Agitation most foul

I think one of the curses of bipolar disorder is the occasional forays into anxiousness and agitation that occasionally afflict me when I'm just starting to venture away from depression. I think the jittery nervousness, gastrointestinal distress and and mental restlessness are simply manifestations of changing brain chemistry, although I think that the nervous anxiety is the way that my mind tries to balance a rise away from lethargy because heaven knows that nothing makes me more upset and depressed than being hyper and anxious. Maybe anxiety is the product of having newfound energy and no outlet for it, as if my mind has become so accustomed to being lazy and slow that the raw products of inspiration cannot find actualization and thus, must find a path to expression even if said expression is frustrating, ineffective and unpleasant.

I'm hopeful that this current malaise is a mere 36-hour hiccup, an annoying sojourn brought on by the inconsistent sleeping and eating that have characterized my weekend. Tomorrow, it's back to work and back to waking up at 5:45, back to breakfast at 6:30, lunch at 12:40 and dinner at 5. Yes, I'm a 50-year-old AARP member trapped in a 24-year-old woman's body.

Three months ago, the first stirings of restlessness were awakening in my mind. I was transitioning from the chronically depressed recluse to a slightly more productive member of society and to that end, I found myself a job that doesn't require brilliance, just an inordinate amount of patience. Now, that restlessness is growing and it needs an outlet or I fear I might nag Brendan to death with my repressed enthusiasm for planning our upcoming move in May, a move I can't plan until we figure out where we're headed. I'm waiting for my muse to more firmly possess my mind before starting any literary endeavors and frankly, I suck at drawing and painting so they offer no relief for my new mental energy. I suppose I'll have to content myself with reading for now. But I'm a bit itchy for action and it's rather odd and uncomfortable given my recent battle with such a sluggish lethargy.

I suppose it's normal for someone my age to have a bit of ambition and inspiration. What isn't normal is to be so devoid of thought, emotion or energy that a complete withdrawal from life seems comfortable and appropriate. Sometimes it's difficult to have valuable insight into my moods when I was low for so long that the mental tundra that is depression seemed normal.

I guess if I really think about it, I would classify my current mood as normal or perhaps very slightly above normal. I'll have to keep an eye on it.

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Nothing Special

A few weeks ago, I received a copy of Ronald Fieve's Bipolar II for review and after finishing it a few days ago, I've been debating about what to say, what I liked and what I didn't.

Whenever I read a book in an analytical way, I'm thinking about not only the content of each chapter, but of how the book is structured and about who the book is written for--is Fieve writing to patients or coworkers or the general public? In a well-planned work, the former two categories rarely enter my mind because the work has a predictable, comfortably flow. That was not the case with Bipolar II. Fieve's work feels very choppy and disorganized, as if he had two dozen topics he wanted to discuss and they were all thrown together. And even as I was reading the final chapter, I wasn't particularly certain that this book was written for patients as it blended the feel of a medical text with the feel of a self-help book, the ultimate result of which was just confusing and frustrating. It certainly was not the guide to tolerating Bipolar II that it was purported to be by some other reviewers.

Fieve's book opens with a preface introducing the reader to his professional work, an impressive record that includes conducting the initial US clinical trials for lithium as a treatment for bipolar disorder. In a habit rather typical of Harvard graduates, Fieve continually finds reason to mention that he authored Moodswing and that he studied at Harvard and Columbia universities. The first time, it was informative. The remaining mentions were like nails on a chalkboard to me, unnecessary self-congratulatory inclusions that served to make me think that Fieve is perhaps a bit megalomaniacal and self-important. Doctors have a tendency to be that way, an unfortunate side effect of wealth, intelligence and success.

At any rate, after our brief introduction to Fieve, the book opens with an introduction to bipolar disorder that felt entirely incomplete and was rendered unnecessary by the second chapter covering the bipolar spectrum. The second chapter opens with a discussion of current theories on what chemical malfunctions might cause bipolar disorder. It then dicusses what medications act on which neurotransmitters, albeit briefly as the topic is taken up again later in the book. And after all that, Fieve backtracks and starts discussing the history of bipolar disorder, discussing the full spectrum of moods that can accompany it. Are you confused yet?

