

## Living Bipolar

By Landon Sessions

Living Bipolar  
© 2014, Landon Session

Self publishing  
Published at Smashwords.com

Cover art © Honeyboy Martin, Fotolia.com  
Cover design by Katrina Joyner, ebookcovers4u.wordpress.com

ALL RIGHTS RESERVED. This book contains material protected under International and Federal Copyright Laws and Treaties. Any unauthorized reprint or use of this material is prohibited. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system without express written permission from the author / publisher.

# Contents

Contents

Preface

Introduction

Chapter 1

Landon's Story (Bipolar 1)

Chapter 2

A Psychiatrist's Opinion

Chapter 3

Cassandra's Story

Chapter 4

Anne's Story

Chapter 5

Ronald's Story (Bipolar II)

Chapter 6

Jane's Story (Bipolar I)

Chapter 7

A Spouses Love

Chapter 8

Through the Eyes of a Child

Chapter 9

A Friend's Perspective

Chapter 10

From a Parent

Chapter 11

Donna's Story

Chapter 12

Creative Imbalance: Artist, Genius, and Manic-Depression

Chapter 13

Bipolar in Therapy

Conclusion

Tools for Recovery

Bibliography

# Preface

We are just like you. We are those afflicted with the Bipolar illness. We are parents, spouses, brothers, sisters, children, and friends. We are those who suffer from the Bipolar illness, and we are those who are affected by the Bipolar illness. To show you how we live healthy, happy, functional lives is the main purpose of this book.

Although our experiences may differ slightly, the feelings are the same, because the common dominator is the same \-- the Bipolar illness. We think this accountant of experiences will help everyone better understand the Bipolar illness, ranging from those who suffer with the illness, and the lives which the illness affects. Most people have little comprehension as to how debilitating the illness is for an individual. Moreover, even those with the illness have little clue as, "How to live being Bipolar." Currently, there is no road map, no guide, and no directions on how to live and cope with the Bipolar illness. We intend this book to do just that.

We will show you how to communicate with doctors, the most important things to do aside from medication, and how to have healthy relationships. We do this from the perspective of people who are Bipolar, and from people who live with someone who is Bipolar.

What is crucial to realize is we have already done the work for you. We have learned through trial and error, and by making mistakes to find the correct path to take. We have failed for you, and we have succeeded for you. We have done the work for you.

And now we wish to share with you, the path to freedom we have found. How we live happy, healthy lives with the Bipolar illness.

# Introduction

Bipolar illness involves and affects others like very few illnesses can. Perhaps what is most striking about the illness is it's invisible. No one can see any physical symptoms, other than erratic behavior (i.e. increased talkativeness, increased energy, spending sprees, drug and alcohol abuse, no sleep, increased sexual desires), thus it is difficult for other people to detect. If a person has cancer all those around them have sympathy for them and they tolerate the person and their behavior. However, this is not the case with the Bipolar individual where one minute they are happy, the next sad, one minute hopeful, the next suicidal, one minute kind and loving, the next picking an argument, one minute calm, the next in rage. The illness brings misunderstanding, fierce resentment, confusion, lack of trust, financial woes, disgusted friends and employers, and warped children. More can be added to the list. We hope this work will inform and comfort everyone who is affected. There are many.

This book has come about as the result of a lack of practical Bipolar experience in how to live life with the illness. When a doctor informs you that you have Bipolar disorder, they do not also hand you A Users Manuel Guide. There are so many variables involved with Bipolar people, so many factors to be accounted for that it's impossible to explain to an individual in a doctor's session all the little things which must be done to manage the Bipolar illness. Therefore, things are often overlooked, such as, how to communicate with doctors, creating a schedule for your daily life, how to live a healthy life while taking medication, and becoming educated about the Bipolar illness, often go by without mention. Other factors such as the most important things aside from medication are forgotten as well.

We will provide you with first hand stories of life as we know to be true. We will talk to a psychiatrist and a therapist to gain a medical perspective, learn from people afflicted with Bipolar I and Bipolar II illness in how they live healthy and full lives. We will also draw from the experience, strength, and hope from parents, spouses, friends and children of Bipolar people to offer you a full range of perspectives. Although this is by no means a comprehensive picture of all Bipolar people, as patterns vary for Bipolar people, the coming pages paint an accurate picture which can benefit all.

For someone who suffers from the Bipolar illness life is uncertain. The highs are highs greater than any life can offer, but the lows are dark, lonely and hopeless. There is no rhyme or reason as to when a person will wake up feeling up or feeling down. Just when it appears the person is doing well, the next second they have regressed back into the pits of hell with the illness. A Bipolar person is similar to the mercury found in thermometers. The same as people cannot predict the weather accurately, thereby, knowing when the mercury will rise or decrease; no Bipolar person can predict when the illness will take over.

What the average individual may not know about being Bipolar is the significance of the medication. Even though a Bipolar person is taking medication, there are a whole slew of complications which arise when taking medications. The very medicine which helps a Bipolar person, also brings side effects which sometimes are too great to bear. These include dry mouth, drowsiness, weight gain, uncontrollable hunger, trouble breathing through your nose (also known as rhinitis), feeling spacey, suicidal thinking, a decrease in metabolism, induced mania, a decrease in libido, sleeplessness, adverse reactions with other common medications such as Sudafed, blurred vision, dizziness, stomach bleeding, nausea, a loss of concentration and memory, and the list can go on. Thus, a Bipolar person must deal with the illness itself, but also deal with what side effects the medication causes.

Life for a Bipolar person is confusing. Sometimes racing thoughts bring grandiose ideas of conquering the world, while depression may bring the person down so low that they forget about what is good about life, who they are, resulting in feelings of hopelessness and frustration.

Additionally, due to a Bipolar person having racing thoughts, sometimes communicating with a Bipolar person is the equivalent to trying to speak to a person who is standing on the streets in five o'clock traffic in New York City. See in your mind's eye people in New York City walking frantically, talking on cell phones, cars honking and people yelling. Then picture yourself standing in this chaos trying to hold a conversation. At times this is the extent to the level of distraction a Bipolar person may deal with, and demonstrates why communication and living can be challenging.

Self-esteem and self-image is another issue. When a Bipolar person is manic their self-esteem will overdevelop and the person will believe they are capable of taking on any task. During these times the Bipolar person is charming beyond comprehension, friendly, outgoing, witty, creative, and the life of the party. Yet, when a Bipolar person is depressed, the self-esteem crashes down in the person where they deem themselves as the worst person alive, they withdraw, isolate, become distant, cold, negative, angry, and in turn, hurt the other people in their lives.

The DSM-IV (TR) lists four bipolar disorders in its bipolar category:

• Bipolar I (divided into six criteria sets to specify the type of the most recent episode)

• Bipolar II

• Cyclothymia

• Bipolar disorder not otherwise (NOS)

-Keck and Suppes 2005: 4-2

Much is to be said about those who live with someone that has the Bipolar illness, or the friends, children, parents, and employers of someone who is Bipolar. For loved one's of Bipolar people, their life is equally confusing, frustrating, hopeful, hopeless, happy, sad, up and down, positive, negative, and quite similar to a Bipolar person. Imagine the difficulties and complexities of being in a relationship with someone who is one person one day, and the polar opposite the next. Yes, for people who have a relationship with someone who is Bipolar, whether intimate or friendly, professional, or as an acquaintance, the extreme changes in mood and personality can lead to places just as dark as the Bipolar person travels.

To understand the Bipolar illness it is first necessary to define the illness itself. The Bipolar illness "magnifies common human experiences to larger than life proportions" (Goodwin and Jamison 1990-5). The symptoms of the illness reflect the normal human experience to such a degree that both patients and physicians often fail to recognize and acknowledge the illness, as only 1 in 3 people receive treatment (Goodwin and Jamison 1990) What is more alarming is 1 out of every 4 or 5 untreated Bipolar people commit suicide as a consequence of the pain experienced from the illness (Goodwin and Jamison 1990).

The Bipolar illness is one of extreme shifts due to the fluctuation from normal to an opposite state -- even with the aid of medication. At times the Bipolar illness can be characterized by productivity, creativity, and high energy, while in contrast, the illness can display itself as one of profound fatigue and indifference to all that life has to offer. The use of medication by a patient will increase or decrease mania, depression and the frequency of episodes.

The Bipolar illness is diverse in its manifestations, and its "symptoms, course, severity, amenability to treatment differ from individual to individual (Goodwin and Jamison 1990:13). Additionally, the behavior and mood fluctuate from patient to patient, differing from one episode to the next, one day to another. _Perhaps what is most challenging about the Bipolar illness is many individuals struggle with grasping the idea that they have a life-threatening illness which requires lifelong maintenance on medication to keep it controlled._

Let's look at some patient's description of the illness:

Depression carries with it common language fragments:

The patient is "slowed down," "in a fog," or "tired" and describes life as having "lost its color," "dull flat, and dreary." Everything is "hopeless," "heavy," "too much of an effort," "drab, colorless, pointless." Life is a "burden," and things just drag on and on." Hypomania and mania elicit descriptions of a much livelier and more energetic kind. Life is "effortless," "charge with intensity," and filled with special meaning." The patient is "racing," "speed up," wired," "hyper," "high as a kite," "moving in the fast lane," "ecstatic," "full of energy," "flying." Other people are described as "too slow" and can't keep up."

-Goodwin and Jamison 1990: 16

Much consideration has been given to what personal cases should be highlighted in this work. We have chosen cases that deal with the full spectrum of the Bipolar experience. Many of the case studies used substances early on to regulate their illness. However, these same people now live sober lives, and have adequate experience living as a Bipolar person on medication.

The Epidemiologic Catchment Area (ECA) study, carried out between 1980 and 1984, estimated that 56 percent of individuals with manic-depressive illness abuse or are dependent on alcohol or drugs at some point during their lifetime (61 percent for Bipolar I and Bipolar II, respectively). And the National Comorbidty Survey (NCS) estimated that 71 percent of individuals with manic-depressive illness (Bipolar I) "reported at least on life-time substance abuse disorder.

-Torrey and Knable 2005: 234

What is important for you is to identify with the stories where you can. In each story, you will find examples of yourself. Take what information you need and apply it for your individual situation. Identification is the key which will allow you to unlock the freedom for your illness. Take what you need and store the other information away for future use. No matter what, the feelings will be consistent for everyone, and the experiences will be similar for you.

This book is not intended to diagnose, self-diagnose, or otherwise, take the place of medical opinion. Diagnoses of the Bipolar illness should be determined by a medical professional. Moreover, although the term "manic-depressive illness" has been changed to "Bipolar Disorder" in the DSM-IV TR, it is used interchangeably throughout this book.

The purpose of the book is to provide Bipolar people with a "How to Manual on Recovery with The Bipolar Illness." While we encourage you to read the entire book, it is designed so if someone is a friend, a parent, or a child of a Bipolar person they can immediately jump to a specific chapter to learn what they can do to recover with that situation. The same is true if a person is Bipolar II and they are only interested in reading about cases dealing with people that are diagnosed as Bipolar II.

To some people the stories might seem sad, negative, and hopeless. The illness is sometimes like this. The stories are set up systematically to show what it was like, what happened, and what it's like now. The names of the people in the stories have been changed to protect their anonymity.

In the following pages you will find descriptions applicable for everyone. You will gain insight into the thinking, behavior, and feelings of Bipolar people. While you can go on and on describing, diagnosing, and classifying various features of the illness, we intend on making a volume which is easy to digest, yet educational at the same time. Throughout the book notes have been included to help you learn about the illness as you are reading. For example, if a person states in the story they are hypomanic; a note will follow to describe what that entails.

The book _Manic-Depressive Illness_ by Frederick K. Goodwin and Kay Redfield Jamison is considered to be "the Bible" in relation to the Bipolar Illness. Therefore, this text is cited repeatedly as it holds the answers too many of the scientific answers we are seeking to learn about the illness. Instead of having to read an academic text containing almost a thousand pages, and searching wildly through the book for answers, this book uses personal examples and then will cite _Manic-Depressive Illness_ on relevant information which is key in understanding the illness.

