Mood Disorders -- Tolerable, Bad and Downright Ugly, Part I

A friend recently asked me for a short description of the difference between Major Depressive Disorder and Bipolar II. I didn't keep it short.  This will not surprise my regular readers, and warn my newer ones.

But here is the short answer.  Normal mood cycles within a normal range, sad/okay/glad.  Major depression has bigger distances, between normal and really sad.  Bipolar has the biggest distances.  Bipolar I ranges from really sad to really really up, with more time spend down than up.  Bipolar II moves the base line down from bipolar I.  It goes up, though not so far, and way, way down, lower than the others.

There are other aspects to mood disorders, affecting thought, desire, motivation, energy, sleep, digestion, appetite and even physical pain.  But this astonishingly short answer says way more than your common perception that depression means you are sad; bipolar means you are crazy.

Since I regularly write about these and the other mood disorders in Prozac Monologues, it may be helpful to give the longer answer here.  So today begins another three-part series.  I do seem to like these three-part series.  Things stretch out when I want to make Prozac Monologues both clear and entertaining -- though I suspect that it's mostly people with diagnoses who get the entertaining part.

OMG!!!That'sWhatTheySaid -- Failed Method/Successful Attempt

OMG!  it has been four months since I last gave an OMG! Award.  It's not that I don't keep finding excellent candidates.  It's just that I have been covering other major topics.  Plus, life just...

I am amazed and disappointed to give this month's award to HealthCentral.com for their July 22nd news release, Failed Suicide Method May Predict Likelihood of Successful Attempt.

First, let me introduce HealthCentral.com.  From their website:

Health Central's mission is to empower millions of people to improve and take control of their health and well-being.
  • Our 35+ sites provide clinical resources and real-life support to those with life-changing conditions.
  • Our wellness resources and tools help people to live healthier, more fulfilled lives.
  • We are honored to serve over 12 million visitors each month.

Health Central addresses lots of different health issues, including mental health.  Often their information is excellent.  This time they missed the boat with this OMG Award-winning title to one of their featured articles.  They don't get points for originality.  They have repeated a much too popular -- what shall I call it?

Let me put it this way:

A twenty-seven year old woman is diagnosed with breast cancer.  Young women with breast cancer generally have a poor prognosis.  So she receives the most aggressive treatment available, including procedures that damage her body in ways that can be mended and other ways that cannot.  She undergoes intense pharmacological treatment using harsh chemicals that leave her sick, debilitated and at risk for other health complications.  Willing to try anything, she joins a support group, does mindfulness and visualization and changes her diet.

These measures eventually do work.  Her cancer goes into remission.  Her health is monitored carefully for a long time.  Just when she and her family begin to breathe again, she relapses.  Again, she opts for aggressive treatment, tries new drugs prescribed in off-label use, and again is left too weak to care for her children or leave the house.

This time, everybody's best efforts do not work.  She dies.

Does her doctor call that a success?  Does the preacher say she fought a long hard battle and finally succeeded?

Let me put it another way.

A middle-aged man has heart disease.  He gets regular medical attention, takes all his meds, monitors everything he is supposed to monitor, changes his lifestyle, even his job to reduce stress.

Nevertheless, he has a heart attack, in fact, several heart attacks.  Each time he is rushed to the hospital, where emergency personnel work their butts off to save him.  He is transferred to ICU, then to a regular bed, then to rehab.  His family posts frequent status reports on facebook, and his church prays for him every week.

Does anybody say he failed?  That he wasn't serious about these heart attacks of his?  When he returns to church or the golf course, do they turn their faces, afraid they might say the wrong thing and provoke another attack?  One that might be successful?

Mental illness is physical illness.  It has a mortality rate, just like cancer and heart disease.  We struggle desperately for years and undergo every treatment we can find and tolerate, trying to survive our illnesses.  Death by mental illness is not a success.  It is a tragedy.  Survival is not a failure.  When somebody has to be rushed to the hospital and manages to fight his or her way back to life, it is a hard won victory celebrated in heaven.  It ought to be celebrated on earth.  This person deserves a party.  With balloons.  And a cake.

Now let me pause to discuss the content of the article with this outrageous title, because the article does give important information.

The article reports research into the prognosis of suicidal individuals according to the method of self-harm they originally use.  The numbers are astounding.

Those whose initial act of self-harm takes the form of hanging, suffocation or strangulation have the poorest prognosis.  Of those who survive, 85% of them die at their own hand within a year.  They do not get it out of their system.  They die.  Within the year.  85% of them.

