09 February 2007

I'm Bipolar: So Who Am I?

Most people don’t understand bipolar disorder. However, if you use the older term, “manic-depression,” you might get a few “Ahhhs.” Even then, the general consensus of the population is one of enormous misunderstanding. The official definition of bipolar disorder is a psychiatric disorder marked by alternating episodes of mania and depression. Bipolar disorder is one that causes unusual shifts in a person’s mood, energy, and the ability to function. These shifts can be quite severe and have nothing in common with the every day ups and downs that most people experience. Damaged relationships, poor job performance and suicide can result.

And then it becomes more confusing when you throw two sub-categories into the mix: Bipolar 1 and Bipolar 2. The first is marked by swings from extreme depression to extreme mania. The latter experiences the extreme depression but a milder form of mania. “Mania can be described as an elated mood (excessive happiness and expansiveness), an irritable mood (excessive anger and touchiness), a decreased need for sleep, grandiosity or an inflated sense of themselves and their abilities, increased talkativeness, racing thoughts or jumping from one idea to another, an increase in activity and energy levels, changes in thinking, attention and perception; and impulsive and reckless behavior.” (The Bipolar Disorder Survival Guide, David J Miklowitz, PhD, pp 15,16). Erratic spending sprees and hypersexual activity are two examples of impulsive and reckless behavior.

“These episodes alternate with intervals in which a person becomes depressed, sad, blue, or ‘down in the dumps,’ loses interest in things he or she ordinarily enjoys, loses weight and appetite, feels fatigued, has difficulty sleeping, feels guilty about him- or herself, has trouble concentrating or making decisions and often feels like committing suicide. Episodes of either mania or depression can last anywhere from days to months.” (ibid, p 16).

I did not start out this discourse on a treatise of bipolar disorder; rather, I want the general public to truly understand the incredible insidiousness of this disease, at least through my eyes (and, yes, this IS a disease much the same as if one had diabetes…just because it is a psychiatric disorder does not lessen its impact on the body). While I can identify with some of the examples of Dr Miklowitz’s aspects of mania, his take on depression has been a grave misrepresentation in my life.

Unfortunately, the population as a whole looks at depression as having a bad hair day. People will often say, “Look, bud, just suck it up and deal with it.” or some other such nonsense. People also confuse bipolar disorder with those diagnosed with clinical depression, a very real and debilitating illness itself. The depression side of bipolar is very similar, but clinical depression lacks that elusive element of mania. For me, depression isn’t about being sad or blue. It is a state of paralyzing nothingness. I don’t experience stages or levels of depression; when my mood shifts, it truly is a crash and burn. I isolate, even among throngs of people when I have to be out in public (when I am at work), otherwise, I sit at home, all alone in this massive house absolutely numb and pained at the same time. Numb to the acknowledgment of the outside world, pained to the point of self-mutilation. I stare at the four walls and wonder to myself, “Is this all I have to look forward to for the rest of my life?” The emotional pain that I feel (most often provoked by nothing) had become so exacerbated that I had resorted to self-mutilation. Ordinarily you find that with much younger bipolar patients, but I am 49 and only just recently have I stopped cutting myself. I have made the carvings on the real estate of my arms into an art of cartography. Being as anal as I am, all of the cuttings are quite parallel and perpendicular to each other, like a grid road map. And suicide? I haven’t just thought about it, but created elaborate plans and methodologies and was quite prepared to carry out my plans on several occasions. Somehow, God was determined that it wasn’t my time in each case and I never went through with any of them. The closest I came was in 2000 as I had access to boluses of potassium chloride (it is one of the chief components in the ole lethal injection scenario), butterfly needles and some heparin. Having been a junkie twenty years ago (and how I lived through shooting up speedballs as long as I did is still a miracle to me), I knew I could pop a vein, anchor the butterfly, and nurse it with heparin so it wouldn’t clot until I was ready to inject the KCl. When I laid everything out on the dining room table in quite an orderly fashion—syringes ready to go—strapped the tourniquet around my bicep and prepped the vein something snapped in my head. It wasn’t that I couldn’t go through with it. I stopped because I couldn’t believe that my life had succumbed to this point.