What is the benefit of using personal examples in learning about the Bipolar illness? Let's take a look at what is written in _Manic-Depressive Illness_ :

Examining manic-depressive illness from several perspectives gives the truest appreciation of the experience. The exhaustively detailed descriptions of classic psychiatric writing focus on the subject with more care and patience in observation than is found in the contemporary literature. With its emphasis on systematic measurement and analysis, the research that is now most highly valued can objectively examine well-defined, specific questions related to the illness--although weighing the results of that research requires the leaven of wisdom that comes from intense clinical interchange. _Accounts by patients themselves add another dimension, perhaps biased in their own way, yet enriching understanding of the illness as only subjective experience can._

Goodwin and Jamison 1990: 55

This book begins telling Landon's story, who developed the Bipolar illness late in his teens, and to cope with the illness, he self-medicated with drugs and alcohol. Ultimately, the illness landed him in jail. Next, an interview with a psychiatrist is given discussing issues ranging from how to communicate with a doctor and the most important guidelines to follow aside for medication. Then, Cassandra's story (Bipolar I) is told from her own experience where the illness struck her early in her teens leading to drug abuse, a suicide attempt, and even upon taking medication the illness became severe to the point where shock treatment was required to get her out of mania.

Following Cassandra's story, Anne's story (Bipolar II) is told highlighting hypomania, shame, and the decision of whether or not to have children, choosing the right group of friends, and using the illness as an asset. Ronald's story follows discussing a suicide attempt, living with suicidal thoughts and inclinations, communicating honestly with your doctor, taking medication as prescribed, and staying in the middle of the road. Then, Jane's story (Bipolar I) gives an accountant of growing up emotionally disturbed, dealing with issues of self-esteem, finding the right medications, and what questions to ask doctors.

Next, Tristan's (Cassandra's husband) story will examine how a spouse can help their Bipolar spouse, the right attitude to maintain in a relationship with a Bipolar person, equipping yourself to deal with the illness, informing yourself about the illness, and then a revealing interview with his wife Cassandra is told. Sally's story is shown from the angle of a child with a Bipolar mom, and her story shows the anger toward the illness, Sally's fears of inheritance, her acceptance, and her realization of becoming the best version of herself.

John's story deals with his best friend Landon, and details life before the illness, witnessing a friend becoming Bipolar, along with the madness which occurs, the decision to continue a friendship after his friend becomes stable on medication, the realization that the illness is not the other person's fault, and advice on how anyone can remain friends with a Bipolar person. Then, Jane's Mom Connie provides her experience in raising a Bipolar child, touching on topics, such as, the realization that by her becoming healthy as a mother, in turn, the rest of her family then becomes healthy; her experience in Letting Go and Letting God; and getting support. Next, Donna will give her experience of her sister committing suicide from the Bipolar disorder and she offers ways to get help.

Finally, an interview with Cathy Guyer who is a therapist will show why therapy for Bipolar people is crucial in addition to taking medication to live a full, happy, and lasting life. A concluding chapter will tie everything to together moving forward, and a chapter titled "Tools for Recovery" will follow as a quick reference for Bipolar people in living a functional and fulfilling life.

Thank you for joining us. A new way of life and hope begins now as you read the proceeding pages.

The post psychotic or recovery phase is an important but seldom discussed aspect of manic-depressive illness. The recovery to normal thinking and feeling and the adjustment to the interpersonal, medical, professional, and financial consequences of mania and depression are usually slow, exhausting, frustrating, and partially futile experiences for patients. In the following passage, one patient describes the stages in her recovery from a manic episode:

The first symptom of recovery was a gradually increasing power to direct my thoughts into desired channels. I discovered that what seemed to be facts were in many cases delusions. Suddenly one day a feeling of self-control returned. The rapidity of thought seemed greatly lessened, and I was once more able to concentrate my mind on one subject for more than a few minutes at a time. Then came the feeling that I was well and must go home. Previous to this I realized my abnormal mental condition, and had no desire to see or be seen by my friends. Now I was seized with an eager longing to see my relatives and friends. It was like coming back from the dead. I overcame my restlessness by cleaning, scrubbing, mending and writing. My brain seemed unusually active and clear. I wrote for hours at a time; essays, poems, aphorisms, etc., flowed from my pen with great rapidity. I again began to take an interest in my personal appearance, and gradually returned to my normal mental health state.

-Goodwin and Jamison 1990: 20

# Chapter 1

## Landon's Story (Bipolar 1)

Bipolar I

Diagnostic Features

The essential feature of Bipolar I Disorder is a clinical course that is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes. Episodes of Substance-Induced Mood Disorder (due to the direct effects of a medication, other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical condition do not count toward a diagnosis of Bipolar I Disorder. In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. Bipolar I Disorder is sub classified in the fourth digit of the code according to whether the individual is experiencing a first episode (i.e., Single Manic Episode) or whether the disorder is recurrent. Recurrence is indicated by either a shift in the polarity of the episode or an interval between episodes of at least two months without manic symptoms. A shift in polarity id defines as a clinical course in which a Major Depressive Episode evolves into a Manic Episode or a Mixed Episode evolves into a Major Depressive Episode. In contrast, a Hypomanic Episode that evolves into a Manic Episode or a Mixed Episode, or Manic Episode that evolves into a Mixed Episode (or vice versa), is considered to be only a single episode. For recurrent Bipolar I Disorders, the nature of the current (or most recent) episode can be specified (Most Recent Episode hypomanic, Most Recent Episode Manic, Most Recent Episode Mixed, Most Recent Episode Depressed, Most Recent Episode Unspecified)...Bipolar Disorder is associated with Alcohol and other Substance Use Disorders in many individuals. Individuals with earlier onset of Bipolar I Disorder are more likely to have a history of current alcohol or other substance use problems...Other associated mental disorder include Anorexia Nervosa, Bulimia Nervosa, Attention-Deficit/Hyperactivity Disorder, Panic Disorder, and Social Phobia.

Average age at onset is 20 for both men and women.

DSM-IV-TR pgs 382, 383, 384 and 386

Patients "defined as those with a history of mania severe enough to have resulted in treatment (usually hospitalization). Such full-mania usually was accompanied by psychotic features.

-Goodwin and Jamison 1990: 64

Landon's Story (Bipolar I)

My life would forever change on July 17, 1993 when I was hit by a car. I was struck and thrown thirty feet in the air while I was running one day training for cross-country going into my freshman year in high school. The car accident turned my world upside down at the age of 14, as it brought physical pain, and the accident limited what I could do both in school and with sports. I suffered a traumatic brain injury and I was in a coma for four days. After the car accident I became severely depressed and I wanted to commit suicide. Eventually, depression led me to use drugs and alcohol to cope with my mood when I was 16. The next big change in my life occurred when I went to college, as the Bipolar illness began to emerge in my life.

In my second year in college, I had my first manic episode, and my life quickly spun out of control. I became overly obsessive about things in my life. Mark McGwire was chasing the home run record, and in a sense I was doing it with him. I had pictures plastered all over my wall and his home run record chase became a part of my life.

After the car accident in high school when I came out of the coma, I remember fragments of my life for three or four months. Similarly, when I was in a manic episode I only remember fragments of my life for a few months.

I also remember I felt a strong connection with one of my favorite bands and the song lyrics. I felt the lyrics were speaking to me. I heard things in the songs that were not there, but what I heard was very real to me. I thought I had special powers and talents as a result of the connection I made with the lyrics, and I believed I had unlocked the code to be a member of the band. I was obsessed with the song lyrics and I would spend hours and hours neatly writing down the lyrics. I would crumble the paper and throw it away if it did not look perfect enough. I hung the lyrics all over my wall. The lyrics were a part of me.

It's hard to describe how great I felt, but the feelings I experienced were better than any drug I've ever done in my life. In fact, no drug I've ever done has come anywhere close to the feelings I've had in a manic episode. Everything in my life seemed to connect like never before. I found signs and connections everywhere. I thought everyone was my friend, and it was very easy when I went out to meet new people because I was so talkative, and could start a conversation with anyone.

At some point during my manic episode my parents became afraid because they thought that I was using drugs, and that drug use was that explanation for my erratic behavior.

And this is a point my parents never understood.

When I was in a manic episode I didn't do, nor did I want to do drugs, because I felt so good during the mania that I didn't want to do drugs.

This is an important because my parent's denial about their son having a mental illness and ignorance hindered me getting proper medical help.

So, in the Fall of my second year in college I had to drop out of school. I know my brother came to pick me up and took me to a treatment center to get help in Atlanta. I was put some medications and everything there was a blur. At some point I was released and I went to live with my mom. I became severely depressed and I had a hard time getting out of the house. I slept all the time and I just wanted to die. I had no interest in doing anything at all. I rarely left my mom's apartment, and I had little contact with other people. The pain and loneliness I experienced was incredible. Most days I would just lie on the couch watching TV, but my mind state was such to where I could not concentrate or comprehend what I was watching. Nothing gave me any release. At times my mom would give me a task to do, but I had trouble doing simple things, such as washing the dishes.

A few months passed, and in February or March I felt better. Suddenly I was working two jobs that my mom had gotten for me. Shortly after this I started drinking alcohol and doing drugs again. One of my jobs was working at a restaurant, and I drank every night at the bar after work.

After some months passed I was right back to where I was before with doing alcohol and drugs every day in order simply function. If I didn't drink alcohol or use drugs I was unable to do anything, for my mood would prevent me from putting one foot in front of the other. I drank every night to help me sleep, and I smoked pot everyday to control my mood and to be able to function in my day to day life.

The following Fall I went back to college and my world began to change again. I don't remember much starting around November. My memory has gaps for the next four or five months. What I do recall is feeling like everything in my life connected once again. I was comfortable with both my jobs, and I was on top of the world. I was writing a lot of poetry, and I was calling everyone I knew to read them my artwork. I would spend hours on the phone conversing with friends and family members, and I thought everyone was proud of me and my grandiosity made me believe people thought highly of me. It was as if I was coming into my own and I was ready to conquer the world, moving on to do big and great things.

The events in my life are fragmented after December. I was still writing poetry and at the time I did not have a car so I had to walk several miles to go anywhere. It's hard to know how many miles I was walking each day but it was around five or six miles, because that's how far my favorite bar was from my apartment, and that's where I went every day. One day I definitely remember walking at least fifteen miles home from the bar where I had worked.

I became obsessed with religion. I would read the Bible and find strong connections in the texts with my life. It felt like the Bible was speaking to me, and the passages that I read in the Bible seemed to indicate to me that I was on Earth for a much higher purpose.

One day I thought I was in a conversation with God. I thought God told me that I was His Son Jesus coming back to earth to save people, and therefore, I began to believe I was the Second Coming of Christ. Since I had a big scar on my neck and shoulder from the car accident, I believed this was emblematic of the pain and suffering Christ endured on the cross.

One Sunday, I remember going to church and I became overwhelmed with emotion, and I kept saying to myself, "I'm not ready for the responsibility of being the Second Coming of Christ."

Sometime after this I went to my former high school one day and the police arrested me. Because in my mind I had done nothing wrong I thought I was being persecuted and this was further proof that I was the Second Coming of Christ. When I was being arrested the police asked me if I knew why I was being arrested, and I said no. They asked me if I knew someone named John, and I said yes, John is a bartender at my favorite bar.

Later I found out that I threatened to kill my best friend John, and there was a warrant issued for my arrest, and that's why the police were after me. However, I never harmed him physically, nor did I even touch or threaten him in person.

Apparently I left a gruesome voicemail on his phone, and to this day I have no idea what I said, and I have almost no memory of it happening. To put this event in perspective it should be explained that John has been my best friend since I was a child of the age of three or four. We went to school together from kindergarten until the sixth grade, and we lived in the same neighborhood. We always spent the summers together as kids. (Later in the chapter _A Friend's Perspective_ John gives his own experience of being friends with someone who is Bipolar).

While I was in jail my mom told me my uncle, a neurosurgeon, thought that I was Bipolar, and this explained why I was acting the way I was. While my uncle is not a psychiatrist, he suggested that I be evaluated by a professional. I felt relieved at the notion that I was Bipolar, and that I could get better with medicine, but later I loathed this diagnosis. I did not want to be labeled Bipolar, because I did not want to be crazy.

THE ROAD TO RECOVERY

After jail I went to a dual diagnosis treatment center in South Florida to begin the recovery process. I felt amazing when I arrived in Florida, and every morning I woke up early and ran. My grandiosity told me I was going to show the other people in treatment how great I was, and I was going to lead them in the recovery process.

However, after being on top of the world for the first week in treatment, I crashed into a depression. I remember crying the majority of the time and all I wanted to do was sleep. I had no comprehension of the verbiage the others in treatment were using. Not only did I not want to accept that I was an alcoholic and a drug addict...I did not want to accept I was Bipolar! The idea of being labeled crazy and having to take medications for the rest of my life was overwhelming for me.

