The Gift of Bipolar Disorder

Bipolar Disorder: The Gift

British actor/personality/genius/self-proclaimed jackass-of-all-trades Stephen Fry describes, in his documentary, “The Secret Life of the Manic Depressive,” bolting out of a local theater after receiving some mixed reviews about a play in which he was starring several years ago, grabbing a duvet, stuffing it in the crevices of his garage door, sitting in his car with his hands on the ignition for two hours, contemplative about starting the engine and suffocating himself to death. During this time, Fry describes envisioning the faces of his parents, of his family, which, to a mental health practitioner, is indicative of an acute psychotic break. Fry fails to carry out his planned suicide.

He sought to discover why he experienced periods of extraordinary creativity, incredibly heightened mood, prolific work output, grandiosity and a hell of a lot of shopping (like excessive no-one-needs-14-iPods-shopping), yet fell victim to total opposite, lengthy periods of suicidal ideation, despair and malaise. He visited a doctor who diagnosed him (properly, at that) as being bipolar, a term he’d not previously heard. It’s more widely known and accepted as being manic-depressive. Fry wanted to know how he “got it,” and whether or not it would get better or continue to spiral worse. He repeatedly refused medication (chiefly Lithium, the oldest bipolar antipsychotic used) because of its reputation of sapping patients of personality and creativity, which are certainly evidence against the use at least that drug in particular.

Second generation antipsychotics and mood stabilizers (which I take, Geodon and Lamictal, in rather high doses, incidentally) have fewer side effects, but yes, I agree with Fry inasmuch as while they even out bipolar moods, their reputation as zombieizers is certainly valid. Fry interviewed noted actors such as Richard Dreyfus and Carrie Fisher, who both struggle with the illness, and each relied on street drugs and alcohol to self-medicate before they received and were treated medically, Dreyfus finding enormous success in the late 1970’s/early 1980’s after an arrest nearly imprisoned him. Fisher, "Princess Leia" of "Star Wars" fame, of note, still struggles in heavy cycling, and, if you watch the documentary, her upward mood swings are VERY typical of someone hypomanic or manic. Across the board, it's not merely a matter of legend how many of us with bipolar disorder have self-medicated with drugs or alcohol before THE DIAGNOSIS or THE DRUGS because you know--you just know--that something is totally, majorly wrong with you, whatever it is, and you just want it to go away. Trouble is, it doesn't go away. More booze and more drugs don't solve it. And for many patients, myself included, over time, it gets worse and more difficult with which to cope. It's a blister that keeps opening and oozing, the Neosporin and Band-Aids a temporary remedy. 

In an episode of mania, EVERY idea is the BEST idea in the WORLD and you want EVERYONE to know about IT. Every thought is brilliant. Every action is over-the-top exciting. Every plan is extraordinary. Elevated moods, however, can grate on the nerves of those who love you the most. You talk, and talk and talk and talk. (My mom notices that my affect is much louder and my speech is much more rapid when I’m manic.)  Impulsivity is the rule rather than the exception. Hyper behavior manifests itself in such things as chemical excess, sexual excess, material excess, uncontrollability. Conversely, depressive episodes (depending on their severity) can completely polarize into suicidal plans, whether attempted or successful, as Fry discovers in interviews with family members of those lost to the disease as well as those involuntarily committed to mental institutions for extremes in mood and a lack of functionality, including one of a British physician. It's not unheard of to not shower for days or sleep for 72 hours straight, unfed, dehydrating and not giving a damn about body hair overgrowth or an empty belly. 

Depending on the patient’s cycling, mood shifts may last between a few days, weeks or months…fortunate is the soul who cycles only a few times a year. I, on the other hand, ultradian cycle, and my moods can switch from manic to depressive in a matter of hours. That wears me the fuck out. Fry notes and interviews a patient who’s written a book on the effect ECT treatment has had in working to ease the severity of his bipolar symptoms in the absence of any other pharmaceutical intervention...a "wit's end" solution, which categorically, does actually work, though it persists in having a dreadfully frightening reputation.

As far as the completion of Fry’s documentary, he was still unmedicated for his bipolar disorder.