The third chapter explores the relationship between genetics and bipolar disorder in a way that demonstrates everything I'm saying about a tragic lack of organization in this book. Under the heading WHAT IS THE BIPOLAR FAMILY, Fieve first looks at research linking a prevalence of substance abuse, major depression and ADD/ADHD to Bipolar Disorder in families. He then uses the example of Sol Wachtler to demonstrate that bipolar runs in families, although Wachtler's particular family--with one suicidal granny--doesn't seem to provide the strongest anecdotal support for the aforementioned research. Fieve then mentions Jane Fonda as a stronger example of bipolar running in families before shifting gears entirely for a moment to talk about bipolar disorder and associated risks of suicide. He then jumps back to exploring how bipolar runs in families with a patient's life story that included discussion of the patient's father, a man with clearly disturbed moods that followed a seasonal pattern. The remainder of the chapter meanders through a discussion of how hypomania can contribute to success, the human genome project and how drugs that work for one family member may also work for another family member. The stories included within the chapter are at best tangentially related to the larger topic being discussed--genetics--and at worst, serve to obfuscate an issue that isn't entirely clear to begin with.

The chapter reminded me of reading a paper that's been revised so many times, it loses any hint of artistry or flow that might have existed the first time it was written.

Moreover, Fieve shoots himself in the foot as he writes this chapter because he says flat out that "it's difficult to give a diagnosis from secondhand information" (p73) but he goes on later in the book to hypothesize that famous people in history like Abraham Lincoln may have been bipolar (p144-145). Uh, because that's consistent. Retroactively diagnosing historical figures to prove a point is unprofessional and frankly, it should be unnecessary if a researcher has a strong point because there should be plenty of current examples to use that can be definitively proven. I find it equally troubling to see this tendency in the gay rights movement...a retroactive witch hunt to declare successful people gay when codes of behavior are so dramatically different that such declarations are useless.

The fourth chapter covers sleep and sleep patterns as obviously, hypomanic people tend to sleep less than their non-hypomanic counterparts. I personally think that Fieve committed a very basic chicken and egg error in his analysis in this chapter as he basically states that changes in sleep patterns precipitate changes in mood. Well, uh, okay. In my own experience, I feel like the chemical shift that changes my moods occurs before my sleep pattern changes. In other words, I feel like how much I sleep is a symptom of my moods and not the cause of them, as Fieve seems to state with so much confidence.

The fifth chapter covers the impulsive misbehaviors that tend to accompany hypomanic periods, demonstrating rather clearly that hypomania can be a temptress of productivity laced with poisonous and occasionally dangerous, self-destructive behavior. After a prolonged discussion of all of the dumb things that hypomanic people do to themselves and their families, Fieve devotes his sixth chapter to a discussion of the upside of hypomania and its benefits. Bwzuh? In one breath, Fieve tells the reader that hypomanic people are impulsive and gamble their money away, have copious amounts of sex that can jeopardize relationships and generally exercise poor judgment and in the next, he tells us that hypomanic people are creative, effective movers and shakers who greatly benefit society. So which is it?

If the answer is both, then that's a serious, perhaps unforgivable and undeniably irresponsible position to take if this book is targeting patients, the vast majority of who lack the insight to know whether or not a given hypomania is of the beneficial kind or of the impulsive kind, particularly if those hypomanics tend to blend beneficial with impulsive as I would wager is often the case.

The second part of the book discusses the diagnosis and treatment of bipolar disorder, venturing clearly into the self-help realm in a way that's been done better by numerous other authors. Two other books that come immediately to mind are The Bipolar Disorder Survival Guide and the mildly annoying New Hope for People with Bipolar Disorder. These other books offer more concrete examples of how to help yourself in a clearer, more accessible way.

I'm not impressed by this book given the oft-mentioned accomplishments of its author. It doesn't provide a self-help guide the way that pure self-help books do. It doesn't provide empathic insight the way Kay Jamison Redfield's Touched with Fire does. It's a forgettable contribution to a growing literature on bipolar II.

