Living Bipolar (7 page)

Patients can get mood charts on the Internet, and they can also find them in books on Bipolar people. On the Internet you'll find questionnaires that will help you map your moods by using a graph, and you'll find all sorts of helpful tools to do these sorts of things to help you gain greater insight into your illness. You can probably go through N.A.M.I. (The
National Alliance on Mental Illness
) as well. These would be the kind of places to check into for the self-discovery process. Any of the Bipolar advocacy groups, would also be very, very helpful places to check for additional information on charting your moods. Also, Bipolar support groups are very helpful as well, and a lot of area hospitals will offer these groups free of charge.

How have things changed in the field of psychiatry, with medicines, and with your patients, from when you began your career until now?

I began training, and started my practice, in the decade of the brain -- that was the 1990’s. Since then there has been a splash of research related to brain dysfunction, and a lot of in psychiatry and neurology. So it’s a very exciting time. We haven’t had much changed though in our diagnostic tools, although some of the new brain scans that are in the research phase might be helpful to making a diagnosis. So these things are exciting. The area of genetics is kind of exciting, in terms of trying to have a better understanding of the background and the inheritability of the illness.

What is the hope for families, friends, loved ones, significant others, and Bipolar people? It’s a very debilitating illness. What is the hope?

Even with the tools we have now, and I don’t want say we have the best stuff available, I hope in the future things are much better, and we look at this period as the dark ages of mental illness. Yet, there is hope in the fact that we are getting better, and with the limited, but effective tools we have right now,
a person with Bipolar disorder can live a full life.
A full and effective life. The can get married, have children, maybe some limitations with women in the choices for medication while pregnant. And the same with the families. It’s a chronic illness. There is morbidity associated with Bipolar disorder -- a person can commit suicide. A person can do impulsive things which put their life at risk. But that’s life too. We can die of anything at anytime.

The hope is
if the diagnosis is correct, and the person understands the nature and severity of the illness, and is
willing to do all of the things they need to do to stay well:

• Have a therapist if it’s warranted.

• Making sure they are taking the medications appropriately.

• Taking care of their bodies, and exercising.

• Having a good support system.

If they do all of those factors, a person can have a fully functioning productive life. There are going to be downsides. Downsides in terms of the illness and that doesn’t mean they can’t reach some spot of healing, where they can move on and feel better. I would tell any patient and any family member, that
it’s a serious illness, no question about it. We can’t take it lightly. But there is good evidence that a person can be fully functioning.

The following is Cassandra’s story who first became depressed at the age of fife-teen, and her first manic episode occurred at the age of seven-teen. As a teenager Cassandra regulated her moods by using drugs and alcohol. Depression eventually led Cassandra to a suicide attempt. At the age of twenty, Cassandra went to a dual diagnosis treatment center where she got clean from illicit drugs and received proper medical attention for the Bipolar illness.

However, her story does not end there. During the nine years Cassandra has been clean and sober from drugs she has dealt with Neurotoxcity from lithium, and after a failed relationship at five years clean she went into a manic episode which lasted for nine months. After not responding to any new medications during this nine month depression Cassandra’s doctor recommended Electroconvulsive therapy (ECT), and this has drastically affected her life.

Today she is married to an incredible husband who is supportive of her illness, and she leads a full life managing the ups and downs of the Bipolar illness. This is her story.

Cassandra’s Story

I was a really happy kid and I had a really happy child hood. Once I became a teenager, my parents thought it would be best if I went away to boarding school because of the school system. I was four-teen and going into ninth grade. I was really upset, and put off by the fact that my parents sent me to boarding school, but indignant to the fact that my parents had the money to get me the best education possible. Every time I ever left home, such as leaving for summer school; I always had a lot of friends. They picked this boarding school in Connecticut, one of the top boarding schools in the country, and it was
different
. It was hard. There weren’t many people of ethnic descent. And if they were of color they really didn’t relate to me anyway, because they grew up in bigger areas where they knew a lot of kids, and I didn’t grow up like that.

I tried really hard to make friends. My personality started to change after I got to boarding school at the age of four-teen. I was miserable. I started doing drugs. Mainly pot, and speed, and alcohol. I don’t recall any event bringing this personality change other than, for the first time
I was unhappy
. I didn’t feel comfortable with myself. I felt that there was something wrong with me, and that whatever I did wasn’t good enough. These feelings lead me to start doing speed when I was running track and cross country. I didn’t think anything I did was good enough. Other than that I don’t know if the unhappiness came from my illness, or from the situation, but I was just very unhappy.

Bipolar disorder typically develops in late adolescence or early adulthood; however, some people have their first symptoms during childhood, while others develop then late in life. Often unrecognized, people may suffer for years before obtaining an accurate diagnosis.

Bipolar disorder affects both sexes equally, but women are about three times more likely to experience rapid cycling; that is, having four or more distinct periods of depression, hypomania, mixed states, or mania in a one-year period.

Both children and adolescents can develop bipolar disorder. Unlike many adults with the illness, whose episodes are more easily definable, children and young adolescents with bipolar disorder often experience chronic mood changes, including rapid mood swings between depression and mania many times within a day. Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder, however, can also appear for the first time in people over 40. The illness that develops in elderly people is less likely to be associated with a family history of the disorder and more likely to accompany medical and neurological problems than earlier-onset bipolar disorder.

Researchers are continuing to learn about the causes of bipolar disorder. Most scientist agree that there is no single cause; rather, many factors act together to produce the illness. Bipolar disorder appears to run in families, often affecting someone from every generation.

