A little education on bipolar disorder from the insider's viewpoint.

This post is long, I know.  I've tried to provide headers for reference if you don't want to read it all in one sitting, and so you can scroll to the more interesting parts.

IMPORTANT: I am not a medical doctor.  My intention is not to provide advice, but rather to provide perspective and information.  Some of you may find some of the situations discussed herein uncomfortable, so be forewarned.


Why Me?

We've all had tough times.  Some have had tougher times than others, of course.  There were times that I felt like my bipolar disorder was due to karma from various bad decisions I had made throughout life coming back to bite me in the ass.  Other times, I couldn't help but wallow in the "woe is me, I don't deserve this" feeling that I know too many of you are familiar with.  I am an atheist. (Disclaimer: I'm not afraid to admit that I am an atheist, but I'm going to kindly request that you keep your opinions about how I need to be saved to yourselves; this is my "religion," please respect it.)  The reason I bring up being an atheist is that it can make dilemmas about why and how certain things happen a little more complicated than, for example, "God has a plan," or, "Is God punishing me for my sins?"  When you are an atheist, there can't really be a higher reason for why bad things happen to you.  It's not because of "karma,"  and there isn't really any reason you don't "deserve" something just because you've been a relatively "good" person, morally speaking (yes, atheists believe in morals; I'd be happy to explain if you're interested).  But still, I can't help but have these thoughts, despite their conflict with my "religious" beliefs.  Personally, I think it's due to how society has affected me.  Most of society believes in a higher power, one that may judge us based on our choices, and especially so where I've grown up. It's hard to escape thinking that's been imprinted on you basically since birth, regardless of my current beliefs.

My point is this: when I get in a funk, I can't help but waver between the "I had this coming" and "I don't deserve this" mindset.  Particularly when it comes to my bipolar disorder.  Which is kind of ridiculous, especially since I believe it's entirely due to genetics and upbringing (while this is a widely accepted concept of the disorder, I can't speak for every bipolar patient ever).  Chemical imbalances in my brain give me the inability to regulate emotions the way a "normal," healthy person can, and aspects of my upbringing have imparted certain triggers that can cause me to have episodes one way or the other (manic episodes, depressive episodes, or mixed episodes in rare cases).  But nothing about these scientific explanations makes me feel any better.


Will there ever be a cure?

There is never going to be a cure for this.  It's not like the flu, where you can develop a drug or vaccine to target a specific causative agent, which, in the case of the flu, would be a virus.  And, as I'm sure you're aware, even fighting the flu isn't as simple as A-B-C.  With bipolar disorder, there is, in layman's terms, something "wrong" with several of my genes, not just one minor error, but likely several errors in several genes on several chromosomes (and it's not yet known precisely which genes, or if there's even a common pattern of genetic anomalies between all bipolar individuals).  It's not likely this can be treated without some sort of drastic gene therapy, and that's too complicated a problem for me to even attempt to touch on in this discussion.  It's a near impossibility in an adult who has already grown up, physically speaking, especially in my lifetime.  Not to mention, it's not a big enough issue for science to want to spend that much attention (read: money) to at the genetic rehabilitation level at this time.

In addition, as I said earlier, upbringing also has a lot to do with the development of the disorder.  I'm not going to talk about the specifics of how my upbringing affected me, because that's very personal, and as there are two sides (and sometimes more) to every story, it would also be unfair to others involved.  But, we're talking about the likelihood of a cure, here.  Assuming I have access to the best therapists in the world, and have unlimited time to work with them talking through my history, how long do you think it would take for me to be "emotionally" cured?  If you answered "never," you're right.  Most people never fully recover from a trauma.  If you've ever lost a loved one, you know what I mean.  It's a terrible pain.  The best you can hope for is to learn how to manage the pain.  There will never be a cure for it.  Many individuals who suffer from mental illnesses, especially stress-triggered ones like bipolar disorder, have suffered some form of trauma, the type of trauma that causes pain that can never be fully healed.  Some people may even suppress the memories of the trauma, but the pain still remains.


