Friday, June 7, 2013

Don't Ask. Don't Tell: Sourcing the Etiology of Madness


"Stop with the labels...because we are not jam jars; we are extraordinary, different, wonderful people." --Caroline Casey


It's no less valid than the curiosity as to why or how my son's eyes had been a deep ocean blue until he was in the primary grades, when they evolved into a rich green, matching my own. What in our DNA causes such profound change? Is it a mutation? Divine (ahem) miracle? Just how does genetic predisposition transfer through generations? What gives?

Why were we all bright blonds in the family as youngsters, eons of us, whose hair turned progressively dark brown (or in my ex-husband's case, red)? Why am I so gray so young, like my father, when my mother has reddish-brown, nary a gray lock, nearing 70 years old, her mother black-haired and not remotely gray until close to age 75? 

Genetics. Fascinating stuff.

I know I've either written about or spoken about it before--the 2 most ignorant questions I've been asked about my bipolar disorder: 1) "How did you catch it?" (asked by my paternal uncle's wife, to which I wanted to snarkily answer, "I ate some under-cooked chicken!") and 2) "What went wrong....what happened to make you the way you are?" (my mom's persistent query). 

Over time, I've learned to shrug off such gross inability to comprehend the etiology of mental illness in commoners ('cause I'm all educamated and shit) and while I know I've explained it biologically over and over and over again, rare is the effort I'll expend to actually, honestly respond to questions I find offensive or hurtful by replying "Your ridiculous question makes me FEEL X,Y,Z...and hurts my feelings" or, more broadly but more defensive, "It wasn't my fault. I didn't DO anything wrong. Busia Marynowski should beat you over the head from beyond with her diabetically amputated leg, which also wasn't anyone's fault!" 

Even children with a rudimentary knowledge of biology learn that psychosis is obviously not a *physically* obvious transmittable illness. It's not the common cold. No one at Adler is going to become manic-depressive by touching the door handle to the classroom after I've entered because of spores on my bipolar fingertips. 

If even Stephen Fry hadn't heard the term "bipolar" until he was 37 years old and was diagnosed as manic-depressive, I suppose it bears weight to forgive souls who...lack tact. Still, the older I grow (especially training within the profession of psychology/psychiatry) and the more I shake my head at the skeletal stigma on mental illness harbored by the Boomer Generation on backaways, the more curious I am to investigate, well, yes, frankly...how did I "catch" bipolar disorder? Is there some credence in "what went wrong?"

Oh, for God's sake, whatever you do, I mean, Jesus, *don't* even broach....ponder....Oh Christ, she uttered....hold your breath....WAS MY LATE FATHER BIPOLAR?  Or mentally ill in GENERAL? Heavens, that question gets deflected around and avoided by my immediate and extended family more quickly than a Bjorn Borg Wimbledon ace whizzed past his opponent. Because the far more plausible and respectable reason why he pickled his liver and succumbed to alcoholism at age 42 was because he was just a stinky drunk who ruined everything he touched. But I know now *why* he drank himself to death. I had a strong hypothesis, which no one in my family could or wanted to confirm. It all goes back to us wanting to avoid familial damning labels.

Going back to the last blog, I described some of the patterns of behavioral excess which hallmark manic behavior. Manic people can be, sometimes, a helluva lot of zany fun. My dad was like that. Never a mean drunk. He was charged with musical and singing ability, loved to dance, loved to pull slapstick jokes, and was (and this is not just childhood pedestal placing) SO loving and affectionate. And hell yes, it was kinda cool how we'd find increasingly more expensive cars in the driveway at least twice a year, even if we barely had a pot to piss in.

Depressive people can be seen (ahem) not getting off the couch (Dad?) for 3 weeks, "on vacation." If I were to graph out the similarities in our personal behavior, they'd be almost mirrors of one another. Substance abuse to numb or mask a mad mind. Alcohol was his only coping strategy. Alcohol and drugs--opiates and benzodiazepines, in particular, sufficiently numbed my senses of despair and inability to manage my moods until the point where, like my dad, the compulsions to acquire and use numbing substances overtook both my psyche and physiology.

But when I ask my mother if she agrees about my father being mentally ill, she disagrees. She disagrees for one or more of the following reasons: a) she is in complete denial, b) "SHH! We don't want anyone to know!" or c) "Crap, I feel pretty guilty I didn't recognize any of the symptoms, but that's kind of all Danny's fault, not mine & I'm going to spend the rest of my life projecting my self-loathing onto my bipolar daughter." I've been referred to my uncle, my dad's older and only brother for details about my father's life which I've only heard as anecdotes. He likewise denies any knowledge of or about my dad's mental condition or cognition.

My father was honorably discharged from the US Navy after only 3 months of training duty, on a 4-year enlistment, in 1959, when he 18 years old, from January-March. His time in the Navy was stationed at the Great Lakes training facility in northeast Illinois. I really wanted to know how he got out of the Navy that quickly, when the family legend was that he was "homesick." Nobody gets out of active military duty because he misses his mommy and daddy.

