Here Comes Your 19th Nervous Breakdown.

Cracklin' Rosie! Another exam tomorrow. I hesitate studying at any great length until tonight, for a number of reasons, the least of which not being the fact that I'm afraid if I study too early, I'll forget it all by tomorrow morning, because drugs and alcohol damaged my brain and coincidentally, a third of the exam is on drugs and alcohol. Again, this test is on: Depression, bipolar disorder, substance abuse, suicide and eating disorders. Apart from a "completed" suicide (obviously) and bulimia (why would I make myself throw up when I throw up so often naturally?), I've dealt with this whole subset of topics in some form or another. As a result, I got 100% on every quiz this week, which is a saving grace.

Between the quizzes and my immense-to-the-point-of-annoying level of class participation this week, and having finished at least the Power Point presentation portion of my research project on Bipolar II, I'm feeling marginally less depressed, about school anyway. My Power Point is 22 slides long. The professor said we needed at least 6 slides. I was feeling inspired.

In the course of the week thus far, I've actually educated the class more than the professor has, from a life-experience, practical standpoint, anyway. I felt old, dated and crotchety being the only one in class who eye-rolled her way through an explanation of who Karen Carpenter was, who The Carpenters were during the anorexia lecture, the other 18 students having been born during the early-to-mid 1990's, with zero frame of reference. I felt justifiably baffled yet no less dated blurting out that "Mother's Little Helper" was a Rolling Stones and not a Beatles song during the lecture on barbituates. (I was like, "Come on, if you don't know the difference between the Stones and the Beatles, I'm relying on you to educate me WHY, exactly?") I quickly shared my experience with anorexia and body dysmorphic disorder, citing the physical ramifications of the disorder and why, subjectively I still view myself as fat, to which the professor said, "Poor baby." I wasn't soliciting sympathy. I was explaining my intolerance to cold temperatures and the fine, blond, downy fuzz on parts of me, lanugo, that's normally only otherwise seen on premature infants (it's on my cheeks and neck and hardly noticeable).

But at no time was the professor more "Holy Shitted" out than when SHE said, "Opiod withdrawal requires hospitalization," which landed my hand firmly in the air. "Not really," I said. I went on, "Real junkies? On the street?..." which drew the class to attentive silence, "You take megadoses of Immodium, like 40mg at a time," at which point the professor interrupted me. She said, "And THEN what?" I said, "Well, the standard dose for diarrhea is 2mg, so for opioid withdrawal, you take 20 pills at a time, and taper off, because Immodium is a morphine-based chemical compound and takes the withdrawal symptoms away." "So you get a high that way?" she asked. "No," I said. "It doesn't cross over into the bloodstream, which is why it's sold over-the-counter," I told her. "Wow, I've NEVER heard of doing that before," she said. I wanted to, but didn't say, "Honest to Christ? In 30 years of clinical practice, you've never heard of the Immodium trick?" (In all fairness, my hapless PCP, Stosh, nor Guy Friend, had heard of it either when I first told them. Stosh, at least, thought it made chemical sense and green-lighted it, albeit extremely unconventional.) That, my friends, is what having clean, fine, upstanding recovering user friends is for, as opposed to all of you straight ass dweebs who fall asleep after one Vicodin. (Would you believe Guy Friend's never had a SINGLE Vicodin in his ENTIRE life? Either he's a) never had surgery, b) never even had his wisdom teeth extracted, c) didn't experiment much as a young man or d) holy crap, he hasn't lived! That's ok, Guy Friend. My narcotics consumption was enough for my lifetime, your lifetime and the lifetimes of roughly half of the population in the Chicago metro area. It's probably fair to say I've outdone Guy Friend on a litany of life experiences, save for growing a mustache.)

But I digress.