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Another Scientology-induced Tragedy

On March 13, 2003, Jeremy Perkins killed his mother Elli while in a delusional psychosis brought on by his paranoid schizophrenia. Elli was aware of her son's condition but as a Scientologist, she refused to expose him to modern psychiatry. Instead, she chose to treat his severe mental illness with vitamins. She died after being stabbed more than 70 times. Here's the news story.

Every time I see someone refusing reasonable medical care due to a misguided religious zealotry, it makes me so angry. This stupid woman didn't deserve to die for her ignorance and more significantly, her desperately ill child deserved access to treatment that may have helped resolve his psychosis. Instead, this man has to live with the fact that he killed his own mother not because he's some kind of sadistic sociopath but because his stupid parents refused to get him the treatment that he required because of a patently ridiculous religious belief. Unacceptable.

I may hem and haw about the indelicacy of psychiatric medication, but fact is that for those suffering the most acute forms of mental illness, medicine is not simply an option. It's the only option. Psychosis will not resolve with Vitamin B and any person not in touch with reality is a danger to themselves and others.

It makes me so angry that such horrible preventable tragedies occur when there are viable alternatives. A hundred years ago, there was nothing that could be done for someone like Jeremy Perkins. But today? Help was available. An end to his suffering was within the reach of medical science.

I suppose you can lead people to progress but you can't make them think.

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Emerging Pet Peeve

So I'm in the process of reading Ronald Fieve's Bipolar II and while I'll reserve my final judgment until I've finished, I have to confess that I'm getting really irritated with the way that he seems to think that psychiatric medications are just so darn wonderful. Don't get me wrong. I acknowledge that meds help a lot of people and that psychiatry has certainly come a long way since the 70s. But a long way from nowhere doesn't necessarily mean that you've gotten somewhere.

I think part of the problem is that Fieve is approaching medication from the perspective of a doctor and I'm reading his book from the perspective of a patient. Sure, in his mentally stable world, he can analytically say that we've come a long way from the days when being bipolar meant being hospitalized and turned into a drug zombie. Instead of tranquilizing patients into stupors, shrinks are learning to manipulate moodswings more artfully. Great. Really. I'm happy for doctors making $150 an hour than they can feel good about their progress. Fan-fucking-tastic.

In the meantime, the patient has a different experience because while I empathize with my 1970s counterpart, fact is, I'm looking for stability and I want it NOW. I'm not looking for some uber educated doctor man to tell me that medication has come so far when I'm taking some little white pill that's made me gain 30 pounds and now, I can't fit into my freakin pants and I'm still horribly depessed. I don't particularly give a shit that I should be grateful that antidepressants have evolved beyond MAOIs when the crap I took made my mouth so dry I thought I would choke on my own tongue even though it did jack shit for my depression. In fact, with every study that comes out saying something like, oh BTW, zyprexa makes you gain 40+ pounds or some other uninspiring crap, I'm feeling less and less charitable toward these psychitrists who don't take these charming medication, but seem to prescribe them with wanton abandon, happily exposing unstable brains to drugs that were perhaps pushed past the FDA a bit too quickly considering that they tinker with your friggin brain chemistry and all.

I don't want to hear about how great medication is. It seems to me that right now, it's all castor oil. It's all about being so incredibly miserable and desperate that if some doctor told you that eating a cow pie would make you feel better, you might just try it because nothing could be worse than the status quo. That's where medication is right now. We're eating cow pies, ending up full of shit and hoping for the best. Shrinks generally have no friggin idea why one drug works better than any other drug. It's not quite a science. It's more like voodoo with an office.

Fieve's attempts to laud medication as the cure ignore all of us eating cow pies because the alternative of doing nothing seems worse than at least pretending that we're taking some active step to manage this charming illness. Who knows? Maybe he'll get into that in the next chapter. We shall see.

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The Quiet Room

I just finished The Quiet Room: A Journey Out of the Torment of Madness by Lori Schiller and Amanda Bennett, a multifacted examination on how Schiller's seemingly untreatable schizoaffective disorder impacted her life and the lives of those who cared about her the most. The views of her parents, siblings and doctors differentiate this book from other memoirs about the experience of mental illness and provide additional insight into the impact such illness has on an entire family.

