What Happened to My Bipolar Brain and How Do I Fix It?

The most troublesome statement in Goodwin and Jamison's Manic Depressive Illness may be this: "Complete symptomatic remission does not ensure functional recovery." This is no small problem. For some 30% to 60% of patients with bipolar disorder, simply treating their mood symptoms is not enough to help them return to a full life.

There’s a third pole that needs to be addressed for that to happen: cognitive symptoms. These often persist even when patients are euthymic, and they range from problems with memory and attention to more subtle deficits such as picking up on social cues and making wise decisions. 

Chris Aiken's article, Eight Ways to Improve Cognition in Bipolar Disorder, opens with these paragraphs. Ironically, what Aiken calls troublesome, I find immensely reassuring. My experiences are real!

Several years back, my pension fund paid for a three-day psychiatric/psychological evaluation of my disability status. I went in with a diagnosis of Bipolar NOS. I thought that PTSD also fit. The pension fund wanted a second opinion and a prognosis. The shrinks asked what my goals were.

I wanted to know what had happened to what I called my Swiss cheese brain, my difficulties with concentration, reading comprehension, memory, word-finding. I was losing track of my thoughts in the middle of sentences. The day I messed up the buttermilk pancakes, an old family recipe, my wife was seriously concerned.

Well, they asked. But I wasn't footing the bill. So...

They ran their regular battery of tests, determined that I didn't have dementia, and that I was pretty smart. The good news is, there is nothing wrong organically, they said. Their conclusion: the cognitive difficulties were all dissociation, caused by my trauma history.

Okay, yes, dissociation is one of my best skills. But it was like I was an Olympic athlete who had gone for a post-injury physical evaluation and been told, You ran a five minute mile. That's really fast. Nothing wrong with you.

True, I was really smart. But I used to be brilliant smart. And the difference between before and after my brain blew up meant that I could no longer pursue my goals. I could not get my doctorate. I could not finish projects that were important to me. And in a variety of small and large ways, I just wasn't very good company anymore.

A speaker at a NAMI meeting described the consequences of his traumatic brain injury. And though I had not experienced a TBI, some of what he described matched my own experiences. I decided to treat my brain as though it were injured and needed to heal.

And it did heal. Not entirely, but it got a lot better.

  • First, I adjusted my expectations. A friend with similar experience recommended that I give myself five years to recover.
  • I gave myself rest, started following every good sleep strategy out there.
  • I improved my diet, less red meat, more veg.
  • I changed my meds. The people who did the evaluation recommended that I take small doses of Valium throughout the day prophylactically. It has never been addictive for me. But after a few months, I couldn't tolerate the brain fog anymore. My pdoc agreed that I could drop it.
  • While lamotrogine helped slow down my rapid cycling, it didn't slow it much. Nor did it relieve the depression enough for me to tolerate the word-finding issue. I was a writer, taking a med that took away my words? So I dumped that, as well. Eventually, once relatively stable, I found other meds that help me maintain that stability, including fish oil and CoQ10.
  • My wife found behavioral strategies for reducing the dissociation thing, like getting my clear attention and making me to write it down when she wanted me to remember something.
  • And I keep trying to take that pause between stimulus and response to let my frontal cortex catch up to my ever-alert amygdala. That one is hard, but an important social skill.

A number of these are strategies that Dr. Aiken recommends. This article was written for doctors, but in an accessible way that patients, even those who are no longer brilliant, can understand. He has recently joined Jim Phelps at Psych Education, a website jammed with information for patients about how to live a bipolar life to the fullest. Go there. Spend days there. You will The website is filled with what your doctor never bothered to tell you.

You can do better than you're doing right now.

May we all have doctors who pay attention to our quality of life and who help us pursue our goals.

How Does the Mind Learn? The Neuroscience of the Way of Love

This month I have been posting at Batshit Crazy Preacher instead of Prozac Monologues. It's a series of daily reflections for Advent, the Christian season of preparation for Christmas. Watching and waiting, not so much shopping and decorating. Lots of people are posting images and reflections on social media for #AdventWord. But me, well, you could expect that mine would have a Prozac Monologues flavor, regardless of the venue.

So in case you don't follow both blogs, here is the link to one of my posts in which I explain the neuroscience behind a particular spiritual discipline. Not meditation, mindfulness, breath prayer, those typical crossover exercises that regulate cortisol. No, I'm talking about learning, at the cellular level, complete with my drawing of a neuron.

Blessings, all.

Prozac Monologues Moves to Batshit Crazy Preacher

Advent is the season of spiritual preparation for Christmas. The idea is to slow down, not speed up. Spend some quiet, reflective time. Remember the reason for the season... Honestly, I think about setting up an Advent wreath, that sort of thing. But our candle holders broke. They broke years ago. I guess I'm just not into the candle thing.