TIPS ON COPING WITH THE BIPOLAR DIAGNOSIS

C **oming to terms with having the (bipolar) disorder may mean admitting to a new role for yourself in your family, in the workforce, or in your personal relationships. It may require you to make some decisions about restructuring your life and priorities, which may mean viewing yourself differently...**

WHAT IS THE BEST WAY FOR ME TO THINK ABOUT THE ILLNESS?

1.Bipolar disorder is not a life sentence.

2.Many creative, productive people have lived with this illness.

3.Try to maintain a healthy sense of who you are and think about how your personality strengths can be drawn on in dealing with the illness.

4.The way you feel right now is not necessarily the way you will feel in three months, six months or a year.

5.There are things you can do in addition to taking medications to control the cycling or you mood states.

-Miklowitz 2002: 54, 67-68

I didn't know how to live without using drugs and alcohol, and the idea of living without using substances was a concept I would not subscribe to. Just being in treatment was hard to do. The medications prescribed to me only seemed to make me tired and I thrived off energy. I believed the medications took away who I was as a person and that made me depressed.

It is very important to understand that the Bipolar illness could not have been treated until I was sober from drugs and alcohol. Medications for the Bipolar illness cannot work if you are using substances. Once, however, I got sober the Bipolar illness could be treated, and I could take action in recovery for the Bipolar illness.

Eventually things got easier. After I left treatment I remained sober, and I got a job where I was successful. After a year at the job I moved my way into management, and my life was going well.

After being sober for two years my life and mood became unstable and I couldn't handle anything with myself or with other people. I had thoughts of suicide every day, and I was paranoid beyond belief. I constantly had visions in my mind of everything in my life falling apart. It felt like my world was coming to an end. To give you some examples of the paranoia I experienced, every time I went to get money out of the ATM I honestly was scared that all the money in my checking account was going to be gone. Also, I was fearful that I was going to lose my job at any moment and I believed other people were out to get me. And when I got a phone call from a number I didn't know, or when I checked the mail, I was scared that something bad had happened. Anxiety and fear of other people ruled my life and my emotions.

PSYCHIATRIC COMORBIDITY

The most common psychiatric comorbidities are substance related, anxiety, personality, and eating disorders...Illness prevalence and comorbidity with Bipolar disorder are:

1. Substance Use/Abuse -- 44 to 61 percent

2. Anxiety Disorders -- 24 to 42 percent.

3. Personality Disorders -- 30 percent general prevalence (comorbidity is debated due to symptom overlap)

4. Eating Disorders -- 0.5 percent to 3 percent

-Keck and Suppes 2005: 5-14

Paranoia in my life lasted for years. But I never realized any of this paranoid thinking was abnormal, so I never discussed it with my doctor. I thought if I worked harder on myself I could combat my negative thinking. As a result of my thinking I believed I was defective as a person. For two or three years I had suicidal thoughts on a consistent basis, but I was scared to share this fact with my doctor because I thought I would be committed.

However, it's extremely important to understand that I was never _suicidal,_ and I never had a plan of killing myself.

For me, I was ashamed of talking about the suicidal thoughts. I believed I had the thoughts because of what happened in my past from being sexual abused as a child and from the brain injury. I never made the connection to the thoughts being a part of the Bipolar illness. I would beat myself up every day telling myself I was inferior, and inadequate, compared to others because of the suicidal thoughts. I believed myself to be broken and if anyone found out the truth about who I was they wouldn't like me. These thoughts lead me to not sharing them with anyone, and I kept most of how I was feeling to myself. Today I've learned that keeping thoughts and feelings bottled up inside is extremely ruinous to my health and mental and emotional state.

SUICIDE AND HOMICIDE RISK

Patients with Bipolar disorder have 10 to 15 percent lifetime suicide rates. Every patient who may have Bipolar disorder or describes depressive symptoms should be asked about suicidal ideation, plans or preparations for suicide, and intent to act on those plans. They should also be asked about access to medications or firearms that may be used to commit suicide. In most instances, suicide attempts are associated with depressive manifestations, either during a major depressive or mixed episode.

While homicidal behavior uncommon, clinicians should also query a patient as to aggressive impulses towards others. A past history of aggressive behavior or legal difficulties as well as aggressive behavior associated with alcohol or other substance used should be explored.

-Keck and Suppes 2005: 4-19 and 20

FAMILY HISTORY

I have often thought about the potential impact of passing the Bipolar illness on to a child. If I have a genetic predisposition for the illness I do not want to have kids, as I would not wish this illness upon anyone. Therefore, I have researched my family history to learn if anyone in my family has ever had the illness. In my family history, there is no one known on my mom or dad's side who had the Bipolar illness. I was told by a neurologist that the brain injury caused the Bipolar illness. In fact, my therapist's sister was in a car accident, and suffered head trauma, and as a result her sister developed the Bipolar illness.

Past history of head injury should always be part of a medical assessment for the possibility of Bipolar disorder because head injury in and of itself can be either a causal or an aggravating factor for bipolar symptoms. Given that many untreated patients with Bipolar disorder have low impulse control and a tendency to engage in risky behavior, the possibility for head injury becomes particularly pertinent.

-Keck and Suppes 2005: 4-17

TRIGGERS

Triggers with my mood have been difficult to identify, but through journaling my moods I have been able to notice patterns. For example, lack of sleep is one of my main triggers, because when I don't get enough sleep I am more likely to get into a negative mood. Most of the medications I take are at night, and most of the medications I take make me tired. Therefore, if I don't get enough sleep I am more tired the following day and more likely to get in bad a mood.

Almost any stressful situation can trigger my mood, whether it's financial, with relationships, or with work. A bad day at work can seemingly push me over the edge, therefore, I work on taking small breaks, focus on my breathing, not taking things personally and keeping things in perspective.

A change in the seasons definitely affects my mood. In the Fall and Winter I get more depressed, and in the Spring I am more manic. Criticism by others can trigger me and send me into a tailspin. I am sensitive and at times I can take things personally, and if someone criticizes me it can send me into depression or anger. When I am in a relationship and I have a fight with the other person; it can either get me down or send me into mania. Also, being around negative people definitely has an effect on me. A negative person seems to drain my emotions.

What I've learned is that triggers get me stuck in my head, and when I am in my head I am in my own way of moving forward and being happy. Triggers cause me to become obsessed with the problem, and when I am obsessed with the problem I project negatively, worry, I'm anxious and paranoid, and I have the tendency of falling apart, which then causes me to get down, angry, and feeling hopeless and helpless.

Some medications have caused me to gain weight, and gaining weight and eating poorly can trigger my mood to where I get down and depressed. When I started to take Zyprexa I began to eat everything in sight, and I put on 25 pounds. Additionally, some of my night medications cause me to wake up and eat a lot of food at night. But through changing my diet I have lost all the weight I gained. I learned to eat smaller portions and healthy food.

Knowing what triggers my mood has afforded me the opportunity to avoid stressful situations. Or if I find myself in a situation which triggers my mood, I work on keeping things in perspective and realize that I don't have to get worked up in emotion and I work on slowing myself down mentally. But even being aware of what triggers me, does not mean that I don't get triggered.

Today I strive for consistency and routine. I struggle with depression more than anything else. I fall into depressions periodically throughout the year, and when I am depressed I lose sight of everything good in my life. But in changing how I live I have found that depression in my life today does not last as long as it as in the past. When I am depressed I work on being good to myself, and I take action in my recovery any way possible. I have learned that if I can push myself to exercise, or talk to other people, journal, mediate, or take a nap, it helps me with my mood. Taking a nap sometimes is the best thing for me, and sleeping can help to break my mood.

Exercise in my life today is crucial. It provides me with stress relief, and working out is form of meditation. I listen to music and zone out. I find that most of the time when I workout, I am in the moment, and working out is a great mental break for me. I have a lot of nervous energy and working out provides an outlet for me. Working improves my mood and self-esteem, and usually it helps me sleep a lot better.

EXERCISE

Doing physical exercise is highly advisable for a person suffering from Bipolar disorder, but we must bear in mind that sports are highly stimulating, so it is best to practice sports during euthymia and still better, during a depressive phase even though one does not feel like it. On the other hand, it is inadvisable to do sports during a hypomanic or manic phase or if we suspect we are going into decompensation of this type.

Remember:

In these cases, physical activity is a natural antidepressant, but it may make hypomanic or manic symptoms worse.

-Francesc and Vieta 2006: 187

Being good to myself is one of the most important lessons I have learned. Some days can be so overwhelming with intense emotions that I don't know what to do. When these days occur I've learned to be good to myself. I try to channel this energy through working out, prayer and meditation, journaling, helping other people, talking to other people, drinking chamomile tea, taking a hot bath, naps, listening to music, and sometimes getting quiet and watching a movie helps. And when none of these things work to alleviate my mood I simply focus on getting through the day.

Slowing down myself is another important tool I've learned. My mind is always racing and my body operates at a fast level. However, my mind is frequently moving way too fast and I get frustrated because life doesn't operate that way, or I will think of a million things I want to do in the morning for the day, and then because I'm thinking of so many things I lose focus of what I need to do and I end up getting nothing accomplished. During these times I will say to myself slow down, slow down, slow down. One thing at a time.

It's important for me to make a list of things to accomplish for the day and scratch them off as I accomplish them. But I must be careful of how many items I put on the list, because if I over load myself I will become very anxious and then nothing will get accomplished.

Having a strong support group is critical, and talking to others brings a new perspective in my life. However, finding support from others is not an easy task because most people aren't able to relate to the illness. If I start talking to a casual acquaintance about having suicidal thoughts, or paranoid fantasies, they probably not know what to do and then they might not want to be around me. Even having conversations with my family can be challenging because they might get scared, concerned, and possibly overreact to how I'm feeling. Today, I have a select group of friends I can turn to for support, and a lot of times I will tell them I just need them to listen. I also have a few Bipolar friends who I can tell anything that's going on with me and they understand exactly what I'm going through because they go through the same things.

MAINTENACNE AND TREATMENT OPTIONS

One of the most important long-term goals of therapy in patients with Bipolar disorder is to prevent the recurrence of additional mood episodes. Since approximately 90 percent of patients who experience a manic episode will have recurrent episodes, it is important not only to treat the initial manic/hypomanic or major depressive episode but also to prevent subclinical or clinical relapses. Maintenance therapy is intended to achieve this objective. Mood stabilizer therapy is the mainstay of maintenance therapy for patients with bipolar disorder.

-Keck and Suppes 2005: 10-1

I am working with my doctor on this journey. It takes both the patient and the doctor for a successful recovery. The more I've learned to communicate accurately with my doctor the better things have gotten. The same is true for my relationship with my therapist. Communication with my doctor works best when I talk about my thinking and behavior, what life struggles I've had, how I'm sleeping, if I can't function in my day to day life, if my thinking is abnormal, and if I've had any physical problems such as muscle spasms, rapid heart rate, nausea, trouble going to the bathroom, etc.

I have learned communication requires action on my part. I must journal and take notes in between doctors' visits to provide my doctor, and for myself, an accurate picture. In communicating with my doctor I've learned to keep track of certain events, such as suicidal thinking, problems sleeping, problems concentrating, anxiety, or problems I'm having with relationships, whether personal or professional. When I get depressed and I hit a wall emotionally I try to figure out what life event triggered the depression. Additionally, I've learned that I must tell my psychiatrist any physical problems I've had, and I must get his permission before taking any type of vitamin, or over the counter medication, to make sure it doesn't interact with the medications I'm taking. For instance when I take Sudafed my body breaks out in a rash and my skin turns bright red and feels like I've been horribly burned by the sun.

But one of the most important lessons I've learned is to do homework on the illness and research medications for myself. Most of this homework has come from talking to other Bipolar people and learning through their experience what has worked for them. I then take what they've done, research the medication myself (websites such as WebMD are great) and then I discuss this with my doctor to see what he thinks. When it comes to me taking medication I don't have to settle for feeling bad or suffering in my life. I can work with my doctor to find the right combination of medication that will work to live a full, productive, and happy life.

Relationships are hard. We wouldn't be human if we didn't have relationship problems. But when you are Bipolar relationships seem to be especially challenging. My mood state causes changes in the way other people treat me.