What's it like looking back on your episodes when you're stable?

My experience with bipolar disorder is hard to explain.  It's the thing in my life I struggle with daily, the thing I would give a great deal for in order to change.  It can be blamed for many of my bad decisions.  Some people say they don't have regrets because even the bad things have helped them grow into the person they are today, a better, stronger person.  But some of the things I did while "under the influence" of my bipolar disorder were things that I really do regret, despite the good things that may have grown from the pain and the lessons associated with the aftermath of those poor decisions.  Imagine not being able to trust yourself.  Imagine being AFRAID of yourself.  Imagine that you could change at any moment, without warning... you might become literally insane before you or anyone around you realizes it, and it could cause you to make a mistake you won't get a chance to regret because you might not survive in order to regret it.  It happens, and not uncommonly.


Can you explain how treatment works?

Bipolar disorder is extremely difficult to treat.  Sure, you may have heard that Lithium has been used to treat manic depressive disorder since before you were born, but what you don't understand is that every single individual's bipolar disorder is different, and reacts differently to different medications.  Finding the perfect cocktail of medications at the perfect doses that cause limited or acceptable side effects can take literally decades.  Right now, I feel I'm in a very good place, mood-wise.  But is that because of my medications, or because I'm in-between episodes?  I am smart enough not to test the theory by discontinuing my medications.  I know now that discontinuing my medications could kill me by causing me to become suicidal, to take unsafe risks, to become negligent.  It's not worth it to test that theory out.  But what if my medications aren't actually working?  What if I go crazy again?  What if I have a particularly bad episode and the medications aren't enough?  All I can do is hope that my support system, my family and friends and doctors, can help me recognize that I'm slipping before it's too late.

My medications.  My crutch, outside of my family and friends.  I have 10 prescriptions, 2 of which are not psychiatric drugs.  I won't give specifics, but I'll clue you in to what my average day is like, medication-wise.

2 pills 45-minutes before I eat: prescription Thyroid pill for my borderline hypothyroidism to increase my energy, as well as a prescription stimulant for energy and motivation.

7 pills with breakfast: 2 multivitamins (this is just the normal serving size, not me doubling up), 1 fish oil capsule, 1 antipsychotic used to treat depression, 1 mood stabilizer, 1 prescription folate supplement shown to help with depression, 1 antibiotic for acne.

2 pills and a gel at nighttime: 1 antipsychotic (different from the one above and MUCH stronger dose), 1 mood stabilizer (same as above, but double dose), antibiotic gel for acne.

As needed: a prescription to treat anxiety (I actually never take this).

I am one of those people who rolls their eyes inwardly when someone says they have a hard time swallowing a pill larger than a single aspirin.  I can take all 7 of my breakfast pills in one handfull, in one swallow.  I can actually take more pills than that, and have in the past.  It's a talent I've acquired via an unfortunate history of prescription medications.

To think: I spent most of my life up until, oh 2008?  Taking nothing but a prescription for allergies, some birth control, and whatever was needed to tread various injuries or ailments.  Now, and for the remainder of my life, I'll be taking enough medications that I carry around one single-row week-long pillbox, and another double-row week-long pillbox (together, these take up quite a bit of space and are a pain to travel with).


How do the medications make you feel?

The medications make me feel normal.  That's the short version.  The long version... well, it's complicated.  I laugh when things are funny.  I cry when things are sad.  I can have fun.  I can get upset.  But things in my brain move a little slower.  I really don't notice it much now, and the medications I take now are worlds better than some of the others I've taken in the past.  It's sometimes hard for me to think of words.  That's probably one of the first problems I noticed as far as mind-sluggishness goes.  Also, the antipsychotic I take at night could knock a horse out.  Once that's in my system, I get very sleepy.  But I'm lucky in that it doesn't make it too difficult to wake up in the morning, which can be a common problem.  My other medications don't cause any other noticeable day-to-day side effects, except the stimulant, which makes me a little jumpy, and that can vary with my mood.  What I HATE about my medications isn't that I have to take them daily, which I actually don't mind too much, but that they have made me gain a ton of weight.  Unfortunately, that's a very common side effect of a couple of the drugs I take.  There are other drugs available that can be better for the metabolism, but I'm feeling stable enough now that I don't want to risk changing my medications.