Most years, the closest I get to Advent wreaths, calendars, whatever, is a box of twenty-four wee drams of Scotch from Master of Malt. I know, I know, Scotch is not what your psychiatrist recommends for your recovery toolbox. At least it usually take me well past the twelve days of Christmas to finish the thing.

Anyway, this year I found a practice that does spark my imagination, #AdventWord. It is an international community of prayer that you can enter in whatever way appeals to you. There is a daily meditation to read, based on a different word every day. Advent Word, get it? The ones so far this year are tender, deliver, strengthen, earth, rebuild, fellowship, and glory. People post photos on Twitter or Facebook, or scripture passages, or songs inspired by the word. You can get a poster with spaces to color in each day. You can doodle, decorate the word, or draw whatever comes to you. When it's finished, it's supposed to remind you of a stained glass window. The whole project lets you do whatever prayer style works for you.

I used to make gingerbread houses during Advent, (see last week's post). But that got just too hypomanic. Nowadays I write. Writing has long been my primary spiritual practice, especially when I was writing sermons. Today I do so much writing and speaking related to the book, I have taken a break from preaching. But I miss it.

So I started posting a reflection on the word of the day each day at my other blog, BatshitCrazyPreacher. These reflections have been a mashup of my two passions, mental health (or my lack thereof) and my quirky take on things scriptural. Oh, and I post my sketch, too.

Good golly, every day! This activity threatened to replace gingerbread on the hypomanic trigger list. But, hey - not my first rodeo. I know to jettison at least some things when there get to be too many things. That is my rather roundabout invitation to you to check out BatshitCrazyPreacher this season, because that is where I will be doing my thing, instead of here.

While I have your attention, I also invite you to follow me on Twitter and Instagram @WillaGoodfellow. You can also check out other offerings for this AdventWord thing on both, using the hashtag #AdventWord.

Happy Holidays!

Gingerbread Houses and Cognitive Behavioral Therapy

Thanksgiving is one of my hypomanic seasons. I'm getting better at not taking on projects that worry my wife. In fact, I have given up gingerbread houses altogether. Which is not to discourage you, just to acknowledge that they were once my one great weakness. That woman in the fringed dress down there? - Each bit of fringe was an individually placed sprinkle, separated out from a container of red, green, and white sprinkles. See what I mean?

But I did learn some things from my hypomanic gingerbread houses. And learning is good for the brain. The following post is a repeat from ten years ago, when I was in the throes of it. It explored the relationship between gingerbread and cognitive behavioral therapy. I am one of many who have a love/hate relationship with CBT, which I freely acknowledged to my CBT therapist in our first session. Nevertheless, she persisted, and I persisted, and I do rely on it daily and have written about it from a variety of angles. So here it is again, for those of you who want to explore CBT and also for those of you who want to know how to make a nine patch quilt out of fruit rollups:

Cognitive Behavioral Therapy - Gingerbread Style, 11-25-2010

First Cognitive Therapy Technique -- Distraction

My therapist said Think of something you might find enjoyable.  You don't have to do it.  You don't even have to enjoy it.  The goal is not to move your mood from 1 to 10.  Any mood change is a bonus.  The goal is simply to give you something else to think about [-- besides what I had been thinking about.]

Distraction is one of those really irritating CBT techniques.  I am traumatized and can't stop thinking about this.  Okay, so think about something else.  I pay money for this?

But my other therapist, totally different method, said pretty much the same thing.  And I was six weeks from a major project I had promised for the holiday season.  And I am not sure it would have worked except that the wheel was ready to turn from early autumn danger to late autumn hypomania.  But he did and it was.  So...

She said think about it.

I guess I overshot the mark.

Ya think?

To Diagnose Hypomania -- Pay Attention

I used to churn out 10-12 gingerbread houses each season, back in my undiagnosed days.  I used the Joy of Cooking recipe and floor plan.  But each and every one was one of a kind: a log cabin made of pretzel sticks and peanuts for the chimney, another with candy canes on the roof for a chalet effect... No, I wasn't manic.  I was excited...

It could be said I don't know when to quit.  So a simple suggestion, think about something you might enjoy instead of what you are thinking about right now, became a fourteen inch high, furnished gingerbread house.

See what I mean?  Once I decided to tile the kitchen floor with candy corn, I was gone.  Note the faucets for the aluminum kitchen sink.  And the handles on the refrigerator.  There is a fireplace hearth down there, made of a Milano cookie.  Even as I was installing these things, I knew I was out of control.  But I could not stop.

