Bipolar 2 From Inside and Out

Diagnosis and Dickinson

The Brain — is wider than the Sky —
For — put them side by side —
The one the other will contain
With ease — and You — beside —

The Brain is deeper than the sea —
For — hold them — Blue to Blue —
The one the other will absorb —
As Sponges — Buckets — do —

The Brain is just the weight of God —
For — Heft them — Pound for Pound —
And they will differ — if they do —
As Syllable from Sound —
Emily Dickinson

I ran across this poem in a book called Shrinks: The Untold Story of Psychiatry (about which more some other time) and it made me think.

Dickinson was, by all accounts a recluse. She seldom went out and, when visitors came, she sometimes sat behind a screen while she talked to them. She never dared to submit her poems for publication. Less than a dozen were published in her lifetime, and those only because someone else submitted them without her knowledge. Her wealthy, loving family sheltered and nurtured her so that she never had to face the outside world.

Emily Dickinson had Social Anxiety Disorder.

And Abraham Lincoln suffered clinical depression. So did Charles Dickens.

Bipolar sufferers include Beethoven, Schumann, and Isaac Newton.

Charles Darwin, Michelangelo, and Nikola Tesla were all obsessive-compulsive.

Autism, dyslexia, and various learning disabilities affected Einstein, Galileo, Mozart, and even General Patton.

And Van Gogh! Let me tell you about Van Gogh. He had epilepsy. Or depression. Or psychotic attacks. Or bipolar disorder. Or possibly some combination thereof.

I call bullshit. I’m not saying none of those people had assorted mental disorders. My point is that we can’t tell from this distance in time.

In none of these cases, as far as I know, did any of the aforementioned people see a psychiatrist, psychoanalyst, psychotherapist, or even a phrenologist. None were diagnosed with any psychiatric condition, and no record of such a diagnosis has come down to us from any reliable source. Some even lived before psychiatry was invented.

People – mental health workers, but also art and literary critics, biographers, and the general public – have looked at these extraordinary people’s lives and work and decided that their behavior and their art look like those of a person who might be bipolar or obsessive-compulsive or psychotic. (They also like to retro-diagnose physical conditions there is no record of or only vague names for. King Tut, Henry VIII, and Napoleon are particularly good theoretical patients.)

Why the tendency to ascribe mental disorders to famous people? I can see two reasons, beyond the thrill of solving a mystery and feeling clever.

The first is the old saying about there being a thin line between madness and genius. These historical figures were geniuses, so they must have been mad. Or as we say now, suffering from mental disorders.

The other is the need for role models and inspiration. If Van Gogh could become one of the most famous artists ever (though not successful in his own lifetime), you too may rise above – even use – your disorder to accomplish greatness.

It’s possible, I guess, but it’s not likely. Certainly those with mental disorders can aspire to and achieve rich, full lives, satisfying relationships and jobs and artistic pursuits. These are the ordinary accomplishments of ordinary people, both with and without mental illness, and it’s a small miracle that people can achieve any one or more of these. Not everyone does – again with or without mental troubles or psychiatric diagnoses.

And for me, at least, it’s enough.

Can the spark of imaginative genius strike a person with a mental disorder? Of course. Can that person succeed and achieve lasting fame? Maybe, though the odds aren’t good. Is a person saying, “Look, I can be Van Gogh!” likely to fall short? Almost certainly. Can that failure to achieve greatness make a person feel worse about himself or herself instead of better? You tell me.

There’s nothing wrong with aiming high, and nothing that says a person with a psychiatric diagnosis can’t do just that. It’s a good idea for anyone. (As one of Lois McMaster Bujold’s characters says, “Aim high. You may still miss the target but at least you won’t shoot your foot off.”)

But pinning your hopes on a similarity with a non-psychiatric, perhaps non-existent, diagnosis of a genius may not be the best way to get there.

Better to look in these geniuses’ work for insights that can help you understand your own condition or pull you through tough times. Here’s another of Emily Dickinson’s poems that has always spoken to me about the experience of a depressive crisis and its aftermath.