The biggest point I want to make here is that I do not feel like a zombie, and I do not act like a zombie. That's a huge improvement over medications I've personally taken in the past, and especially over medications used in past generations to treat mental illnesses in general.


What have your experiences been during hospitalizations?

I've been hospitalized 3 times, and 2 of those times were within about 2 months of each other.  Each one was at a different facility.  I won't name facilities, but I'll tell you a bit about how my experiences differed.  Note: each time I was hospitalized was due to suicidal ideation.  The general rule is that you will be hospitalized for at least one night if you exhibit that you are a danger to yourself or others.

The first experience I had, I was somewhere between cooperative and resistant when it came to my hospitalization.  They take all potentially dangerous objects from you, including shoelaces, drawstrings, even zippers (sometimes; this can vary from facility to facility).  You are not allowed to keep anything in your room except your clothes and maybe a picture out of the frame, or some papers.  The first two places I stayed allowed me to have a quilt from home and some coloring books and pencils, though the pencils, along with personal hygiene supplies, were kept at the nurse's desk and were only provided upon request.  The first hospital separated suicidal patients from psychotic patients (psychosis, if you don't know, is when you have hallucinations or delusions, or in other words, see, hear, or believe things that are not true or real) for the most part.  We only interacted with the psychotic patients when we had arts and crafts time and when we ate meals.  Our day was highly scheduled, with meals, group therapies, game time, arts and crafts time, television time, and hygiene time blocked out for the most part.  All of your medications are rationed out at specific times of the day, and you are expected to take them in front of the nurses.  They don't check your mouth like they do in movies.  I think I spent 2 or 3 nights there, I don't really remember.  I do remember that the first 24 hours was probably one of the worst 24 hours of my entire life.

My second hospitalization was at the county hospital, which is where they take crazy homeless people. Supposedly it was because of some mix-up with my doctor.  It's a really long story, but I'm still infuriated by it.  I think I spent 2 nights there.  Definitely no more.  They didn't have many rules, basically just don't start fights.  I was so cooperative they released me pretty early.  They didn't have activities or anything, just food and TV.  It sucked and didn't help much with recovery.

My third hospitalization was a place known for providing better care and keeping their patients for much longer time periods than any of the other hospitals I'd stayed at or heard about in the area.  I was there for 6 nights.  They were the strictest about what we were allowed and where and how, etc., and it made sense considering that about half of the patients who were there were psychotic in some way, and the other half were just suicidal.  It was a bit uncomfortable for me, because my roommate, while sweet, was pretty delusional and very wired, and I couldn't really get a moment to myself.  She always wanted me to draw something or color her a picture.  It was pretty annoying, but kind of sweet, too, in an odd way.  We had group therapy, individual therapy, an assigned psychiatrist, more individualized care and close medical monitoring... it felt safe, which was what I needed.  It was the first place I felt like I was actually getting the treatment I needed for my immediate pathology.

In general, the hospitalizations were a lot like you see in movies.  Medications given in little cups that you take getting stared down by a nurse.  No plasticware aside from a spoon.  No privacy.  But the part that was different, for me, at least, was that sense of being robbed of my rights and being mistreated like is so often portrayed in movies.  It wasn't fun, and I'm doing my best to avoid it again, but honestly, it wasn't so bad.  If you just take a second to realize that the caretakers are there to keep you and the other patients safe, it makes it a lot easier to swallow.


What happened after being released?  Certainly you weren't magically cured.