Here is a nine patch quilt, made from fruit rollups.  Plus a teddy bear on the pillows.  Should you decide to start quilting with fruit rollups, here are my methods.  Unroll them a few days in advance to dry a bit.  Don't overreach.  Let the materials tell you what they are willing to do.  Use liberal amounts of vegetable oil on your fingers and cutting utensils.  Keep the knife clean.  I recommend an exacto knife, under supervision if you have a problem with sharp objects.  Place your product between oiled sheets of cling wrap, then between sheets of paper.  Iron at LOW heat for five seconds.  Breathe.

I refer to this as my diagnosable gingerbread house.

By doubling the dimensions, I had introduced engineering issues.  I needed weight bearing walls.The closet was designed for that purpose.  I made a double wall facing the living room.  But I failed to double the wall with the door.  Two by twelve inches, it was the first piece to break.  The pretzel sticks inside the closet hold it together.

Metaphor Alert -- Community

If I were to get philosophical -- and while I bent over this project, holding my breath and waiting for icing to turn to cement, I had plenty of time -- I would reflect that sometimes things or people are created that do not have the structural integrity to withstand the pressures to which they will be submitted.  Nevertheless, they can get by with a little help from their friends, even friends that brittle themselves, like pretzel sticks.  This is the essence of support groups.  Get into one.

Some of us are not particularly unstable, but we collapse under pressures beyond normal experience.  If we don't have to bear the weight by ourselves, we can make still our own creative contribution to the whole.  The fireplace wall fell into three places.  Twice.  It stood, once it received a full back brace.  The brace is not flashy.  It is not even visible, covered by the outside of the fireplace.  But it is essential.

This is the essence of community.  Christians call it the Body of Christ.  If the house were all ribbon candy, how would it stand?  If the house were all support, what would cover the kitchen floor?

Anyway, diagnosable.  The roof also collapsed, the weight bearing walls notwithstanding, because I pushed too hard while attaching it.  Be gentle with yourself, my friends.  The stronger parts can injure the weaker.  Self-restraint is especially important where you are strong.

But we can learn from our mistakes, and turn them into more creative opportunities.  The roof went for snacks to a bible study group.  I replaced it with a lighter version.  And then I broke one side again.  This time I finally listened to my spouse, and put up just half a roof, so people could look in on that nine patch quilt.  None of us has all the answers.  And sometimes irritating advice is good advice.

Even if it is irritating.

Another Cognitive Therapy Technique -- Dialectical Thinking 

Even in the midst of this craziness, I kept aiming at sanity.  My mantra was Prototype, prototype.  The point of a prototype is to make as many mistakes as possible, in order to learn, and not make the same mistakes while doing the real thing.

I was making a lot of mistakes.  Boy, was I learning.

Dialectical thinking means that life is not divided into black and white.  One can hold a painful thought and a positive one in the same brain at the same time.  That and valium got me through.

I learned not to use a double barrel aged single malt scotch as a brace to hold up a wall while assembling, like the soup cans above.  The bottle was missing only as much as is pictured here before I made that particular mistake.  Sigh.

After mopping up the nearly full bottle of scotch and as much shattered glass as I could find, it was time, it was time to stop working on the prototype.  Well, after I built the fire in the fireplace.

Two hot tamales, cut on the bias, a couple little pretzel sticks and a sprinkling of ribbon candy crumbs.  The back of the fireplace is the inside of a mint Milano with the white frosting scraped off.

Like I said, diagnosable.

It wasn't finished.  It still isn't finished.  But the time for prototype was at an end.  The time for the real deal had begun.

To be continued...

all photos of gingerbread houses by Helen Keefe 
photo of scotch by Suat Eman

Ritual, Stress, and Surviving a Pandemic Thanksgiving

Human beings are pattern-seeking creatures. Place us in an absurd situation, we feel stress. We respond by ritual behavior, or clinging to biases, or even inventing an explanation. Does this sound like anything happening around you for the last several months?

Some of these responses serve us better than others. Biases preserve energy by saving us the time it takes to make case by case evaluations. But they also can be mistaken and rob us of original insights.

Invented explanations are how we manage the terror of acknowledging any bad thing that is out of our understanding or control. Why did Daddy hit me--again? Who is to blame for all these fires lately? How could my candidate have lost? We tell ourselves a story that makes sense of the event, relieving the pain of uncertainty, and thus gaining control over our emotions.

Ritual behavior has been found to reduce the stress of absurd situations. Rituals here can be anything, repeated actions whether checking the doors at the end of the day, knitting (for heaven's sake!), saying the rosary or other mantras, or social gatherings with predictable patterns like sports events or family dinners.

Oh dear. Here comes Thanksgiving Day, with its predictable guest list, predictable menu, predictable behaviors. Even the arguments create a sense of normality, they are so predictable. Rituals, every one. And while we might have dreaded some of these things in years past, will this year's quarantine mean we will be denied even the ritual dread?