I was gathering data via my Facebook friends with regard to bipolar disorder and what immediately comes to their minds when they hear the term, or what they assume the illness is about as laypeople. Uniformly, my friends figured it was "either really happy or really sad," "black and white with no gray area," or "life at one extreme or another." I explained more about the disease and debunked much of what they had in their heads as "manic-depression." When one friend remembered having seen Sally Field portray a manic-depressive on the show "ER," I had vague recollections of it, having been a fan of the show. I sought out a clip, and showed this to my friends, asking them if they thought the character was in a manic or a depressive episode, or how accurately they thought it was portrayed.

In case it's not blatantly obvious, that's an acute full-blown mania with psychosis, on an unmedicated patient with Bipolar I. (As you know, The character, Abby, makes a grave mistake in telling Dr. Luka that her mom's behavior is "part the disease." which is what sent Sally Field (Maggie) into bipolar psychosis. ( I'm Bipolar II with mixed-mood episodes, so I never get THIS nuts.) Though if you want to get technical, an ER doctor wouldn't be ordering a medication for her own mother in a grossly emergent situation, they'd sort of need to know her weight to know how much Haldol to administer, and, barring the time to start an IV line, would give the injection intramuscularly, the onset of effectiveness NOT immediate enough to totally knock her out. (Haldol is an anti-psychotic most often used with schizophrenics, for one thing. Secondly, if that were me ordering the meds, I'd knock her out with barbituates and start a Haldol IV drip to ease the psychosis, keeping her restrained the whole time.) 

Tomato/tomahto, though. It's a DRAMA, meant to be DRAMATIC. And why can't doctors look like Luka's character in real life? Where is Goran Visjnic now, anyway, except *not* in my bed? I mean, Jesus Christ. Why yes, as a matter of fact. I do have a thing for guys with dark hair and blue eyes.

Even when I was manic and unmedicated, while I'd have paranoid quasi-delusions (like the one I had about Chris and a girl he was romancing on the side dismembering me and throwing me into Lake Michigan), had racing thoughts, engaged in risky life behaviors (over-spending, over-sexing indiscriminately, over-eating, over-drinking, over-drugging, cutting, having the cops visit me, etc.), I never had a full-blown episode of psychotic mania, luckily. Full-blown major depression? Sure. What separates Bipolar I and Bipolar II is the severity of the mania and the evidence of a major depressive episode within a given amount of time. I had, and still have, hypomania ("smaller" mania) and depression, unfortunately most often at the same time. 

As I iterated to my class, the meds help CURB the symptoms, but nothing makes them go away completely. Stress and life changes exacerbate mania and depression. Bipolar disorder has the highest mortality rate of any of the mood disorders, save for the mortality rate of anorexia. Why? Suicide. Why suicide? Because bipolar disorder is a really fucking intolerable way to live, and a lot of desperate, unfortunate, hopeless people (the majority of whom aren't on meds for any number of reasons) would honestly rather die. Hell, I'm on a crapload of high doses of meds and there are days when I question why the fuck I'm hanging around for this circus. Then I think about Luke, if nothing else, and press onward, revealing my desperation to few.

Having serious reservations over the weekend about my career path, I was surprisingly cemented back into being a therapist by virtue of my living out loud about my struggles with bipolar disorder. So many people persist in asking me why I'm so open about it, why I share my experience, and how I can *not* be ashamed of it or feel stigmatized for having it. "Aren't you embarrassed?" they ask. No, I'm not. "What are the negative consequences-what if a potential employer knows? What if you're treated differently?  Why do you talk about it so much? (Uh, because it's as intrinsic in my daily functioning as showering or feeding myself.) What if? What if?" 

Here's a good "What if?"... WHAT IF it helps somebody?

Which is a question that's been answered too many times for me to count at this point. Strangers, friends, acquaintances, and family members will invariably solicit me for advice or direction regarding all of my mental disorders and my addictions, and if I know I've helped even one person, that's God's calling for me, not teaching bonehead college students how to write. 

