Bipolar 2 From Inside and Out

Posts tagged ‘bipolar disorder’

Mini-Meltdowns and Many Meltdowns

When my brain broke back in 2001 or so, I thought it was the first time that had happened. Later, on reflection, it turned out that wasn’t so.

The 21st-century breakdown was certainly the most dramatic. Although I had just quit working in an office to start a freelance career, I found myself unable to work after a few months.

I had become unable to work in the office because of mounting difficulties that I now realize were warning signs of the impending breakdown: inability to concentrate, increased anxiety (the feeling that an angry badger was about to claw its way out of my stomach), lessened ability to interact with coworkers, sudden flares of temper, turning people away with unintendedly cutting remarks and sarcasm, isolating, inappropriate affect, catastrophizing – you name it, I had it.

What was causing all these symptoms? My bipolar disorder, obviously. But I’ve had that for years. What was pushing me over the edge this time? I had trouble at work. My boss left and, when I “came out” to my new boss as depressed (which is what I was diagnosed with at the time), she reacted with wariness and incomprehension. She gave me the first bad review I ever had at that job.

My mother’s health was deteriorating seriously, too, about then. I lost time at work taking her to various appointments and I had to have “the talk” with her about how much longer she could live alone. Eventually I took over her finances – and by then I was scarcely handling my own.

I experienced a lift when I quit my job and began freelancing. Hypomania? You bet! My new flexibility allowed me to take better care of my mother, and the assignments kept coming in.

Then everything came crashing down. I screwed up my finances and my mother’s. She began having worse falls and injuries, hospital stays and drug reactions, even hallucinations which scared the hell out of me. I emotionally judo-ed my sister to come up and help, then fought with and resented her, and had to take care of parts of her life as well.

Those and other difficulties on top of my mental disorder added up to a non-functioning me. I dumped all the chores and coping onto my husband, which was a rotten thing to do, fought with him, sobbed for no discernible reason, became unable to work, or care, or do much of anything except think up at least three different ways (and reasons) to kill myself. Fortunately, I was too immobilized to try any of them.

I’ve written before about the things that helped me get back to some kind of functioning – a proper diagnosis, the right meds, time without work (as we gutted our retirement savings), lots of psychotherapy, and my wonderful, patient, ever-helpful, devoted husband.

But now, looking back, I can see that it had happened before, though not so dramatically and completely. In childhood, in my teens, in college – at every stage of my life I had at least one breakdown, often triggered by the circumstances of my life, but fueled and stoked by my mental illness. In every one, my ability to function deteriorated a little more.

The first one that I remember clearly was when I was around 12. My best friend and I were in charge of a birthday party for her younger sister and some friends. This was the old-fashioned kind of party that everyone in the neighborhood had then: cake and ice cream, party games, presents, and not much else. It happened during pin-the-tail-on-the-donkey. I was blindfolded – literally – and my friend kicked me in the ass – again, literally. In front of all those younger children.

I ran home sobbing. And I curled up into a fetal ball and didn’t quit for at least three days. Non-functioning, non-responsive, non-everything. What finally brought me out of it was seeing my mother’s pain at this inexplicable (to her) meltdown.

I had a mini-meltdown in my freshman year of college, which involved sitting in my nightgown in the hallway, staring for hours at a richly detailed poster of a fantasy realm. (I managed to frighten an intruder by arising, ghost-like, in my pale yellow shroud as he entered the suite.)

This one was triggered by my realization that I had probably chosen the wrong major and that there were no job prospects ahead for me. (It turns out I was wrong about that. Maybe I should have stuck with it, but my next choice turned out pretty well.) I took a year off college and took a job as a cashier in a restaurant, where I spent a lot of time crying into the roller towel and being told I should smile more. This convinced me that going back to college, with a new major (and even fewer job prospects), was the right thing to do.

The next meltdown was major. I had finished college, endured a year-long train wreck of a relationship, and lost a job as an assistant restaurant manager (I hadn’t fully learned that lesson yet). I got unemployment, which meant I lay around the apartment for most of the week (except for making half-hearted attempts at job hunting).

