The Guilty Demeanor

Emerging from the thick clouds of depression always entails some devestating speed bumps that threaten to catapult you right back into the black hole from whence ye came. (yes, i'm from 1500 apparently)

Here I am, staring off into space with a sleeping cat by my side contemplating how I've spent my summer—in a depressive haze, sleeping, eating and watching TV. I could have gotten a job and earned thousands of dollars. I could have written 50 pages of my thesis, if not the entire damn thing. I could have worked out at the gym every single day for two hours. I could have done so much more than I did.

But I didn't.

And now I feel so guilty. I've squandered away more precious time in my life in complete misery. Why?

Why wasn't I more productive? Why couldn't I put my nose to the grindstone in spite of myself? Why wasn't my house spotless, my dog svelte, my fiance well fed?

How could I have allowed myself to waste so much time when I have so many things to do?

Predictably, this thinking is not conducive to personal happiness. I just feel so horrible about it.

And what do I do when I feel horrible? Stare off into space. Not accomplish my goals. Pitch myself back into a depression.

It's like a stupid cycle that is harder than you'd think to escape. To feel better, I need to do more. I'm not doing a whole lot, so I have no motivation to change and actually do something.

I am SO FRUSTRATED.

Ugh!

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Insane in the Brain

I have an appointment with a neurologist this morning to investigate the reason for my prominent headaches. Like so many ill people, my sickness will manifest itself in numerous ways, including hideous digestive issues that accompany anxiety, headaches, shaking hands and feet and muscle tension. I've been to more doctors than most old people.

Anyway, did you know that bipolar people's brains actually look different than normal brains?

Check out this site for the basics of neuroimaging and the changes in the brain that occur with bipolar disorder. This site has actual images of the changes that occur in the brain during mania and depression.

The best site I've been able to find so far has a great example of the changes that occur in bipolar disorder.

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The Elusive Normal

I suppose that being frustrated and impatient is an inherent part of being sick. It's the I-want-to-get-better-NOW syndrome. Having a mental illness or a brain disorder as certain activists would say is additionally challenging because recovery entails the endless pursuit of normality.

Yet no doctor I've talked to can tell me what exactly this normalcy involves. Some say that my moods will be more consistent. Others posit that I'll be able to live free of the fear of upcoming panic attacks or depressive episodes.

Of course, until I was 19, I thought that my thoughts and my moods were just like everyone else's. We all feel sad, we all feel scared, we all feel happy. My cultural acumen taught me that all teenage girls feel unhappy, ugly and moody. Being a teen is supposed to be hard. If you don't struggle, you're not normal.

No one ever told me what normal felt like and so, to me, I was normal. At what point do you learn that the way you think and feel isn't how everyone else relates? One of my roommates my sophomore year of college told me about her childhood—a time she spent living alone with her paranoid schizophrenic mother. This girl believed her mother when she was told that people at Kmart poisoned candy, that her friends actually hated her, that she shouldn't wear shoes because the manufacturers put chips in them to track people's movements. Poor kid believed her mom until she slowly started to realize that the catastrophic situations her mom saw in everyday objects never happened. After dissecting a show and finding no chip in it, her view of her mom shifted. This cognitive paradigm wasn't accurate.

When I was younger, no one said that a person could be too happy or too productive. No one mentioned that feeling down for months at a time was not just part of being a teen. Unfortunately, nobody noticed that I wasn't normal.

It's hard for me not to view my label as an identity, like alcholics are always alcoholics. Instead of saying, hi I'm George, an alcoholic, I should say, hey I'm Becky and I'm entirely bipolar. In fact, if you hang around me long enough, you'll see me so lethargic that I don't get out of bed, and so energetic that I barely sleep at all. Jeckyl and Hyde, perhaps.

I've found myself identifying with other crazy people on the news. There was a story about a woman in a manic episode who believed that the police chasing her down a San Diego freeway were trying to kill her. Not surprisingly, she was speeding away from them like a social conservative at a lesbian mothers' meeting. She hit a car with four people in it, killing two of them.

While most people were outraged that this "crazy" woman was out on the streets, I was furious that the city of San Diego and the state of CA had failed to provide her with adequate care that could have prevented this tragedy. Now, through no fault of her own, she has to live with the fact that during a psychotic break which could have been prevented with the right medication, she killed two people. With the right support, she might have been at work instead of speeding down a freeway.

Screw normal! I wouldn't want to be like that—whatever the hell that is—anyway.

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The Unbearable in the Ordinary

Today has been incredibly challenging for me. Everything, from the click of these keys under my fingers to the way my hair blows under the breeze of the fan, has been driving me NUTS! The most mundane, pedestrian events are like nails on a chalkboard. It's been all beast and no beauty.