When I am feeling good, that is, when I feel like myself, I am happy, friendly, outgoing and I have few problems in getting along with others. But when I am depressed I am distant, cold, withdrawn and very sensitive. In fact, I am sensitive to the point to where the slightest comment can hurt me. When I am depressed and "sensitive" and I get my feelings hurt, I get angry, frustrated and I experience such strong negative emotions that can result in me to creating a situation where I want nothing to do with the individual who hurt me and my feelings.

Intimate relationships are an entirely different issue. When I feel good I am affectionate. But when I am depressed I don't communicate well, I have trouble making decisions, and for the most part I don't want to be alive.

The characteristics I experience when I am depressed affect the woman I am intimate with. When I am depressed my mood and my way of being brings confusion, frustration, and resentment in the other person. Then, the other person I am in a relationship with takes my actions personally and they think they have done something wrong to have me act the way I am acting.

I remember seeing a woman once who had no exposure with a Bipolar person, and therefore, she had no education about the illness. Although I would try my best to explain to her what happens with me when I go through my changes in mood, she was still unprepared for these mood changes. Even though I told her when I was feeling depressed and down -- and therefore gave her reasons for my change in behavior -- what I failed to prepare for is she still has feelings.

Although I thought I had done my part by communicating with her my depression, I failed to realize that when I am in a relationship it's not all about me, whether I'm depressed or not. When I am depressed I am still responsible for my actions, and I am still responsible for how I treat other people.

Relationships take work and more work. In the past, I have ended relationships when I have gotten depressed. Instead of taking the time to work through difficulties and explain my situation, and learn solutions with my moods with the other person, I've taken the easy way out and I have just quit the relationship. But after so many failed relationships in my life I have come to a new awareness, where my old way of thinking and living no longer serves me.

Today I take responsibility and action on changing how I treat other people whether I feel good or bad. Part of taking action in this area requires communicating with others where I'm at that day. This requires me being aware of my actions when I'm depressed, as so far, as to not step on the toes of the others around me or rub other people the wrong way. But it takes work, more work, action and more action.

I have a mood disorder which affects my perception and I see things in black and white. I also minimize and maximize events in my life. Thus, clarity in my life is crucial when my thinking and perception is off. Bipolar people are blessed in so many ways. We really are. It's important for me to focus on what I have in my life -- not what I do not have. The easy road in life is to point out every little detail which is lacking. The abundance in life comes from being thankful for all the gifts I already possess. No matter how bad things may get at times, I know if I just hang in there life will get better. And as soon as things get better I enjoy the good things life has to offer. Life is beautiful when I see life as beautiful.

I have a strong faith in God, and deep down I believe He has been involved in my entire recovery process. Despite my strong faith there have been periods in my life where I have doubted and cursed God for my condition. I have questioned myself as to why God would create a person to have the illness. When I am in the hell of the illness it's hard to accept God is there with me and it's hard to accept that God will heal me. But my experience is God is there working in my recovery whether I choose to believe it or not.

Today I have faith in the process, and I recognize God is in the process. God is **G** ood **O** rderly **D** irection. I trust and believe, that no matter what, things in my life will improve if I follow the direction of recovery as outlined in this book.

My life today is good. I can live with the illness, and more importantly, I'm learning how to work with my illness. I have limitations and I accept that. Even though I have limitations I still have choices in my life. The fact is that even when I'm depressed, even when things are terrible -- I know I will get through it. That's been my experience. Life still happens no matter what I do. The best thing I can do is learn to work with my illness and work with what hand life deals.

It's easy to fall into self-pity, and fall into the trap that I am all alone. But this is not factual. Everyone has good days. Everyone has bad days. Everyone feels happy and everyone feels sad. The bottom line is everyone feels and everyone has experiences just like me. Therefore, I am determined to overcome any mood, or set back I experience with the Bipolar illness.

Today, I accept I have the choice to be active in my recovery, or to stand still, and not get better. Recovery for me is something I do every day, no matter what situation or mood I am in. In the past, I did not have any tools in dealing with the Bipolar illness, and consequently, my life was complete chaos. However, today I work on living one day at a time.

Now you are given the same choice:

To take an active role in your recovery and get better, or to continue the same old routine living in chaos.

Which path will you take?

This book is meant to be suggestive only. We are by no means the sole authority on how to recover with the Bipolar illness, yet we realize this book is an important first step.

# Chapter 2

## A Psychiatrist's Opinion

Interview with Psychiatrist Dr. Joseph Mavica

Interview with Dr. Mavica

What else can Bipolar people do to help themselves, aside from taking medication?

There are a few things you can do. But we should probably start with psycho-education. Psycho-education would be knowing as much as you can about the disorder, and what that disorder is for you and for each individual. Now there are many manifestations of Bipolar disorder -- we've got the textbook diagnosis of Bipolar disorder, but there are many different colors of that depending on the person's personality, and if they've had substance abuse problems, depending on if there are other problems, such as, anxiety, obsessive compulsive disorder. So all these things color the individual's type of Bipolar disorder.

Once you understand your illness though: _How does it manifest itself? What are the first signs of the illness?_ I think those are important things. _Is there a decreased need for sleep? Or is there some sleep disruption? What's the cycling pattern? Do you go from a depressed phase to a manic phase? How long are you in a normal phase before you might switch \-- how rapidly do you switch? Does the weather or the climate affect you? Is there a seasonal pattern? Is it more apt for you to get depressed in the wintertime or more in the summer time? Is there some specific pattern you know about with your illness?_

Knowing this information just takes time. It takes charting the mood. It takes maybe reading about Bipolar disorder, educating yourself as much as you can; talking with your doctor as freely as possible.

Are there any books you are thinking of that people can educate themselves with?

_An Unquiet Mind:_ _A_ M _emoir of Moods and Madness_ by Kay Jamison is a very good reference. This autobiography considering her stature in the mental health field, and also her recollection of her mood problems is significant. Really, any of the celebrity biographies are good sources. If you really want to get esoteric you can read the "Bible:" _Manic Depressive Illness_ by Fred Goodwin and Kay Jamison. But really I think just the experiential world of anybody that has gone through it; any book that talks to that, you will see the differences.

Some of the actors and actresses we know that have the illness you would never know by seeing their work. They are in the acting field, they are artistic, and you never think of them as being Bipolar or having a psychiatric illness. Those are the good places to start. There are also support groups. Through the internet you get a lot of information. There is NAMI: The National Alliance for Mental Illness. These are all good sources to learn from. _The more you know about your illness_ , I think that's the first thing you can do for yourself aside from taking appropriate medication.

You have to know your illness. But with that said, once you know your pattern, once you know how the medications affect you, and once you know that even with the best of medicines \-- no matter what combination you are on -- you can still have some break through mood problems. You might get a phase of depression, you might get a phase of mania, but these phases don't reach the threshold of severity where you need hospitalization, or you need ECT, or you need a whole do over of your medication. You need to be aware of the fact that medications do wear off, and that's parcel to anything in psychiatry. People develop a tolerance to medications. These are all known things which can help us. You know understanding the illness, and what's the next step for us. So I think _education is the most important thing_.

In terms of what's the next step proceeding education, I had a friend who managed his mood swings by running excessively. He would run eight miles a day. It helped his sleep patterns. He usually did this when he was in a manic phase. He would have to be out there running, and he had to pound the pavements for his eight miles. But it helped him. _Running was his mood stabilizer._ Thus, EXERCISE is very important. Science is not quite sure yet what the significance is yet, but there is a brain chemical that is released when we do aerobic exercise that might have some benefit in depression, but we (the scientific community) are not quite sure where it fits in with Bipolar disorder that's Brain-derived **neurotrophic factor** (BDNF), and that is released with aerobic activity. But I can't speak fully on all of the ramifications of that.

It's kind of exciting because it causes or tends to help regeneration of brain tissue. And that's exciting. As opposed to thinking that we just have a closed system of this many brain cells, to think that regeneration of brain cells can occur, that changes the way that we think about some of these illnesses. So exercise is on top of the list. There is no question about that.

It might just be my knowledge base of foods, but I wouldn't say one food over another is important for the Bipolar illness. Although it seems like omega-3 fatty acids have some mood stabilizing properties. I read some studies where three grams a day have some benefit both ways, for depression and when you are manic. I'm not really sure if there is anything which just supports those dietary supplements as enough to maintain mood. It certainly isn't where it's not going to benefit you if you do take it.

What about caffeine and sugar?

You've got to be careful with caffeine. You've got to be careful with caffeine.

Why?

You _don't want to disrupt your sleep patterns._ That's another thing when you talk about what else can we do aside from medications, you want to maintain good sleep hygiene. Good sleep hygiene would be something like not taking too much caffeine and certainly not drinking any caffeine too close to bed time that's going to disrupt your pattern, because that can send you in to a manic phase as soon as that sleep pattern is disrupted. You don't want to trigger that sort of a problem. And concerning sugar, a lot of patients complain about having low sugar, hypoglycemic, and feeling some mood swings with that. Irritability tends to happen.

I know personally if I'm not eating appropriately I get a little bit irritable. But as a trigger for mood I'm not quite sure about diet. I haven't seen that as a classic pattern, but good nutrition is the route which needs to be followed. You want to make sure that you are giving your body subsistence. Unfortunately sometimes, especially in a manic phase people might overeat or not eat at all. Mania can almost be as if a person is speeding on cocaine. Or similar to if a person was on amphetamines. Sometimes mania can cause a person to stay away from food, but you can't neglect your body. The same thing can happen in depression where you are not eating. You've got to maintain some level of subsistence for your body to function.

Other than good nutrition make sure you hydrate yourself -- especially if you are on lithium, you want to make sure you are drinking enough water. And all these medicines tend to dry you out. You've got to _make sure you are hydrating yourself_. You don't want to be dehydrated, especially on lithium; you never want to get dehydrated because you can get toxic. So these are all good things to do.

You mentioned "triggers." How can Bipolar people discover what their triggers are?

Well that takes time. What we know about Bipolar disorder it seems like some stressful event happens, like most of the disorders in psychiatry. You have, maybe, an underlining predisposition to develop the disorder. It seems like some stressful event occurs, and that precipitates the first signs of the illness, whether it's Bipolar disorder, major depression, schizophrenia, it seems like that's the best general way we can describe the onset of the problem. So what's the watershed event? What's the one event that might have precipitated it -- was it a very stressful thing. Well, it's probably specific for the individual. It doesn't necessarily need to be a catastrophic event.

Can you give an example?

Puberty. It happens to all of us, and that in itself might be enough to precipitate it, with all the turmoil associated with it. That developmental phase of our lives, combined with all the stresses and strains of trying to become an adult -- the evolution in our sexuality. Approaching that aspect of our lives might be enough to cause it -- you know the hormonal rages. That could be enough to precipitate it, and it's a normal human event. We all go through it.

Or, it could be a series of events. It could be the lost of a parent, which seems like a high risk factor in developing depression. But once it's manifested it doesn't seems like it needs stressors. It has a life of its own. However, the better we are at copping with those stressors -- that's something else we need to work on. The better we are able to say, "Okay, this is the stress of our life. How are we going to manage it?" And we are going to have stress in our life by definition.

Do we take time outs? Are we getting enough sleep? Are we eating well enough? Are we taking care of ourselves in terms of meditating, giving ourselves some vacation time?

Those sorts of things. That's going to help our illness. That's going to help us stay illness free.

You mentioned working through some of the stressors. How important is it for Bipolar people to work with a therapist?

It's very important. From a primary level a psychiatrist might think the most important thing for a patient to do is stay on their medications, but I think in a life management way working with a good therapist is essential as well. And the therapist doesn't have to be an expert in Bipolar disorder. It doesn't need to be something like that. It just needs to be a therapist that can understand you and your problems, and be effective enough to recognize the disorder for what it is, the ups and downs of the illness, and the many colors of the manifestations of the illness. And to be able to work with the day to day stresses of living.

This type of therapist would be considered a good one to have. It doesn't have to be some specialized guru in Bipolar disorder. Just someone who is sensitive to the needs of a human being, and can help another human being cope with their stressors. I think that's very important. There is reason to support that patients in therapy and taking their medications as well, are more apt to stay stable.

Are there reasons for why Bipolar patients do well taking their medications and being in therapy?

There could be a few reasons for that. First of all, the person feels connected with someone that's listening to them. They have a disorder. The patient feels understood. They feel like they aren't alone in the world. Sometimes patients with Bipolar disorder have an interesting way expressing themselves that might push other people away. Unless they are around other patients with Bipolar disorder, then they feel like they have a kindred spirit. But taken in isolation sometimes that's how the patient feels, so when they are talking to a therapist that understands them, or attempts to understand them, and feels for their problems and trials and tribulations. Just like any good relationship it's very helpful.