After great pain, a formal feeling comes —
The Nerves sit ceremonious, like Tombs —
The stiff Heart questions ‘was it He, that bore,’
And ‘Yesterday, or Centuries before’?

The Feet, mechanical, go round —
A Wooden way
Of Ground, or Air, or Ought —
Regardless grown,
A Quartz contentment, like a stone —

This is the Hour of Lead —
Remembered, if outlived,
As Freezing persons, recollect the Snow —
First — Chill — then Stupor — then the letting go —

Was Emily herself depressed? We’ll never really know. And as long as we have her poems, I don’t really care.

Mind Like a Steel Trap

Rusty. Unhinged. Not really good for trapping things.

Especially memories.

That’s not quite true. I have that uncanny ability that all depressed people seem to have to remember every stupid, clumsy, embarrassing thing I’ve ever done, as well as every trauma. It’s like a mental DVD that stores them up, then plays them at random moments. Or maybe not so random. Maybe just when I think I’m doing okay.

The memories can be as traumatic as the time other children threw rocks at me or as trivial as the time one person asked for a glass of water and I gave it to someone else.

Unfortunately, the recording feature only works for bad memories. A lot of the good ones are MIA. I don’t remember huge chunks of my childhood, except as stories that family members have told me. I don’t really know if the memories are mine or theirs. And I’m scared to compare notes.

My theory about these childhood memory deficits – and to tell the truth, all the way through my teens and early twenties – is that when you are profoundly depressed, memories don’t imprint the way they’re supposed to. Whatever synapses and neurochemicals are involved in memory are out of whack. I’m also afraid to do the simple Googling required to find out whether this is even a plausible theory. If it’s not, I don’t think I want to know. I have an explanation that makes sense to me, and the memories won’t come back if I learn my theory is wrong.

Later in life, medication has helped controlled the depression and, after it was diagnosed, the other effects of bipolar 2. But if I thought my memory was going to function properly, I was wrong. Some of the drugs left me with a memory like Swiss cheese.

My memory lapses seem more random now. Good things, bad things, neutral things, all disappear into the Pit of Unavailability. Sometimes they are embarrassing – I forgot a friend’s father had died and asked how he was. Other times they are more distressing – mere scraps left of trips I’ve taken. Sometimes they’re heart-searing – total nonrecall of a never-to-be-repeated sexual encounter.

Good and bad, gone.

(“Oh, yes,” said the doctor. “That drug will do that. You can stop taking it now.”)

I guess I’m lucky. If I’d had the electroshock, my memory would probably be as raggedy as old underwear. And about as useful.

Churchill’s Dog

Winston Churchill famously compared depression to a black dog. Here’s a video that takes that metaphor and runs with it.

Andrew Solomon, author of The Noonday Demon: An Atlas of Depression, says, “Depression minutes are like dog years, based on some artificial notion of time.” He goes on to describe how the simple act of getting out of bed and taking a shower can consume hours, leave you exhausted, or be simply impossible without help.

The Noonday Demon

There’s even a Black Dog Institute in Australia, which is a non-profit organization that provides information about depression, bipolar disorder, suicide, and other topics.

Home

There are other metaphors. J.K. Rowling, creator of Harry Potter, talked about depression and dementors. Here’s a link to a post I wrote about that.

Read Your Way to Sanity

The black dog is with me now.

The big story last week for those of us with mental disorders was this one:

http://www.rawstory.com/rs/2015/02/truly-barbaric-florida-deputy-drags-mentally-ill-woman-through-courthouse-by-shackled-feet/#.VOyTNKh2Gbc.facebook

For those of you who haven’t read it or seen the video, here’s the gist. A woman, Ms. Rios, was declared mentally incompetent at a hearing for a minor offense and not allowed to say goodbye to her mother. She wanted to sit on a bench and cry for a bit. When she did not go promptly with the officer, he dragged her through the courthouse by her shackled feet. A video was taken on a cellphone camera by a lawyer who happened to be present, but had nothing to do with Ms. Rios’s case. If you watch the video clip you can see and hear her distress.

As the headline says, this was barbaric.

But there’s lots neither the headline nor the story says. I have questions.