Those who jump, or use a firearm or drowning are at a moderately lower risk of subsequent death (69-78%, as reported in the original research.)  Those who use poisoning, overdose or cutting have the lowest risk of completed suicide with in year (25-36%.)

These figures hold true when controlling for diagnosis and for sociological factors.

That said, the single greatest risk factor for death by suicide is a previously survived episode.  Nobody gets it out of their system.

These findings have implications for aftercare.  Just as the most aggressive treatment is warranted for younger women with breast cancer and out of shape persons with heart disease, those whose original method of self-harm is hanging, strangulation or suffocation need the most intensive follow-up, monitoring and treatment.

Again that said, one potentially harmful consequence of this report is that those who use less lethal means, such as cutting or poison, may be dismissed as not serious, as engaging in attention-seeking behavior.

Yes, cutting and overdose are attention-seeking behaviors.  They are the serious attempts of seriously ill people to get serious attention for their serious condition.

Cutting and overdose have serious health consequences.  They are the methods used most often by Latina and African-American girls, who have less access to health care and mental health care anyway.  The consequences of not receiving the attention that these girls plead for are first, brain and liver damage, and then further deterioration of their lives, including dropping out of school, substance abuse, being continued victims of violence at their own hand or that of family and acquaintances, continued poor health choices and early death on account of all of the above.

If you turn your face from anybody who commits a potentially fatal act of self-harm by any means, you become the Scribe who turned his face from the man who was mugged, beaten and left for dead on the road to Jericho, because you count your agenda more important than that person's life.

As I said, this would be an unintended consequence of this article, and one that the author seek to avoid: However, "although use of more lethal methods of self-harm is an important index of suicide risk, it should not obscure the fact that self-harm in general is a key indicator of an increased risk of suicide," Hawton wrote.

Back to the OMG! Award.  I am on a Mission from God.  It is my mission, in whatever years I have remaining of my own life, permanently to eradicate the use of the word successful in the same sentence as the word suicide, and to eliminate the scandalous naming of survival as failure.

So I plead for your help.  I plead, when you hear a grieving friend or family member say that their loved one who died of mental illness was successful in the attempt, I plead that you tell that person, kindly and gently, Suicide is not a choice; it happens when pain exceeds resources for coping with pain.  I am so sorry for your loss, and so sorry that your loved one has lost the battle.

I plead that you, whenever you hear health care professionals refer to a failed attempt, that you feel and that you express your shock and horror at the words.  I plead that you confront them, and urge then to examine the hostility toward their patients and clients that lie beneath their words.

I don't usually inform people that they are winners of the OMG!!That'sWhatTheySaid Award.  Following what I have urged you to do, I will inform Health Central of their award.  Right now. 

Mood Charts -- Why Bother?


Last week I discussed two barriers to using mood charts, the complexity of some charts and the life styles of those with mood disorders.  I also suggested strategies to overcome these barriers.  Perhaps today's post should have come first.  Given the difficulties -- why bother?

The chart I use is here, the same destination linked to Mood Charting on the left side of the blog, under RESOURCES ON MENTAL ILLNESS.  The second page puts my remarks in context.  The first page was written for doctors.  This post will make all that verbage user friendly.

So let me tell you about my experience and why I am still at it.

The essential point is to understand your illness better, so you can manage it better.  These are things I have learned from my chart:

Calling All Mood Charts

A few months ago, I posted this video description of my mood chart, calling it "Bipolar II with a touch of PTSD."

I also asked readers' experiences with mood charts, and promised a report.  Such as it is, here it is.

First, a mood chart is a basic tool in recovery, a way to record visually how your moods vary from day to day, or within a day for you lucky ultradian cyclers.  There are a variety of charts out there that vary by the features recorded. The chart can be paper or digital.  And yes, there's an app for that.

The chart I use keeps it simple. I record my mood each day, high or low, scale of 1-3, plus sleep, drug and alcohol consumption and meds taken or not.   I add two extra features, anxiety and irritation, again on the 1-3 scale.  These are basics.  When my meds change, I scribble little notes about side effects.  One page covers the whole month.

Nationalism and Patriotism -- For the Love of My Country

There is nothing funny about nationalism. Nationalism does not laugh at itself.

Patriotism, on the other hand, is like family. The Muppets are patriotic. Even those who don't speak English.