Now let's talk about communication with doctors. Thanks to HMO's patients get 15 minutes to talk. How am I as a patient to know what I need to talk about in that 15 minutes?

Can I make a joke? Talk fast!

But if I talk fast then I'm hyper verbal to you!

Well, I'll just make a note of it. Appears to be manic!

You know if you are doing therapy, one of the old thoughts of doing psychiatry and therapy, _you wouldn't want patients bringing in notes_. You would want your patient to _describe their problems so you can see the process of the person's problems unfolding._ But I think in a lot of ways when patients outline _their problems, making bullet notes: I've had a problem sleeping_ ; you want to make sure you cover this with your doctor. Another example is, "it seems like I'm having a problem falling asleep and waking up in the middle of the night, and this pattern has been going on for the past two weeks. You want to make sure you cover that. Or you might note that you're racing thoughts worse in the morning, or whatever the pattern is.

**When you do the bullet approach that's helpful**. _That organizes the patient, and that organizes the doctor_. Having suicidal thoughts, or anything that is a detriment to your health are things to bullet. Any suicidal or homicidal thoughts. Any psychotic processes where you're thought patterns are way off. Any hallucinations. Making bullet points of these things. Even if it was a short lived hallucinatory period. The doctor is going to want to know these things.

So whatever that is going to key you to utilize that time the best you can. That's good.

Okay, so I am a novice. Can you elaborate further on hallucinatory periods? How would I know I am experiencing it?

Hallucinations are when you are hearing and seeing things that aren't there. They are perceptual difficulties, as opposed to illusionary difficulties. Illusions would be like a person misinterpreting real data. Looking at this plant, and thinking the shadow of it looks like a ghost. Well, that's a little bit bizarre, but it's a real stimulus. There is a plant there, and it's a misinterpretation of a real stimuli. Versus interpreting stimuli that aren't there, like hearing a voice outside of the persons head.

The person suffering from that would be drawn to it as if someone was actually talking to them. That's a hallucination. That's an auditory hallucination: hearing sounds repeatedly, any dialogue of voices, people talking back and forth to each other, maybe talking about the individual or seeing things. It could be a function of drug abuse or sometimes medical problems. Perceptual difficulties with no real stimuli are hallucinations.

Can you give examples of what it's like for a person who hears voices?

Classically it's a voice of some sort -- male or female -- sometimes the sexual identity of the voice cannot be discerned. It's mumbled. But it's typically outside the head. Or often times it's a disparaging voice, kind of putting the person down. We used to make a joke in training that you very rarely hear a patient complaining about hearing a voice that says, "Get a job!" I've had one or two patients say that, but it's not a typical pattern.

That's a little bit of a joke, but conversely you don't hear a patient's voice that reports, "Don't work," either. Those are not the typical patterns of hallucinations. It's usually something that's disparaging, and it usually relates to some themes the patient is suffering from, they might have a paranoid back ground; they might have a sexual background. The patient may have some fear of homosexuality.

I'm recalling one patient that felt when he walked into a room the most prominent thing he heard was "You're a fag. You're a fag. You're a fag." He wasn't homosexual at all, but he had the fear of being a homosexual. This was the theme of the voices that he heard.

How common is suicidal thinking and suicidal ideations among Bipolar people?

Oh, that's very common. I think Bipolar patients -- you could check the statistics on this one -- I'm not sure if it's 10% to 15% of patients with Bipolar disorder commit suicide. The frequency of patients experiencing suicidal thoughts is -- I don't know the actual number -- but it's fairly high.

I bring this up because I have suicidal thoughts, and for a couple of years I wouldn't talk about it, instead deeming myself as inadequate. It took me a couple of years to communicate these thoughts with you and other people, because I thought I just hated my life, and I didn't want to be committed back into a psychiatric hospital.

See it becomes a condition of the illness, a symptom of the illness. As opposed to something to act on, you know this is your option; you are in the hopelessness of the disorder. _You recognize more that it is the disorder talking_. This is something you certainly discuss. I've noticed a lot of patients when they feel free enough to say something about it they really don't have a suicidal plan or an intention, but _the thoughts are a reflection of the pain they are feeling_. And sometimes just talking about it is a relief of the pain.

As a clinician we get nervous, of course, when a patient starts having suicidal thoughts, does this person need to be hospitalized? Do we need to involuntary contain the patient? And those are appropriate thoughts because we are concerned about the patients well being. But for a good deal of patients it's just the expression of those feelings, just as you said, you have those types of thoughts. Am I nuts? Am I crazy? What's wrong with me that I'm having these types of thoughts?

What's wrong with you is your illness. It's the illness talking.

Talk about Bipolar people and their tendency towards substance abuse and addiction.

Well, with some of the research they're looking at right now there might be a connection between impulsivity -- there might be a commonality between impulsivity, and Bipolar disorder, and patients afflicted with addiction. The common ground is the impulsivity nature, just the same with patients with ADHD. If you look at that continuum of impulsivity, verse compulsively, that might be a common genetic predisposition. A person with Bipolar disorder can be more apt, especially in a manic phase, to be a little bit more thrill seeking, just as any impulsive person may be, and that thrill seeking side of us needs to be satiated.

Some patients are probably treating themselves , self-medicating, and some patients' will self-medicate in a depressed phase, and in a manic phase. The Bipolar patient might be looking for a little bit more of a kick during a depressed phase, and therefore, they will be drawn toward stimulants, and in turn, some patients when they're depressed may feel somewhat euphoric with alcohol -- even though we know alcohol is a central nervous system depressants, and vice versa. A lot of people when they're manic smoke marijuana, because they feel like it calms them down, and the marijuana lessens their racing thoughts they feel. Some patients when they are manic want to continue doing cocaine, and they really want to amplify the manic phase. Then, a lot of people after using cocaine, shortly thereafter, are calming themselves down on benzodiazepines, or anxiety medicines, or opiates, it's a vicious circle of behaviors.

If you look at that impulsivity strain, that might be the common thread, whether it's the same genetics, or whether it's the same region in the brain that gets stimulated. But I think research will help us understand more about this. There seems to be a group of patients that use drugs as a self-medicating form, but I don't think that's the ponderance of patients though, I think it relates much more to some sense of impulsivity, or thrill seeking side in the patients. Also, there doesn't seem to be a clear pattern of what drug a Bipolar patient might have addiction problems with.

Alcohol is high on the list. You definitely see a lot of alcoholism with patients who have Bipolar disorder. Often when you look at a person's history, and you're suspicious of that patient having Bipolar disorder, you look back in the family history, and discover maybe the father, or mother, had problems with alcohol. For instance, there might be descriptions that the person in the family history was a raging drunk, and very irritable, and people wouldn't know what kind of mood daddy was going to come home with -- but he was always so drunk. Chances are this person in the family lineage was an undiagnosed Bipolar person, and they were trying to medicate themselves through alcohol.

Can drugs cause a person to become manic and stay manic? Can drugs lead to a person being Bipolar?

I think that's a great question. There's a whole category of diagnoses in DSM-IV, where you have substance abuse induced mood disturbances, substance induced mania, substance induced depression, substance induced mixed states. Usually, you would hold back making a diagnosis of major depression, or Bipolar disorder, within a given timeframe in these instances. That's kind of spelled out in the text. So there's that problem where a mood disturbance can occur by substances, and the substances can be more than just drugs of abuse or recreational drugs. There can be regular medications too that can precipitate these problems. Sometimes, and I'm thinking of a friend of mine, if we think of the diathesis stress model of mental illness, meaning there's a predisposition for a mental illness, whatever that may be -- genetic or environmental -- versus a stressor, then the substance abuse can be the stressor that precipitates the onset of the illness.

That has certainly been a possibility, whereas, a stressor in someone's life might be the loss of a parent which precipitates a mood change in a given individual, before you know it they have full blown Bipolar disorder, or major depression, or some other disorder. Substance abuse can also cause the onset of Bipolar disorder. Specifically, what's happening in the brain is there are neurotransmitter changes when you abuse a substance, so that in itself can be enough to probably pull out some underlying pathology. Although there doesn't have to be chances are there's probably some predisposition for a mood disturbance underlying it.

So if someone's doing a lot of cocaine, and there displaying a lot of manic like symptoms, once they get off the cocaine do the symptoms go away?

Right. That would be a substance abuse induced mania by nature of the cocaine usage or the cocaine intoxication. Exactly. Versus someone who takes a couple hits of cocaine and then three, or four, months down the road they can't sleep, they have racing thoughts, they're buying impulsively, and they have all the signs and symptoms of a manic episode. This individual would have a predisposition for Bipolar disorder or another type of mood disturbance.

Is there anything parents, or spouses, can do if they've got someone who's Bipolar in their family struggling with an addiction problem? What's the best way for a family to cope if they've got someone who's sick, and the Bipolar patient needs to take their medication for Bipolar disorder, but they are struggling with a substance abuse problem?

For instance a family might be wondering if their loved one has a drug problem, or a substance abuse problem -- what do they do?

As long as we've ruled out it's not a substance induced mood disorder, and we clearly have an existing Bipolar disorder, that the person also has problems with addiction, yes the information for the families would be: be informed as much as possible to know that both of these illnesses occur together, and for the family to understand there's a high rate of co-morbidity with the illness. Education with the family, and the patient, that abstinence and sobriety is vital for the mood. Additionally, it's important for the family members not to personalize how they handle their loved ones problem. They have to recognize the coexistence of both problems. But families can sometimes have a problem if there's not the coexistence of both those problems.

For example, parents can have a problem when they find out that their loved one is Bipolar in the first place, and the family does not know exactly how to handle that problem. They might have a hard time understanding the notion of mood swings, ups and downs, suicidal thoughts and behaviors, hospitalization, and the chronicity of the illness, and how important it is to be on the medication. Even when the patient is compliant, it's still difficult to get the patient to stay on their medications, and remain taking the medications, and sometimes there's a breakthrough in the mood, and how do families handle that? Geez, you're taking your medication, you're seeing your doctor, what's going on? You're still not where you should be, or where we think you need to be. Versus what kind of progress that individual is making themselves, that's an educational process, and support groups can be very helpful for this, because it's educational for all involved.

Once families see there are other families in the same predicament, and try to understand the nature of their loved one's illness, the end result is a better understanding of the situation as a whole. And the same thing is said for substance abuse. With substance abuse we are willing to point a finger and say this is a weak willed individual. We know drugs can kill. We know drugs can worsen the pre-existing psychiatric condition, let alone Bipolar disorder. From a family's perspective, why does someone want to work against themselves? You know you're ruining yourself by doing this, whether it's a standalone illness of addiction, or the co-morbidity of addiction and Bipolar disorder. These are difficult things for families to accept.

I think what we need to do, though, is think of the analogy of diabetes, or any chronic illness. Why does the diabetic continue to not exercise? Or why do they not continue checking their blood sugar regularly? Why does the diabetic patient persist with an unhealthy diet? Why do they continue without having a full investment to help themselves in regards to their health with diabetes and their well-being? So other families in other settings can get very, very frustrated to, when the individual has a setback with their diabetes. Just the same as any other problem with medicine, it's a matter of trying to understand the nature of the illness, how much can be done, what kind of research is available, what kind of resources are available for the individual with the affliction?

If you try to manage it from this point, from the family's perspective, it can be very challenging, but it's vital that the family is not punitive, as that has no place with recovery.

Does daily stress exacerbate the Bipolar illness for the individual who is taking their medication? And if yes, what techniques can Bipolar people use to help keep their daily stress down?

The usual buzz on stress is we get back to the diathesis stress model. Some stress probably precipitated the illness, and there is the underlying predisposition for the illness itself and something happened to cause it. Whatever the signal event was who knows. It depends on who's doing the looking. People on the outside looking in, might say well that stress didn't do anything to me when I went through my life event, such as adolescence, which can cause someone else to become Bipolar. Therefore, someone else might say, "Adolescence wasn't a big deal for me, why would it be a big deal for another person?" But it's driven by the individual, and their genetic makeup.

_Whatever stress may have precipitated the Bipolar illness, though, it seems like once it starts the illness has a life of its own. It doesn't seem like, at least some of the information that you gather, the Bipolar illness needs stress to make it any worse, or better, rather it just has a life of its own_. The Bipolar illness travels its own course, and you can still have breakthrough mood disturbances, whether you're on medicine or not, although the longer you're not being treated the worse the Bipolar illness is going to get. Yet, I think over the course of time people can be susceptible to chronic or catastrophic stress, and it can affect their mood. Even when you're taking medication, and I think it's intuitive to think that way, but over the course of time seeing patients, it just doesn't follow the usual textbook story, at least in my practice anyway, that you don't need to have stressors to worsen the illness.