For the first year and a half during which I was being treated with the aforementioned drugs, I felt strongly that I’d lost my ability to write. My blog laid untouched on the internet for quite a long time. After a breakthrough in 2011, I came to a thoughtful conclusion that I should start writing again. Fluidly, the thoughts, ideas and flair returned (with practice). I had not given myself due credit regarding my abilities, but that’s typical Annie. One subject in the Fry documentary fears that her depression is so severe that she (a gifted creative writer) may face the fact she’ll never be capable of writing again during a session of cognitive behavioral therapy, which causes her to cry in despair. I feel very similarly at times.

With much careful consideration, I came to the decision in 2010 or 2011 that my calling in life was to become a counseling psychologist. I wanted to aid, in particular, comorbid or dual-diagnosis patients who suffered from mental illness coupled with substance abuse histories. A successful summer course in the introduction to psychology afforded me an “A,” which encouraged me to pursue my study at the graduate level. After losing my job in January, 2012, after and amid nearly grave physical illnesses (chronic pancreatitis, anorexia, a hysterectomy), I took another prerequisite of abnormal psychology and again, did respectably well. After a sabbatical, during which time I wrote my blog prolifically, I applied for and was accepted to the Adler School of Professional Psychology in Chicago for a master’s program in Counseling Psychology. I began full-time graduate study in the fall of 2012.

My first semester, I was more or less mentally stable, though faced challenges of concentration, short-term memory retention, and the more stress which was placed upon me, the mentally sicker I became though my physical health began to stabilize. I was encouraged to cut my course load in half for the spring, while still maintaining full-time status. Spring 2013 at school was incredibly difficult. I rapid cycled between mania and depression the entire term. Deadlines were graciously extended. Letters from my psychologist and psychiatrist confirmed my diagnosis and while I did not achieve formal consideration within the tenets of the Americans with Disabilities Act for the school, my professors (as well they should in a psychological school) were incredibly understanding. That being said, earning straight “A's” for Spring term glided me on a high, primarily because they were so undeservedly surprising, as I tend to view all of my achievements, which certainly must be pure happenstance and not a result of my intelligence or articulation. I felt ready to tackle the summer full-time with vim and vigor.

Not byproducts of delusionary grandiosity, I’m a self-taught drummer/percussionist who improvises very well, can’t read music and plays by ear. I know I’m a very good writer. When stable and healthy, I have a photographic memory. I’ve kept a young human being alive and thriving for 13 years, who’s a verifiable genius.

While my undergraduate grades weren’t reflective of my innate ability, I urged the Adler school during the admissions interview that THAT student in her early 20’s wasn’t the student they’d come to know in her early 40’s. I hadn’t gone to school full-time since 1995, when I received my BA in English-Writing from Knox College. That 20-year old was bipolar, psychotic and didn't *know* it. This 40-year old is being treated.

We are rounding week five of the summer term, and I’m taking 3 classes—one, a 6-hour long psychotherapy skills class and lab, the other two online (Adlerian theory and Biopsychosocial Foundations—all that funky disease and drug stuff I already know by heart because I’m a walking, breathing, living DSM). It’s going well thus far, but I already have asked for a few hours’ extension on an assignment due tomorrow, to which I simply cannot devote the effort or the concentration, which I told my professor. Literally, the 3-5 page paper is merely a regurgitation of information I’ve learned about Alfred Adler and his therapy systems over the course of the last 4 weeks. It’s busy work.

Considering I was in bed at 8:45 last night, in the middle of texting one of my BFF’s, I should’ve anticipated that a full-blown depressive episode was emerging, having gone back to sleep by 7 or 8am and awakening again at 10:30am. All day, I felt in the mood to nap, but fought it, fearful that despite potent prescription sleep aids, it’d keep me awake all night and I have a pathological aversion to insomnia. It is not unusual for me to sporadically sleep 14 or more hours a day when I’m depressive and still sleep all night.