For example, my fiance, my parents and I were chatting about our lives and our plans. I couldn't stop noticing that my mom was playing with the fringe of her placemat and everytime the edge of the placemat left the table, I felt this stab of irritation vibrate through the my core. Even writing about it now makes me want to run around the house screaming and breaking things, just to expel this quirky energy.

I'm so happy that I don't have children right now because I shudder to think of how my lack of patience would impact them. Hmmm...that's a great way to think about my day. If we all start everyday with a certain amount of patience—picture a glass of water—I started today with a paltry collection of droplets instead of the requisite glass, full to the brim. I started today with so little patience that within 20 minutes of waking up, my tank was on empty.

Stupid things I wouldn't normally notice are obscene to me. The fact that my animals are shedding makes me want to throw a tantrum. The way my air conditioner hums when it runs has me pulling out my hair. A glitch in my diet has me twisted up inside.

If I feel this way tomorrow, I'm going to the gym to exhaust myself with exercise because I think that my exhaustion will balance this irritation. This is the downside of the upswing, the black cloud on the silver lining, the mole on Brad Pitt's bum.

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The Sore Shoulder

Ah, the charm of another tension headache is upon me. Forgive me if I don't post yet another brilliant train of thought here.

All of you out there suffering like me, know that you are loved. You are strong and you are beautiful.

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The Upswing

I have to confess that my favorite part of being bipolar is the upswing. After being depressed for months, I've finally started to see the roses instead of the thorns. My depression isn't gone yet, but I can feel it lifting.

Being bipolar is like living in a thunderstorm. The onset of depression is like watching a thunderstorm roll in over the horizon. It starts with clouds, and builds with an increasing intensity until the sun is completely obscured behind a thick layer of darkness. Then the rain starts and the storm increases in violence and magnitude.

After the worst of it, the rain stops but the sky is still dark and the aura of the thunderstorm hangs in the air like thick humidity. That's where I am right now. The impact of the rain is still palpable; the trees are still shedding fat droplets and there is no guarantee that the storm is over.

I think it is though. The upswing is divine. The clouds start clearing and the sunshine illuminates everything creating this beauty that is almost inexpressible. The droplets of rain sparkle like thousands of diamonds in the most mundane places, making everything seem more beautiful. Your thoughts are drawn to the miracle of creation and your faith is restored in the most reassuring and comforting way.

My faith always reasserts itself on the upswing. Next, I start becoming productive again. Obligations that I've neglected in my depression are taken care of. I become almost normal. I shower daily, I exercise, I eat my vegetables. I clean, pay my bills, train the dog, and write my thesis.

It's as if all of the mental energy I've been storing in the storm is unleashed. I remember hearing a story from a horseback rider about how horses need to be put out to pasture after a rain because they need to run around and burn off some of the energy they've saved from being cooped up for so long. I feel like that. I've in the blocks and I have an energy running through me that needs to be let out.

I'm entering what medical dorks would call hypomania. Hypomania is the best. It's like always being inspired. I feel creative and sexy and powerful. I'm like a work of art, with gentle curves that radiate a sensuality and allure that men should find irresistable. If my fiance wasn't around, I would be a sculptor of one night stands and hot but fleeting sex.

The tragedy of the upswing is the knowledge that what goes up must come down. This inspiration is temporary. The storm will return and at first, it will be unbearable because I've known such profound beauty.

But for now, I'm going to appreciate my state of mind. I'm going to create, to write, to dream, to make love, to reestablish friendships, to cuddle, to flirt, to accomplish. I'm going to dream impossible dreams while I still can. I'm going to experience this joy to its fullest extent before it flutters away like the last autumn leaf to fall.

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The Childhood Dilemma

After awhile, it's relatively clear the no one has a normal childhood or a normal family. Parents yell and fight, kids get spanked. Sometimes there's mentall illness or substance abuse tossed in for good measure. Some kids are generally ignored while others are built up so high that reality comes crashing down when they leave the nest.

But for kids with mental illness, life is a bit different. For the longest time, psychiatrists believed that the earliest onset of manic depression occured in adolescence, but current research suggests that kids, infants even, can exhibit the bipolar symptoms. Naturally, bipolar kids exhibit "atypical" symptoms; in other words, kids don't reflect the same symptoms as adult men. They can be anxious to the point of paranoia, aggressive, hypersexual, distracted, irritable. They have nightmares, suicidal thoughts and separation issues.

Bipolar kids are often diagnosed with ADHD and given ritalin, which often prompts a manic cycle. The violent mood swings, particularly in children, can gain momentum and have been shown to cause scarring in the brain. Researchers of bipolar children have demonstrated that there are fewer neurons in certain parts of the brain, which may explain why the brain would flood itself with certain neurochemicals to transmit messages.