For some dumb reason, an inkling of clarity broke through and I called my family physician and told his nurse that I had to come and see him right away. I guess something in my voice told her to say yes without even checking with him or the calendar for the day (ordinarily, he was usually booked up). To this day, I don’t even remember driving to the office, but when I got there, I was ushered right back to his office, not even one of those small patient rooms. I waited for about 15 minutes before he came in, shut the door and took the seat next to me. I showed him my arms (I had done quite a number on them the night before) which wasn’t a surprise—he’d seen the scars from previous efforts which I would never discuss as he would write me a prescription for an anti-depressant. Then he asked me what else had happened and I told him the truth. He got up and immediately made a phone call to one of his good friends (they played racquetball together) and said that he really needed to make some time to see me. Then my doctor asked me if he could trust me to go over to this other doctor’s office without going home and carrying out my well-laid plan. I agreed.

At this point I think I was in shock as I began to absorb the enormity of it all. I drove over and waited about 20 minutes and then was seen by his nurse who proceeded to barrage me with questions, all diagnostic in nature. I just sat there looking down at my lap answering monosyllabically as the tears finally began welling up in my eyes. When she was done, she left me alone for a bit and then introduced me to what I realized was a psychiatrist (my doctor may have said something to that effect before I left his office; I just don’t remember.). Having reviewed my answers, he began talking to me in a very quiet, subdued and soothing manner. That seemed to make some difference to me, because up until that moment I felt as though I couldn’t breathe. Suddenly I could exhale and breathe again. We talked at length about my long history and he asked me more questions, presented various scenarios to me to see how I would react to different situations, and continued to probe further still into my past behavior. After spending about three hours with me, he decided I was suffering from Bipolar 1 disorder and that I needed to be hospitalized (primarily because of what was waiting at home for me—obviously I was a danger to myself). He wasn’t sure he could trust me to drive myself over to the hospital; he seriously considered an ambulance, but I convinced him that I would drive directly over to the psych ward of our local hospital. Of course, he called in everything ahead of time and they were expecting me by the time I arrived. He even arranged for me to have a private room even though my insurance would only cover a semi-private room unless a private room was all that was available. There were other semi-private beds available; the nurses just wrote it up in a way that the insurance company would accept.

When they showed me my room, I changed out of my street clothes into a pair of scrubs and terry-cloth slippers that had those anti-skid rubber strips on the bottom and just curled up in the bed. I wouldn’t come out for any meals and the only time I left my room was to get my medications, a powerful cocktail that made me dizzy for quite some time. The psychiatrist, who took me on as a special favor to my doctor (he no longer treated inpatient adults, only adolescents), came to see me every day for the week that I was there. He asked if I had a friend who could get into my house and remove all evidence of my suicide attempt. He wanted to make sure when I got home, I was as safe as I could be. My friend was instructed to not only remove all of the medical supplies, but all of the liquor in my house. He also asked her to go by and pick up the prescriptions he called in so I wouldn’t miss any doses by the time I got home.

No, the medicines, nor the hospital stay made that much of a difference to me when I first got home. However, after about six weeks, the cocktail of meds finally began to take hold and my moods appeared to stabilize for the first time that I could remember.

All of that happened seven years ago this summer. Has life been good to me since this diagnosis? Absolutely not. There are medicines than can attempt to control the mood swings, but there will never be a cure for this disease. Many of the medications, such as Depakote, Zyprexa and Seroquel are massive weight gainers. What do you think that does to your self-esteem when you are cycling down into a depressive state? Sure, the medications help, but I have the learned a few lessons the hard way. I did what most bipolar patients do when they start to feel much better. In 2004, after losing all of the weight I had gained on the medications, I really did begin to feel better. So, I did what was the worst thing I could do. I went off my medication. However, I really did well without them for quite a while, until I became involved in a romantic relationship. Even then, it didn’t become evident until well into six months of being with her. She was everything I had been looking for in a partner and for the first time that I could remember, I was genuinely happy. We moved in together, but the stressors brought on by being in a relationship for the first time in many years, coupled with the fact that I was now living with someone after being alone for so many years, brought all of the symptoms back with a fury. I was still seeing my psychiatrist (every four months just for a med check since I was doing so well…I never admitted that in October of 2004 I went off everything until I told him the following April). He was amazed that I seemed so stabilized in the absence of medicine for such a long period of time. He admitted that it was very rare that someone could actually come off his or her medications. He chalked some of it up to all of the weight I lost (250 pounds) as the hormone estrogen, which is fat-soluble, can wreak havoc on a bipolar patient. He decided to put me in a wait-and-see mode and I promised him that I would call right away if I saw any red flags.