In the United States, responsibility for managing a worldwide pandemic has been fobbed off on state governors, which seems to me to be above their pay grade, but it is what it is. So how this year's event may or may not resemble last year's will vary across state lines and local willingness to follow executive orders. In Iowa - good luck even figuring out what those orders are. In Oregon - no more than two households may gather in one room, with no more than six people. Our family's Thanksgiving includes six people, but four households. So we will be making some changes.

Under the circumstances, our strategy is to control what we can control and reenact what rituals we can reenact. So Darryl will pour drinks, at least at his house. Margaret will try a new recipe - the specific recipe is not a tradition, but that Margaret will try something new is as predictable as Thursday. Helen will make the pies. And I will pour a glass of white wine as the first step of making the giblet gravy, with a mix on hand in case of disaster, but there never has been a disaster, so Helen will question why I buy the mix, just like she does, and I do, every year.

We'll have a bit of novelty, but even that will have a ritual aspect. While I am making gravy, Helen will take a pie over to Margaret's and come home with Margaret's Brussel sprouts, because Helen always makes the pie and Margaret always makes the sprouts. If we time it right, maybe we will synchronize the sitting down to eat, with Darryl saying grace over Zoom.

I think we can manage it. And next year, God willing and the people cooperating, we will return to the original pattern, and close the day with hugs all around, having given thanks that we are all still alive to give them.

I pray you will be too.

We can do this. Happy Thanksgiving!

gifs from giphy.com

Between Stimulus and Response

I went searching for a Viktor Frankl quote. Mental health pro-tip: When desperate, Google "Viktor Frankl quotes." I mean, how does even the most desperate, darkest depression argue with a Holocaust survivor?

Here is what I found:

Okay, I confess, when you put an inspirational quote on top of a beautiful peaceful scene, it loses its inspirational value for me. That's just the way my brain works.

So I'd make my own image if I were inclined to that sort of thing, like if I were having a hypomanic episode. It would be three boxes, left to right.

On the left would be a screenshot of a webpage saying something like, Cannot open page because search timed out. Maybe, Cannot find printer. I saw those images on my laptop a lot last week.

In the middle would be one of those breathing gifs.


On the right would be... a question mark. Because the response is unknown. That is the area of freedom. So we don't know the response until it is chosen. Get it?

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.

So there is a story behind my interest in the space between stimulus and response. It goes back to that first image, the screen that said my laptop could not find, of all things, my website. (My wife's laptop couldn't either. This was not a laptop issue.) Its address is plastered all over all my social media accounts and emails, because I am a new author with a book to promote. But that morning, my professional website seemed no longer to exist.  In fact, when I tried to sign in to the platform, the platform denied my existence. Like, as though I didn't even have an account.

That was stimulus, alright. And these days, the stimulus made me even more wobbly than I already am. How about you? Are you a bit wobbly, too, these days?

David Conroy says, Suicide is not a choice. It happens when pain exceeds resources for coping with pain.

If you don't get the connection between losing a website, losing the existence of a website and suicide, well, good. You've never been that close to the edge. And I'm glad for you. 

But believe me, it could have been the last straw, the very last straw. In another year, it might well have been. But lately I have a little less pain and a bit more resources. That critical balance is in my favor.

I paused. I put some space between stimulus and response. I breathed. I slept on it, thinking maybe this catastrophe would just go away in the night. Actually, I didn't sleep much, but you get the idea.

In the morning, the missing website was still missing. But now I remembered one of my resources. My son just happens to be a lead software programmer for a major cyber-security company. He fixed my website once when an update rendered it uneditable. So I texted him.

He got me in touch with the host. (What do I know about platforms and hosts? One refers to shoes the other to communion wafers?) Well, they couldn't find a problem. Neither could my son. And over the course of an afternoon spent chatting with one and texting with the other, somehow the platform straightened itself out and my website made a fully functional return to my laptop.

What was the problem? Who knows. The programmer threw around phrases like hug of death and the rdap database event that he saw on the host's log. He said, 

I've learned not to try to understand everything.

Has anybody created an inspirational poster with those words on a beautiful peaceful background? 

He also said The internet is held together with toothpicks and elmers glue. Oh wait, I do have an image for that one:

So anyway, I spent the day practicing the pause (more or less). I am sure that the cortisol did wipe out a few brain cells, but not as many as it might have, and not so many as to push me over the edge. I call it a win.

And I commend the process to you today and in the days to come. Between the stimulus and the response there really is a space. And that space is your power to choose. Hang onto that space until you are able to choose wisely.

Sanity, the Serenity Prayer, and the Way of Love

Last week I just couldn't. Well, my laptop was dying. And then my printer wouldn't install. But all that within the context of everything that well, you know... So last week there was no new post.

This week, I still can't, not really. I can't find any new research that intrigues me. I can't bear the thought of yet another rant. I am determined not to spread any more pain.