Language in the Clinician's Office

This week I return to my favorite theme -- the power of language.  Those of us who have a mental illness deal with the power of language every day.  Notice I didn't call us the mentally ill.  Language forms who we are in this world.  It underpins the terms of our treatment.  It structures how we pay for our treatment.  Diagnosis is where language meets money.  And money is power, power over our lives.

Reframing is a process of becoming conscious of the power of language.  This is a standard tool in Cognitive Behavioral Therapy.  The term is used in a variant of CBT called Neuro-Linguistic Reprogramming (NLP).


Summer Reading Picks from Prozac Monologues

Last winter I did the blog piece on movies for surviving the family holiday scene.  With or without family issues, here come my picks for summer reading.  This is an all purpose list, for normals and the mentally interesting alike, and just for fun.   Books to take to the beach -- or the backyard, should the beach be out of reach.

The following is my opinion.  Strongly-held, but my opinion.  Feel free to have your own.  That's what comments are for.

I asked friends for their input in two categories: lovable loonies and alternate worlds -- fiction, unless they could make a very compelling case otherwise.  Now I have a new reading list, too.

We begin with lovable loonies.  My all-time number one favorite book, perfect for beach, book club, hospital bed, you name it, is Lamb: The Gospel According to Biff, Christ's Childhood Pal by Christopher MooreYou know, there were other gospels that didn't make the original cut.  I don't think this one would have, either.  Nevertheless, it had me at this sentence: The first time I saw the man who would save the world, he was sitting near the central well in Nazareth with a lizard hanging out of his mouth.  It seems Joshua (Jesus) was entertaining his little brother, who kept smashing the lizard's head with a rock, whereupon the savior of the world would put it in his mouth, bring it back to life, and hand it back to his little brother.  Practice for later.  This gospel fills in the missing years of Jesus' life and explains the invention of cappuccino, judo and grace.  A loonier evangelist you could not find.  So that's number one.

Another Christopher Moore pick, though out of season, is The Stupidest Angel: A Heartwarming Tale of Christmas Terror.  It reintroduces a character from Lamb.  And boy, is he stupid.  The lovable loony is the sheriff's wife, a former actress who played a Xena-type warrior and never quite got out of character.  In a sub-plot and nod to O'Henry, she quits her meds to save up for her husband's Christmas present, while the sheriff plants an acre of pot.

Actually, the whole purpose of this blog piece is to get more people to read my second favorite book, Lucky Dog by Mark Barrowcliffe -- a talking dog named Reg who helps a helpless loser win at poker -- the helpless loser being the only one who can understand what Reg is saying, of course.  After first meeting him, Dave goes on meds.  So Reg gives Dave the silent treatment, because his feelings are hurt .  Notice the running theme, meds.  This is a Prozac Monologues list.  Eventually Dave misses Reg's conversation, quits his meds and figures out that Reg gives him an advantage at the gaming table.  It's all about smell.  You've got the mob, a rich old lady, a love interest, the world from a dog's point of smell and redemptionWhat more could you want for summer reading?

A friend reminded me of Kurt Vonnegut -- whom I already started rereading a few months ago.  Vonnegut makes reference to his lovable loony, Eliot Rosewater in a couple of books.  Rosewater gets his own book in God Bless You, Mr. RosewaterMaybe he has a touch of psychosis (but only some of the time.)  Maybe he is a hopeless idealist.  Maybe he just needs to say no.  But he is indeed lovable and a volunteer fireman.  Bonus loony: Kilgore Trout.

Also in the lovable loony category is The Hitchhiker's Guide to the Universe by Douglas Adams.  Couldn't we all use a book with Don't Panic on the cover?  Hitchhiker's Guide is the first of a triology with five books.  I think the second volume, The Restaurant at the End of the Universe is where I learned that every planet in the universe has a drink called gin and tonic.  You make it differently on every planet.  But there you are.  You can get the perfect beverage to accompany your summer reading, assuming the ingredients don't mess with your meds, on any planet in the universe.

I haven't read The Eyre Affair by Jasper Fforde.  Yes, I spelled his name correctly.  Another friend, a bookophile who knows loony recommends it.  It is the first of Fforde's loony alternate reality series, starring Special Operative Thursday Next, a literary detective who is chasing down the evil Acheron Hades who has stolen... It's a Lost in Austen/Inkheart kind of alternate reality, blurring the boundaries between the world of normals and the many worlds of books.