One notable symptom of this breakdown was my near-complete immobility. One errand in a day – say, going to the post office for stamps – made it a productive one for me. I had maybe three of those a month, with one being the obligatory visit to the unemployment office – a supremely depressing place to be depressed.

I had some truly irrational thinking that time, too. I thought I could cheer myself up by watching light, fluffy sitcoms on TV. But as I lay there on the couch, I found myself crying with every upbeat, cheery theme song that came with them. Laverne and Shirley making their dreams come true. One Day at a Time, which advised me to get up on my feet because somewhere there was music playing. And, oh, Mary Tyler Moore. Love is all around, my ass.

After that, it was a long, slow slide to my major breakdown. It wasn’t unrelieved misery. I got married. I got a master’s degree and a job in publishing. We acquired a house and cats. We traveled. But the Big One was waiting for me.

Nowadays, I still have mini-meltdowns, but they usually last a maximum of three days, rather than weeks, months, or even years. They still tend to be triggered by stressful life events, especially financial ones. But when I get one, I know I’ll be coming out of it soon. And that’s a wonderful feeling buried in all the misery.

 

 

Sense of Self

The air is still and blankets all my sense.
I’m muffled, muzzled in the sheltering dark
But dare not hope for fire, with bright, intense,
loud flames that rend the silence with a spark.

I breathe or not. It’s sometimes hard to tell
When swathed in dimness. Stifling, musty scent
Fills up my nostrils and my brain as well –
Which cannot will the veil be shredded, rent

to save from suffocation. How shall I
Withstand this cycle till the day appears
And breezes blow the dust away from my
Stopped ears and eyes and lungs, plugged full with fears?

Pull off the cover and let free the soul.
Take broken breath and heal it into whole.

Abilify: The Next Chapter

I’ve been taking Abilify as an add-on to my other psychotropics for about six months now, and I have some pieces of good news to share.

Good news #1: The generic (aripiprazole) is now available! There was a slight delay between the time the FDA gave approval for the generic (April) and the time it went on sale. But now it has arrived in drugstores. (I understand that the same company makes both the brand name and the generic, which strikes me as goofy, but then what do I know about drug marketing?)

Good news #2: Between my insurance and my pharmacy, I now have to pay only $15/month for the generic. The brand-name Abilify was $800 without insurance and $125 with. My insurance is not cheap, though it is still less than the cost of brand-name Abilify. When you add in all my other prescriptions and doctor visits and tests and such – plus all my husband’s drugs and other medical expenses, the insurance suddenly doesn’t seem so pricey. (I got this insurance through the Affordable Care Act, and I hope the Supreme Court doesn’t screw it up for me.)

Good news #3: Despite my tiny dosage (2 mg.) I have noticed significant effects. After six months on the drug, I have more energy, better focus and concentration, and fewer down/useless days (unless I overdo and run out of spoons). (See http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/ if you don’t know what I mean by that.)

I’ve been doing major housecleaning/sorting, going out – actually outside the house – to run errands other than my shrink appointments, and I even went to a party – a reunion of people I used to work with. I wore my new skirt, navigated the social milieu successfully, and stayed an hour and a half. (The next day was one of my no-spoons days, though.)

This is only the third time in my life that I’ve noticed a significant effect from taking a new prescription. The first was Prozac (fluoxetine), which felt like looking at a color television after years of black-and-white. With static. Showing only commercials. The second was Lamictal (lamotrigine), which felt like a switch flipping and turning on my ability to think rationally. And now there’s Abilify.

Whatever side effects I may have, I’m willing to live with. (Unless I get the tardive dyskinesia. That would be a deal-breaker.) This feels like real living and I’m happy about it. I don’t think this is hypomania, either. I think I’m supposed to feel this way. I’m going to run with it.

Of course this isn’t the end of bipolar disorder for me, or the end of this blog. I still have plenty to say about my experiences with bipolar depression, mental health in general, and particularly mental health in the media and society.

Sorry if I sound sappy, but it’s good to be alive and functioning!

