Unimagined Sense of Loss

I sit here, unable to sleep even though I need to get up at the crack of dawn because I am so far behind in my work. And all of sudden I am hit by such a profound sense of loss... At the end of the day, I can take stock in my life and it really adds up to one big zero. I guess I’m not getting to experience the manic phase after all. Seems as though I am sliding right into the pits. It’s actually a mixed-phase for me. I can’t sleep, yet the wholly encompassing envelope of loneliness engulfs me, while at the same time of fighting off all these racing thoughts that never amount to anything. It’s as if my brain has been stuck in 11th gear with nowhere to go. The utter randomness of the racing thoughts are probably most disconcerting. It’s absolutely amazing that I can be in a room filled with people I know and still feel so estranged.

I feel that when I am in a room of people, especially those with whom I have a relationship of sorts, I am always on the outside looking in. I feel invisible. This is the beginning of my downward spiral, and I never know each time just how bad it will get. Suffice it to say, that now I am in this space, I will do nothing to extricate myself from it. I will only continue to burrow further down, keeping everyone at arm’s length. My rather cognizant brain has the capacity to tell myself that I can remove myself from this environment by choosing to engage with those around me. But, the sad fact is that there just isn’t anyone out there with whom I can engage. I really do not have a real friendship base.

The walls slowly begin to close in; my options slowly cease. I am left with nothing but the four walls of my house. Is this what I really have to look forward to as my life as I know it? I don’t know if I can survive my life like this one more time. I’ve been in this spot before and the solutions presented then to help me crawl up to the land of the living really didn’t offer me much hope. The majority of me is quite content to just sit in my four walls and never venture outside or interact with anyone else. And, at the same time, that realization causes me so much emotional pain. To feel all alone can be the most frightening feeling. Every day I find myself just slipping a little further from reality. My reality is what is inside these four walls and nothing else.

I feel myself slowly shutting down—distancing myself from everything. My answering machine is off; my cell phone vm is disabled. I have effectively begun to build my walls where I can keep everyone out. I have completely cut myself off from my family of origin to even include my son. I just simply want to be left alone. I find it to be quite an oxymoron. When there are those who are hurting at church, it’s all I can do to just want to take them into my arms and show them God’s love. In those moments, I want to give of myself to help someone else.

But my disease is invisible. No one can perceive the profound loss and sadness I feel. No one understands bipolar for all its implications and trappings. I just want so much for someone to see the pain I feel and reach out to me, but part of the façade is to never let anyone in. Catch-22. Damned if I do, damned if I don’t.

Maybe I’m just a phony. Maybe I really don’t have anything to offer someone who is hurting. I want to, but would it ever be received? As I sit here tonight, I feel hopeless, unable to help myself, unable to help anyone else, and most importantly, totally unable and unwilling to receive anything from someone else. What can they offer me? No one knows the dark corners of my mind, and the room dims with every growing minute.©2009

Where Do I Go From Here?

If you’ve read one of my previous entries then you know I have bipolar disorder. I like the word disorder. Think of its synonyms: chaos, disarray, confusion, mess, turmoil, anarchy, mayhem—you get the idea. I’ve gone from chaos to anarchy in just a few short steps at times. I think it’s the latter I am experiencing at the moment—utter rebellion.

I’ve reached a point with this disease process that nothing works anymore. I have tried every known cocktail of meds available on the market today in multiple combinations. Even in the midst of taking my meds faithfully, I can be in a full-blown manic phase with thoughts racing so fast my life becomes a blur and yet, at the same time, fighting the paralyzing depths of depression. It’s not even fair; I can’t enjoy the flights of fancy the mania can sometimes provide if I am battling the depression at the same time.

I have become completely treatment resistant with nowhere to turn. Well, there is one alternative to escape the depression, one that I refuse to even consider. It’s ECT (electro convulsive shock therapy). One of its major side effects is memory loss and I am unwilling to lose chunks of my life, no matter how miserable some of it has been. There have been too many happy memories that I am unwilling to lose, all of which revolve around my wonderful 24-year-old son. The many opinions I’ve sought (being unwilling to listen to just my psychiatrist, but others within the medical field) have tried to convince me that this form of therapy has come a long way since One Flew Over the Cuckoo’s Nest. This one option is simply a no-brainer for me (pardon the ill-conceived pun). And, it’s not as if the medicines have had no side effects. As I mentioned in my earlier posting, one of the biggest side effect to most mood stabilizers is weight gain. Almost everyone I know has gained weight at one point or another in the search of finding that magic combination of drugs. In my case right now, while all of the meds I am on are weight neutral, one I take in the morning makes me feel so loopy that I have a hard time concentrating on my tasks at hand—not a very good side effect if I want to keep my job.