What is the woman’s mental illness? Or why is she mentally incompetent? The stories vary, usually calling her “mentally ill,” which is shorter for the headline writers, but so far I have seen nothing more specific. One could get the impression that in the mind of the media – and therefore their readers – that the two terms mean the same thing. Was she medicated or unmedicated or off her prescribed meds? Does she have a developmental disability? An autism spectrum disorder? An emotional or behavioral disorder? We don’t know. But does the label make her automatically suspected of potential violence? The woman did not behave like an animal even when she was treated like one.

I think we all know people who have mental disorders but are still mentally competent to conduct their own affairs, up to and including court proceedings. In fact, I know you know one – me. But who among us, or among the sanest and most stable of the general public, wouldn’t have needed to sit on a bench and cry before going to wherever the officer thought we should go? Who wouldn’t yell and protest and try to hold on to a table if we were dragged anywhere by our shackled feet?

Why is the officer’s action called “barbaric”? I’m not saying it wasn’t barbaric. But how was it more barbaric than other things routinely done to the incarcerated mentally ill (or incompetent)? Could it be because the officer’s actions were caught on tape? How many everyday barbaric actions aren’t? And putting aside simple human compassion (which he did), didn’t the officer’s actions create a larger, potentially more dangerous disturbance?

Why did the other officers present do nothing? You can see them on the video. They are spectators. No one says, “Hey, do you have to do that?” or “Give her a minute to calm down” or “Here, let me take care of this” or “You know, there are other ways to handle this” or even “Are you sure you want to do that with the camera rolling?” Nothing. Nada. Zippety. Doo-dah.

Why weren’t the officers and other courthouse personnel trained to handle situations like that? They obviously happen occasionally. Officers are (supposedly) trained to handle situations involving violent felons (which Ms. Rios wasn’t), domestic violence, and how to restrain suspects properly. Some even get sensitivity training on race, sexual orientation, and ethnicity. Where’s the training for interacting with the mentally ill (or mentally incompetent)? For de-escalating a situation instead of throwing gas on the fire? How about anger management before incidents like this one instead of after? Shouldn’t every law enforcement official be able to control or channel his or her anger and not take it out on the public?

Why the hell aren’t police officers required to wear body cameras – and have someone whose job it is to, oh, I don’t know, review them occasionally? Certainly when there’s been a complaint, but spot checks might also do some good. Why are civilians subject to increasing surveillance, while law enforcement personnel – who are also civilians, by the way – perform their jobs with minimal oversight.

And why is the Golden Rule suspended when the “others” have a mental disturbance? I’d really like to know.

___________________________________

I am cross-posting a slightly altered version of this essay to Et Cetera, etc., my general purpose blog (janetcobur.wordpress.com).

Sensation in the Brain

I know there is no physical sensation in the brain. It cannot feel pain. It cannot feel touch. Even in a car accident when the brain sloshes from side to side and bashes against one side of the skull and then the other, the brain sustains injuries, but feels nothing.

That notwithstanding, twice in my life I have felt physical sensations in my brain – or at least what felt like them.

The first time was at the dentist. I am terribly phobic about dentists, so even for routine procedures I need anti-anxiety medication. This was not a routine procedure.

The dentist was very understanding. He put me in the children’s treatment room, which had brightly colored designs of cactus, coyotes, cowboys, all painted on the walls in comforting colors and playful attitudes.

He also brought in a traveling anesthesiologist so that I could be unconscious during the procedure instead of terrified. My husband was there with me, of course, both to drive me and to give me moral support. (It also turned out that he had to give permission for one of my teeth to be removed in the middle of the procedure while I was unconscious.)

While the anesthesiologist was putting me under, my husband and the dentist were casually chatting. My husband made a remark and the dentist said, “Oh, she can’t hear us now. She’s already pretty far under and won’t remember a thing.”

“I bet she will,” my husband replied. The bet involved giving me a word to try to remember when I awoke. They selected the word green.

“You mean like the color of my pants?” I said. They were actually more like olive drab.

“Yes,” the dentist replied. “Green – the color.”

Just for the hell of it, as I was sinking into unconsciousness, I silently repeated to myself the word green in a slow and steady manner: green green green – until the drugs took me under.