While I may be a student at a swanky, private psychology institute, I am a patient reliant upon the Illinois state Medicaid system. Doctors and therapists at a local mental health center are paid pennies on the dollar to help me maintain my sanity, and to a certain extent, you get what you (don't) pay for. My therapist, an LCPC, is hands down, one of the most useless expulsions of oxygen I've ever encountered. She doesn't work WITH me. She doesn't deliver useful tools or solutions to my behavioral problems. A chronic time-waster, it is I (and thank God I'm armed with education) who develops treatment plans and theoretical approaches she simply handwrites on a form for submission to the State. She likes to tell me what to do but not how to do it. Put more simply, I can't fucking stand her but I'm stuck with her. The psychiatrist working with me--with whom I was afforded 15 minutes every 1-3 months, quit, and was recently replaced by a woman with whom I spoke on the phone last week regarding my medication refills, which were running low. Her first available appointment isn't until the end of June, when she'll receive approximately $4 for what a private psychiatrist would earn $125. While this upcoming appointment is more of an intake checkup, in the future, I will meet the ol' pill pusher every so often as she rattles off pieces of paper labeling my drugs whereupon I'll walk out the door with a stack to take to the pharmacy. Welcome to American Modern Psychiatric Practice.

There was something really fun and exciting I wanted to do over the weekend, which would’ve taken place at midnight either Friday or Saturday, and I invited a friend along, but he turned me down, so I didn’t go. It would’ve been a gas and a welcome diversion to spend some time with someone I care about. My personal feeling is that he bowed out due to fright and nervousness over what was a subversive sexploitation movie from 1970, not the fact that it was past his bedtime. (PS, it you haven’t seen “Beyond the Valley of the Dolls,” you’re TOTALLY missing out.)

Literally, as I'm trying to iterate through this piece, my mother--my family, besides my son, Luke, who gets it, tell me I dwell too much on bipolar disorder and that if I just "don't think about it," it won't affect me. That I "blame" my behavior on my mental disorder. Sure, because I'm choosing to live like a maniac. If I muster the courage to admit I'm depressed, I'm lengthily questioned as to why, when most of the time, I don't have any idea and the explanation of "my brain chemicals are fucked up" is seen as a cop out. While still in control of my faculties, I live in fear, as a patient in Fry's documentary lived out, that a pound on the door will be met with a straight jacket, a syringe, a social worker, an MD and a trip to a mental hospital. 

I liken it to this example:  if you just *forget* that you have Crohn's Disease or cancer, your symptoms will magically disappear. No matter what illness you have--mental or physical--you can't "psyche" yourself out of it. What an absurd conclusion. My mother thinks I use it as an excuse to be crabby or hyper, neither of which is the case. It's a matter of riding the storm out, which I've done 1,000 times before (often silently) and will continue to do so. 

Fry's documentary is SO compelling because his level of frankness and detail is incredible. He's just the type of personality to bring a level of humanness and reality, with humor, to what I believe he does call a "morbid disease." He mentions at one point just not caring if he lived or died, and that apathy is something to which I can relate. Like that night I accidentally took 20 Ambien after taking one, and I just went to sleep. If I woke up, great. If I didn't, no big deal. That's different than suicidal ideation or plan. It's just life-apathy. It's during those times I surround myself staring at the people I love the most and shake myself out of it realizing the impact it'd have on all of them. Especially given my brother's recent near-fatal motorcycle accident and residual suffering and pain, and my son's idolization and deep love for me which just give me that glimmer to keep going. Fry'd laugh at me to call it divine intervention, but I honestly have no other reasonable explanation, because certainly my own strength is for naught. 

Whether lucky or unlucky, I cycle so rapidly, I anticipate that this depressive cycle will lift soon enough. Mania would be a bit useful in getting my school work done, but it's at the expense of my diurnal cycle, my physical well-being and my overall sanity. Mania for me is like 5 shots of espresso shooting in an IV ALL DAY LONG. Then BOOM. You're down for the count.

Fry's documentary made me feel less solitary in my struggle, and hearing anecdotes and treatments from people he interviewed, while they didn't lift my depression, made me feel more "normal" in what's a totally abnormal state.

The toughest thing about a depressive episode is that everything becomes so pointless, & if it was acceptable to cry without causing widespread household panic, I’d lose it, but I can hardly rouse attention in the house blowing snot out of my nose in tears, even behind closed doors, without an inquisition. So instead, I sleep. Barring sleep, I just lie there, and quite literally, I think I can feel my brain—organically—synapses firing and dousing to disintegration all at the same time, and it’s in those moments the din of the pain leads to over-medicating with sedating drugs, or thoughts of other self-harm, or just wishing away Chicago and escaping to India or somewhere there’d be peace.