Why should I continue to take the medicines that I truly can no longer afford (of course, none of which are generic) if the end result is no recompense? If the meds can’t control this disorder, why bother to take them at all? It’s not as if things could get that much worse. Moreover, I feel more than rebellion. Anger is seething through every vein in my body. I am not angry that I have to deal with being bipolar; I know too many people who have successfully managed it and weaved its patterns into their lives. I am angry because I represent the few that can’t seem to be controlled by any of the medications that are available. The ironic part is its analogy. Think of someone who has a major disease process that cannot be cured and they ultimately die from it. I don’t even get that reprieve. I have to live through each and every grueling minute of this experience I am supposed to call a life.

I truly feel as though I have reached a point where I can no longer function. Sure, I can get up each morning, shower and get ready for work and do my job (with a great deal of concentration), but my job is my only reprieve. Once I get home from work, I am faced with staring at my nine-foot ceilings that seem to cave in all around me. I have earnestly made an effort to attend legitimate support groups, but I couldn’t connect with anything anyone said. I always felt like the outsider because no one could understand the true level of impact this disorder has had on me. It has certainly broken me financially between all of the visits to my psychiatrist, the hospitalizations and, of course, all of the medicine. Not even having enough money to put gas in my tank, let alone meet all of my monthly bills has really done a number on the depression side of the equation.

I’ve said all of this simply to say, after one full year of trying, I have now elected to wean myself off all my medication. I won’t have the dizzying side effects any longer and it will certainly contribute to my bottom line. If I thought there was a chance in hell that these meds would make a difference, I wouldn’t be making this decision. Yes, I am fully cognizant of all of the medically sound arguments not to pursue this line of action, but what is the point at this juncture? You may say that suicide will become my eventual downfall, but if that is already ever-present on my mind with the medication, what is the difference? I truly cannot think of one solid reason why I should bother to continue in this futile effort to stabilize what has become the roller coaster ride of my life.©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 1^st 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

Racing

The darkness of the night escapes me,
No shafts of moonlight to hem me in.
I soar with angels, buffeted by their wings
As the air around me sizzles and pops with electricity.

The fire grows into a molten pot deep within my belly.
The urge to create anything at all stokes the cinders—sparks fly in all directions.
My bed beckons me in this wee hour of the morning,
But my mind races forward, chasing one elusive thought after another.

The slumber my body craves is in itself a dream.
Hour upon hour I remain vigilant at the slightest vague supposition.
Any inkling will do as my mind does cartwheels in this grand space of time.
How the quiet is suppressed by the clamor of thoughts in my head.

It passes me by, one fleeting abstraction after another.
Too much noise encircles the ego in this still burnt cork of night.
They come at me like bat’s wings in frightful flight,
A blur that cannot be captured and imprisoned to evoke expression of creation.

As the nights melt into the days with repetition that knows no end,
The expectation of creation grows silent amid the dissonance that abounds,
Despite the impulse—the drive—to construct.
My mind desperately reaches out to catch even one of these thoughts that race.

And suddenly, as quickly as all these mental images beckon,
There is this tremendous thrust of despair.
What was once a dizzying envelope of energy
Has been usurped by an utter drain of force.

This crushing desolation, while unexpected at the time,
Stands at the head of the line with anticipation.
It’s time to crawl back into the void, craftily disappearing at will,
Knowing that the night has finally closed in and shut out all of the dreams that once filled the sky.©2007

The Canvas

I wake up from what appears to be a nightmare
Only to realize that it is life imitating art—
My life the canvas upon which these vials of medicine are spilled.

“I feel just fine,” I tell myself in the mirror.
I look and act like my normal self.
Hah! Now that’s a good word—normal—
A word that has lost all significance in my life.

There really is no need to continue with all of these pills.
Everything is in control, and their effect only dulls my senses.
So what if I stop? Who is to know?
I desperately need that clarity stolen by these cunning capsules.

The peaks and valleys come back with a vengeance.
The highs I desire—that cheap thrill ride of ecstasy
That seems to last forever—the clarity is back,
And the canvas is bright with colors once again.

Yet, I know in my heart where everything will ultimately lead.
The long and twisted road toward that downward spiral,
Slow and insidious at first, then slamming into my face—
Immediately life no longer has any meaning,
And the clarity so brazenly pursued goes up in a flash.

Too soon I pay the price—the canvas melts before my eyes.
Instead, only a numbing sensation filled solely with shades of gray.
How deep will I sink this time? How long will I let it continue?
Surely, another high is just around the corner—can I make it ‘til then?

I know this vicious cycle all to well—my own personal crash and burn.
There never is another summit lurking when I need it,
Only the dark void that replaces all life.
Too late to admit that these pills paint my canvas whether I like it or not.

So, my choice is to escape from this trail of meds and experience all that life has to offer.
And that leaves me with only one option: to take the brightly-colored canvas
Along with the ultimate death grip I know will come my way—My canvas is blank.©2007