When I was a little kid, I remember having night terrors. Most kids have nightmares, but night terrors are like nightmares times ten. It's almost like you can't tell the difference between your dreams and your waking life, like these horrible things are actually happening in real life. I remember waking up one night sobbing because I was certain that my entire family was dead. I still shudder when I think about them...like I'm residually scared or something. I was a sleepwalker too. Nothing is more disorienting than going to sleep in your bedroom upstairs and waking up behind a chair in the family room.

Anyway.

For more information, check out this news story for a glimpse into the world of a family with a bipolar kid. The NPR interviews here are particularly poignant and informative.

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The "Trendy" Diagnosis

I'm sure that my fellow bipolar sufferers will be overjoyed to learn that our diagnosis is trendy according to the pillar of culture known as Cosmopolitan magazine. Apparently, being depressed is on its way out.

I'm not some kind of cultural stickler, but I have to confess that I'm a bit peeved at Cosmo because a reader who has just been diagnosed bipolar will have to wonder: "is my doc just calling me bipolar because that's the latest medical trend?" Thankfully, I don't have to ask that question because I was diagnosed bipolar quite awhile ago, but I sympathize with other patients who might question their doc's judgement because of some stupid editor at a silly magazine.

Editors probably don't think about the crucial role that trust plays in the relationship between a psychiatrist and their patient. I need to be able to know for certain that my doctor is qualified, that he's doing his absolute best to ensure that my medications are correct because I know that if the doc f*cks up, I'm the one who's going to suffer. A good doctor asks all the embarassing questions. He want to know how you behaved as a child, how crazy the rest of you family is and how your medication is affecting your sex life. Undermining that trust is serious business, business that's led me to consciously switch shrinks three times.

When a doc decides to take you off a medication thereby pitching you into months of withdrawal and the accompanying misery that entails, somehow the notion that your suffering is trendy loses its appeal. When your in credit card debt up to your ears and going through your fourth divorce because you're a bit impulsive in your manic phase, your fabulous pants and trendy diagnosis doesn't soothe as well as it might.

Personally, I hypothesize that the reason bipolar diagnoses are on the rise has to do more with the fact that doctors are looking for the symptoms more often. It also seems feasible that people who are situationally depressed, or suffer from a touch of depression might receive too much medication. After all, if you take a normal brain and add some uppers, it's not impossible for the most mentally sound person to tip into mania. Those folk would probably benefit from more exercise, which is as effective as medication in mildly depressed patients.

Some people are looking for easy solutions to their problems. To me, there's a huge difference between being lazy and being genuinely ill; I think that reality is being ignored by people desperate for a quick fix. Let me tell you, if hopping on an exercise machine for 30 minutes a day would cure me, I'd be on that damn machine every day.

It's like the difference between my mom and me. We workout together twice a week and we each work out separately when we aren't together. We were both a little down before we started exercising together and at my father's prodding, we hauled our butts to the gym. After a smattering of weeks, she's feeling happier and more energetic. I'm feeling the same way I felt before we started going, except I have headaches more frequently now so I have a bit less patience for life's little irritations.

So the moral of the story? Cosmo is dumb and if you feel a bit blue, go to the gym before you start popping pills. Believe me, the withdrawal just ain't worth it.

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The Hunt for a Diagnosis

A recent study by the American Psychiatric Association estimates that anywhere from 15 to 40 percent of patients with bipolar disorder are misdiagnosed. For some, it can take years before their psychiatrist finally fits the pieces together.

My own journey through the mental health system supports the APA's conclusions. My first diagnosis was delivered by the Student Counseling Center at USC. Their doctor told me I had an anxiety disorder, not otherwise specified. The translation? He couldn't tell me if I had a panic disorder, generalized anxiety disorder, social anxiety disorder or another, less common type of anxiety problem.

After three months, my counseling quota was exhausted and I was forced to hunt for another shrink. I landed on the office doorstep of Dr. Saul Niedorf. Dr. Niedorf was and is a compassionate doctor who cares very much about his patients and their lives. He opined that he preferred not to attach labels to his patients because they only served to limit his perceptions of what was wrong. Eventually, I bothered him often enough that he decided I might be cyclothymic. In layman's terms, that means he suspected that I had a touch of bipolar disorder--the most mild derivation. A deep, unrelenting depression forced him to hypothesize that I might be seasonal affective, meaning that the change in light prompts a depressive response. A mismanaged change of medications prompted a withdrawal so ugly and painful that despite my fondness for Dr. Niedorf, I decided to switch doctors after my departure from LA.

This decision shoved me through the money-saving doors of the ASU Student Health Center, where I met with Dr. Foran. She serves as the only psychiatrist for a student body of 60,000. She attempted to provide treatment, but seeing as how my illness is severe enough to require office visits more than every three months, I was prompted to again switch psychiatrists.

