? Do you experience bipolar irritability, anger, and rage? What skills has your doctor taught you to identify it and control it?
(to be continued)
Monday, May 5, 2008
One of the values of writing a bipolar blog is reading about other people's symptoms and seeing how they deal with them, or watching how they play them out. Before I continue, I must admit I'm not perfect either and certainly have lapses and make mistakes. Having said that, I wonder why people who know they're exhibiting unseemly bipolar behavior don't try and change it?
Hopefully, we all know by now that excessive communication is a hypomanic (or manic) symptom. I'd mentioned a few weeks ago that when I'm hypomanic and with my husband at social gatherings, I have him give me signs to let me know when I'm talking too much (and it's up to me to decide to stop). But when I'm by myself I find it's sometimes difficult to stop talking on the telephone or in person. And in hypomanias past, I am embarrassed to admit that I sent way too many emails to friends and business associates. I also wrote excessively lengthly responses to their emails.
I wonder why I wasn't aware of this behavior when it's so obvious. Now that I know about it, I try my hardest to prevent it. However, I have recently wondered how I should alert my friends to let them know it's okay to tell me when I'm monopolizing a conversation, or to alert me when I seem "over the top." I'm not sure how I could have them do that without hurting my feelings, and yet I need to be sensitive to their feelings as well.
You see, I believe that bipolar behavior that's out of control isn't okay. Why? Because it can be intrusive, frightening, and disturbing. What I find interesting from reading other bipolar blogs is that some people know their behavior is "way out there" and don't seem to care. Worse, they're almost proud of it.
This is a point of view that I neither agree with nor understand. If we know what we're doing is making others feel uncomfortable, why persist in doing it? If we know we're emailing people (not our best friends who have said it's alright) multiple times a day, what persist in doing it? If we're writing too many daily comments in someone's blog (or comments that have nothing to do with their posts), why don't we exercise more self-control? If we know we're calling people on the telephone too often, or talking too much when they call us, why not just stop?
If we can't self-regulate, how do we want others to handle it? If we don't help them help us, chances are they're going to drop us as friends and acquaintances. Given that, should we suggest they email us and politely tell us our behavior is making them feel uncomfortable? Should they remind us that excessive communication is a hypomanic byproduct?
Lately, I've been getting a lot of keyword activity on "bipolar anger and rage." I'm not sure if it's from BIPs or their friends and relatives. To BIPs, I would ask: If we know we're inappropriately angry, why don't we seek help? Actually, I had a lapse myself a few weeks ago, but for the most part I've greatly improved on diminishing my anger and irritability.
Tomorrow, I'll write more about bipolar anger and rage. In the meantime, what unseemly bipolar behavior bothers you the most, and how do you deal with it?
Friday, May 2, 2008
I was reading a new bipolar blog that I'm finding quite interesting, Succor Midst Sorrow, and I was struck by one of Lily's posts, My Meds Work, I Still Have Mood Swings. I think most BIPs have the misconception that if only they find the right medication, they'll be fine. In truth, whether you do or don't find the right medication, it's just one piece of the puzzle.
If I were a psychiatrist with a newly diagnosed bipolar II patient, I would give them a pamphlet about my Bipolar Wellness Pilot Program, and offer the following advice. (Bipolar depression is what I truly know about. I'm afraid I don't have similar advice for those of you who come to this illness from the manic side because I believe it's almost like having an entirely different illness. However, some of my advice is applicable to you as well.)
1. I believe you can control this illness and live a "normal" life. However, it will require your active participation in your treatment, your willingness to assume responsibility for your own healing, and your adherence to a wellness program that we will develop together.
2. You need to religiously keep mood charts (and I will provide them) in order for us to determine the patterns of your illness.
3. We need to figure out what triggered your first depressive episode and resolve it, and to determine what other triggers are causing current depressive episodes.
4. We know that exercise reduces depression and we need to figure out an exercise program for you.
5. We know that nutrition can play a key role in wellness, and I will recommend a nutritionist who can help you evaluate your diet, and suggest dietary guidelines.
6. We know that a lack of sleep fuels hypomanias and manias and I recommend that you get 8-9 hours of sleep a night.
7. We know that alcohol is a depressant and recreational drugs cause a multiplicity of problems so I need you to refrain from using both. If you have an alcohol or drug abuse problem, I will recommend recovery programs.
8. We know that there are depressive symptoms and hypomanic symptoms, and I will provide you with a list of both. I believe there are ways to stave off a depression before it takes hold, and we will discuss that. I also believe there are techniques to deal with hypomanic symptoms, and I will work with you on ways to handle them.
9. There are lots of adjunctive activities that we know work for people and I will provide a list of free classes at our Bipolar Wellness Center, including expressive writing, spirituality, yoga, music therapy, art therapy, mindfulness meditation, and Qi Gong, among others.
10. If you are currently depressed, I will recommend an antidepressant medication that will hopefully help end this episode, however, I must advise you that antidepressants can cause increased hypomanias, and over time, taking them will worsen your illness. While medication has proven effective for manias, there is no clear evidence that either mood stabilizers or antidepressant medication works for bipolar depression.
There's a wealth of other information I would provide, but most of all I would discuss my belief that bipolarity is controllable although it may require lifestyle changes and a genuine commitment to wellness!
What treatment options would you recommend?
Thursday, May 1, 2008
As I write this--I am thinking about Tony C., who is courageously adjusting to lithium; Gianna, who is courageously trying to withdraw from the medication that's making her so desperately ill; JayPeeFreely who courageously does a job each day that is far beneath his intellectual capabilities, but spends hours working on his writing projects; Danielle, who is courageously dealing with parental abandonment, and my mother who courageously wanted to live despite the humiliation of dementia and an assortment of physical ailments--and I'm sure there are so many more among us, who are dealing with a multiplicity of issues.
What is courage? To me, it's facing adversity with a sense of humor. It's getting up each morning, and vowing to make each and every day meaningful despite how I feel. In the past, it was sometimes feeling so low that I wondered how I could possibly survive, and yet hiding that feeling beneath a smile so that my son wouldn't sense my despair.
I particularly like the definition of courage that I found in Rollo May's book, The Courage to Create. He writes, "This courage will not be the opposite of despair. We shall often be faced with despair, as indeed every sensitive person has been during the last several decades in this country. Hence Kierkegaard and Nietzsche and Camus and Sartre have proclaimed that courage is not the absence of despair; rather the capacity to move ahead despite despair."
So, when you feel bad that people are marginalizing you because of your illness, or you feel sad because you are depressed, or embarrassed because of your manic behavior, or exhausted by the ravaging side effects of your medication, think about how courageous you are because you have demonstrated the "capacity to move ahead despite despair."