An unknown time later I awoke. The dentist asked me, “Is there something you were supposed to remember?” I shook my head groggily.

As soon as I did, I felt an odd sensation in the back of my brain. It was like a little bubble rising up through liquid. When the bubble reached the surface of whatever the liquid was, it burst and released the word green. “Green?” I said uncertainly.

“See?” said my husband. “I told you she would remember.”

The other sensation in my brain came about six weeks after beginning a new psychotropic medication. I had gone through a long, miserable time of trying drug after drug after drug – tapering off on one and ramping up on the next – all with no effect, except unpleasant ones.

Dr. R. was ready to recommend electroshock for me. And after such a long time – I think it may have been two years – of trying and failing with different medications, I was ready to take the plunge. I admitted as much in one of my sessions.

“There’s one more thing I’d like to try before we do that,” said Dr R. “Here is a prescription for lamictal”.

“Okay,” I said. “How does it work?”

“We don’t really know,” he replied. This was our standard conversation whenever he prescribed a new drug. I was used to it, but I always asked anyway.

So I tried it. And felt the usual nothing for almost six weeks. Then one day I was in my husband’s study and we were talking, when I felt it.

It was the physical sensation in the back of my brain of a light switch being flipped. I thought I heard an internal click. When that switch flipped, suddenly something in my brain changed. It remembered how to think and to feel and to not be miserable.

“Oh!” I said. “I remember this. This is the way my brain is supposed to work.” Since then it has kept working – not continuously in the proper manner – but often enough that I consider the drug a success.

I know that in both of those cases nothing happened in my brain that caused a physical sensation. Both times, my brain gave me a metaphor for what was happening. In the dentist’s office the metaphor was a bubble rising to the surface to explain coming out from under sedation – and a little bit of self-hypnosis.

In the case of the drug, the metaphor was the cliche of flipping on a light switch. This time something had changed in my brain, something biochemical. I should not have been able to feel it, but according to my brain, I did.

It seems I have a clever brain. It gave me ways to understand what was happening in terms I could relate to. The fact that I know the brain can have no physical sensations did not matter to my brain.

Human brains are amazing – and sometimes even in a good way.

Sun or shade
feel or know
safe or strayed
stall or flow

Thought or whim
drought or rain
sink or swim
heart or brain

Stop or start
bound or free
light or dark
bipolar me

I have a lot of friends who are creative – writers, musicians, singers, woodworkers, knitters, and other craftspeople. I also have a lot of friends who have assorted mental or emotional disorders – depression, bipolar, PTSD, OCD, autism spectrum disorders, and probably many more that I don’t know about. In many cases, the two categories overlap.

Common wisdom holds that there is a link between creativity and madness. Look at Van Gogh, for example. People have spent years debating what specific disorder he may have had, but nearly everyone agrees that he had something. The question is, would he have been the great artist without the mental or emotional disorder? Or, perhaps, would he have been an even greater artist if his brain functioned in a more typical matter? Science so far has given us no answers.

Many creative people realize that their everyday functioning is impaired, but they are reluctant to seek treatment for it. They fear that tampering with their brain or thought processes will somehow inhibit their creativity – make them less than they were in some fundamental way. When you start tampering with brain chemistry, who knows what will happen?

It’s a valid concern.

Throughout my life, my brain has been all that I have, or nearly so. My intelligence and creativity were the things I was most proud of. How could I risk losing those simply because I was eternally miserable? The question seems absurd now.

Eventually I decided that I had plenty of brain cells to spare, and that if taking Prozac took away a few of them or lessened their ability, I could live with that. (Just in case, I took up pursuits that are supposed to strengthen the brain – math puzzles in addition to word puzzles, music in addition to writing. Not everything I tried was a success, but I hope they stretch my brain muscles.)

My experience with that first psychotropic med convinced me that Better Living Through Chemistry is not just a chemical company’s slogan. It turns out that – surprise, surprise – thinking more clearly and feeling more well-adjusted actually empower one’s creativity. My output changed from poems full of young adult angst to creative nonfiction, personal essays, and the occasional short story. I now make my living doing freelance writing and editing – an unstructured process that I couldn’t have made a go of before having my mood disorder treated. The ability to concentrate – to focus – is what enables me to sustain a creative effort.

