Tuesday, January 31, 2006

I Think, Therefore I Read Way Too Much

A little late on the Tuesday entry but today was one of those days where time slipped by and here it is, almost 7 p.m.

Books on manic depression. Yep, I have three that I like and own. One is a reference book, the other two are a memoir and a treatise on manic depression and creativity.

The reference book that I have used, New Hope for People with Bipolar Disorder by Jan Fawcett, Bernard Golden and Nancy Rosenfield, is the perfect primer for the newly diagnosed as well as parents and spouses/significant others who live with bipolar children and adults. It's easy to read, has a lot of good information and addresses many, many concerns.

What makes this book worthwhile is that it was co-written by a psychiatrist (Fawcett), a psychotherapist (Golden) and a manic depressive (Rosenfield). Truly a balanced viewpoint of the disorder. While I would not wholly depend on any book for medication info, since pharmaceuticals, dosages and side effects can change, New Hope talks drugs in layman's terms. New Hope is practical (how about a real, down-to-earth disorder management plan), friendly and understanding. And above all, it does give you new hope. Really.

The other two books, An Unquiet Mind and Touched with Fire: Manic-Depressive Illness and the Artistic Temperment, are both by Kay Redfield Jamison, a psychologist who is also manic depressive. An Unquiet Mind is the story of Jamison's manic-depressive life and how she took control of it. Very inspirational and well written. Her other book, Touched with Fire, deals with how the illness affects creativity and discusses famous poets, writers, painters and other creative souls who were bipolar or depressed. Completely fascinating, especially when you consider that treatment for bipolars has come a long, long way. Certainly An Unquiet Mind should be required reading for anyone who has been diagnosed bipolar. And perhaps their family members, too.

Jamison, who teaches at Johns Hopkins, is a highly regarded figure in the bipolar world. She and Frederick J. Goodwin, M.D., have written a comprehensive book on the subject, Manic-Depressive Illness, which is commonly acknowledged as the definitive tome. However, this is not written for the masses. It is a serious reference for psychiatrists and tough going for most people. But it's comprehensive, to the nth degree.

I know that when I was first diagnosed, I wanted to know absolutely everything I could about this disorder. I still do. Because I keep learning, even ten years after the fact. These are not the only books on the subject but they are the ones that gave me hope and encouragement. And I re-read An Unquiet Mind once a year, just because it's such a good book.

If anyone else has some good books, let me know. I'm always on the lookout.

You know that whacked-out Tony what's-his-name with the Gazelle exercise contraption on TV? I swear to God, whenever I get bogged down, I hear his crazed voice in my head screaming, "YOU CAN DOOOW IT!"

You can. I can. It's all about being big boys and girls and not fobbing our disorder off on parents ("My mother hates me so that's why I spend too much"), spouses ("He makes me so crazy"), kids ("They make me so crazy") or anyone else. Ya wanna be well? Take responsibility for yourself. Read some books. Get some knowledge. Talk honestly to your doctor. Don't decide that you're hopeless or that it's your "fault" that you're sick. Keep at it. And sound off in the Comments, if you want.

I've heard it all before and believe me, I've probably been there and done that. If there's some topic or question in particular that you'd like me to write about, let me know. I'm not a doctor but I've been around the Horn with this thing, so if I don't know the answer, I might be able to point you in the right direction at the very least. This is your sounding board, too. So use it.

Tuesday, January 24, 2006

You Talkin' To Me? Huh? You Talkin' To Me?

If you had asked me a few years ago, had I ever had a psychotic break, I probably would have answered no.

Now I feel otherwise. For many years, as I began to come down from manic euphorias, the first sign of impending depression was a weird paranoia. People were talking about me behind my back. They were watching every little thing I did at work and criticizing me in secret. I would drive with apprehension, watching out for every cop on the road because they might stop me for some unknown breakage of the law on my part. I was sure my neighbors were watching me from behind closed curtains.

Of course, all of this was totally ridiculous and completely untrue. Nonetheless, when it happens, it's real. Too real. And quite psychotic, in its own way.

Once the depression set in, the paranoia would get worse, to the point where I would be afraid to leave the house. In any case, generally my depression would be debilitating enough where I wasn't capable of getting dressed without a huge effort. Because I always seemed to have a little bit of energy left, I could usually manage a shower by noon. Of course, three hours later, I would have to go back to bed. Bed and warm bedcovers, by necessity womb-like, were the best and only comfort.

Psychosis plays its own role in manic-depression. In a way, the euphoria that goes with the mania is very psychotic. I can write a bestseller to pay for all my overspending. That was my favorite delusion. Yeah, sure. Perhaps I do have the writing ability to do that; however, during a manic episode, my thoughts and actions were certainly not cohesive enough, nor sane enough, to put together any kind of a book proposal, let alone write a chapter.