Me and My Brain: A Story of Love and Dysfunction

As they say, of all the things I’ve lost, I miss my mind the most. Or anyway, a properly functioning brain.

I love my brain, despite all the trouble it’s given me. For many years I thought it was the only measure of my worth, the only thing about me that made me special, the only thing that I could truly rely on.

I reveled in learning, in thinking, in reading, in questioning, in contemplating, in discovering. My body was not dependable; my brain was.

Little did I know the biochemical pitfalls that were waiting for me. Little did I know that my brain was ill. Disordered. Unbalanced. At the very least, uncooperative.

For instance, my brain decided other people were always pointing and laughing at me. Sometimes they were, of course, but that paranoia became my baseline assumption. (Shrinks call that “ideas of reference.” I just called it life.)

My brain played back for me every socially awkward or embarrassing thing I ever did, either randomly or at the worst possible moments.

My brain made me cry at the stupidest times – at an upbeat sitcom theme song, when someone mentioned foreign travel, when opening boxes from the garage, when thinking about my college years or birthday parties. Whenever I was confronted with how damaged I am.

My brain had irrational thoughts. Bad thoughts. Cutting. Worse. You know what I mean.

Eventually my brain refused to let me live any kind of a normal life – go out, talk to people, care for my house or my pets or myself, or even read, once the greatest joy of my life, the thing my brain and I best liked to do together.

But my brain also worked just well enough to send me looking for the help I needed. I’ve gotten back parts of who I was and what my mind was. And for that, I’m grateful. Even with it disorderly and uncooperative, it’s still the best part of me.

Crazy Pills

Once upon a time in the land of Jublia lived a kind and powerful queen named Lunesta. One day the dragon Cialis and the evil sorceress Humira attacked the castle, but Jublia was saved by Lunesta and her faithful dog Boniva.

And the peasants rejoiced.

Honestly! The names that pharmaceutical companies give their drugs these days! It’s bad enough that the drugs have a list of side effects longer than the symptoms they’re supposed to cure. Not to mention the drugs where the side effects are the same symptoms they are supposed to cure, or the ones where the side effects are considerably worse than the condition they’re being prescribed for.

My favorite has always been, may cause death (excuse me, “increases risk of death”). That has to be the ultimate side effect. You’ll be dead, but your toenails will look great for the funeral. Leave instructions that include sandals.

I made a list of all the drugs that I’ve been prescribed in my pursuit of something resembling sanity. It’s quite long. I’ve tried almost every class of drugs there is – tricyclics, atypical, SSRIs, anti-anxiety drugs, and hypnotics – in various combinations and assorted doses, and even for off-label uses. (TIL that Abilify can be classed as an “atypical atypical,” which makes me feel a certain kinship with it.)

The only ones I know I haven’t taken are lithium and the MAOI inhibitors. which is a good thing, because I do so like red wine and cheese.

Here’s the list, as nearly as I can remember:
Abilify
buproprion
Desyrel
Effexor
Inderal
Lamictal
Lexapro
desipramine
Prozac
Sinequan
Tofranil
Topamax
Wellbutrin
Zoloft
Ativan
BuSpar
Ambien
Valium

I may have missed a few, what with the brand names and generics, the decades over which all this occurred, the memory deficits, and the ones I took for only a month or two before the side effects became too heinous.

The side effects I’ve encountered along the way include:
dry mouth
memory loss
nightmares
agitation
lethargy
weight gain

Not all at the same time, of course, thank heavens. Right now I seem to have dry mouth, residual memory loss, and weight gain. Given the alternatives, I can live with these. More or less. (That is to say, I have to.) The memories, I understand, are not coming back. I just hope I don’t lose any more, especially ones of the hot-n-juicy variety.