So to all those people out there who wonder if they are sabotaging themselves and their creative impulses by seeking treatment, I say go for it! You have nothing to lose but your immobility. You have everything to gain – the ability to create, to express yourself and do it clearly, and the possibility to create something truly wonderful.

Sylvia Plath was a poetic genius. But she could have given so much more of her talent and vision to the world if she had not killed herself. Perhaps her poetry, had she been treated for her mood disorder, would not have been as searing and powerful. The point is, we will never know. Would she have become more ordinary, or more extraordinary? Dying young obviates the answer.

I believe – for me – that psychological treatment, appropriate medication, and more stable moods have expanded my creative process. And I try to prove it every week when I post in this and my other blog. Whether I succeed is for you to determine.

Have I lost a step? Maybe. But two forward and one back beats the hell out of one forward and two back.

I’ve been called a lot of things in my time, from schoolyard taunts (loony tunes, weirdo) to psychiatric labels (clinically depressed, bipolar 2). This used to bother me, but anymore, I don’t mind.

It’s not because of the old saying, “Sticks and sones can break my bones, but words will never hurt me. We all know that’s a damn filthy lie. I think it’s because I’ve developed a sense of humor about the “crazy” thing. If Al Yankovic can embrace “Weird,” I can embrace “squirrel-bait” or “wacko.” Even “bat-shit” or “bug-fuck” crazy don’t get me riled, though many find them offensive – and I can’t fault them for that. Everyone has a different level of tolerance and sense of what’s funny.

Take, for example, the time when my sister Kathy gave me a t-shirt that said, “Leave Me Alone. I’m Having a Crisis.” Her husband was dubious about the gift, thinking that I would be offended. I wasn’t. Kathy thought it was a hoot and so did I. (I just bought a t-short that says, “You Won’t Believe the Crazy Shit That Happens Next…” I’m going to wear it to my next psychotherapist appointment.)

I admit to being disconcerted when publicly confronted by a person who asks “Are you the one there’s something wrong with?” or “Do you have mental problems?” (In the first case, the elderly gentleman was thinking of my sister-in-law, who had MS, and in the second, the person recognized me from the psychiatrist’s waiting room.) But I’m not offended. Mostly I regret that I didn’t have snappy come-backs. (I thought of some great ones later.)

There are still some assumptions that do offend or at least irritate me. Here’s a link to an article that enumerates a few of the touchy subjects and unwelcome phrases.

10 Harmful Myths About People with Bipolar Disorder

That sums it up pretty well. I’m not going to walk into a fast food outlet and start shooting up the place. Mania is not fun. I’ve decided not to reproduce, but nobody can tell me that I shouldn’t.

Oh, and there’s one other thing. In the past, when I’ve mentioned my mood disorder to acquaintances or co-workers, they feel obliged to take my emotional temperature five times a day. “Are you okay? How are you feeling?” So I would add to the list: Not all people with bipolar disorder are rapid cycling.

So, am I crazy? Yes. But I don’t think that’s necessarily a bad thing. Most people use the word “crazy” to describe how they feel when they’re in love. And I’m good with that.

Not Waving but Drowning

Consider this a trigger warning. The third section is going to talk about some difficult stuff, although in mostly general terms.

Here’s a list of how I know how bad my mood disorder is at any given time. Being bipolar, I cycle in and out of these phases, along with periods of reasonably competent functioning and even, occasionally, contentment or even happiness.

There are basically three stages of increasing dysfunction.

Starting to Sink
My sense of humor takes a hike.
I need more alone time.
I take mega-naps.
I forget that music can help.
I snap at my husband.
Noises irritate me.
I can force myself to work.

Floundering
I don’t want to eat.
I turn off my phone.
I sleep up to 14 hours a day.
Attention span is one hour (or one average book chapter).
I can trick myself into working.