Without going into detail, it happened last night, when I was ready to put myself to rest, when an old friend emailed me about her symptomatic and very ill bipolar husband who is med and therapy resistant, after she'd seen my recent posts on my research project. Knowing I'm in school and busy, she told me to take my time in replying, but to me, the sooner I addressed the issue with her the better, because the safety of a young child is involved and my friend is suffering emotional and verbal abuse and manipulation. 

That being understood, and while by no means excusing her husband's actions and reactions, I pleaded with her to first accept that, in all likelihood (as she herself described), her husband wasn't a bad person. He is a sick person who needs a lot of professional help. Men, historically, are far more resistant than women in seeking professional counseling for mental disorders, as it is a gender-reflective emasculation to some degree. A sign of weakness, when it's totally not. Getting help is an empowering thing, and necessary if you want to continue to function. Without full knowledge of what meds he's on, it was tough for me to give an opinion either way about what might need pharmaceutical adjustment, but clearly his doctors have some tweaking to do. (Even I need tweaking. And soon.) And I'm not a physician OR a psychologist...yet. I do have a veritable well of exhaustive practical experience, however and a copy of the Physicians Desk Reference.

The rest of the advice I dispensed? I'm not sure if was of any help or not. I shared my experience in dealing with this illness and how it's affected my relationships and my lifestyle, and again told my friend to try and find, though she's considering divorce, that place in her heart where she loved her husband in the first place (they're still technically newlyweds). Why she chose to marry him, even knowing he was ill. At the same time, I emphasized that the safety of herself and her little one were paramount, and that if she feels her husband is threatening to harm either of them, to get out and go somewhere safe, which fortunately, she has the resource capacity to do. She went into the marriage with the knowledge that he was bipolar, but says she didn't realize how bad it was until they were living together. I told her that unfortunately, without proper treatment and counseling, it is going to get worse before it gets better, and explained how bipolar can concurrently run with other issues, most prevalent being substance abuse or addiction, as was my case. (It's all about self-medicating the insanity inside.) I asked her what he did for a living, to see if he was a creative, just out of curiosity. 

I told my friend that the downside of being so open, and the downside of having bipolar disorder, is that it's really tough on our loved ones and friends, who exhaust over our relentless instability. I said that consequently, we lose people along the way in our lives who can't or won't accept us and the love we ARE capable of giving. It is the faith from those who stand by us unconditionally that counts. None of us enjoy being abandoned when we need love the most, even if we're acting like assholes and are unstable and challenging. I make no apologies for the inconvenience of bipolar disorder in my loved one's lives. Why? Because it's not my fault that I'm sick. It's not my friend's husband's fault either, really. Still, I can't help but wonder if there are people out there who perceive that distancing themselves from me will relieve the burden attached to me that's put in their laps. "She's so high maintenance!" is a commonality. Functioning soundly is made markedly worse when someone you love leaves you for a situation that is out of your control. I have envisions that my friend's husband, if she were to leave him, would put his own life at risk, if he continues down the path he's on.

(I've tried getting in touch with Guy Friend numerous times over the last few days, it's clear I'm still in a mixed mood episode right now, and I went so far as to pose him the questions I asked my Facebook friends about their impressions of bipolar and asked him to email me his answers. He didn't. You can only text someone so many times with no response or acknowledgment before you learn that you've inevitably been put on "ignore mode."  I'm sure he'd chalk it up to being busy, but I'm busy too. I *wanted* to go to bed last night when that email from my friend came in. I stayed up late to reply to her, because she needed a friend she could talk to and since it was important, I listened and engaged with her, for while we've known one another since we were very young children, we're not close friends who do things together. So a big thank you to Guy Friend for exacerbating the depressive episode with his indifference and silence. It's worthy of mention that I never call Guy Friend. I wait until he calls me, when it is convenient for him. I do text him a lot, though, which he used to like, but now, I assume, is really fucking tired of. At least, now I'm pretty clear on what he meant when he looked me in the eyes and said "I love you." Women take that statement differently than men do, I think.  I also now know the subtext of his statement of "I'll never abandon you." It was "unless it becomes inconvenient for me, because being your friend isn't very important to me and, similar to your family, I  tolerate you, though unlike your family, I wouldn't insult you so gravely by actually saying that." I understand, Guy Friend. It's happened to me before. Rejection is a sensation that, once it becomes the rule, rather than the exception, in your life, you're more resilient. A broken heart full of scar tissue mends in time, but afterwards, your heart is left hardened and more jaded, and you get used to it, because it's all you know. And you might know a lot about hearts, but I know a lot more about love.)