My newest psychiatrist is named Dr. Greenman. I'm not entirely sure what to make of him because we've only seen each other once. My gut reaction is that he's very qualified, though I've felt that way about all of my previous shrinks. I suppose I try to give every doctor the benefit of the doubt until they prove to me that they are unworthy of the opportunity to manipulate my brain chemistry. To me, "oops" is not a viable option.

Dr. Greenman provided me with the diagnosis of bipolar II--go here for more information on bipolar disorder. I suppose if two out of four psychiatrists agree, it must be true.

I suppose the part of my journey through the mental health system that angers me the most falls into the very first psychiatrist that I ever saw. I was having severe problems at home with my parents and we were getting to the point where we couldn't even talk to each other without fighting. My father started berating me about something and I was simply fed up with being blamed for familial problems that I started to smile at the horror of it all. My dad decided that I needed to see and shrink because of this response. I think he was done dealing with screaming fights between me and my mom. So, into the psychiatrist's office I went.

She didn't perform any kind of diagnostic tests, but merely tried to figure out why my mom and I were at each other's throats. She missed the fact that I was miserably depressed. She missed the fact that my mom was miserably depressed, that her SAD was in a severe stage, that part of our problem was that my mom was blaming me for a lot of her troubles and vice versa.

That was awful. It turned me away from the mental health system for years when I could have used help.

The subjectivity of psychiatry is disturbing. Patients die and years of people's lives are lost to the ravages to mental illness because of faulty diagnoses.

Makes me cranky.

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The Grieving Period

In a recent post on a bipolar yahoo group, one woman mentioned that she is still grieving over her recent diagnosis. I suppose that I've never given much thought to the anguish I've felt over my own label.

I felt a deep sense of loss when I finally realized that I will be on medication for the rest of my life. Unlike a cold, my mental flu is chronic. This battle will never end. I will always have to struggle to navigate my moods, to ensure that my illness causes the least amount of damage to those around me. I am always going to be cognizant of the slightest variation in my emotional state. I will always have to worry about whether a day of sadness will push me into months of depression. I have to be wary of my happiness, lest I tilt into mania so intense that I'm ready to exhaust my lover with sexual energy.

I have to tiptoe through life's ups and downs and for the longest time, I felt bitter about it. I felt persecuted. I was angry that I was feeling so anxious, so depressed, so hyper and irritable. I suppose I still mourn over the memory of the day I realized that other people did not have to struggle so hard. They can take for granted their emotional and physical calm. They don't understand that some of us have to fight for our sanity, for the ability to wake up every morning.

I mourn for the notion that I will never be a survivor of this disease. It will never go into remission. It can only be managed. It can not be cured. I will be sick forever. I will always be treading water while others can stand on solid ground. When I get pregnant, I will have to decide whether to withdraw from my medications or to continue them at risk to my child. When my babies are born, I have to decide whether I should breastfeed when my medications are excreted in breast milk. This illness will always impact my life.

Those are scary thoughts. They overwhelmed me at one point and I fought them. I think that my half-hearted suicide attempt was born of my despair and frustration of truly experiencing those thoughts. Now I've come to slowly accept them because fighting reality is simply fruitless. It's too painful to foster the hope that I can recover when all current medical trends indicate that I cannot.

I suppose a part of me will always grieve for what might have been, for the happy ending that has become increasingly elusive. But overall, I have learned to be humble, to accept what I cannot change.

I've been trying to convince myself that being bipolar makes me special somehow. I experience emotions more deeply than other people. I can tell you what true despair feels like. I know what it's like to be utterly hopeless, to feel as though Lucifer is hiding under the bed torturing me. Conversely, I know absolute joy. I know what it's like to be so passionate that everyone is a potential sexual partner.

Life will never be boring. And maybe that's the silver lining on this cloud.

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Beginning Insanity

Good morning minions. I'm posting from bed as my fiance sleeps soundly beside me and I can't help but envy his peaceful face. My thoughts have been tremulous these past few days, swaying wildly between joyful exuberance for a bright future and utter dread at the intuitive notion of impending doom. I've been suspended in time for the past few months, like a mosquito caught in amber. I've been waiting for my idleness to lift but it clings to me as if I'm the most desirable wench in the universe. Some days I long for death and others, I feel the first inklings of joy. It's confusing, what this disease has done to me.

My psychiatrist has changed my medications so I am now navigating the impact of his capricious decisions. I'm exhausted and hyper, enraged and lethargic. My head feels light and my thoughts are horribly disconnected. I feel drunk and often forget my train of thought in the middle of a story. It's embarassing and I find myself avoiding friends and conversation with people other than my parents and my lover because I know that I can count on their love regardless of my unpredictable behavior.

Some who stumble upon this blog will undoubtably think that I am merely undisciplined, that I cease to fight this illness and simply let it wash over me like a wave over sand. Perhaps there is some truth to that. Sometimes, I think we all get tired of fighting, of treading water, of running with weights attached to our heels while so many stroll without burdens.

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