I found a file in a cabinet today that I don't believe I was ever supposed to see. I wanted to research the statistical prevalence of bipolar or other mental issues in first-generation offspring of the mentally ill. In the folder, my father's Navy history was contained, so puzzle pieces were quickly thrown together without me having to contact anyone on the national military level. The coding pre-1960's was difficult to find on the internet, but I found the diagnostic codes as pictured below: 1) Article C-1030, and BuPar's manual, Code 36 E.( BuPar and BuMed aren't even used these days, I believe.)




In the archive manual for the Navy, I did some reading on the codes for which he was discharged. It confirmed my belief for several years that my dad had at least *some* manifestation of mental illness. Genetics help to explain much of how I wound up bipolar. Not only did I inherit the uncontrollable behavior and depressive mood disturbances, I inherited the substance abuse gene. It's not known at this time if bipolar passes from a parent to child through direct genetics, but statistics point towards the onset of active bipolar symptoms in an offspring as quite high. The prevalence is bipolar disorder is 2 to 1 in females rather than males, but my brother is not mentally ill and I am. 

Here's the psychiatric flow chart used to assist in a differential diagnosis, from the Navy; which, if you're interested, can be found (in larger print) at: http://www.dtic.mil/dtic/tr/fulltext/u2/023253.pdf:



The flow chart, in combination of the codes I discovered, point to Section 5, letter "G" underlying my father's mental incapacity for service in the Armed Forces. 


Thus, my father had to have gone through the neuropsychatric testing and would've been honorably discharged under special circumstances. What irritates me to no end is that if, in fact, he suffered from manic-depression, WHY on earth was SUCH a stigma attached that his condition that it was necessary to keep it completely hidden or best ignored, while he struggled from early adulthood up until his untimely death. But that's just how things were back then, back in the days of "the men in little white coats."

If girls who became pregnant during high school were shipped off to special schools where they could be educated with other "troubled" girls, what was a morbidly mentally ill patient to do when a) medications hadn't been developed yet to effectively treat bipolar disorder and b) to be victim of reduced mental faculties was a scarlet letter, a shameful, closeted mark of madness?

My elder generations don't want to explain why because they're too guilty themselves of having observed and watching a man crumble, blaming it all on "bad habits." Do I believe they know exactly what happened? Yes. Will anyone own up to it in our family? I highly doubt it. 

What "went wrong to make me the way I am" is that I was, as I said before, bestowed an incredible gift for which I refuse to apologize, probably as a result of some funky DNA. From what I remember of my dad, especially during the last days of his life, he repeated and reiterated time and time again how much he loved and how crazy he was about my brother and I.  To those in my family who assign me a label of "cursed," I feel sorry for them. To the naysayers close to me who bite their nails in anticipation of my total breakdown, you're all very encouraging. Keep up the good work. To those of you who'd like to gain control of not only my financial but also medical decision making, good luck finding any committee or judge in the country who would classify me as incompetent. 

Looking through the secret file containing my dad's Navy papers, there was a list of the financial obligations he left behind for my mom to clean up after he died, and other miscellaneous paperwork. His life was incredibly messy. He made a lot of mistakes and decisions that, yes, a sane person would scratch his head over. A SANE PERSON.











5 comments:

Anonymous said...

To be fair, I think "what went wrong?" is a fairly normal question for a mom, focusing perhaps less on (as you seem to heat it) what did you do wrong and more on what she did wrong. We know now that there's a very strong genetic component to bipolar (like many mental - and physical - health issues). But we know so little about what might "trigger" those genes. Why you and not your brother? Should she have eaten more kale when you were in utero? Did she let you eat too much sugar? Could she have spared you some of the struggles by doing something differently? I am notsaying such thoughts are fruitful at this point. But I do think they are natural. We all have things we wish we could "fix" and want to think that we have some sort of control. Who knows? Someday or understanding may approve and we may know more things we can do or avoid doing so that our loved ones with a predisposition to any illness can be protected from it.

Andrea Miklasz said...

Thank you and I agree wholeheartedly. In existential psychology, which happens to be one of my preferred theories, *nothing* is anyone's *fault.* The proposition of assigning blame is a fruitless use of brain power and a detriment to emotions. Yet (at least in my family, and in many others, methinks) people naturally look for reasons things go wrong by fault.

Let's say my son presents as bipolar when he's a young adult. I won't blame myself. I won't blame my dad. My ex and I will effectively help Luke cope and get him the proper treatment and therapy, case closed.

Anonymous said...

That's the beauty of education. Knowing what you know now, if you ever do see signs in Luke, you have a great chance of recognizing them early and giving him the tools he would need to navigate.

Rob Cheney said...

What an interesting blog post genetics are incredible, eg I am somewhat sturdy yet both my parents are skin and bone but my fathers siblings and their father have my build.

Andrea Miklasz said...

I like how, in much of our family, both sides, short men seem to breed redwood-tree-tall offspring after a couple of generations. And at this rate, by the middle of high school, if Luke's growth pace keeps up, he'll barely fit under a doorway, like my brother's (who's 5'6") son who's 6'2."