Hitchhiker's Guide and The Eyre Affair are my segue into alternate worlds.  I was heartbroken when we got to the end of the Harry Potter series by J.K. Rowling and lost that annual Hogwarts fix with its witches and wizards, port keys, Marauder's Map and all the rest.  According to a Face Book quiz, if I were a Hogwarts teacher, I would be Remus Lupin.  I may reread all seven books in preparation for the last two movies.  And I am delighted that seven books became eight movies.

Another friend fave and mine, too, is The Wrinkle in Time series by Madeline L'Engle.  These are cross-over youth/adult sci-fi, but you don't have to be a sci-fi fan to appreciate them.  One summer vacation/road trip, my six-year-old listened to Wrinkle on tape.  Every time we stopped for lunch, he wanted to discuss it.  Every time he got to the end, he started again at the beginning, and I was happy to listen with him.  I wonder if this was the root of his vocation as a philosopher.  The misfits are the heroes who save the planet from IT, the force that wants to eliminate unhappiness by eliminating deviance in the universe.  (I suspect that IT really just wants to get rid of deviance.  The unhappiness thing is just part of the sales pitch.)  In the first volume Meg figures out, same and equal are NOT the same thing.  Bonus: it turns out that It was a dark and stormy night is a great way to start a book, after all.

Michael Chabon rewrites history in The Yiddish Policemen's Union.  Imagine that at the end of World War II, Jewish people went to Alaska instead of Israel.  Fifty years later, Alaska is about to revert to the United States.  Enter your basic hapless detective.  Combine a murder mystery, political intrigue, orthodox Jewish mobsters, chess and a red calf.  Shake vigorously.  Serve on the rocks.

Chabon provides another alternate world in a tale of two Jewish adventurerers, Gentlemen of the Road.  Set in 10th century Khazaria, two con men/bodyguards/swashbucklers star in a dime store novel with elegant prose, inadvertently fighting for justice and the rightful heir to the Khazarian throne.

Not all alternate worlds are fantastical.  Like Gentlemen of the Road, books set in real times and places can sweep you up so that you leave your own world and enter the author's.  The day my mother left her third husband, the good stepfather, separating hers and theirs from his, I postponed going crazy by moving to China via Pearl Buck's The Good EarthNever mind the 1931 copyright.  It won a Pulitzer Prize, and seventy years later, Oprah made it a Book Club pick.

Lately I have been living in nineteenth century England.  Jane Austen's biggest hit is Pride and Prejudice.  I haven't tried the graphic novel nor the sequels it inspired, including one with zombies.  You're on your own there.  Currently I am doing the Bronte sisters.  Emily Bronte wrote Wuthering Heights.  That link takes to you the edition that is easy to read in bed -- whatever that means.  Jane Eyre by Charlotte Bronte has inspired the same kind of take-offs as Pride and Prejudice.  All of them have been made into multiple movies and mini-series, if you want to extend your reading experience into other media.

Rounding out our alternate world category, Ellis Peters takes us to a Benedictine monastery in twelfth century England, in the midst of a civil war.  Cadfael is a second career monk, a crusader turned herbalist and forensic scientist detective. The series starts with A Morbid Taste for Bones and goes on for nineteen more volumes -- God bless Ellis Peters.  This series has also been filmed, with Derek Jacobi as Cadfael.

Douglas Adams and Hebrew poetry have both inspired me through the years.  I told you I had two categories.  So here is a third -- compelling nonfiction.  These two are on my own to read list:

The first is friend-recommended The Spirit Catches You and You Fall Down by Anne Fadiman. It is a tragic story of the clash between two cultures, that of the Hmong and that of Western medicine. The parents say Baby Lia Lee's soul is outside her body, captured by an evil spirit.  She needs a shaman.  The doctors say she has epilepsy.  She needs medication.  The doctors win.  The results are not good.  I haven't been reading biographies of people who live with mental illness lately.  But I might make an exception for this one.

The second and last is Invictus: Nelson Mandela and The Game That Made a Nation by John Carlin.  This edition has pictures from the movie.  The original edition is titled Playing the Enemy: Nelson Mandela and the Game That Made a Nation.  Combine the typical sports narrative structure: loser team triumphs, with that incredible, grace-filled moment in human history: oppressed people triumph and don't wreck vengeance on the oppressors.

So there are more than enough books to fill out my local library's summer reading club requirements.

What are you reading this summer?  Enjoy.

photo by Molku, who placed it in the public domain

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