Having said that, _stressors do exacerbate the Bipolar illness_. Just like anyone, a healthy person, or a person with a mental health problem, _maintaining good health is a matter of how do we handle stress in our lives_? I think this is across the board, with any human being, how do we handle stress, and how do we define the stressors in our lives, and how do we define stress period? What do we consider stress? Is it a negative thing, or is it a positive thing. For instance, getting married is kind of stressful. But you approach it the same way, _what's good hygiene for you_? What's good mental health hygiene? You can apply that to someone without a mental health disorder, and someone with a mental health disorder. You can apply this to someone with an acute exacerbation versus someone who has an chronic illness.

_Exercise is always good for stress, any type of aerobic exercise_ , and things that you like to do. _Anything which gives you a timeout from the day,_ anything, of course, other than illicit drugs. _Good hygiene is anything that's healthy for you. It might be a simple thing like reading a book or watching a movie._ Activities that are refreshers for the individual, maybe it's just being with someone. It can be as simple as having a spouse, or a good companion, good friendships, and anything a human being does with loving people. Essentially, it is anything which aides in our longevity and adds to the pleasure in our lives.

What can a Bipolar person do to help themselves not get into a full-blown rage, for instance, maybe after leaving a day of work which was very stressful?

_No matter what your prominent symptom is, part of understanding your illness, is understanding yourself, and your illness._ What symptoms seem to flare up when you're in a manic state, or an irritable state, or a depressive state? What are your triggers? Whether it's in social settings, or work settings, circumstantial things, whatever they may be. _Just the same as the family needs to be educated on the illness, the patient needs to be educated on their illness as well_. You've got to know yourself and this will minimize the escalation of big flare ups. _Therefore, knowing yourself is the first key step of minimizing rage or any other emotional flare up._

While knowing yourself is all fine and dandy, sometimes people will still get triggered and fall into a rage. At this point, you will really have to work on giving yourself a mental count to 10, even when your medicine is working. _You have to be able to step back from the situation, and say, what am I doing here, what's the trigger causing this, where's my mind going with this trigger? Do I need to change the situation, do I need to change the scenery, or change my focus to stop this escalation_? Sometimes when you're in the middle of this it can be very, very difficult to stop these feelings. _But it starts with needing to change your focus; you need to change the scenery_. For instance, if you're driving and you get in such a rage that you want to throw a hand grenade, maybe you need to pull off the road, or change the radio station to calm down. _Whatever it is for you, you will need to simply change the circumstances, and back off. Slow down._

These are kind of typical things to do, otherwise your mood will escalate, and before you know it you'll be in big trouble. And you certainly don't want to de-escalate by getting into trouble -- you hit someone, you ran into someone, or you did something to hurt someone, and then the police need to intervene in one of these costly situations.

How does a Bipolar person get to know oneself? If someone is a new patient, or if they been Bipolar for five, or ten years, how does a person go about the self-discovery process?

Biblio-therapy is really helpful, reading about the illness. In drug and alcohol treatment settings therapists give the patient a Bipolar packet. You can read things about Bipolar disorder, see what things match up with your personality, and see what things don't match up. Maybe doing a mood questionnaire to inquire into what kind of things happens from a mood standpoint, and to discover how frequently the symptoms occur. Knowing yourself is an educational process, and sometimes this takes a while, and it takes a while for the people around the patient that are supportive to learn, and understand the patient's symptoms as well, and give feedback from a reasonable standpoint.

Patients can get mood charts on the Internet, and they can also find them in books on Bipolar people. On the Internet you'll find questionnaires that will help you map your moods by using a graph, and you'll find all sorts of helpful tools to do these sorts of things to help you gain greater insight into your illness. You can probably go through N.A.M.I. (The **National Alliance on Mental Illness** ) as well. These would be the kind of places to check into for the self-discovery process. Any of the Bipolar advocacy groups, would also be very, very helpful places to check for additional information on charting your moods. Also, Bipolar support groups are very helpful as well, and a lot of area hospitals will offer these groups free of charge.

How have things changed in the field of psychiatry, with medicines, and with your patients, from when you began your career until now?

I began training, and started my practice, in the decade of the brain -- that was the 1990's. Since then there has been a splash of research related to brain dysfunction, and a lot of in psychiatry and neurology. So it's a very exciting time. We haven't had much changed though in our diagnostic tools, although some of the new brain scans that are in the research phase might be helpful to making a diagnosis. So these things are exciting. The area of genetics is kind of exciting, in terms of trying to have a better understanding of the background and the inheritability of the illness.

What is the hope for families, friends, loved ones, significant others, and Bipolar people? It's a very debilitating illness. What is the hope?

Even with the tools we have now, and I don't want say we have the best stuff available, I hope in the future things are much better, and we look at this period as the dark ages of mental illness. Yet, there is hope in the fact that we are getting better, and with the limited, but effective tools we have right now, _a person with Bipolar disorder can live a full life._ A full and effective life. The can get married, have children, maybe some limitations with women in the choices for medication while pregnant. And the same with the families. It's a chronic illness. There is morbidity associated with Bipolar disorder -- a person can commit suicide. A person can do impulsive things which put their life at risk. But that's life too. We can die of anything at anytime.

The hope is _if the diagnosis is correct, and the person understands the nature and severity of the illness, and is_ _willing to do all of the things they need to do to stay well:_

• Have a therapist if it's warranted.

• Making sure they are taking the medications appropriately.

• Taking care of their bodies, and exercising.

• Having a good support system.

If they do all of those factors, a person can have a fully functioning productive life. There are going to be downsides. Downsides in terms of the illness and that doesn't mean they can't reach some spot of healing, where they can move on and feel better. I would tell any patient and any family member, that _it's a serious illness, no question about it. We can't take it lightly. But there is good evidence that a person can be fully functioning._

# Chapter 3

## Cassandra's Story

The following is Cassandra's story who first became depressed at the age of fife-teen, and her first manic episode occurred at the age of seven-teen. As a teenager Cassandra regulated her moods by using drugs and alcohol. Depression eventually led Cassandra to a suicide attempt. At the age of twenty, Cassandra went to a dual diagnosis treatment center where she got clean from illicit drugs and received proper medical attention for the Bipolar illness.

However, her story does not end there. During the nine years Cassandra has been clean and sober from drugs she has dealt with Neurotoxcity from lithium, and after a failed relationship at five years clean she went into a manic episode which lasted for nine months. After not responding to any new medications during this nine month depression Cassandra's doctor recommended Electroconvulsive therapy (ECT), and this has drastically affected her life.

Today she is married to an incredible husband who is supportive of her illness, and she leads a full life managing the ups and downs of the Bipolar illness. This is her story.

Cassandra's Story

I was a really happy kid and I had a really happy child hood. Once I became a teenager, my parents thought it would be best if I went away to boarding school because of the school system. I was four-teen and going into ninth grade. I was really upset, and put off by the fact that my parents sent me to boarding school, but indignant to the fact that my parents had the money to get me the best education possible. Every time I ever left home, such as leaving for summer school; I always had a lot of friends. They picked this boarding school in Connecticut, one of the top boarding schools in the country, and it was _different_. It was hard. There weren't many people of ethnic descent. And if they were of color they really didn't relate to me anyway, because they grew up in bigger areas where they knew a lot of kids, and I didn't grow up like that.

I tried really hard to make friends. My personality started to change after I got to boarding school at the age of four-teen. I was miserable. I started doing drugs. Mainly pot, and speed, and alcohol. I don't recall any event bringing this personality change other than, for the first time _I was unhappy_. I didn't feel comfortable with myself. I felt that there was something wrong with me, and that whatever I did wasn't good enough. These feelings lead me to start doing speed when I was running track and cross country. I didn't think anything I did was good enough. Other than that I don't know if the unhappiness came from my illness, or from the situation, but I was just very unhappy.

Bipolar disorder typically develops in late adolescence or early adulthood; however, some people have their first symptoms during childhood, while others develop then late in life. Often unrecognized, people may suffer for years before obtaining an accurate diagnosis.

Bipolar disorder affects both sexes equally, but women are about three times more likely to experience rapid cycling; that is, having four or more distinct periods of depression, hypomania, mixed states, or mania in a one-year period.

Both children and adolescents can develop bipolar disorder. Unlike many adults with the illness, whose episodes are more easily definable, children and young adolescents with bipolar disorder often experience chronic mood changes, including rapid mood swings between depression and mania many times within a day. Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder, however, can also appear for the first time in people over 40. The illness that develops in elderly people is less likely to be associated with a family history of the disorder and more likely to accompany medical and neurological problems than earlier-onset bipolar disorder.

Researchers are continuing to learn about the causes of bipolar disorder. Most scientist agree that there is no single cause; rather, many factors act together to produce the illness. Bipolar disorder appears to run in families, often affecting someone from every generation.

-Keck and Suppes 2005 1-1

By the time I was fifteen my life completely changed. Something around me changed. At this point I wasn't just having a hard time, I was really, really depressed. There was no happiness I found in the world. It felt like I had been kicked down a black hole, and I couldn't get out, even though I tired, and I tried, and I tried. I just couldn't get out of this state. I found myself unable to sleep. In my dorm room at school I had a rocking chair, and I would sit in it all night crying for seven or eight day's straight. Then I would crash, and I would do it all over again. I'd stay up all night, and people at school got really worried. I wasn't eating, and I was basically living and functioning on coffee. I also started doing more drugs. For instance, on the weekends I would go with people to New York City, and I would party the whole time.

Then a switch had been flipped inside of me. I wasn't just sad anymore _;_ it was _really, really bad_. I don't know how to explain it. While, I was sad in my childhood at times, now something had completely flipped. I wasn't just sad; rather it was I couldn't live my life any more. To cope I started cutting myself. Then, the school figured everything out, because I stopped going to class. So the school called my parents, and said, you have to take your daughter home. This was Thanksgiving of 1995.

Once I got home my parents said to the school, "No she's fine. There's nothing wrong with here. Kids get sad, and it's not that big of deal." And my parents sent me back to school. Back at school I was cutting, doing drugs, not eating, not sleeping. Then my parents found out about all of my negative behavior, and then they thought maybe she is sick.

I came home just before Christmas and I couldn't stop crying. Then, I started to hallucinate about a man with a plastic bag over his face that would chase me all over the house. I don't know if he was white or black or brown.

I couldn't sleep still, and I continued to get worse. I wasn't doing any drugs because I couldn't leave the house. By this I mean, _I physically could not walk outside of the house_ for fear of something, anything. I feared something would come to get me, and kill me. I began to experience suicidal ideations. I wanted to kill myself ever waking minute of the day. I would dream about putting my head the oven like Sylvia Plath. Or slicing my wrist open and laying in the bathtub with candles everywhere.

I believe I went to five institutions from the time I was fifteen until the time I was eighteen. During this time I didn't leave the house. I didn't go to school. I pretty much just laid up in a ball. I wasn't able to cope with anything. When I was about six-teen my parents found me a psychiatrist, and this particular psychiatrist said he would do the therapy for me as well.

Then I tried to kill myself -- BIG. While in the past I had I made little attempts here and there at killing myself but it had not been serious. I was six-teen years old. One day my mom said I have to go to a meeting about two hours away. Immediately I thought this is my chance to kill myself. As soon as I knew she was going, I knew this was going to be my opportunity to kill myself, and I got happy. I mean really, really happy for the first time in a long time. I was giddy almost. My dad said to me "I'm supposed to have a tennis match today, do you mind if I go?" I told him "Go, go. I'm fine. Everything is fine." So he left.

Nobody was home but me. My parents had locked the medicine in a wooden cabinet, and I took a hammer and destroyed it. I took whatever medications I could find. The only thing that I didn't take was Tylenol. The reason I didn't take Tylenol was because I remember seeing a girl on TV. once who was deaf. She was deaf because when she was a kid she took a whole bottle of Tylenol. So I thought I'm not going to take Tylenol, because if I don't die I don't want to be deaf.

I took mainly prescription drugs and I took a whole bottle of sleeping pills. This is kind of embarrassing but I took all the medication, and lined all of the pills on the dining room table. I think I spelled something out, but I don't know. I took three hundred and fifty pills with a fifth of vodka very quick.

