Friday, March 30, 2018

World Bipolar Day and the Color Red

Prozac Monologues -- the book -- is coming!  It really is.  Well, a chapter and a half still to go.


Here is a sneak peak that may answer the burning question,

Why are you wearing red on World Bipolar Day?  

It's called:
Three

Have you ever noticed -- flight of ideas, distraction, talking fast/pressure to keep talking -- these are symptoms of a serious mental disorder (we're talking the manic phase of bipolar here) and also kind of -- fun.



The thing about hypomania, when it's good, when it shows up as elevated or expansive mood, not irritable, and increase in goal-directed activity, as in, can get that course outline written before noon, it is very good.  It can turn you into the life of the party and the boss's favorite employee.

Nobody goes to the doc to complain, There were tears, they laughed so hard at my bank robbery story, or I wrote a book in three weeks.

No, we go to the doc in our deepest darkest, at which point, the question, Have you ever been manic? is just silly.  It turns out, most people filling out a patient history form do not remember that they were ever diagnosed and treated for bipolar, or even once hospitalized for running down the freeway in the altogether.

No, I'm not manic.  I'm excited!

Defending themselves from responsibility for seven years suffering and deterioration caused by misdiagnosis and mistreatment, doctors say bipolar II is tough to diagnose.  When you have a cycling condition, it's a crapshoot which pole is going to show up in the office.  And the dice are loaded against the up option, on account of Nobody goes to the doc to complain...  Yes, we have heard it before.

So how are docs supposed to distinguish between somebody who has plain old vanilla depression and somebody who can't remember ever feeling better than the bottom of a sticky shoe, but might really have bipolar anyway.  Like, before you take antidepressants and get worse for seven years before somebody figures out the correct diagnosis after the police escort you to the hospital.

The docs who know bipolar have found ways around the loaded dice.

I sat next to a family physician in an airplane once.  He was curious about the Journal of American Psychiatry in my lap.  So I told him about Prozac Monologues.  Whether it was the story itself or the way I told it, or maybe the volume at which I related my medical history to a total stranger on an airplane, he suggested I Google MDQ when I got home -- Mood Disorder Questionnaire, Just remember MDQ, he said.  Which I did.

Now I didn't want the results it gave me, different from the diagnosis three psychiatrists had already made.  So I didn't mention it to my doc, which they tell you to, until I was on my fourth psychiatrist and past desperate.  But it shaved two years off that average of seven years' misdiagnosis once I did.  MDQ is used around the world to screen for bipolar, takes five minutes to fill out, and it baffles me why family physicians and even psychiatrists don't use it before prescribing another pricey new antidepressant when the last four have failed.

But I am sure the money has nothing to do with it.

Click here to take the MDQ yourself.

Nasser Ghaemi and Ronald Pies use a story.  Read the story.  How much does it sound like your own story?

You will find Bipolar Spectrum Diagnostic Scale, BSDS right here.

Hagop Akiskal has his own approach, called The Rule of Three.  The Rule of three operates on the insight that many aspects of bipolar actually offer some advantage.  Now there is a concept worth exploring.  People with bipolar, in our love of excess, have rich and varied life histories.  Yes, let's put it that way, rich and varied life histories.  Google famous people with bipolar.

Akiskal works off that insight and probes for threes: three changes of profession or religion, excels in three sports or three musical instruments, speaks three languages.  That last one works only for US-born, because what do you can somebody who speaks just one language? -- an American.

There are other less attractive examples, three divorces, dated three different people on the same day, three unfinished degrees, three failed antidepressants (sigh), three provoked car accidents.  Sexual promiscuity falls under the same rubric, but the bar is set way higher than three.  Yeah, if you are mentally counting your encounters, don't worry.  Well, I don't know how far you have counted so far...

You get the idea.  The Rule of Three.

The color red is Akiskal's second criterion, as in red flag.  People with bipolar have flamboyant tendencies, which may show up in things like colorful dress or using a red pen to sign your name.  I suppose that red pen thing doesn't work for grade school teachers and editors.  Context, people, context.

Don't miss that context point.  First, this only applies to people who slump in their chairs at the doctor's office and don't remember ever feeling better than the bottom of a sticky shoe.  Second, pay attention to the life circumstances.  The color red is not a red flag on a clown.  That red wedding dress, however, is worth investigating.

Hmm, I got my first red shoes as soon as I could walk, and threw such a hissy fit when our dog Fritzi chewed them up that Grandma had to go out and replace them that very day.  I have three pair of red shoes in my closet and one on my feet right this very minute.  Does that count?

photo of shoes -- selfie
illustration of butterflies from In Fairyland by Richard Doyle, in public domain
photo of broken bike wheel by Giusto Cerutti, National Dutch Archives, public domain
red flag from wikimedia, public domain

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