But there's graduate school work. Finances. Papers. Classes. Deadlines. Busyness. Going. Going. Going. Parenting. Science fairs. Taking out garbage. Organizing. Making music. Keeping my body clean and presentable. Laundry. Jotting to-do notes, many things that were supposed to be done days or weeks ago.

People depend on me. I depend on people.

People I love are likewise suffering, though differently, some severely. Patients and clients I have yet to meet will count on me. I'm not going to bank $500k a year doing this work like a cardiologist. For all the years, all the effort, comparatively, even as a doctor, my salary will be paltry as a specialty. If I were in it for the money, it'd be the most selfish act in the world--I'd be capitalizing on my illness. I refuse to do that. I refuse to capitalize on the suffering of others who've been ON THAT LEDGE. I won't save all of them, either. But if they stumble, goddamn I'm going to help pick up the pieces. I survived to give back that much. 

Put simplistically, bipolar disorder is terrifying because IT'S TERRIFYING. If you're the God-believing type,  one whom Fry would a) laugh at and b) exchange in heated debate of existence, how can a deity of love and compassion besiege someone--let alone millions of people (4 million in the UK alone)--with a lifetime of enduring the deadliest (20% successful suicide rate) chronic, incurable mental illness? After a long period of "Why me's?" and "You expect me to hang around for THIS bullcrap?" part of the acceptance of the disease is that VERY realization (usually uttered not by you, but by someone who loves you deeply) that you have been bestowed, in a tangible but maddening means, a gift.

In the latter part of Fry’s documentary, he asks of the people he’s interviewed if they could “press a button and release their bipolarity, would they?” Out of everyone he interviewed, only two said yes. Fry, himself, said, “I wouldn’t press the button. Not for all the tea in China.” I tend to agree. That which makes me sick, and furious, and insane, and creative, and suffering and joyous to me, anyway, is sort of a messed up vision of how I wish everyone could (even in a drib) experience life. It’s never boring. The narratives in your head never stop. Your keen eye for what’s beautiful versus what’s hideous is zoned-in like a pinhole.

It’s widely known and historically significant that a great many of the world’s most prominent artistic, musical, cultural and political contributors were all manic depressives, long before the term bipolar was employed. Not all of them survived the drudgery of this disorder. But I challenge you to name one whose imprint did not transfer multi-generationally.

Individuals suffering and living with bipolar disorder are no different than you, but at the same time, completely different from you. Our lives are forcibly made a hell of a lot more complicated. We’re not asking for pity. We’re not asking for alms or mercy or an exorcist. We are asking for the respect paid to anyone else in the world, regardless if that person is ill, chronically ill or even in hospice care on his/her last breaths. Typically, illnesses we cannot see, we refuse to understand. That’s but one thing that needs to change in the medical community; particularly in the mental health community, and that’s where trainees like myself plan to turn things around.

Fry’s most powerful scene which hit me as a mother was in talking with a mother around my age (40’s), living with a partner, with 3 children—believed to be two young teens and a boy about 11-12. The woman has difficulty in explaining the effects of her bipolar disorder on how she behaves and interacts with her children. She says she feels she “Should be normal,” whereupon she lists off a string of what would *make* a mother normal—sensible, responsible, etc. Her youngest boy says, “You ARE normal.” The young teens can’t begin to imagine their mum any other way and go on to explain some of her more unusual behaviors and patterns. The mother is surprised that during the manic times, the children don’t get “fed up with it.” The youngest explains, “Everybody’s got a special voice. So this is like a special voice, but BETTER.”  Fry asks Elaine, the mother, if she’s surprised that her children consider her mental disability a “gift.” They all do, and accept that sometimes she’s up and doing a lot of things, while other times, she just needs to sleep. The adaptability of children cannot be misconstrued or not considered, for it is our children who often have more insight into their parents’ personalities than do the doctors.

Hugging and kissing my son goodnight tonight, I held his neck tightly and said, “Luke, do you promise you wouldn’t rather have any other kind of mom?” He thought the question was a little silly and obvious. “Mom. I promise,” he said, hugging me more tightly, "I love you." My mind might still be downtrodden, but my heart is warm and full.