But there's pain out there. There's pain in here. And this blog is about the things I can change. So this I will do.

I have a spiritual discipline that I am using to walk through these days. I am a Christian, and this is a Christian discipline, or series of ancient practices - though my guess is that nonChristians can find something of value here. I will do my best to do some translation.

It's called the Way of Love.

Every morning, I turn. Whatever happened the day before, today I recommit to follow Jesus, or to follow the Way of Love.

Part of my turning is to repeat the Serenity Prayer. In the Episcopal Church, Morning Prayer begins with the Prayer of Confession. But many years ago, I replaced it with the Serenity Prayer. My own version shifts from time to time. Lately I pray:

Grant me the serenity to face what I cannot change.
Grant me the courage to do what I can.
Grant me the wisdom to know the difference.

The Recovery Movement uses this prayer on a daily basis and does not presume theism on the part of the one who prays it. Define the one you are addressing any way that you want. Serenity, courage, and wisdom - those are the kernels.

Then I learn. I read my sacred Scriptures. I follow a set series of readings called a lectionary from Hebrew Scriptures, New Testament, and Gospels. They renew my sense of my larger context in the faith community, all the people who have endeavored to follow the Way through dark days, those people who live in the Bible and those who have looked to the Bible ever since it was written. The Koran, poetry by Mary Oliver or Rumi, substitute what catches you and connects you to something bigger than yourself...

Then I pray. And this may be the place where I lose even some Christians, because this is where it gets hard. I pray for my enemies. But hear me out. Remember the Rabbi's prayer for the Tsar, God bless and keep the Tsar... far from us! Jesus said to pray for our enemies. And I do, something along the line of He's your kid; you deal with him. I pray it sincerely, knowing that God's will for each of us is better than we can ask or imagine. So I can leave it at that.

One of the consequences of praying for my enemies is that I do not become them. I inoculate myself against the disrespect and cruelty that passes for public policy these days - to the extent that I am able.

Then I worship. Now don't get stuck here either. The Recovery Movement lets everyone define their own Higher Power. I have heard of somebody who took gravity as his Higher Power. The point is to acknowledge that I am not the center of the universe.

And that is a point worth repeating: I am not the center of the universe.

Then I bless. This may strike you as bizarre, too, unless you are familiar with my bent frame of reference by now. But seriously, this is my spiritual discipline: I go to Twitter and then to Facebook and find some way to be generous and kind. (It's easier on Twitter, fewer family triggers.) I comment on somebody else's tweet. And it doesn't have to be some stereotypically "blessing" sort of comment. Any kind of nontoxic engagement, any show of interest in what somebody else has posted is a gift.

That's where this discipline really begins to bears fruit - it sets my perspective and my relationship to the world.

Then I go. At some point in the day, I try to engage in a positive way with somebody outside my bubble. That's not as easy as it used to be in maskless days.

Finally I rest.  Because I am not the center of the universe, because I can face what I cannot do (see above), and because this whole way is not easy, I have earned and I am able to rest. Or play Candy Crush.

Nah, I am struggling, too. But my prn meds are lasting a lot longer than I might have expected.

And from an existentialist perspective, the Way of Love is simply the way I have decided to follow. I commend it to you.

graphic for the Way of from from the episcopalchurch.org

meme from Fiddler on the Roof from sabbaththoughts.com/

Hubble image of an explosive galaxy used under the Creative Commons license

Confessions of the Good Suicide Survivor Story

I was suicidal. I nearly killed myself. I am glad I didn't do it. Because I got better.

Moral of the story: You will, too.

That's it. That's the good survivor story. Hopeful. Virtuous. I have told that story, and when I do, I get all kinds of strokes, including publication of my writing on other websites.

Some of it is true. It did get better. For me. For now.

For now.

There is more to the story. When I tell the more, I do not get publication. I don't even get acknowledgement that my submitted piece was received. I guess I am submitting to the wrong websites, to places that have one story they want to tell, the good survivor story.

And like I said, it's true, some of it. According to David Conroy, there are 50 million people alive today who have struggled, are struggling, or will struggle with suicide. 45 million of them will die of... something else. That's success, right? 90% of us will find another way.

But that's not the same as the good survivor story. Because for the 45,000,000 of us who survive, we have all kinds of stories.

Some of us spend our lives going through crisis after crisis. Yes we survive, but we're not sure it is worth the cost.

Some of us live with passive suicidality on a chronic basis, like treading water. Even if we never actually drown, the tug of the water is always there.

Some of us get better, and don't quite struggle at that same level of lethality again for now. For now.

All of these stories need to be told.

Truth be told, I have no idea whether I will be one of the 45 million who die of something else. It is my ambition to do so. But each of those trips into the abyss was deeper than the one before. And I simply cannot imagine coming back from anything as deep as that last one...

