The Benefits of Bipolar Disorder

When I am manic, I get things done. That is as long as I am not running to the top of the inside stairs and down again seeking something that I cannot remember. Then it is The Great Eater of Time. My depression helps me to see what projects I have taken up that are pointless wastes like the schemes of making a million quickly by stuffing envelopes at home. I can detect what is rigged: I will not spend hours trying to win games that cannot be won or spend money on hobbies that I will never get around to finishing. I have ships in a bottle that I have not pulled the rigging up. I bought these in hypomania.

Depression has a wisdom about it, bitter at times, with a predictive power and insight into the motives of some men and women. I do not trust certain people when I am in depression: This often proves a smart thing.

Then there is the stillness that comes, a beautiful blue film that falls gently over my consciousness calling for silence and appreciation of the moment. If I shut down the voices that hector me for a moment, I find the peace that the racing thoughts of mania do not permit. I may feel fatigued, but I am not agitated as I am in a mixed state. Depression is a better place in the mind than mania or the vicious mixed state.

Reminded of Algernon

Not sure what triggers so proceed with caution

I have 3 brothers and 2 sisters. I used to have 4 brothers. Pat passed away over 30 years ago. For a long time I didn’t speak about him. Everything upset me too much. I speak some now. But, it is I sad story and I don’t want to discourage people. Different times, different people.

Pat had a breakdown at 20 when he was at college. He came home a different person, first he would just stare. Then he was obviously mentally ill. He claimed he had been brainwashed by a cult,.he was also the soccer player Pele’ and other people. He was unpredictable and scared me. He would try to act ” normal” mimicking others, which was even worse. My father felt Pat could just stop it if he wanted and would yell and even hit him.

my father didn’t believe in mental health treatment and the only help my brother got was when he was picked up on 72 hour holds. They would give him typical antipsychotics, this was the late 70s, and send him home. He would be psychotic and sedated which just made his differences more apparent.

then, in 1985 he was picked up in a different county. They tried a different medication. lithium. Everyone told me he was back like his old self again. It was as close to a miracle as I could imagine. But, when I went to visit he wasn’t well. He was looking at me suspiciously. He was talking about the bible excessively and was hard to understand. My mother said they were having trouble finding the right dosage.of medication.

he took off that night. I never saw him again. He went to Yosemite. He fell at a large waterfall and died. Suicide or risky behavior? I am not sure.

I have all kinds of mixed up feelings. Mainly guilt. That I didn’t try to understand more and be closer and not so afraid, that I didn’t do more to get him some kind of help, that I am fine and he wasn’t.

and just sad that he was fine for a little while and then started to go back into the psychosis he had been trapped in for years.

(About how the title: my children were talking about ” Flowers for Algernon”. I know the story is about intellectual disability, but the idea of improving and then going back to the old state hit me as similar and sparked the memories)

 

Conference of DBSA California, 2016

I have just returned from the conference of the Depression and Bipolar Support Alliance of California. Between keynote addresses and workshops, here are the things I attended (for some, I have notes).

Keynote speaker for Friday morning, stand up comic David Granirer, on “I’m OK But YOU Need Professional Help: Creating Recovery – One Laugh At A Time!” For obvious reasons, I didn’t take notes for this one.

Adult Suicide Prevention Training (presenter Liam Mina, MSW): Liam Mina is a social worker with Didi Hirsch, a Southern California organization founded in 1942, which works on suicide prevention. After the death of Marilyn Monroe, in which they were involved in a “psychological autopsy,” they started getting phone calls, not about Monroe, but from people who themselves wanted help. So they established the first suicide hotline in the US. Now they have 24/7 service in English and Spanish, along with texting and chat for the deaf, and Korean and Vietnamese from 4:30 pm to midnight Pacific time. 90% of suicide is associated with mental illness, but 50% are not in treatment. Responding to warning signs of suicide: Build rapport, assess risk (ask directly, and for people who do say that they are thinking about suicide assess degree of risk by asking about plans and with scaling questions), establish safety (make a plan, connect to resources, ask to repeat back plan).