The side effects I haven’t suffered include:
death (obviously)
fatal skin rash (Stevens-Johnson Syndrome, which I wrote bout a while back: https://bipolarjan.wordpress.com/2014/03/07/saving-face-or…-die-from-that/)
tardive dyskinesia

I hope the drug regimen has settled down for a while. I must admit that I don’t follow the instructions to the letter. They’re simply too overwhelming: Take this one on a full stomach, this on an empty stomach, another with milk or never with grapefruit juice; something else at bedtime or half an hour before bedtime, or with the noon meal. And don’t forget the non-psychotropics (cholesterol, blood pressure, etc.), or the vitamin, fiber, and calcium pills my GP prescribes or recommends. Well, and the OTC Benadryl, Tylenol, and Immodium, as needed.

(Yes, I did once look up all my meds in a drug interaction database. Every one interacts with every other one. Maybe that’s one reason mixing an effective cocktail has been such a crapshoot.)

I knew a woman who took so many different drugs for her variety of illnesses and conditions that she had a kitchen timer that she continually set and reset every time she had to take a dose of something. Her meds were more precise than mine, though. If she screwed it up, the consequences would be dire. Her side effects did include death.

The regimen I’ve settled on is this: one set of pills when I wake up (whenever that is) and one set at 11:00 p.m. I eat whenever I’m hungry, and I don’t like grapefruit juice anyway. Anything more complicated than that I can’t be sure of remembering. It’s still complex, what with the only-in-the-morning pills, the only-at-night pills, and the take-twice-a-day things.

I have little tricks to help me remember the routine – daytime-only pills in a plastic bag, nighttime-only on the lamp base, twice a day on the tea cart. Turn the vitamin bottle upside down after taking morning pills. I suppose I should get one of those daily pill caddy things, but they never seem to have enough, or big enough, compartments.

Is this routine crazy? You should see me without the pills.

Well, no, you shouldn’t.

Haiku Cycle

Break time here at the
synaptic schoolyard. You can
ride the swings all day.

Day lights sights you see,
saw before and that may be
In sight tomorrow.

Tomorrow times out
Wheels round and ticks away the
Body clock of mind.

Mind and brain play tag
I’m it as ducks and geese still
Wait while we circle.

Circle back and start
again, or stop before my
feelings crack and break.

Note: Poetry is something I used to do, years ago. After my Great Meltdown, my therapist suggested that I view it as an opportunity to rebuild myself, discarding things that were no longer useful and reclaiming things I want in my life.

So I decided to try poetry again. I used to write mostly free verse, but I decided to start with more structured forms because of needing some structure in my life now.

I have started with a cycle of haikus. They do not have to be read in order. Picture them as a ring. Pick any one as the starting point.

If you like this, and as inspiration strikes, I may attempt some more poetry for this blog. Is there a sonnet in our future? Dare I say it – a villanelle? Someday a sestina? We’ll see.

The Hypomanic Blogger

When I thought I had unipolar depression, I used to wish I were bipolar, on the theory that I could get a lot more done. (I later found that not to be true, as I’m sure many of you can attest.)

I had a lot more experience with depression than with mania. My bipolar disorder is Type 2, which means I get hypomania instead of full-blown mania. And most of the time the hypomania comes out sideways as anxiety and/or irritability.

(Don’t ask me why I get the full-monty-style depression and only a smidge of hypomania. I don’t know. If my shrink does, he hasn’t told me.)

Looking back, I can remember only one hypomanic episode before my new diagnosis made me more aware of the possibility. I was working at writing and editing – the same things I do now, only then I could do it in an office full-time instead of at home and freelance. A woman came to me, asking about how she could become a writer for magazines.

I positively burbled and babbled. I gave her all sorts of advice on query letters and Writer’s Market and niche publications and getting bylines and clips. I told her about how I started, writing for I Love Cats magazine and editing my martial arts club’s journal, and working my way up. (Incidentally, I am, as far as I know, the only person ever to have articles published in both Black Belt and Catechist magazines.)

The woman went away inspired, she said, though I never heard how she made out.

Now I can more easily recognize hypomania when it hits. I still get the anxious and irritable sort, but now I get more of the buzzy kind. And even though it makes me twitchy, I can make use of it.