Well, the red flag appeared in June. I started to rapid cycle (meaning that I was mood shifting quite suddenly from high to low in short time spans). I went in to see him and back on the meds I went. But this time he put me on one that was weight neutral (I told him that I refused to take any drugs whose side-effect was weight gain) and I began to take Abilify. But I found we had to steadily increase the dosage as it wasn’t making the difference we were hoping to see in the time frame we were expecting. My mood swing this time went south and stayed there for what seemed like forever. I started drinking again, knowing full well I had no business drinking alcohol while taking the medication. Needless to say, all of this took quite a toll on my relationship which also began to deteriorate by November. On 01 December 2005, after being in a manic state for three weeks straight without any sleep, I crashed hard and became absolutely suicidal. I decided to call my psychiatrist and voluntarily checked myself into the hospital. This time there were some new meds on the market, all of which were weight neutral, with which we began to experiment. Within a week, I was back to feeling stable and went home.

But I didn’t stop the drinking which I think was a by-product of just being unhappy in this relationship. I wanted to leave her; I just didn’t know how. I loved her with all of my heart; I just didn’t want to live with her any more. I felt trapped between the proverbial rock and a hard place. On 27 December I drank so much I passed out and she couldn’t bring me out of it, called an ambulance and rushed me to the ER. She told the doctor of my bipolar history, and by the time I had sobered up, I was given two choices: I could voluntarily check myself into a psychiatric facility, or they would go to court and have me committed. So, back into the hospital I went (voluntarily). I don’t think I had ever hit bottom this hard, or so I thought.

She wouldn’t come and visit me and only talked to me on the phone twice before announcing that she was coming to see me on January 1st as long as there would be a therapist present to facilitate the visit. I wasn’t sure what was up with that, but I said fine. I really did need to see her again; I missed her so much. Well, she came and promptly announced that I wouldn’t be moving back into her house upon my discharge and that we were no longer together as a couple. Talk about getting your heart ripped out and stomped on. That’s when hitting bottom really slammed me in the face. It was a good thing I was in the hospital, because I can honestly say without a doubt that I would have committed suicide that night. I cried for three days straight (if you asked any of the other patients, it wasn’t crying but dissonant wailing). The two previous times I had been admitted I was in for only five days each. This admission lasted 18 days.

It’s been one year, one month and nine days since my world came crashing to a halt and I have to say that I have persevered. My psychiatrist and I have come up with what has been a remarkable cocktail of drugs to which I have not become tolerant (yet). I am living in a beautiful, huge house all alone in prime downtown real estate and, yes, I still struggle. The meds aren’t perfect. I cycle—I can be manic for three weeks at a time—but I haven’t been suicidal when I plummet down. And regardless of how depressed I get, I haven’t cut myself in almost one year. I’ve been able to hold my job throughout all of this and I have been blessed to have a very understanding boss who will be the first to tell me that she doesn’t know beans about being bipolar—she just knows I’m one of her best employees. I still haven’t figured out who I am in all of this, but I do know one thing: I am a survivor.©2007

1 comment:

  1. I feel like we have so much in comment. We're both radical dykes and we both have bipolar. I'm just not sure which feeds of which sometimes, at least as far as being radical. I understand the loneliness you feel and certainly the isolation. But you are so damn eloquent about how you express yourself. I plan on going through all of your entries just so I can learn just who AlixRites is all about!