Schiller started hearing voices when she was about 17 but her illness did not become truly debilitating until just after she graduated college and attempted suicide for the first time in a desperate effort to silence the cacophony in her mind. Thus began a series of hospitalizations that only ended with the creation of a new medication that finally eliminated Schiller's psychotic symptoms to a point where she was able to reestablish a connection with the world around her and regain her independence. The casualties of her illness included 10 years of her life.

After her initial hospitalization, Schiller's parents had to confront the idea that their overachieving daughter was seriously ill. Her father, a psychologist, had earned his degree in the 1950s when the vogue model of explaining mental illness blamed it not on biological quirks in the brain, but nearly entirely on an individual's upbringing. As one might expect, that model caused Schiller's parents a great deal of personal grief as they both tried to figure out what they did to make their daughter so desperately ill. Schiller's mother confessed that Lori's illness put a strain on her parents' marriage as each blamed the other for their daughter's condition. Eventually, Schiller's mom realized that her own mother, Lori's grandmother, had also exhibited signs of schizophrenia, as had one of her cousins.

Her brothers alternated between thinking that Lori's hospitalizations were some brilliant stunt for attention to being frightened that they would end up like their sister, a virtual prisoner unable to function in society. One of her brothers said something along the lines of "when I used to think about my future, I would think about Lori. But I didn't want to do that anymore."

Schiller's own recalling of her illness reflects the confusion of her mind and reflects the fact that she spents years of her life without any true insight into what was happening to her. In that regard--as a recollection of the experience of being personally mentally ill--this book is not as good as some of the others that I've read. The value of this work is in its ability to reflect the impact of a crippling illness on a family and how painful it can be to acknowledge that the person Lori was prior to being incapacitated by mental illness will never return.

Even as Schiller's world was overrun with malicious voices and delusional beliefs, she understood and was frustrated by the fact that her illness was preventing her from living up to the potential that her intelligence offered her. She was frustrated because while she was sitting in a mental hospital making macaroni necklaces, her friends were advancing in the corporate world, getting married and having children. The reality of being schizophrenic meant that Lori's entire life had to be put on hold while she dealt with her illness and the progression of this book makes it painfully clear that there is no effective way to deal with delusions and hallucinations. There is no coping with disordered thoughts and altered perceptions of reality. There's only hospitalization, a complete removal from society.

Schiller was only able to reenter society when she found a new medication that eliminated her hallucinations, silencing the voices that had been tormenting her and easing the paranoia that had been isolating her. Perhaps one of the most compelling aspects of this memoir in terms of Schiller's account of her illness is her explanation of the process by which she discovered that the voices were not really there. How could she trust her doctors when they told her the voices weren't real when she heard them as clearly as she heard the doctor's own voice? When your own thoughts and senses betray you, why should you trust anything?

Above all else, this memoir made me so sad for Schiller and for everyone who suffers from being so desperately ill without a medication capable of allieviating their symptoms. This woman lost ten years of her life, her 20s, because psychiatry failed her. How many other people has psychiatry failed because the field wallowed in pseudoscience for so long? And while psychiatry has made huge improvements in the past 20 years, it's still a whole lot of guess work. And frankly, is it that much to ask for a definitive diagnosis before someone fiddles with my brain chemistry?

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Next up in my book queue is Ronald Fieve's Bipolar II.

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Do downs have their upside?

Now that I've been out of the doldrums for about six weeks, I've been contemplating what value, if any, the downslide I was in for about 18 months had. I'm loathe to just write off that much time, even though the vast majority of it was spent sitting around my house alone, writing and generally trying to avoid other people. But surely I learned something about myself and the world in that time. I mean, even if I kind of withdrew from the world, I didn't just stop living. And while I admit that being out of it makes reentering the world that much more vivid, I still think that there has to be some value to being down and out beyond whatever realizations you have upon getting up again.

I, for one, think I've gained a tiny bit of humility in the past year. I've always been booksmart and since I've spent the vast majority of my life in school, I've always had some external validation coming from that. Even if I was bummed out, I still had stellar grades. But this past year, I wasn't in school and I didn't have anything to look at and say 'even though I'm blue as can be, at least I'm doing ____ or I've accomplished _____.' I wasn't doing anything and suddenly, those people I looked at in high school and thought I was better than were looking way more on top of everything than I was. Hell, at least they can function. What the hell was I doing? Nothing. I was a blight on society, a nonproductive but secretly capable person hiding in the confines of my own home misanthropically judging people when I did emerge from time to time.