Ask the Pros: Kent Layton and Himasiri Da Silva. This always popular session allows people to pose questions to a clinical psychologist (Layton) and a psychiatrist (Da Silva). Topics included what to do in a crisis, what to do if you’re allergic to all the meds, what are the effects of different strains of marijuana, the difference between ADHD or ADD and bipolar disorder, whether ketamine is recommended for treatment-resistant depression (and the same question for Lexapro), what about food supplements, and the DSM-V.  A few notes from the answers: Medical marijuana isn’t recommended for bipolar disorder. Useful supplements include fish oil (omega-3) and folic acid (not in place of medication, but alongside it). Da Silva feels that the DSM needs to build in more bioevidence; bipolar disorder had a large genetic component. As time goes on the DSM will become more biologically and evidence based. If you’re in crisis, keep showing up and suiting up, get up even if you can only manage a walk around the block, and don’t give up even if getting your meds right takes trial and error.

Bipolar Disorder: A Family Affair (presenter Angela Paccini): I didn’t take many notes on this one. It focused a lot on family stories, in the interest of showing what knowing roles and triggers and providing support looks like.

Bipolar Disorder – The Future (presented Da Silva): There have been four eras in psychiatry: The Asylum Era, the Psychodynamic Era, the Psychopharmacology Era, and what we are now entering, the Molecular Neurobiology Era. We still draw on what was learned in earlier eras (e.g. psychotherapy, especially CBT and DBT, helps, as do medications developed in the psychopharmacology era), but a new improvement in treatment is our understanding of pharmacokinetics and pharmacodynamics. Medications don’t provide chemicals in the form effective in the brain; first they need to be processed by the liver. Here, pharmacokinetic genes, such as CYP450, are important. The CYP450 system involves 57 enzymes responsible for drug metabolism, primarily in the liver. People can be normal, fast, or slow metabolizers, and a genetic test can show which you are. For example, only 55% of people metabolize Seroquel normally, while others metabolize faster than normal (and therefore see less effect) or slower than normal (and therefore see more side effects). Medication interactions are important (for instance, the estrogen in birth control pills can speed up the breakdown process for Lamictal). So is folate, and some people, with a variant form of the MTHFR gene, lack the ability to metabolize folate and may need, instead, to take methylfolate. Genesight offers genetic testing. Da Silva also talked about evidence based practices governing which medications should be given first (ones for which there are large scale studies supporting efficacy and few side effects).

Saturday morning keynote speaker: Antoinette Brunasso spoke on Coping with Depression and Bipolar Disorder: The Impact on Self and Family. This was a very good talk, at a level easy for a lay person to understand, largely around developing what Brunasso calls a “solid, flexible sense of self,” one that allows you to tolerate anxiety, and avoid reacting to conflict by reflexively caving, avoiding, or locking in your position, but rather work through the conflict toward a solution that works for both partners. How “fusion” can lead a spouse to get stuck in the same place as the bipolar or depressed spouse, and how developing a healthier sense of self can help you work through marital conflicts better even when one of you is also dealing with mental illness.

Reflective Functioning and Mentalization in Relation to Bipolar Disorder (presenter Nazare Magaz): Mentalizing is the capacity to imagine inner states in self and others. It can be affected by your early attachment process, which can lead either to secure attachment or to less secure forms (anxious avoidant, anxious preoccupied, disorganized); if you are a therapist, both knowing your own attachment style and recognizing that of your patient can be useful (don’t crowd someone whose attachment style is anxious avoidant). In bipolar disorder, ability to mentalize drops when you go into episode. Signs of mentalizing: You can imagine multiple states of mind that could lead another person to behave as he or she does. If you can only think of one possibility, you may be falling out of the open, curious state you need to mentalize, and instead in a place of psychic equivalence, where you have a thought about what another person is thinking and then assume it’s true. What do you do when someone else is in a place of psychic equivalence? You need to empathize with that person first. How do you develop mentalizing ability? By being around and learning from people who have it.

Lunchtime keynote speaker: David Miklowitz, on Child and Adolescent Mood Disorders. I didn’t take notes on this one, because having notepaper around a lunch table is awkward, but I did live tweet some of it after I had eaten.

Happiness with music (presenter Mike Sullivan): We played ukeleles. I didn’t take notes.

Trauma Effects – Depression and Bipolar (presenter Christine Monroe): Trauma is always part of psychotherapy. It’s part of life. This talk covered: What is trauma? How does PTSD compare to bipolar disorder (e.g. flashbacks to traumatic event compared to depressive ruminating)? What events can lead to PTSD? What puts people at risk? References: Ross Rosenberg on trauma levels. Dan Siegel on parenting. Evidence based treatments: Trauma focused CBT, exposure therapy (start mild), relational therapy, and, a particularly good therapy for PTSD, EMDR.