Nevertheless, I dutifully make my crisis plan. I fill out those forms about what kind of treatment I want in a psych hospital and what kind of treatment I don't want, knowing full well that when push comes to shove: 

  • I will be sent to the hospital where a bed is available, if a bed is available, not where the treatment I want is offered; 
  • I will have NO choice about who my doctor is; 
  • My advance directives notwithstanding, the doctors will do whatever they think they need to do; 
  • Chances are pretty high that I will experience trauma; and 
  • I may well come out of it worse than when I went in.

Actually, working on the plan is pretty traumatic in itself. I can't find a psychiatrist. Oh, there are psychiatrists. Last year the pdoc where I get my primary care recommended a drug combo that triggered my PTSD - not the treatment (which I refused), but the suggestion of the treatment. It would take me two minutes to find the research papers demonstrating that her suggestion was crap. Crap in general, even before she consulted my history, which also would have demonstrated that it was crap.

I asked another psychiatrist who is an expert in bipolar (and who had already told me never to take the meds my local pdoc wanted to prescribe) to recommend a new psychiatrist for me. He had no answer; he suggested I simply hope for the best.

Hope for the best.

So, I hope for the best. It does get better. Sometimes it gets worse again. I hope that if it does, it will get better again.

Meanwhile, I will keep doing all those things that keep it from getting terrible, because those things do help.

But to anyone who ever read anything of mine that did get published by those people who publish good survivor stories, I apologize if I conveyed the impression that mental illness does not suck.

I will keep doing all those things, and I encourage you to do them too, because even if they help us feel only a little better, still, feeling a little better is better than feeling worse.

photo of dandelion used under creative commons license
book cover image from Amazon.com
photo of Mahia ocean waves by Mathyas Kurmann and in the public domain
photo from Emergency Room by Thierry Geoffroy, used under Creative Commons license 

Bipolar Screening - People with Bipolar Know It When We See It

Psychiatrists and people with bipolar both have told me that my book captures what the manic experience is like.

Reviewers tend to say either, She must have written it when she was manic. Too bad her editor didn't fix it. One star. Or: She must have written it when she was manic. So glad her editor didn't fix it. Five stars.

Which gets me thinking: Doctors say bipolar is really hard to diagnose. But if people who have it know it when we see it, what if we wrote a screening tool? Bear with me here. I'm thinking something like this:

They say: A distinct period of abnormally and persistently elevated, expansive, or irritable mood.

What we hear is: Are you abnormal?

To which we answer: No. I mean, duh.

So what if they said: Has there ever been a time when everybody around you just didn't understand why the world was so great or why you felt so good? Or has there ever been a time when everybody around you was massively irritating?

That is the core symptom of mania. Moving on to the others:

They say: 

  • Increased self-esteem or grandiosity.
  • Decreased need for sleep.
  • More talkative than usual, or pressure to keep talking.
  • Flight of ideas or subjective experience that thoughts are racing.
  • Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
  • Increase in goal directed activity (socially, at work or school, or sexually) or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences

How about instead, the way we would put it: 

  • Despite how shitty you feel right now, have you ever understood just how special you really are?
  • Yeah, the decreased sleep one works okay.
  • Has there ever been a time when you had to keep trying to get your point across because others were too dense to get it?
  • Has there ever been a time when others couldn't keep up with your ideas? Has there ever been a time when your ideas flowed like out of a spigot?
  • Has there ever been a time when you recognized that nothing is unimportant, when everything needed your attention?
  • Have you ever worked so efficiently that you were your boss's favorite employee or your teacher's favorite student? Have you ever had so much to do you couldn't waste time sitting?
  • Has there ever been a time when you knew that life is a banquet and most poor suckers are starving to death?

I mean, it's a matter of perspective, isn't it?

People with bipolar go seven and a half years on average from first manifestation of symptoms to an accurate diagnosis. A third of us are misdiagnosed for ten years or more. Would somebody like to turn my list into a research project, find out if it does indeed produce better screening results than what they do now? Go for it. Just mention my name.

Suicide is Not a Mystery - Get Beyond the Romance to Get to the Work

Suicidal people have not been quiet this year during Suicide Prevention Month. Most years we are the topic of conversation, not the source of the content of all these campaigns. But Twitter, at least, has been filled with our own voices this year. I have always shot my mouth off, and seldom taken the party line. Which means my voice is never included in the campaigns of the typical mental health organizations.

The following is an example, a post from a previous Suicide Prevention Month, edited with my more current thoughts on the matter.

