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!

Popular Posts