And then there's the old "there's nothing I can't get accomplished without sleep" syndrome. Working away at 2 a.m., having huge amounts of energy and yet getting little done because I was too off the wall to think rationally.

These days, although I still have sleep disruptions, they are nowhere like the ones I had during acute manic phases. I try to get at least seven hours of sleep. I try to eat properly, although I still have a bad habit of skipping breakfast. Unfortunately, much of what I do is sedentary. That's about to change, though. On the advice of a good friend, who is not manic-depressive herself but lives with a bipolar, I'm about to get my ass out to the gym and get some exercise into my routine. That will help raise my seratonin level. And perhaps get me back into some kind of physical shape. I've been doing some walking during the day but I need more structure.

As far as posting to this blog is concerned, there are two things that I've decided. One is that I will post on Tuesdays only. It's really not all that healthy to be so obsessed with one's disorder that it must be written about daily. The other is that I put most of my effort into the book that I'm writing and into my other blog, The Knitting Curmudgeon.

In my next entry, books about manic-depression. There's some good ones out there. And some bad ones too.

Tuesday, January 17, 2006

Don't Ask, Don't Tell?

It's very nice that some of the people who have commented think that I'm brave and courageous for writing a blog on a disorder that makes "normal" people's hair stand on end.

It's really got nothing to do with bravery, courage or any high moral values on my part. Believe me, I'm the world's biggest chickenshit.

What it has to do with is my acceptance of who I am. Consider a gay person coming out of the closet. Now that takes guts, in my opinion. And total acceptance of who you are and complete disregard for "public opinion". Which may or may not include one's family.

And then there is always the question of who do you tell. I don't wear a "Kiss Me, I'm Bipolar" badge on my shirt. Most people don't even suspect that I have any kind of mental disorder when they meet me or even get to know me. However, the workplace can be extraordinarily difficult for someone with a mental disorder. Let me give you an example.

In my last position, which was operations manager for a small consulting firm, I was literally chief cook and bottlewasher. During the course of a week, I might have been off at a client site doing database consulting work, managing the network back at the office, running statistical spreadsheets, interviewing someone for a temp office position, designing and implementing the company web site, organizing trade show crap, writing contracts for clients, and a host of other things. I juggled many responsibilities.

However, during a medication change, suddenly I was falling asleep in front of my computer at 2 in the afternoon. Despite my using a Franklin-Covey planner religiously, I could not remember simple things, such as renewing service contracts on the company laptops. Always a sharp proofreader of my own work, suddenly I was making mistakes that were being caught by other people. Not good. And my boss was concerned enough to ask me if there was anything wrong.

So, what do you say? "Gee, I guess I screwed up?" Or, "I didn't tell you when you hired me but I'm a manic-depressive and I take killer drugs that can turn me into a zombie."

Anyone who takes psychotropic medication will find at some point that their functioning may become somewhat less than it had been. My feeling regarding my employer was that while he had the right to some explanation of why my performance wasn't up to speed, he did not necessarily have the right to know everything. My solution was to explain to him that I had been recently put on medication that had certain side effects such as drowsiness and that I did not expect the side effects to be permanent. And of course, they weren't. In the context of my work performance, he completely understood. To a point. I knew that if my mental state did not improve, he wasn't about to live with it indefinitely.

Sure, there's always disability when the going gets tough. I've been on disability exactly once--during a severe depression, for three months until I was better. However, I prefer to keep working rather than rely on SSI, which is harder than shit to get anyway. Working at something is really the best medicine, whether you have a high-level job or not.

In this country, people with mental disorders have rights under the Americans with Disabilities Act. Making sure that your rights are respected at work may mean that you will have to disclose your disorder. Here's a very good article about handling your disorder at work. I've found it to be quite helpful.

And when you're really struggling at work or with anything at all, think about all the well-known, creative people, past and present, who've been manic-depressive or depressed. They did it. There's always hope.

Saturday, January 14, 2006

To Sleep, Perchance to Wake Up Every Hour

I dunno about you but my biggest problem lately seems to be a sudden screw-up in my sleep patterns.