And that was my last workshop. I condensed my notes a lot for this post, so I may, if I find time, have a longer post on one or another of the individual sessions.

 

 

Words Have Power

Words have power. They can hurt but they can also heal.

This is something I read and modified from the dbsalliance website. I also made a youtube video

People living with mental illnesses often experience symptoms like feeling hopeless, empty or worthless. You may want to say something to make the person feel better, but not know what to say. Are there comments you should avoid?

If your loved one is experiencing ongoing thoughts of suicide or is in immediate danger, contact a doctor, got to a hospital emergency room, or call the National Suicide Prevention Lifeline at
1-800-273-TALK (8255)

Remember to take care of yourself so you are able to be there for your loved one. Find support for yourself with understanding friends or relatives or in therapy of your own.

As a friend or family member of someone with a mental illness your support is an important part of working toward wellness. Don’t give up hope.

Treatment for mental illness does work, and people with mental illnesses can and do live productive and thriving lives.

What you say

Some things could be hurtful:

It’s all in your head

We all go through times like this
Look on the bright side
You have so much to live for
What do you want me to do? I can’t change your situation
Just snap out of it
You’ll be fine. Stop worrying

What could help:

I understand you have a real illness and that’s what causes these thoughts/feelings
I may not be able to understand exactly how you feel but I care about you and want to help
When you want to give up, tell yourself you will hold on for just one day, hour, minute-whatever you can manage
You are important to me. Your life is important to me.
Tell me what I can do now to help you
You might not believe it now, but the way you’re feeling will change.

Articles on dealing with people with mental illness-review

I never know whether or not to open links to articles on how to deal with someone like me. I have problems with it from the get go. I am an individual, not one size fits all. I feel like i am being talked about without my input.

I recently braved reading:

4 Ways to Find Out If Your Partner Is Using Their Depression as an Excuse for Controlling Behavior

http://everydayfeminism.com/2015/07/depression-and-partner-abuse/

She then lists four things controlling/manipulative people sometimes do. You don’t have to have depression to do any of these things:

Do They Make You Spend All of Your Time with Them?

Do They Threaten Suicide When You Have Disagreements?

Do They Make You Feel Responsible for Their Mental Health?

Do They Trivialize Your Problems in Comparison to Theirs?

Keeping you to themselves is common in abusive relationships

I had an ex-boyfriend with no diagnosis threaten to commit suicide if I didn’t get back together with him

Many co-dependent partners worry their partner won’t be okay if they leave.

I don’t think trivializing others problems is solely something done by the mentally ill

I really don’t like the title or premise of this article. It could just be signs you are in a controlling/abusive relationship.

I do think there are some topics in this article that could be good for family members.

We are taught to take all mentions of suicide seriously. But, what do you do if it seems manipulative? I don’t know and that would be more meaningful for me.

How do you leave someone with a mental illness (or other condition) when you worry about how they will be on their own?

I felt the author used a provocative title/subject to grab readers

The Night of The Cut *Graphic Self Harm Trigger Warning*

******TRIGGER WARNING: Anorexia somewhat and EXTREMELY GRAPHIC SELF HARM******

DO NOT READ THIS IF YOU ARE EASILY TRIGGERED BY SELF HARM ESPECIALLY IN GRAPHIC DETAIL.

You have been warned.

This is probably the single most important story in my life. It led to a cascade of events: hospitalization, my correct diagnosis of bipolar, getting kicked out of school, and finally getting the real help I needed.

It was 6am when I finally asked my ex-boyfriend for my knife back. We aren’t on speaking terms and we are clear that we can never be. We’re either together or not. And together is awful, dangerous, addicting, full of love, full of hate.

Today I see him to get it back, so I stress out about it of course. I overthink what I will wear. I felt the need to show him how much my appearance has changed, how much have changed. Both of which are major improvements.

Should I go laid back in my cute dorm-room college girl get up all from Victoria’s Secret? Or should I go with my traditional assemble which people describe as “edgy” because its boots and leather jackets and what not?
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Unseen Contributor to Teen Mental Illness?

It has been bothering me for a few years now. The surge in young teens who seem absorbed in mental illness.

I first noticed it after I’d had my iphone for a while. Probably over a year after (I was 18 when I got it). I’d been diagnosed when i was 17, and was probably 19 when I noticed. I was on instagram when I got the random desire to see if there were posts about mental illness on there.