It was in a bout of hypomania that I decided to start this blog (and my other, general-purpose one – janetcobur.wordpress.com).
It’s hypomania that has kept me going for over a year so far. Though I can now, thanks to medication, force myself to work while in the dysthymic stage or the “meh” stage, if I hit a spell of hypomania, I can use it to write and edit. Right now I’m using a hypomanic swing to stockpile ideas and first drafts against the inevitable downswing.

Of course, the ramblings that go with hypomania are not worth posting (or submitting to a client) the way they hit the screen. When I’m less jazzed, but not in the Pit of Despair, I can re-read, edit, and improve. It’s a fine balance, a tightrope I’m learning to walk. And it takes both therapy and medication to maintain.

In essence, the not-properly-treated bipolar 2 made my work go downhill (even as I did), until I was unable to work at all. Now that my diagnosis and my meds are more on track, so am I. I may not be well, but I certainly am better. I can live with what I’ve got, and even re-learn how to use some of the abilities I lost in my most recent, largest, most devastating crash.

I wouldn’t recommend mania or even hypomania to anyone, but as long as I’ve got it, I might as well make it be good for something.

Depression Hurts

You’ve probably seen those commercials where the announcer and the actress playing the part of a depressed person try to answer the question: Does depression hurt?

Once when we saw this commercial, my mother turned to me and asked whether my depression hurt me physically.

I had to say yes. I don’t think I ever took Cymbalta, the medication that the commercial was touting, but I was clear on the fact that physical pain is involved along with the psychological suffering of depression.

My head and eyes hurt from all the crying spells. My back hurt from lying in bed all day. I had painful knotted muscles from the anxiety that went with the depression. I had intestinal cramps because my overactive nerves led to irritable bowel syndrome. I had headaches and eye strain from the over sensitivity to light and noise. And I had the general flu-like malaise that is practically the hallmark of depression. You know the one. Every bone and muscle aches, but you can’t think why.

Were these aches and pains psychogenic? Undoubtedly some of them were. But others, like the irritable bowel, were all too demonstrably physical phenomena.

The mind and body and soul are inextricably intertwined. We know this to be true. Depression affects them all.

And it does hurt.

Mr. Fix-It

Him: I just groomed the cat. I used a cat-a-comb.

Me: *total silence*

Him: Hey, honey! I just groomed the cat – with a cat-a-comb!

Me: *more silence*

I was depressed, and he was trying to cheer me up. Using exactly the same joke that had gotten no response only seconds before. I don’t know why he thought it would work better the second time.

Many men have the instinct that, when confronted with a problem, they will try to solve it. When something is broken, they will try to fix.

I wasn’t broken, exactly, but I was deep in the Pit of Despair, aka the lower mood swing of my bipolar disorder. At that stage I am immobilized, uncommunicative, and utterly humorless.

The fact that Dan had worked in hospitals and psychiatric facilities was actually a bad thing, despite what you might expect. He had run laughter therapy groups, he knew the jargon, and he sincerely wanted to be helpful.

But he didn’t know – viscerally – what depression was like. How it felt in your body and mind and soul, how it damped down your personality and blunted your reactions and removed your ability to view life as anything other than miserable. Certainly not funny.

Later Dan learned all this when he experienced his own bout of clinical depression and became another one of my Prozac pals. But until then, he would occasionally come shrinking at me, until I had to tell him to stop. I could accept a hug, but not a joke or a “remedy.”

But all that was early in our relationship and before I had begun to heal or even get proper treatment. And I literally would not have made it this far without Dan. I need him and likely always will.

When it’s Pit of Despair time again (which it sometimes still is), he checks on me to see if I need that hug, or some food, or a kind word, or just to be left alone. When I am better, he still does the cooking and shopping, and reminds me to eat regular meals and take showers and tells me I smell nice after I do. Sometimes he can coax me out of bed with a tape of The Mikado or out of the house with lunch at Frisch’s. If I’m too nervous to drive to my appointments, he takes me. When I’m together enough to work, he keeps the house quiet and fixes food when I need a break and validates me for being able to bring in money, even when it’s difficult.

But he can’t fix me. And now he knows that.

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.