Here's the drill:
  1. Go to bed at 11:30
  2. Lie in bed for 45 minutes with at least ten topics jumping around my brain such as:
    • If I decide to redesign this Aran sweater, which motifs should I use? And how should I place them?
    • Where did I put that reference book?
    • Do I really want to go back to school?
    • Why hasn't my brother-in-law called me lately?
    • Should I call him?
    • Did I forget to buy toothpaste?
    • Maybe I could move to New Hampshire
    • Maybe I should go back to work at a real job instead of writing a book
    • Should I include a chapter about weaving and spinning in the book?
    • Do I want to get married again? If I did, who would I marry anyways?
  3. Get up and get a drink of water
  4. Go back to bed
  5. Count backwards from 10
  6. Switch positions
  7. Look at the clock
  8. Doze off
  9. Wake up an hour later
  10. Look at the clock
  11. Repeat from Step 1.
Now I don't mind taking my regular meds but I sure as shit don't like sleeping medications. First of all, they make me groggy, which is an entirely different state than just being tired. Second, if I don't have to take something, then I won't. However, I'm always worried that poor sleep can morph into a full-blown manic episode where I just don't sleep at all. Of course, being manic means being hugely productive. But then, there are other not-so-great things about being manic. Like the ensuing paranoia, the gross irritibilty and the inevitable crasho grande.

So I've been trying melatonin, which is a homeopathic sleep aid and really can't do much harm. I buy my vitamins at GNC, so I'm pretty sure the quality is OK. I'm all for homeopathic remedies as long as they aren't harmful and they work in conjunction with my meds. One that I've found doesn't work for me is St. John's Wort. (It should never be taken with antidepressants, incidentally.) I know a lot of people swear by it but when I hit a depression, I do the best with regular pharmaceuticals. Paxil CR works well for me.

Actually, in its way, lithium is all natural, since it's an element and a salt. I guess there's some comfort in that, although the side effects can be a bitch.

The melatonin seems to have helped quite a bit. It certainly makes me sleepy and shuts off the brain chatter for a bit. However, the chatter and the poor sleep cycles probably have little to do with each other. I suspect that the chatter needs be dealt by a medication increase. That will come in a few weeks, when I see my new pdoc.

I'm glad that people are reading this blog and that it's been of some use. As with any blog, generally the writer gets the biggest rewards from writing it, not the reader who reads it.

However, if you knit and you're crazy, then I'm your woman. For sure.

Thursday, January 12, 2006

It Didn't Come From OUR Side of the Family

I was thinking about my aunt Helga a few weeks ago. She's been dead now for 10 years, hit by a cab in NYC one sleety December Saturday in 1995. I miss her sometimes. For all of her craziness, she was a good aunt and was always willing to take me to the Metropolitan Museum of Art to see the mummies for the thousandth time.

When I had gotten out of the hospital that previous summer, I went back to work in NYC as a managing editor for a collector's magazine. Helga had recently retired from Swissair and we would occasionally meet for lunch. The story behind my father's family is a lengthy one--they came to this country in 1940 from Hamburg, Germany via London. My grandfather was a Jew, my grandmother a Gentile. Their children, my father Herbert and Helga, were, in a sense, both victims of this mixed marriage because my grandmother, a neurotic, anxious woman, and my grandfather never got over their guilt.

Now all of them were dead except for Helga. There were no other relatives on my father's side as far as was known. Helga lived her entire life with my grandparents, never marrying, having relationships with married men and working for a Swiss company where she would never be appreciated because she was a woman. Helga suffered from depression. My father, who died at 43, may well have been bipolar. He was an excessive spender, often had rather grandious ideas and also may have had depression. My grandmother had at least two major depressions, one after my father's birth and another after an abortion when my aunt was small.

But were they mentally ill? Of course not. As far as they were concerned, psychiatry was akin to witchcraft. So I debated with myself before that lunch with Helga. Should I tell her? Should I not? I wasn't quite sure how she'd react. But I thought that perhaps by telling her, I could get more information from her about the family psychiatric history. What little I knew, I had heard from my mother.

So we sat down to lunch and I said to her, "I've been diagnosed as manic-depressive and I've just been released from the hospital."

She immediately said, "It didn't come from OUR side of the family."

Yeah, right. I almost said, "Well, where else do you suppose it comes from?" So much for being upfront and honest. I dropped the subject. Even though I knew her doctor had prescribed an antidepressant for her, which she refused to take, I decided that there was little point in trying to have an open discussion on the family's mental health history.

That was the last time I saw her, although I spoke to her on the phone thereafter. Two months after that lunch, she was gone.

If it had not been for my mother overhearing conversations about my grandmother's breakdowns, I would never have known. I might have figured it out, since it was obvious to me, even as a child, that my grandmother was an anxious, unhappy, depressed woman.

As for my mother's side, she and my aunt are both recovering alcoholics. Mom says that her father often suffered from Lincolnesque "black moods," where he would lock himself in the bedroom and not talk to anyone for weeks. So there's a bit of something on the other side of the family too.