And what I saw horrified me.

Kids as young as 12 were posting horrible photos. Typically it was just the cliche depressed quotes over and over again. But there were also photos of other things… there was “thinspiration” where people would post skinny girls who were their “goal” look in terms of thinness. And then there was the pencil test to determine if you really are thin or not, so people posted pictures of those. And pictures of thigh gaps. But I can’t relate to eating disorders, never had one and don’t think I ever will. Then there were ones that flooded my search and were even triggering to me- self harm photos. They were everywhere. I was horrified.
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How to Talk Listen to a Mentally Ill Person

The mentally ill person is not a child. I have had the experience of would-be helpers who treated me so. When I attempted to describe what I needed, they argued and belittled me for needing help. I felt very alone and one result was that I stayed away from the church where this person was not only a member, but an officer of sorts. It was hard for me to treat him with charity. I turned my back when he greeted me afterwards because I could not stand his hypocrisy.

We are sensitive about being patronized because of our condition for the same reasons that African Americans are sensitive about race. No one wants to be excluded on the basis of a condition that he cannot help. No one wants his condition denied. No one wants to feel cut away from the body politic. What we want is for people to take us seriously whether or not we are in episode.

Many of the problems that people have with the mentally ill have to do with communication. Those who wish to help (and those who do not want to help) believe that the objective of interaction is to get the mentally ill person to follow a treatment plan or pull herself up by her bootstraps or realize that it is “all in your mind”. (“Have you tried not being depressed?”).

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Ran out of meds… and very scared.

So we all know quitting your meds cold turkey is a very bad idea. But sometimes… things happen.

I wasn’t really paying much attention to how many meds I had. I knew I saw my psychiatrist and would get a prescription and then the mail order pharmacy would send it to me (they’re much cheaper- 3 months for the cost of 1- and they’re authentic). However, I ran out early. I called my psychiatrist to have her fax a 1 month prescription to my pharmacy but when I got there they said my insurance had already covered this month through the mail order service. In other words- I’d have to pay out of pocket.

1 pill costs $12. And I take 2 a day.

I called my mom asking how long it’d be before we’d get the pills in the mail. And she said it won’t be for at least a few more days. The service had emailed us saying that the medications were “delayed.” But when I demanded to know what that meant, she simply sent me the email. All the email said was that it was delayed. That was it. No hint as to how delayed, nothing.

I left the pharmacy holding back tears. I guess I was going off my meds for a few days, with no tapering.

When I got home I broke down sobbing. My mom called me back about it and then asked if I was crying, when I said yes because “you don’t know what this is going to be like” she yelled at me saying I shouldn’t put this stuff off for so long.

She later apologized.

And yes I am terrified. When I forgot my pills one night I almost killed myself. Although when I found out I felt that way only because I forgot my pills, I cried with relief.

I take 2 anti-psychotics. Luckily this is less important one. My main one keeps a lot of symptoms under control- mania, anxiety, etc. This one just keeps me from being depressed. It actually made me feel like a normal type of stable. Generally I was in a good mood, instead of my normal slightly-down mood.

I am scared of having to endure the next few days until I get the medicine. We are going to call the service tomorrow and ask them to expedite it, it costs money but it is literally less than paying for one days worth of the medication.

I will survive. But it will be hell.

And I am scared.

-Quinn

Twelve Myths About Bipolar Disorder

I have to rebut these when they are said by family members, fellow patients, and random members of the public. Every one of us who lives with the condition has heard some if not all of these time and again. You might even have a few of your own to add. You may note that I don’t include “It’s all in your head” (though the issue of faking is covered below). It is all in my head! Bipolar disorder is an organic brain dysfunction and the brain resides inside my skull. So I don’t count that a myth, just a misapprehension of the truth.

Here are my twelve most common myths:

Bipolar disorder is just something psychiatrists made up so that they can get rich.

Not too long ago, a Fox Radio commentator told a caller that she had been duped by her psychiatrist. They just made it up to get your money, he told her. She begged to differ but he was having none of it. Even when he was forced by his employer to apologize, he equivocated.

There are a few things wrong with this belief. The first any person with bipolar disorder can tell you: the highs, the lows, the paranoia, the hallucinations, and the delusions are all too real. Physicians have observed the disease in patients since the time of Hippocrates. And patients have suffered, suffered mightily.

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