I went and laid down in my parent's bed. I was just beginning to fade out, and my sister called. I picked up the phone, and I said, "I love you Anita. I'm sorry." I was completely falling out already, and my sister picked up immediately on what was going on. She was in Philadelphia, and she told her roommate to call 911. My sister then stayed on the phone with me the entire time. When 911 got there they knocked down the door.

The next thing I remember I had a tube up my nose, and a catheter and the emergency team was pumping charcoal into me as fast as they could. I was so ungrateful. My sister called the hospital, and she was crying, and she was so upset. I said "I'm so annoyed. I have tubes up my nose and my urethra." That's all I could say to her. My parent's reaction to this was _tears_. Tears more than anything else. They didn't know what was going on.

Rates of Attempted Suicide

Studies of attempted suicide in Bipolar patients show that 25 to 50 percent attempted suicide at least once. Combining data for both sexes' results in an attempted suicide rate ranging from 20 to 56 percent. Women, however, appear far more likely than men to attempt suicide, showing both a higher minimum and maximum rate, 15 and 78 percent, respectively. The attempted suicide rate for men was consistently lower, ranging from 4 to 27 percent. Johnson and Hut, the only investigators to specify the severity of suicide attempts, classified 90 percent of them as serious enough to warrant hospitalization. In the general population, women attempt suicide two to three times more often than men, but men actually commit suicide two to three times more often than women.

Goodwin and Jamison pg 231

When I wanted to kill myself I was able to make anyone come to my side. After the suicide the doctor said, "You might be Bipolar," and my parents said what does that diagnoses mean? I was sitting with my dad one day after this, and he said "You know your uncle, my brother, has obsessive compulsive disorder. He is very sick, and he won't meet women, even his nieces, because women are dirty to him because they have periods. He's sick. I didn't even know my brother had a dad like that. I didn't even know. Then my mom said her brother married a woman, and they told me she died of a foot fungus. But really she killed herself. She hung herself.

After the suicide attempt I was so upset. More than anything I think I just wanted to be angry at someone and I was very angry in general. I wanted to visualize my illness at something, or someone, I could just be very angry at. So I chose my dad as the focus for my anger. I blamed him constantly because the illness is on his side of the family. Every single member on my dad's side of the family has some sort of mental illness. Everyone. Most of it is either O.C.D., depression.

My family history is my dad has five brothers. One uncle has obsession about religion, obsessive compulsive disorder, and a little bit about of a personality disorder. Another of my uncles has obsessive compulsive disorder also. My uncle has two sons and one has a personality disorder so bad he can barely function around people. My sister has depression, and I have Bipolar disorder.

Mental illness is in my whole family, and I was really angry with my dad, because mental illness is on his side of the family. I would curse him, and hate him, and I would sneak out and go do drugs. I was just angry. They put me on lithium when I was sixteen, and everything got better Bipolar wise. For the most part I started feeling better. But because I was feeling better I thought it meant I could do bad things, and deep inside I was still angry because I knew I wasn't normal. I knew there was something really wrong with me.

My parents coddled me like you wouldn't even believe. They didn't know what to do, and I was so manipulative. I was in mania a lot. The doctors were upping my meds, up and down, when I was 16 and 17. My meds were so off that I went into neurotoxicity multiple times.

With all the med changes I started wetting the bed around seventeen. The next year when I went off to college I wet the bed once, and I was so embarrassed. It wasn't my fault at all, because the doctors had me on so many pills. I was probably on four or five meds, and it was hard. It was hard adjusting.

College was just lots and lots of drugs. During college my drug use went up a lot because it was a lot easier stomaching drugs to control my moods than the actual medicines that were supposed to help me. I could smoke a joint before bed and I could fall asleep. But if I took my meds I would have a stomach ache, I would be ill, and I wouldn't get a good night's sleep. Also, I could take ecstasy and it would make me happy.

When I came to Florida for treatment it was really hard. I had a manic episode once a month. It was really difficult because I would have the episode the third week of the month, and the second week of the month I would get ready for my manic episode. The third week of the month I would have the manic episode, and the fourth week of the month I would be dealing with repercussions of my manic episode. It was terrible.

My mental illness is definitely related to my menstrual cycle. And I didn't have a menstrual cycle one when I was using, and I didn't have one when I first got clean. This through me off (my body) a lot. I had a manic episode once a month, and it was terrible. Because I hadn't learned to deal with the episodes yet. I'd eat like a whole week's worth of pixie sticks, and then I wonder why my manic episode was so bad. I wasn't being good to my illness during this time. I would go shopping and go on psychotic shopping sprees. My eating was bad. It was mostly sugar and coffee and things like that.

I think a large part of my mental illness is taking care of myself. That's the biggest thing. I wasn't taking care of myself for a while. I was twenty when I came to treatment in August of 1999. For the first couple of years down here...I don't consider life...they weren't good years. I wasn't taking care of myself, and I don't think I was hanging out with the nicest people, and the best people.

My therapist didn't encourage me to eat better. But when I started doing it...better eating, exercise schedule, sleeping at the exact same time, taking my meds at the exact same time...when I started doing these things my therapist said it was good. My doctor never told me to do these things either, except for the sleeping. That's the one thing my doctors want from me is taking my meds at the same time, so I can sleep at the same time.

I pretty much found out on my own what to do to live healthy with my mental illness. I stopped drinking coffee all together about three years ago. I drink tea, lots of tea. My sugar intake is quite low. I cook well balanced meals three times a day. Eating better is good and it makes me feel better. I work out every day. I try to do things that make me happy -- like art. Art makes me happy. So I do that.

ECT Electroconvulsive therapy (ECT), also known as electroshock, ECT is generally used in severely depressed patients for whom psychotherapy and medication are proven ineffective. Also, it may be considered as an option when there is an imminent risk of suicide, because ECT reacts much quicker than antidepressant remedies. Typically, the procedure is performed on an inpatient basis, and maintenance may be administered on an outpatient once a week.

The patient is required to fast for 8-12 hours prior to treatment. Administration of ECT is usually done by a psychiatrist, anesthesiologist, and other medical personal. The patient is anesthetized an electrical current is then passed through the brain, inducing a grand mal seizure. The seizures generally last thirty seconds, to over a minute, and the patient does not feel any pain.

During the seizures there are a series of changes in brain waves. Upon awakening the patient may experience headache, nausea, and temporary confusion and muscle stiffness.

There are different opinions on how memory is affected by ECT. Many patients report loss of memory for days, weeks or months after ECT. Sometimes memory may return, but this is not always the case. Some patients report their short term memory continues for months after ECT.

ECT can be effective for the treatment of severe depression. However, ECT is the most controversial treatment in psychiatry.

What lead to me having ECT to treat the Bipolar illness was I fell in love. Then I met this guy in my Organic Chemistry class. Things really changed when I met Roy. I was clean about three years, and I was with him for about a year. Roy had bad habits and I fell into the bad habits as well. He wouldn't go to class, so I wouldn't go to class. He had something about him that...I don't know. He was half Indian and half Israel. He was pretty. He was smart, and I liked that. _I fell in love without looking_.

Eventually, he broke my heart. He said that he couldn't be with me because I'm not Jewish, so let's not go on another further. I lost it. I was so upset. I couldn't get out of it. I was so devastated. And he would continue trying to be in my life. But then pull away again. H would do it over and over and I would cry and I'd cry and it was so much. He was just so awful to me.

And I couldn't be with anyone else. Even though I'd date other people, I would break it off because I was so messed up over him. This was from the time I was twenty-two to twenty-four, and I was really messed up over him. After the break up the manic episodes...they didn't end. Normally my episodes would last a month or two months. And now it lasted nine months. And it wouldn't go away.

I couldn't be in school. My dad came to stay with me. My sister came and stayed with me. Everybody tried taking care of me when the manic episodes wouldn't stop, and no one knew what to do. The episodes just wouldn't stop.

The doctor was one who approached me about doing ECT. He said, "It's been nine months, you aren't responding to the medications"...and I was all messed up and manic and I just agreed to it.

With ECT you have to go under anesthesia for a very short time. First what happens is you sit in a waiting room. Then this one guy who worked there, this really hot guy, he would come and get me every time. And he was always really nice.

There were six beds in the hospital all separated by curtains. And they always would put me in six, and I would say please put me in the first bed, because I wanted to get the ECT over with. But they'd always put me in the sixth bed. I would lay down and the worst part about this is your head faces out toward the center of the room.

I would just hear beep, beep, beep, beep, beep, beep, beep, and beep, beep...And when you heard the beeps you'd know someone just got shocked. I can't tell you how scary it was just sitting there while you hear five people before you getting shocked. Ugh, hearing the sound. Hearing the beep, beep, beep, beep, beep, beep, beep, beep...

When it was finally time for my turn, the anesthesiologist would come, and I would beg him, _please give me something for the nausea._ Please give me something for nausea, and then I would go under. Next I would wake up, and be thrashing around, and yelling and I'd want to throw up, because of course I wasn't given the nausea medicine. I would say when is it going to be over! And they would say Cassandra it is over. And my teeth hurt, oh my teeth hurt so much from biting down on the rubber mouth guard.

I had a bad headache, I was tired, and I had dry mouth. And then I wouldn't remember anything. I didn't know my daddy's name. I didn't know he was my dad. I didn't know my name. I had no idea where I was at all. My head hurt. It feels like your head got smashed against your frontal lobe, which of course it couldn't never do, because you have enough fluid in your head that it would never do that. But never-the-less, it feels like your head got smashed against it.

The first time the memory lost lasted about a day or two. I lost my memory for a day the first time I had the ECT's done. But then something changed, probably after the sixth time I had ECT's. My memory didn't come back... _at all_. It just didn't come back. My short term memory, my long term memory, both just stopped. For example, my dad would do flash cards with me, and I would do well for the first six, but then my nothing -- my memory just stopped, and it kept getting worse and worse. My memory was terrible.

I had shock treatment done around eight times, but I don't particularly remember all of them. The first time I had ECT done the nine month manic episode went away. While ECT did help some _the experience was absolutely miserable._ Today I still have memory problems. Sometimes it's really good, but it just takes work. Like if I'm listening to music, watching a music video, where there is audio and visual I will remember it a lot better. But when I'm sitting and reading a familiar book, even though I read it years ago the memory of it is gone. Sometimes I have to sit and read and I have to read pages over and over and over and over again.

Now I can't be in school. And I tried. I tried so hard to be in school. I've gone to so many classes and I've had to leave. And the process just becomes painful. I want to finish my degree. I would love to finish my college my degree. But I can't even read a fiction book!!!

MEDICATION

When I was little...well, not even when I was little, I've struggled my entire life with finding the right combination of meds. When I got clean from drugs it became quite obvious that one mood stabilizer wasn't going to do anything for me. However, I _can't survive without lithium_. That's the one medication that if I don't take it my life becomes miserable. I take nine hundred milligrams of it right now which is very low. The lithium level is kept at .7 for my body.

I've always been very, very sensitive to prescribed drugs. Anytime doctors would increase the lithium to above .7, I go into lithium toxicity. My whole body starts itching; I'll be covered in sweat. There is too much salt, so I'll be retaining all this water, headaches, and things like that. Even without the toxicity being on lithium is having a life of excess, sweating, holding in water, being a little lethargic, if you eat salty food -- and I love salty food -- you get itchy afterwards. I get headaches, I can't be out in the sun light, or I get sick.

Notes on Neurotoxicity:

Neurotoxicity occurs as a result of exposure to natural or man-made toxic substance, called neurotoxins, which alter the normal activity of the nervous system causing damage to the nervous tissue. Eventually, this can disrupt or kill neurons which are key cells that transmit and process signals in the brain and other parts of the nervous system. Symptoms of neurotoxicity may appear immediately after exposure or the symptoms may be delayed. Symptoms include limb weakness or numbness, loss of memory, vision, headache, cognitive and behavioral problems and sexual dysfunction.

The Term "Neurotoxic" is used to describe a substance, condition, or state that damages the nervous system, and/or brain. Generally the term is used to describe a condition or substance that has been shown to result in observable physical damage.

Neurotoxicity is kind of like your high I guess -- but wrong. I use to envision the road had pot holes everywhere, so when I walked I tripped over the pot holes because I saw them, but they weren't really there, but I saw them. It was bad.