The result of this family history is that it was passed on to my generation. I am bipolar, my brother is clinically depressed and on medication and my sister insists that she has ADD. Which she probably does, although I don't see her doing anything about it. My 12-year-old nephew has a cognitive disability, although he does very well these days. My oldest daughter has had depressive episodes in the past. Her treatment has been sporadic but she seems to be doing fine at the moment. My granddaughter, we watch as she grows into her teens. Her father is probably bipolar but was never diagnosed or treated. However, he is an alcoholic and has been to rehab many times without much success.

My grandparents were born more than 100 years ago. When they were alive, mental illness was never discussed and treatment never sought. These days, our family talks about it openly and frequently. We support each other.

When my brother became severely depressed a year ago, he came to me and we talked about it. He went back on meds. When I start having symptoms, I call him or my mother. If somebody's behavior is off and they are unaware of it, they get told. I'm sure the old folks would be shocked if they were still alive.

I'm very fortunate to have the family I have. We stick together because we've been through a lot together. Family relationships can make or break you. Acceptance of each other is the critical ingredient. Without that, there's nothing.

Tuesday, January 10, 2006

I'm Not Sick, It's Just Hormones

Being manic-depressive, really understanding all it entails and then managing the disorder means having an epiphany of sorts.

Like being a born-again Christian, only not nearly as obnoxious.

A good, swift kick in the ass helps the process along. In my case, it was hospitalization. I'd finally reached the point in July 1995 where the antidepressant I was taking was not making a dent in my condition and Dr. D, my pdoc, decided that perhaps I wasn't just clinically depressed, I might be bipolar.

It didn't help that up until that point, I hadn't mentioned the continuous out-of-control spending sprees that had gone on for years and that had driven my poor husband Jimmy absolutely crazy. Dr. D immediately decided to put me on a lithium kicker and hospitalize me for observation because I had made this damning statement:

I want to stay in bed until I rot.

This, my friends, is considered a suicide threat. I didn't quite see it that way; after all, "rotting" has no time limitations and is a pretty ineffectual tool. If you're going to kill yourself, you usually pick a more efficient way of doing the deed.

So off I go to the local psychiatric/rehab facility, The Charter House, which is located in Summit, NJ, and was formerly known as Fair Oaks. Its main claim to fame was having treated Papa John and Mackenzie Phillips for their drug addictions. I believe it has again changed names to something else.

I was a mess when admitted. Crying constantly, unresponsive to other people. I was barely able to sign the admitting papers. Somebody, a counsellor, took me up some stairs and into a large dayroom, where I sat at a table with my head down, crying, for several hours. And then, suddenly, I felt fine.

And I knew why. It wasn't manic-depression, I had gotten my period. Why, it was simply a bad case of PMS. Of course. That explained everything.

It didn't quite explain why I had been severely depressed for weeks, but hey--a minor detail. I was now a well person sitting on a ward with a bunch of crazy people. This was going to come to a screeching halt. I was not about to waste my time here. But having worked as a psychiatric technician myself (yes, this is true--the crazy leading the crazy), I knew that the only way I was going to get my ass out of this hole was to present a reasonable case to the attending physician, whom I was due to see momentarily.

Presentation is everything. The attending doc seemed like a reasonable guy. So I figured, if I treat this like a job interview, I'll present my facts intelligently and coherently and he'll have to agree with me. Anyone who can do that, doesn't belong in a nuthouse.

He took my medical history and when I told him that I didn't drink, he looked at me askance. Many manic-depressives drink to self-medicate--in fact, more do than not. So right off the bat, he was skeptical that I was telling him the truth. And then, as I presented my PMS situation to him, he simply listened and said nothing. That was not a good sign.

"So I think if I just go home and take a hot bath and some aspirin, I'll be fine." That's how I finished up. And his response? "You can discuss your plans with the ward doctor tomorrow morning, when he comes in."

Shit. Foiled. I'm in a rather shabby dayroom, with people watching "Baywatch" on the TV, for crissakes. And then I discovered my NJ Transit monthly train ticket in my pocket. The train station was a block away. Escape was in order.

But the doors were locked. I tried every single one. I waited to see if I could slip out when someone came in. Nothing doing. We were taken out for a cigarette break. Into an enclosed courtyard. No exit there.

Back upstairs I went and sat in a chair. Nobody spoke to me and I was damned pissed off. I went up to the head nurse and loudly demanded that I be released. Sure, fine, she said. But if you leave against medical advice, you, not the insurance company, will be responsible for the entire hospital bill.