This is Suicide Prevention Week - from September 8, 2011

When I started Prozac Monologues, I didn't know there was a Suicide Prevention Week. I spent a month writing about suicide in June, 2009. I chose June because it is the month when the highest number of suicides take place. So I wonder why the officially designated week is in September. Maybe because when everybody else is so happy about the sunshine in June, they wouldn't give any thought to the darkness? Maybe because they didn't ask those who are suicidal?

If you want to know my take on suicide prevention, here is the link for those original posts. Among the Labels in the right-side column, you will find links to other posts tagged suicide, suicide prevention, and the like.

Looking back at these posts, I wish I had less to say about suicide. But having this much to say, and frankly, a lot more, I think it's best I go ahead and say it. That was my POV for The Suicide Monologue. And I'm sticking to it. I urge you to take the same approach. If you have something to say about suicide, go ahead and say it.

You know, all those years we never talked out loud about cancer, our silence never saved a single life.

Several years ago, John McManamy, author of McMan's Depression and Bipolar Web, gave the day on his blog over to an excerpt from Nancy Rappaport's book, In Her Wake: A Child Psychologist Explores the Mystery of Her Mother's Suicide. Rappaport wrote about how even psychiatrists sit around and wonder how a person comes to the conclusion that he or she wants to die. Most of us want to live. Even those of us who want to die, for the greater part of our lives, we want to live. Her mother's diaries are full of her struggles to survive. What happens in somebody's mind to make that change? Rappaport says it is a mystery.

In Her Wake is a powerful memoir of the aftermath of suicide. People who struggle with suicide need to read such accounts to fortify them in their struggle. But I think she has misidentified the mystery.

I think every person is a mystery. 

We have our joys, sorrows, strengths, dreams, fears, failures. We have capacities and weakness that sometimes we tell to others, and sometimes they divine. But the core of the person remains a mystery.

I am a Christian, so I believe there is One to whom we are not a mystery, One who knows our true name and calls us by it. And we ourselves don't even know that name until we hear that One call it. And when we do, then we know ourselves for the very first time. 

But I don't think suicide is a mystery. 

Suicide is simple. Each of us wants to live. That is how our brains and bodies and souls are constructed, for life. And each of us dies anyway, when our brains and bodies and souls give out. Suicide is one way that we give out. We don't give up. We give out. We reach the limit of what we can survive, whether it be a tumor, lack of oxygen, or a knife that turns in our chest, whether figuratively or literally.

I learned this perspective from David L. Conroy, who learned it from his practice and from his own experience. And I confirm it in my experience. He says, and I repeat it from time to time in this blog, 

Suicide is not a choice; it happens when pain exceeds resources for coping with pain. 

After a suicide, the survivors are indeed immersed in mystery. It is the mystery of the heart of the person who died. It is the pain of questions we cannot answer. We never know the sum total of the pain another had to bear, or was able to bear, or not, nor who or what was available to help, or not. I don't know that psychological autopsies ever satisfy. What we really want to understand is the core of a person. That is the mystery.

But we can understand suicide. We can recognize its broad strokes. And we can prevent it, not every time, but most of the time, the way that suicide crisis lines do it, by relieving pain and by providing resources for coping with pain. If we can help shift that balance, between the pain and the resources, then the person at risk will be able to do what he or she really wants, to live a life worth living.

45,000,000 Suicides Prevented 

Fifty million people who are alive today in the United States have or will at some point struggle against suicidal pain. I am one of them. I have a disease with a 15-20% mortality rate. Someday I will die of something. It is my fervent prayer to be one of the forty-five million who survive suicidal pain and die of...

something else.

It doesn't improve my odds for me or you or psychiatrists or anybody else to ponder the mystery of suicide. You can't prevent mystery. You can provide resources to prevent suicide.  Here is a list to get you started.

It's a long list. It comes from David Conroy's book. Unfortunately, in its attempt to be thorough, and perhaps in the limitations of the voices consulted, certain things get glossed over.

I am thinking in particular of the major components of suicidal pain list, the items bunched into one: loss of: esteem, security, health, talent, job status, job, money, relationship, home. Let me expand. Major components of suicidal pain include shame, discrimination, job loss, crushing debt, chronic untreated health issues, solitary confinement, police harassment, white supremacy, domestic abuse, bullying, homelessness...

Why don't we have a suicide prevention month that talks about this sort of stuff? You can't medicate these pains away. You can trace their effects on suicide statistics.

This graphic is based on the research by Jasmin Brooks, et al., in that last link:

What can you do to prevent suicide? Justice. No, you can't fix it all. So pick an issue. Do something to make this world a less sucky place to live.

If you want to focus on one person, pay attention to these issues in that person's life. Make a difference in their life situation.

I expect that strategy would work for all of us. If you struggle with suicide, is there one thing you can do to make your life or somebody else's life less sucky? It's a place to start.