Going Under
Can’t sleep.
Can’t work.
Can’t read.
Attention span: 15 minutes max.
Thinking “Maybe the plane will crash and I won’t have to deal with this anymore.”
Regretting I flushed my stash of pills.
Urge to cut.

Fortunately, I am well-medicated enough that category 3 doesn’t happen nowadays, though I remember it clearly and am appalled. At that point, the only things I can do are keep seeing my doctors and taking my meds. And remember to thank my husband when I come out of it.

(The title of this post is from a poem by Stevie Smith. The last two lines are: I was much too far out all my life / And not waving but drowning.)

In Defense of the Armadillo

Let’s consider the armadillo. Better yet, let’s consider this brief video. Take note of the armadillo’s defense mechanisms, if you will.

I have always identified with the armadillo, for a variety of reasons. It is the symbol of Texas music, which I love. I have a purse shaped like an armadillo. I also have toy armadillos, crocheted armadillos, wooden, stone, cement, armadillo jewelry, you name it. My uncle and I have a catch-phrase: El armadillo amarillo de mi tía es sobre la mesa.

What does all this have to do with bipolar disorder? I’m glad you asked.

Most of all, I admire the armadillo for its defense mechanisms, which resemble some of mine. For those of you who skipped the video, here’s a recap.

The armadillo has armor (obviously). I have tried to construct a similar impervious shell. When I have been even partially successful, it has proved counterproductive. When you wall off feelings, you wall off the good ones too.

The armadillo rolls up in a tight ball. I isolate. This has also proved counterproductive. If sorrow shared is halved and joy shared is doubled, then isolation – well, you do the math.

The armadillo leaps vertically when threatened. My anxiety makes me jump and release fight-or-flight hormones. This defense is also counterproductive, both for the armadillo and for me. One of the armadillo’s main predators is the automobile; the armadillo jumps straight up to bumper height. I waste energy on panicky behaviors even when I’m not threatened.

The armadillo has a low body temperature and is therefore useful for research on leprosy. This is not a defense mechanism, but it is a Fun Fact to Know and Tell. I have never had leprosy.

All things considered, the armadillo is not a good role model for a person (me) with bipolar disorder. But I like them anyway. They remind me that I need to check whether my defenses are doing me harm rather than good.

Plus, with my armadillo handbag I get lots of practice in the social skill of making light conversation strangers – and even children!

Erma

Erma

The Universe vs. Me

I set out Friday to drive from Ohio to Michigan – about a 3-4 hour drive, depending on traffic.

Five miles out, the Saturn stopped working. Called husband and AAA. Towed to local mechanic. Probably bad clutch.

So we switched my luggage to my husband’s Blazer. About 30-40 miles away from home, car stopped working. Called cell phone emergency road service. Towed to nearest garage. No idea what’s wrong with it, or if the random mechanic is any good.

So my husband picked me up and put my luggage in the back of his ’84 pickup. Halfway home, the radiator blew. I had a meltdown. Called AAA. Towed home. Had pizza delivered.

That’s it on the vehicles. Not even a bicycle left.

Also, there is No Money, except maybe enough to pay the mortgage and health insurance for February.

I have my Abilify, but it hasn’t kicked in yet.

A couple of friends suggested that this was the universe’s way of telling me not to go to Michigan, thereby avoiding something even more heinous that would happen there.

My questions regarding this theory are:

Did the universe really want us both stranded at home, with no way to get to the store or pharmacy, or for that matter, to the other cars?

Did the universe really want Dan to miss more work and lose more pay, especially since he lost nearly a month’s pay going to stay with his mother while she recovered from surgery?

Did the universe really want us to invest yet more money in the cars, when we just bought two of them new wheel bearings?

My answer: No.

The universe is not conspiring against us. This is not divine retribution for a life of sin. This is not bad karma because I was a cannibalistic serial killer in a past life. This was not caused by some higher power that knew I shouldn’t go to Michigan because the place where I was going to stay would spontaneously burst into flames in the middle of the night.

But sometimes it sure feels like it.

I believe there is no larger “because.” Just the fact that we have crappy vehicles and can’t afford the upkeep.

I have no idea what to do, except go to bed, finish having my meltdown, and stay there till the Abilify revs up.