I think there's value in renewal and rebuilding, value to the upswing. Everyone can see that. But there has to be value to the descent. There has to be value to riding at the top and watching your life fall to pieces. There has to be a value to breaking down, withdrawing and hiding. There must be some lesson there, some grain of truth or nugget of wisdom that I otherwise wouldn't possess if I hadn't gone through it. I'm different than I was a year ago. I'm like a newborn deer unsteadily trying to walk around when four or five years ago, I was running with the best and brightest. I wonder if I can still run like that or if I'm too far behind to figure out how to get back in the race.

You know, I've been thinking a lot about popular imagery and metaphors that people use that I would take for granted as obvious but now they've taken on a deeper meaning. For example, people talk about getting thrown from a horse and getting back up in the saddle again. I don't think I ever appreciated how hard that could be, especially if you were thrown a great distance from a big freakin horse. Not only do you look at the beast and wonder how the hell you ever did it to begin with, but then you start pondering whether or not riding horses is all that great anyway. Do you really want to get into that saddle again? And once you do, where the heck are you gonna go?

When I was younger, I always pictured myself doing something important but I never had a clear idea of what that would be. Right now, I'm working at a place where I wouldn't need a college degree, let alone a graduate degree. Should I be proud of the fact that I'm working at all or disapointed that I don't have something better? Ugh.

Speaking of that debate, I have a question for y'all. Do you think it would be better for me to keep the job I have until May, when Brendan and I move OR should I keep my job until winter break and then look for some higher paying, temporary positions come January?

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Musings on motivation

I think if I had to pick an adjective to describe the last 18 months of my life, I would pick amotivated. I simply didn't care about improving my life or the world. I just wanted to get through each day and I didn't have very many goals or ambitions, no real concern for what the future would look like.

Thank God that's changed. As my most recent bout of depression is lifting, I'm starting to regain some of my ambition and spunk. Doing that is harder than it might seem and I think that one of the most trying aspects of coming out of a depressive funk is looking back at your time and kicking your own ass thinking about all of the things you could have been doing and how much better your life would be if you had done them. For example, if I had say, volunteered, instead of holing myself up at home, then I would have a better work history to show a future employer. If I had put a greater emphasis on eating at home, we might have a) more money and b) I might be a better cook. And believe you me, there are thousands of examples of this here phenomenon of the if only.

If I would dwell on that, I think I would sink right back into being depressed. It's like quicksand trying to suck me down and there's only so much I can fight that. Right now, my strategy is to silence that particular thought process. I think it might be better to just ignore all those things I could have done in favor of becoming more undepressed so that I can start doing things. And then, hopefully by the time I start thinking about those things again, I'll be able to say, yeah, I wish I did x, y or z, but at least I've started doing q, r and s now. Does that make any sense?

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I have to say that one of the more frustrating things about coming out of this depression is that my attention span is WAY shorter than it was a few months ago. I mean, I don't have any problem watching a movie or what not, but when I sit down to write or to blog, I lose my focus after about 20-30 minutes whereas when I was in the throes of my latest funk, I would literally write from the time I woke up in the morning until the time I went to bed. Given, my stories were nothing brilliant but my output was undeniably prolific, in excess of 1000 pages. A part of me misses that, misses getting entirely lost in a plot that had nothing to do with my everyday life. Twas a beautiful escape.

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I have a feeling that in a few years, I'll look back at this time in my life and think that there is something significant in the fact that my favorite part of my day is my morning commute. I get to see the sunrise over the misty corn fields and I confess that this is the most beautiful commute I've had, far prettier than the trek I was making in Phoenix this summer to retrieve Brendan. My commute to and fro ASU in grad school was also very beautiful; if I was driving home at sunset, the fading light would illuminate Red Mountain, Four Peaks and the Superstition Mountains. I hope that wherever Brendan and I end up, I'll have another pretty commute. It makes the morning so enjoyable. I can't wait for winter when the sunrises promise to be pale and the roads miserable and slick.

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