Meanwhile, if your suicide needs preventing right now, tell somebody. Tell somebody who cares about you (and is not an idiot). Or call 1-800-273-TALK (8255) in the US. The Trevor Project at 866-488-7386 is particularly for young people, lesbian, gay, bisexual, transgender or questioning, and the people trying to help them. There is a link at the top of this blog called Suicide - Resources to find numbers outside of the United States and other help. They can't pay your rent. But they may have some ideas that get you through that dark hole where all your own ideas disappear.

I want you to die of something else, too.

And if this post has brought somebody else to mind, somebody to whom you have said, "Call me if you need to talk," then don't wait for the person who may be clinging to the edge by their fingernails to make the call. YOU make the call. Even if you don't catch them on the edge, even if they are fine, it's one way to make this world a little less sucky.

Which we all could use.

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book jackets from amazon.com
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photo of scales from Deutsche Fotothek of the Saxon State Library
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Understanding Bipolar Disorder - A Review

On the one hand, bipolar disorder can sweep like a tornado through a family, disrupting every aspect of daily living and relationships.

On the other hand, family members can be one of the most significant resources for a person's recovery and stability.

In my own case, my wife is the one who described the symptoms that helped my psychiatrist recognize that I have bipolar, not major depression. But once that happened, what did she, as a family member, as the member of the team with day to day, hour to hour access, receive by way of help and guidance?

Nothing. Not a word. Butkus. Like, not even a pamphlet.

Nope, nothing. She worried. She worked from home to protect me at my sickest. She shouldered every responsibility. She thought through and recommitted to and excelled at "for better for worse, for richer for poorer.

Eventually she got to Family to Family, NAMI's program for education and support of people whose family members have a mental illness. And that helped. It gave her a skill set. It let her know she was not alone. It was more than a brochure.

What she needed was Aimee Daramus's new book Understanding Bipolar Disorder: The Essential Family Guide. Daramus, a clinical psychologist with over twenty years of experience in mental health, from psych units to private practice, has written the definitive guide for family members of people with bipolar. She takes you by the hand and leads you from a chaotic landscape to a steady path.

Step by step, the information is presented in the order that it is needed. It's a good book to read over the course of a year, and to reread for a refresher as time goes on.

  • Bring something to occupy your time in the ER, where mental illness is gets to wait, sometimes for a very long time.
  • Get release of information forms signed, so that the doctor can communicate critical information with the family.
  • Let people have their own emotions and opinions; share them rather than argue over them.
  • Develop emergency plans.
  • Adopt specific lifestyle measures.
  • Don't expect to get it all right all the time.

My wife and I worked out much of this on our own. And Daramus is right, ten years later, we do not get it right all the time. Weekly family meetings help. Daramus's book reminds us of pieces that we still don't have in place.

The language is clear, simple, calm. The formatting makes it easy to follow. The anecdotes are relatable.

I bought two more copies to give to friends who could use the help. How's that for a recommendation?

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World Suicide Prevention Day from a Different Perspective

Many people who are suicidal hate suicide prevention campaigns. We notice that they are not directed at us, but at would be heroes. They publish lists of risk factors, things to watch out for in those of us who would thwart their efforts. But we fail to see listed what drives us to suicide: poverty, bills, homelessness, rape, child abuse, bullying. Nor do we hear anything about addressing these issues that might actually reduce suicide rates.

What about helping parents understand their children's sexuality so that LBGTQ children don't end up on the streets? What about bully intervention programs in schools (designed to prevent bullying, not treat the victim)? What about universal health care and food security? What about a health care reimbursement structure that encourages doctors to go into psychiatry? What about treatment that isn't demeaning? What about...

Instead, we get posters of "head clutchers." Get a grip.

I could go on. I did go on a month ago in a blogpost titled A Better Suicide Prevention Month. I suggested that people with actual experience of living with suicide might come up with something better than a head clutcher. Because it turns out we do know something about preventing suicide. We do most of the work anyway, preventing our own suicides.

How would you, somebody with lived experience of being suicidal, design a suicide prevention campaign? What messages would you like to see? What do you want to have happen in the month of September to prevent suicide?

That's what I asked. Today I discovered that people really are working on this. The website says.

RE:CREATE Psychiatry is a Mental Fight Club project that emerged in 2015 from our flagship creative space The Dragon CafĂ©, a weekly arts and health pop-up in the Crypt of St George the Martyr Church in Borough.

Mental Fight Club? I have to learn more about these people!

Meanwhile, today they posted one of their projects, a suicide prevention project, a film called Living with Suicide, scripted and produced by Eve Loren. Find out more here. And watch it below:

There could be another way to live... We need to make space for truth... Redefine what is normal... Replace compensation for the dead with help for the living... It's time to change the system... Channel self-doubt into anger... Fight.

It's time to fight.

I have to learn more about these people.

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