Sunday, June 29, 2008

For Irene and Katherine

Irene and Katherine,
May this always be the place where you feel free to vent and rant, where you know that someone wants to hear you. I hear you and my heart bleeds for you both.

My oldest daughter has suffered from depression and sought treatment without my badgering her. My younger daughter's first husband was an abusive alcoholic, probably bipolar. Her second husband is bipolar and controlled on meds--he's a real sweetheart. I cannot imagine the excruciating pain that you both live with.

If I ever make a little difference for someone in writing about my struggle with manic depression, then I've fulfilled my promise to myself. When I had my come-to-Jesus moment in the hospital back in 1995, I knew that if I accepted my disorder for what it was, I'd fight for myself tooth and nail. I'd fight against the stigma of mental illness. I'd demand the care that I needed. Your children were victims of our dismal mental health system. We should all fight for those who do not get the care that they need.

You can write as much as you want in my Comments. I would rather see you do that and feel perhaps a little momentary relief because you've opened up and told your story to me and those readers who have walked the walk.

I say that to you all. This is not just my blog--it's yours, as is The Knitting Curmudgeon. I treasure my readers of both and I want to hear those voices, be they in pain or in happiness. Got it? Good. May the higher power guide you to peace.

Friday, June 27, 2008

Jammin' It Down Your Throat

Now, you may find this very amusing. I know I do. Did you know that I was a psychiatric technician from 1973 to 1982? Yeah. I worked at a county institution, mostly because in 1973 I had a 4-year-old and a 1-year-old who needed their mommy during the day, so I worked the evening shift while my husband watched them.

No "it takes one to know one" jokes. Even though it's true. I began on the med/surg ward, worked there for about a year, learned to pour medication, give subcutaneous and intramuscular injections (nonprofessionals could do this in New Jersey at that time), and learned firsthand about death and insanity. The things I saw are forever a part of my consciousness and I hope I never forget them.

When I transferred to the short-term 30-day crisis intervention ward, it was there that I met people who were manic depressive. Amazing people, too. An opera singer, a sculptor, a writer, several seductive drug addicts who had immense charm and an unbelievable capacity for self-destruction. All of them brilliant and all of them in the desperate throes of the disorder. We'd all sit and talk for hours. I was their caretaker but they became my friends too. Little did I realize that we had an awful lot in common.

Their mania or depression very often triggered mine, although I was too lost in maintaining bare survival to recognize my own illness. And what was worse? A friend from high school, Becky, was brought into the ward screaming, out of control, trying to climb the barred windows. She was placed in seclusion immediately. And committed. Because I knew her, I was recused from caring for her. But I watched helplessly as she disintegrated mentally. It took five months of commitment before Becky was more or less stabilized. Mostly less but they let her out.

Back then, commitment was fairly simple. You went to your commitment hearing and two doctors had to pronounce you a danger to yourself or others in front of a judge. Then you got the old 60-day commitment order. You couldn't leave and you were forced to take the medication, even if it had to be administered via a shot in the butt.

Then came the public advocates and everything changed. Not for the better, either. Patients now had rights. They could refuse treatment, no matter what. So began the deinstitutionalization of our mental health hospitals. And out the patients went, all too often with no place to go, since their families were sick of dealing with them.

The question then and the question now is, when you are that mentally ill, do you have the right to refuse treatment?

This is a terribly hard moral dilemma. On the one hand, people with manic depression or schizophrenia can be helped with medication. On the other hand, forcing people to swallow pills and spend their days in straight jackets so they won't harm themselves seems to be enormously cruel.

It's not. As someone who has been off the wall crazy and shoved into a hospital against her will, I honestly thank God that I was forced to face my disorder and deal with it. Trust me, I was a hard sell. Maybe in my next post I'll tell you the story. It's in its way funny but also dead-on serious.

I was close to commitment but they didn't go through with it because in actuality, I was not suicidal but rather having suicidal ideations. Now, sometimes those can lead to the real thing but my history was ideations rather than actions, so they let me off the hook. To a point. I wanted to sign myself out but the doctor informed me that if I went out AMA (against medical advice), he'd get me commited. Yikes. I stayed.

When your sense of mental balance is so incredibly warped and out of control, you can't be capable of making sane decisions. Your brain is fucked up. You need someone to support you and maybe sit on you so that you take your meds and do what you need to do to get better.

This doesn't work in many cases. Trying to force someone who's off the wall to take meds is frequently a no-win deal for both sides. But I do believe that anyone that sick can't help themselves. I know I couldn't, when I was at that point. I will be forever grateful to that doctor at Fair Oaks who didn't give into me and made me take what I needed and face my demons.