-Keck and Suppes 2005 1-1

By the time I was fifteen my life completely changed. Something around me changed. At this point I wasn’t just having a hard time, I was really, really depressed. There was no happiness I found in the world. It felt like I had been kicked down a black hole, and I couldn’t get out, even though I tired, and I tried, and I tried. I just couldn’t get out of this state. I found myself unable to sleep. In my dorm room at school I had a rocking chair, and I would sit in it all night crying for seven or eight day’s straight. Then I would crash, and I would do it all over again. I’d stay up all night, and people at school got really worried. I wasn’t eating, and I was basically living and functioning on coffee. I also started doing more drugs. For instance, on the weekends I would go with people to New York City, and I would party the whole time.

Then a switch had been flipped inside of me. I wasn’t just sad anymore
;
it was
really, really bad
. I don’t know how to explain it. While, I was sad in my childhood at times, now something had completely flipped. I wasn’t just sad; rather it was I couldn’t live my life any more. To cope I started cutting myself. Then, the school figured everything out, because I stopped going to class. So the school called my parents, and said, you have to take your daughter home. This was Thanksgiving of 1995.

Once I got home my parents said to the school, “No she’s fine. There’s nothing wrong with here. Kids get sad, and it’s not that big of deal.” And my parents sent me back to school. Back at school I was cutting, doing drugs, not eating, not sleeping. Then my parents found out about all of my negative behavior, and then they thought maybe she is sick.

I came home just before Christmas and I couldn’t stop crying. Then, I started to hallucinate about a man with a plastic bag over his face that would chase me all over the house. I don’t know if he was white or black or brown.

I couldn’t sleep still, and I continued to get worse. I wasn’t doing any drugs because I couldn’t leave the house. By this I mean,
I physically could not walk outside of the house
for fear of something, anything. I feared something would come to get me, and kill me. I began to experience suicidal ideations. I wanted to kill myself ever waking minute of the day. I would dream about putting my head the oven like Sylvia Plath. Or slicing my wrist open and laying in the bathtub with candles everywhere.

I believe I went to five institutions from the time I was fifteen until the time I was eighteen. During this time I didn’t leave the house. I didn’t go to school. I pretty much just laid up in a ball. I wasn’t able to cope with anything. When I was about six-teen my parents found me a psychiatrist, and this particular psychiatrist said he would do the therapy for me as well.

Then I tried to kill myself -- BIG. While in the past I had I made little attempts here and there at killing myself but it had not been serious. I was six-teen years old. One day my mom said I have to go to a meeting about two hours away. Immediately I thought this is my chance to kill myself. As soon as I knew she was going, I knew this was going to be my opportunity to kill myself, and I got happy. I mean really, really happy for the first time in a long time. I was giddy almost. My dad said to me “I’m supposed to have a tennis match today, do you mind if I go?” I told him “Go, go. I’m fine. Everything is fine.” So he left.

Nobody was home but me. My parents had locked the medicine in a wooden cabinet, and I took a hammer and destroyed it. I took whatever medications I could find. The only thing that I didn’t take was Tylenol. The reason I didn’t take Tylenol was because I remember seeing a girl on TV. once who was deaf. She was deaf because when she was a kid she took a whole bottle of Tylenol. So I thought I’m not going to take Tylenol, because if I don’t die I don’t want to be deaf.

I took mainly prescription drugs and I took a whole bottle of sleeping pills. This is kind of embarrassing but I took all the medication, and lined all of the pills on the dining room table. I think I spelled something out, but I don’t know. I took three hundred and fifty pills with a fifth of vodka very quick.

I went and laid down in my parent’s bed. I was just beginning to fade out, and my sister called. I picked up the phone, and I said, “I love you Anita. I’m sorry.” I was completely falling out already, and my sister picked up immediately on what was going on. She was in Philadelphia, and she told her roommate to call 911. My sister then stayed on the phone with me the entire time. When 911 got there they knocked down the door.

The next thing I remember I had a tube up my nose, and a catheter and the emergency team was pumping charcoal into me as fast as they could. I was so ungrateful. My sister called the hospital, and she was crying, and she was so upset. I said “I’m so annoyed. I have tubes up my nose and my urethra.” That’s all I could say to her. My parent’s reaction to this was
tears
. Tears more than anything else. They didn’t know what was going on.

Rates of Attempted Suicide

Studies of attempted suicide in Bipolar patients show that 25 to 50 percent attempted suicide at least once. Combining data for both sexes’ results in an attempted suicide rate ranging from 20 to 56 percent. Women, however, appear far more likely than men to attempt suicide, showing both a higher minimum and maximum rate, 15 and 78 percent, respectively. The attempted suicide rate for men was consistently lower, ranging from 4 to 27 percent. Johnson and Hut, the only investigators to specify the severity of suicide attempts, classified 90 percent of them as serious enough to warrant hospitalization. In the general population, women attempt suicide two to three times more often than men, but men actually commit suicide two to three times more often than women.

Goodwin and Jamison pg 231

When I wanted to kill myself I was able to make anyone come to my side. After the suicide the doctor said, “You might be Bipolar,” and my parents said what does that diagnoses mean? I was sitting with my dad one day after this, and he said “You know your uncle, my brother, has obsessive compulsive disorder. He is very sick, and he won’t meet women, even his nieces, because women are dirty to him because they have periods. He’s sick. I didn’t even know my brother had a dad like that. I didn’t even know. Then my mom said her brother married a woman, and they told me she died of a foot fungus. But really she killed herself. She hung herself.

After the suicide attempt I was so upset. More than anything I think I just wanted to be angry at someone and I was very angry in general. I wanted to visualize my illness at something, or someone, I could just be very angry at. So I chose my dad as the focus for my anger. I blamed him constantly because the illness is on his side of the family. Every single member on my dad’s side of the family has some sort of mental illness. Everyone. Most of it is either O.C.D., depression.