(Update: Early Thurs morning:  he emailed me extremely briefly this morning and said he'd call over the weekend "to see what mood I'm in." Uh, m'kay. My mood at present? Tired and bleak.)

My research paper this weekend, due Monday, is on Bipolar II and has to be 8 double-spaced pages. That's roughly the duration of half of any given blog and is on the dry DSM-IV-TR clinical explanation of the disorder. Let's blindfold me and have me type it out in my sleep, thank you. I'll tackle that on Sunday. 

Guy Friend? This one's for you. I don't think any written dissertation (separate from my dissertation on bipolar disorder) on the song is required:

In my friend's case, her husband is totally resisting that which would benefit him the most, which is really sad. 

 I revel in my unique situation. It makes me giddy that my version of bipolar is so rare that it's undocumented as wrote diagnosis in the DSM-IV-TR. I try and make light of it as much as I possibly can, given the circumstances. Helping people and having a few laughs at my own expense is the least I can do living with this illness. Hypomanic episodes, while I wouldn't constitute them as "fun" or really "happy" are easier to tolerate and less taxing than depressive episodes. The combo platter symptoms which are typical for me? They're mostly "sleep for 3 hours, awaken charged, do what you have to do, completely burn out and require a nap by noon, and after the nap, spend the rest of the day pretty hopeless and get the bare essentials accomplished, like making coffee for the next morning when you awaken before dawn charged again after 3 hours of sleep." And, so, the rapid or ultradian-cycling continues. Rapid-cycling is alternating moods every few days, which does happen to me. At my sickest, however, I experience ultradian-cycling, which is an expressed change in moods over the course of a few HOURS. Trust me when I say, it's really exhausting and the non-bipolars' suggestions to go out and get some exercise are ludicrous. Your "energy" is 90% mental and 10% physical, and whereas you could sit down and crank out an entire book, you don't have the energy to shower. Blessed with a helpful mother and relatively independent son help me out a lot. That said, what is probably the hardest thing to do while in ANY episode? Hide it from my loved ones and pretend I'm fine, for fear I'll be chastised for either extreme mood, which is too familiar.

Back to the books for the exam, though it's essentially a review of a lot of shit I already lived through.  It's a shame I have to go through all this psychology mumbo-jumbo in order to professionally help people. True, I have a better historical and practical understanding of the concepts and principles at hand, but in the real world? The world of the insane and the addicted? Life is very different than how it's outlined in my textbook. Very different than what my professor, a PhD in clinical psychology, deals with in her practice, which is largely children and adolescents. (I do know she farms out her substance-abusing patients, because she has no knowledge as to how to treat them and actually proposed the idea to the class, via the textbook, that "controlled drinking" was a better choice for recovering alcoholics than abstaining and utilizing a program like AA, which is total bullshit. A great concept that has no basis in reality, as any alcoholic will attest. Step One: We admit that we are powerless over alcohol. But let's partake of a glass of wine once in a while! Won't hurt a fly! Never mind that one drink will become 8 drinks through the course of the night...)Thanks, but Communion wine is all I'm going to imbibe in for the duration of my life, continuing to bravely walk past the liquor sample guy at the drug store en route to the pharmacy...

UPDATE, SUNDAY NIGHT: Guy friend never did call me this weekend.