Incidentally, I saw my high school friend Becky at my 40th reunion last weekend. I could have cried. She barely recognized me and I could see the madness in her eyes. Her hair was done in weird little braids, she wore a dress that was somewhat strange, and a mutual friend of ours, who is a nurse, was staying with her the whole evening. Lisa, the nurse, told me that Becky was very fragile and she was afraid that Becky might act out. She didn't but I could tell she was agitated.

It was then that I realized what I've probably known all along. There are striking degrees of manic depression. Even though I am diagnosed as bipolar I, I am what is known as a high-functioning manic depressive. I haven't been back to the hospital since that time, through the grace of God. I am blessed. I can function, even though it's a daily battle. Becky cannot. And clearly, all the commitments she went through, all the medication she's taken over the years, have brought her scant relief. I grieve for those for whom nothing works. But I don't know if commitment is the right answer or not.

Wednesday, June 04, 2008

Baby Bipolars

Last week, Newsweek had a very interesting cover article on childhood bipolar disorder. A condition that evidently is discounted by many so-called medical experts.

I was most certainly a bipolar child. Perhaps not as severely bipolar as the young boy in the article, whose behavior is so out of control that he frightens his parents, his teacher, his schoolmates, everyone around him. A child who wishes to kill himself? Absolutely. I know. I was that child.

I was "trouble" from the moment I was born. In fact, before I was born, since my mother was in labor with me for almost three days. Once I popped out, I then made her life a living hell with colic, screaming, not sleeping, and generally driving her to a nervous breakdown. She and my father temporarily moved to her parents' house because she could not cope with me. They stayed for three months until I "settled down."

As Mom always says, I didn't learn to walk. I ran. Into walls. Literally. And at 18 months, I perpetrated the first of many "stunts" (quotes are all my mother's). While she was on the phone, I climbed up onto the stove, turned on all the burners and plopped myself in the middle. Stunt #1 was a doozy. Out of control already.

Then, at 3, I pushed an old lady in a wheelchair down a hill at the Forest Hills Tennis Club. My mother was sitting on a bench, talking to her friend Joyce, Joyce's daughter Vivian was not interested in playing with me because she was 5 and much too sophisticated. So I was bored. And saw the old lady, whose nurse was also talking to a friend, and decided she was bored too. So I hopped onto the back of the wheelchair, released the brake, and down the hill we went, with her screaming. Yes, I do remember doing this, very clearly.

Besides impulsive actions, which my mother dealt with by literally leashing me so that I wouldn't run away, I had terrible temper tantrums. Constantly. These seem to have started when I was around 3, or at least, that's as far back as I remember. I would be overtaken by uncontrollable rage, and would throw myself onto the ground screaming. I had to be physically restrained so that I wouldn't hurt myself.

So I was a "bad" little girl, at least to some of my family members. My maternal grandmother was the only one who gave me unconditional love, who saw that I wasn't bad at all. And I rarely had mood swings when I was with Grandma. She was a calming, loving influence. My paternal grandmother, a dour German woman who had her own mental health issues, would chase me around with a stick, yelling that she was a witch who would cook me and eat me. Crazy Hansel und Gretel time. I despised her.

Once in school, it became worse. I couldn't sit still, I fidgeted constantly. My handwriting was illegible because I simply had not advanced enough neurologically to be able to control a pencil. However, in 1958, in second grade, I was considered sloppy and lazy, with my teacher torturing me with handwriting exercises that I could not do.

Throughout the rest of my childhood, I was always being reined in. And I remember lying in my bed at night, depressed, wishing I could die, because I just wasn't good enough and I couldn't seem to make myself better. I had no self-esteem. To give my mother credit, she realized it. However, back in the '50s, a mentally ill child was simply trouble. End of story.

Recently, my friend Marcia, who I've known since elementary school, said to me, "I thought you got sick when your dad died." No, that's when the disorder finally blossomed to the point that I became seriously ill.

I was 17 when my father died of stomach cancer. He was probably bipolar too, a man of great generosity, joie de vivre, and one of the finest impulse spenders I've ever known. But I adored him and his death at 43 was devastating for me. I did not know how to grieve. A week before Daddy died, my brother Rich and I were summoned to his bedroom, where he told us that we should be like Spartans, keep a stiff upper lip, because he was going to die.

We had not been told his illness was fatal. In fact, although we realized Daddy wasn't getting better, it never occurred to us at 13 and 17, that he was dying. Until that day.

Thereafter, my descent into madness, as the novelists like to call it, was rapid. And for many more years, it became a nightmare from which I thought I would never awaken.

So yes. There is such a thing as childhood bipolar disorder. I know. I was one of many children whose mental illness was defined as being a bad kid. There are no bad kids. Just kids who need help. So let's not push them away. Let's take care of our bipolar children. Because it is a REAL disorder.