No magical, quick cure.  The third hospitalization got me started on the medications that form the base of my current medical regimen.  But all they did was keep me there long enough to take a test and confirm that my medication was within therapeutic levels in my blood.  After all 3 hospitalizations, I went to the same long-term group therapy program.  It was life changing, honestly.  I spent every weekday from about 8:30 to 4:30 going to group therapy and seeing a psychiatrist 2 or 3 times a week for 5 or 6 weeks.  Yes, it was intensive.  But it helped me on more levels than I can say.  Not only did I meet people who I could relate to and who could provide me with wisdom from their own experiences, but it allowed me the time to find out who I was.  Once I "graduated" from this program, I continued seeing my regular psychiatrist (who I see monthly now that I am stable) and my regular therapist (who I see once every week to two weeks, or more often as needed).  It's what's working for me.

That sums most of it up.  If you have any other questions about my experiences, feel free to comment below, or message me on facebook, what have you.  I am a huge proponent of educating as many people as possible about the realities of mental illness, and I'd be happy to share.

It's August Somehow

Since it's the beginning of August, I figure I owe you guys a check-in.  Last Friday July 27th until the 30th we were in the Denver area.  Friday we spent in Rocky Mountain National Park, and holy cow did that 12,000 feet get to me!  It was exhausting just walking up a hill for a few minutes.  Saturday, while my husband played in an ultimate frisbee tourney in Boulder, my Aunt and cousin and I spent the day in Black Hawk gambling on penny slots.  We got back in time to watch my husband finish his last game before it started raining (it's monsoon season there, so it rained every afternoon and kept the temperatures down in the seventies!), and then we went for dinner in the mountains overlooking the city.  On Sunday, us girls went shopping at the mall, while the husband played more ultimate.  We dropped my cousin off at the airport, and we ate pizza for dinner and watched some movies to end the night.  Monday, we went to the downtown Denver aquarium, which was really amazing, and afterward chatted until it was time for us to leave for the airport.  So, it was an awesome weekend filled with awesome people.  But also filled with lots and lots of a little too awesome food.

When we got back, I was scared to weigh myself.  But, I bit the bullet and had only gained about a pound since my last weigh-in before we left.  And since I've been home, I've been easing back into my diet, but I wasn't good about exercising.  However, this morning I was graced with some good news.  Here are my numbers:

Weight: 172.1
Waist: 34.5"
Hips: 45.5"
Body Fat %: 35.1%

So, I'm a little disconcerted about the body fat % number.  I expected more of a decrease, but I don't know how reliable my scale really is with regard to measuring body fat.  We will see how it trends over the next few weeks.  But I'm happy with the other numbers.

This upcoming Monday, I'm picking back up with my couch-to-5k program.  I had to slack off due to shin splints.  Now, I have new shoes (my old ones were more than 2 years old and I had trained for a half-marathon and ran said half-marathon while it rained the entire time).  My new shoes are the same model as my last two pairs, just updated for this year.  I love my Asics Gel Kayanos.  I will forever and always buy them as my running shoe.  I have never found a shoe that is more comfortable, stable, and has the right flexibility and support for me.  I LOVE them, and they are totally worth the money.  Especially if you're a heel striker like I tend to be.

From Left to right: Asics Gel Kayano 18, 16, 15

I'm doing great.  I'm getting back into exercising, and I'm feeling motivated and more like I want to do more things.  It's wonderful, and something I haven't felt for much too long: since I got out of the hospital in January, pretty much.  So, mentally, I'm FINALLY strong and healthy.  I'm even looking into applying for receptionist positions so I can make a little more money for personal expenses as well as household expenses.  It's something I feel emotionally ready for.  Managing other people's problems is something I feel I can handle.  Doing research is much, much more stressful than the average non-scientist could ever understand.  All the unknowns in the research itself, the unpredictability, the unreliability, the endless repeats, the stress of a grant looming over your head... it was too much for me, and I will likely never work in research again.  Teaching college was something else: the responsibility of other people's education was pretty stressful, and I hated grading papers!  So, I think a receptionist-type job will be a step down, and in a different direction, and at least something I don't feel I'll be locked in to long-term.  

That's about it for now.  I'll keep you all updated on the job hunt, if there is anything to update on.  In the meantime, I wish you all a happy and healthy month!