So back I went to my chair. And sulked. And cried. And called Jimmy from the pay phone and told him I had to come home, I couldn't stand it. He calmed me down and told me he wasn't coming to get me, that I needed to stay at least for the night. He had forsaken me. I slammed the phone down and went back to my chair.

And then, something happened. It hit me from nowhere. What if they're all right and I'm wrong? What if I really am manic-depressive? Doesn't being manic-depressive explain all the bad behavior, all the ups and downs, all the unhappiness for all those years? And if it's so, maybe I should just shut up and listen for once. Maybe I haven't done a great job in managing my life and maybe I can stay here and try to learn something.

I tentatively went over to a group of patients sitting at a table and introduced myself. Sure, they were a little whacked out, but being manic-depressives, they were intelligent people with stories to tell. Stories that I could relate to. Stories that mirrored my life. Talking to them and slowly coming to accept the fact that I had a serious chemical imbalance but that it could be treated.

I spent four days at that place. And got far more from talking to people who had been in my shoes, who understood exactly what manic-depression was and who were in most cases bright, intelligent, successful people.

I've not been hospitalized since. Probably more from luck than from learning to manage my disorder. But I became a believer and that is critical to managing any illness. There are days when I don't even think about the disorder and days when I do. But most of all, I accept that it's not PMS.

In the ensuing years, I spent a good deal of time juggling my medication and spending time in one-to-one therapy. The therapy helped as much as the drugs insofar as it taught me how to manage the disorder. Get enough sleep. Eat properly. Learn the warning signs. Don't wait to get help. Let your family help you.

With the latter, I've always been fortunate because my family has been enormously supportive. My brother, who has clinical depression, in particular has been the one family member with whom I could share my trials and tribulations. He knows. He's been there too, although he doesn't get the manic highs. It's all in the family, you know.

So maybe the next time I post, I'll talk about getting the cure if there ever is one. And in the meanwhile, if you have something you'd like to discuss, put it in the comments.

And for those of you who read my other blog, The Knitting Curmudgeon, be advised that my manic spending sprees encompassed buying yarn. Of course.

Sunday, January 08, 2006

Abilify? What the Fuck?

I've been doing some research on this "new" drug, Abilify. Probably not for me, since it's supposedly for those manic-depressives who are in an acute manic phase.

Which I'm not. I tend towards dysphoria rather than the full-blown, Vivian Leigh-run-naked-in-the-street mania.

I'm a lover of drug names and it's a job I'd love to have, thinking up new, catchy names for chemical compounds. I mean, Abilify? Shit, that's fucking great! I'd love to meet the genius who thought that one up.

Sounds like something Bush would use: "Allegations that we have abilified the oil companies are false."

Tegretol. I make the connection to "integrity." You can depend on Tegretol because it's trustworthy.

Lamictal. Laminated.

Depakote. Protective coating. Sounds like Home Depot's house-brand paint.

The drug companies spend a ton of money making their pharmaceutical brand names reflect the drugs' implied function.

Umm, umm, good.

I would prefer names that reflect the actual effects, like Woozit, Tremolin, Vaguen, Zombil.

Don't get the idea that I'm anti-meds. I'm absolutely not. Medication has saved my ass many times. But despite the fact that I live in New Jersey, home to many of the major pharmaceutical companies who employ many residents here, I have no love for the pharmagreed.

Next time: If you could be cured, would you?

Friday, January 06, 2006

The Zone

I'm in the zone. That's the only possible reason for starting a second blog.

But no. It's more than that. It's a nasty dysphoria that's knocked some sense into my head. And made me realize that this disorder the shrinks love to call "bipolar" isn't going away. When I find it impossible to verbalize, I can always write. Hence my blogging.

I prefer the term "manic-depressive" to "bipolar." In an onomotopoeia sort of way, it sounds like it is. Bipolar just doesn't cut it, doesn't give the sense of grand movement like manic-depressive. However, since my latest doctor has diagnosed me as bipolar I, I suppose it has some use.

I was first diagnosed bipolar II at 45 (I'm nearly 56 now), after years of borderline functionality, huge depressions, and manic behavior that I tried to cover up. In fact, I'm almost convinced I was a bipolar child--there were temper tantrums, anxiety attacks, impulsive behavior, and moodiness as far back as I can remember. Who knows? It certainly took the better part of my adulthood to be diagnosed.

Every manic-depressive's story has its interesting edges. Mine certainly does. This blog will help document my life as a manic-depressive and provide a forum for me to express my views on a very unique ailment.

I'm still in the process of formatting this blog, which will take a while. Ultimately, I hope this will become a resource for other manic-depressives as well as their family and friends. Yeah, you can Google for info but it's nice to have a repository.