I've taken a sleeping pill since I was 14, and I have to because I can't sleep on my own. I have to take a thyroid medication in order to counteract the lithium. I've been on almost every single mood stabilizer offered. Some of those caused me to go into neurotoxicity, some of them don't do anything. I have seizures because of the medications. When I was eighteen and nineteen years old I had multiple grand mal seizures, and it was because they put me on Wellbutrin. I've had multiple seizures because of medications.

I have to take an anti-psychotic whenever I have a manic episode. Anti-psychotic kind of stop Bipolar episodes in their tracks. Some are better than others, but three top ones are zyprexa, risperdal, clozaril. Rixperdal messed with my head a lot. Clozaril is very difficult to take because you have to get blood levels taken every week. And zyprexa is wonderful, because it stops the mania right in its tracks, and it makes me feel absolutely wonderful. But you gain a lot of weight on it. Weight gain is common with a lot of the medications

Antipsychotic Medications

A **person who is psychotic is out of touch with reality. People with psychosis may hear "voices" or have strange and illogical ideas (for example, thinking that others can hear their thoughts, or are trying to harm them, or that they are the President of the United States or some other famous person). They may get excited or angry for no apparent reason, or spend a lot of time by themselves, or in bed, sleeping during the day and staying awake at night. The person may neglect appearance, not bathing or changing clothes, and may be hard to talk to--barely talking or saying things that make no sense. They often are initially unaware that their condition is an illness.**

**These kinds of behaviors are symptoms of a psychotic illness such as** schizophrenia. **Antipsychotic medications act against these symptoms. These medications cannot "cure" the illness, but they can take away many of the symptoms or make them milder. In some cases, they can shorten the course of an episode of the illness as well.**

**This information has been provided by The National Institute of Mental Health (** www.nimh.nih.gov) **.**

Story Continued

The hard part about being on medication is you have to be on medication for the rest of your life. I can't take cold medicines, because my particular brand of drugs that I'm on, if I take cold medicine _I'll have a seizure and possibly die_. I can't take Sudafed, and Nyquil. Being on medication is like a chain attached to your leg. You constantly have to be aware of it, and know what's going on with yourself, and be very, very aware. You have to know that you may be on three mood stabilizers and one antipsychotic, but if you're not feeling good, _it doesn't always necessarily mean more. It means you need to be aware of your own body_ and maybe you should take something different. Or maybe you should take something else.

I think the most important part about taking medication, is not the taking of it; _it's recognizing your body and yourself. Recognizing what it all means_. My doctor does not know I can't live without lithium. My parents know I can't live without lithium because I know. In order to be aware of what's going on with your body being honest is a big thing.

Being aware of what's going on with your body is important, and you must be honest with yourself. You must recognize what is good for you and what is bad for you. To be honest with yourself, you must listen to yourself. For example, if I go out walking right now, and I feel drained and itchy and awful, I'm not going to blow off how I am feeling, and not deal with it. I'm going to do something else. I have to realize something physical is going on with my body, I wonder what it is? Then you realize, every time I go in the sun this is what happens. Thus, I'm constantly aware of what's going on with myself.

_I can't take a back seat in my medical care._ I can't let other people prescribe things for me that I am not aware of. I can't let people do things to me, or come up with treatment plans, unless I'm okay with it. Because if I'm not okay with it, it's going to bite me in the ass.

In taking an active role with my medical care, I go to my doctor and explain this is what's going on with me. Then he tells me his thoughts, and I will either say no or I will say yes to his suggestions. Whatever I feel is right for me. Sometimes I'll just say, why don't you give me the names of every medication you are thinking of putting me on, _and I'll do my own research_ , and I'll get back in contact with the doctor, and we'll decide where we will go from there.

Remember, it's not all about medications at all. It's about _taking care of yourself._ You take care of yourself by 1. Listening to your body 2. By getting verbal with what's going on with you 3. Not letting anyone run over you 4. Doing the right things which are not that hard to do.

If I eat too much sugar I get hyper. When I get hyper I'm almost in mania. So the smart thing to do is to calm down on the sugar. When I work out a certain amount it feels good, but if I go over than I'm in a state again which is similar to mania. It's like the mania is almost there. Too much sugar and too much working is very close to being in mania. Close. But I know if I do either of those things, I can make myself crazy. If I don't sleep on a regular basis, I'm going to get a manic episode.

_It's about staying even keel for me._ You don't hype yourself up too much, or get too sad. Take care of yourself. I eat properly, I exercise, I have healthy relationships with my husband and my friends, and I don't overdo anything. That's the most important thing that happens in my life: _if I don't take care of myself the Bipolar illness is just going to get worse_.

COMMUNICATING WITH YOUR DOCTOR

I have a very close relationship with my parents. I have a close relationship with my therapist who doesn't let me get away with anything, which is really good. I talk to my parents between one and four times a day. My husband and I talk constantly. So when something isn't right with me, I can tell all of these people what is going on. I tell my therapist everything, and she helps me figure out what's going on with me. _Communication with my doctors starts with everybody around me_. It's probably not the right thing that, but my doctor is usually the last person on the totem pole. We have family talk constantly, with my cousins, my sister, we all talk and we love each other, and explain what's going on. I talk with my husband and my parent's everyday about my day. By communicating like this I'm able to know when my illness is off. I talk to Tristan (my husband) a couple of days ago, because all of a sudden I was feeling really emotional. And I cried, and I felt really, really emotional. I know that by him being like, hey what's up? What's going on with you?

I have constant contact with everybody. It's one of the bonuses of my life that I have such a great support group. I have lots of different friends. I have friends that I can talk to about Bipolar stuff, and I have friends who are really all about science and school. There are different roles friends take on. I'm blessed to have you in my life. There are very few friends who can understand something that I'm going through. And as much as Tristan and my parents are great to have, they are also my family and it's important to have people outside of that circle.

My family and Tristan have different feelings than other people. Mom and Dad grew up watching me struggle, from the time I was okay until the time I was not okay. So my parent's point of view is going to be different than Tristan's or anyone else's. It's nice having all the different kinds of people.

I've become really uncomfortable around other people. I feel like I'm on display for other people. I'm not sure why I'm having a harder time around other people. I think after I had ECT's done I got a lot more emotional. And I don't know why. I think I did. I think I've had a lot more trouble dealing with life after ECT's. I was able to function in a job before ECT. I was able to function in school before ECT. It was easier. And I was happier. Not being able to do these things is hard.

None of my friends can relate to this. This is my cross. Sometime it sucks but I deal with it. _Plain and simple about being Bipolar disorder is that things suck sometimes._ But you have no choice; _you have to deal with it_. You either kill yourself, or you deal with it. And that's it. I don't want to kill myself, so I deal with it. I know I shouldn't be so black or white, but it is for me. _You were dealt these cards and you just gotta deal with it, that's it_.

Yes, I struggle with the fact that there is a lot I can't do that normal people are able to do, but _we have a life._ It's not like there is something inherently wrong with us, and this is a death sentence. We can live beautiful, beautiful lives. I can't relate to people feeling bad for themselves. Especially people who are Bipolar. I can't talk about any other illness, but I understand this illness, _and for a person to make their life seem so bad, I just think is ridiculous._

The thing I enjoy most about being Bipolar is my relationships are so close, because I rely on them, because of my Bipolar disorder. My mom and I -- my mom is like my best friend \-- and she is amazing. I can talk to her about anything. My dad is so cool. The best thing about being Bipolar is my mom, my dad, and I planned my wedding. That is the greatest thing about being Bipolar. It probably wouldn't have happened if I was sick. You know we, we are planned the wedding and we are so close, and we love each other, and we talk about it, and we did it together.

The hardest thing about being Bipolar is not being able to work. It's hard. I feel really abnormal, I do. That's the hardest part. It doesn't bother me that I'm not normal, it bothers me that every other Bipolar person I know is able to work a job and this bothers me.

The best advice I can give other Bipolar people is to stop complaining! It bothers me so much how some Bipolar people _think their life is over, and have to be so miserable about being Bipolar_. I think it's terrible. There is so much the world has to offer. And people don't need to be like that.

Pets are so important I believe with this illness. My dog is so wonderful. When I start crying she (the dog) comes and lies on me. If I'm just alone and crying she comes to me. Having a dog gives me a sense of responsibility. I have to feed her, and walk her, and pet her, and play with her. This responsibility is important; knowing that I can take care of another life feels really good. My dog makes everything seems okay. She's always there for me. Having a dog really helps. I don't know any other way to put it. She makes me feel better.

THE BEST WAY TO HELP YOURSELF

I think the best way for a Bipolar person to help themselves is to create a schedule, and sticking to a schedule. Wake up at the same time in the morning, eat meals that are healthy and not too sugary, work out; go to bed at the exact same time. Be in the sunlight each day for a little bit, which will help you be a little less sad. Just a regular schedule you can stick to everyday basically. I think that's the best thing any person with Bipolar disorder can do for themselves.

I am really lucky. I attribute my feeling well today to living a stress free life, which is something I've learned to work at. For me it's a matter of not letting the small things get to me. I completely take control of everything in my life and I don't worry obsessively. When I get really stressed, and I start getting nervous, and when everything in my world starts to fall apart, that's when my illness acts up. Now, if I start getting stressed in my life, I take a break, and I go somewhere and breathe. I calm down. I don't let things get out of control.

Honestly it's really easy to live like this \-- stress free. It's being able to focus on the fact I am that a certain times I am driving myself nuts, and then stopping yourself and say "Whoa, what can I do differently?"

For me when my mood starts flaring up I work on calming myself down. And I can get myself really worked up. I can create a manic episode by allowing myself to get really, really stressed. Also if I drink lots of sugar it can cause me to start freaking out. By doing this I create a manic episode. In contrast, if I recognize my feelings, and see that things are getting out of control, I can mentally say to myself calm down.

Manic episodes will always happen. I've learned I can make manic episodes easier on myself. I don't know how better to explain what I do, but I simply work on calming myself down. If I put myself into overdrive I can create a manic episode. _I am the biggest cause of my manic episodes more so than anything else_. _I am my own worst enemy._ I am the one who makes the manic episodes bad. Being your own worst enemy is a personal thing. Learn what agitates you and gets you upset. You have to learn, and discover, what frustrates you and then do the opposite of that. For me being Bipolar I love getting excited because it feels great to me. I always want to be in the excitement state, but I can't. When I am in the excitement state that's what gets me going and the excitement can send me straight into an episode.

It's my decisions and my ideas which get me into trouble. If I decide I want to drink a lot of caffeine, eat a lot of sugar, and do things which are obvious catalysts to becoming manic, then I send myself into an episode. _However if I don't work on sending myself into overdrive, and if I breath and do activities such as yoga, I help myself stay in the middle and out of danger_. Cooking is something which helps me also, because I like to cook. I work on doing simple things which don't excite me, and it makes my life infinitely easier.

I get angry sometimes at my illness but with acceptance things in my life have improved. If you're able to accept that you have a problem which is an illness, you can also accept the fact that the illness is not that bad. Other people have illnesses which are far worse. Some of the most brilliant and creative people are Bipolar. Truthfully the illness is not that bad when you come from a place of understanding and recognize what areas you need to work on to make yourself better.

I'm really in tune with myself. Meaning, I listen to myself. This is not something which comes easy and it's not something that came the first day I found out I was Bipolar. This has taken a lot of work. But I am able to figure out today what works for me and what doesn't work for my illness. I've learned when not to do certain things by listening and learning. And it's taken a long time to get here. This has only come with practice and work.

Be kind to yourself. I know life sucks sometimes and the illness hits hard, and you can feel like everything is falling apart, but you've got to learn to be kind to yourself. Cut yourself some slack and realize that you might get sick and you might not feel well on certain days but it's not the end of the world. If you take care of yourself, and you are your best friend, and you love your body and do what's best for your body, then your life becomes so much easier.

You can be your own worst enemy easily. I hated myself for so long and I made myself miserable because I hated every inch of me. But when I was able to change my way of thinking -- my life became good, really good.

I used to grip and complain all the time about my illness. I would complain about being angry and I would complain that my life was terrible. But finally, I couldn't complain anymore -- because I realized "Wow! I am being really ridiculous! Look at how bad I am being to myself!" I was really embarrassed by how I was thinking. _And then I decided no more. No more bashing and beating myself up for things in my life. I am going to be a friend to myself and I am going to love myself, and when this awareness sunk in my entire outlook, attitude, and personality changed for the better._

I enjoy myself today and I enjoy the little things and things have become so much easier.

# Chapter 4

## Anne's Story

Anne is twenty-three years old and is diagnosed as Bipolar II and Borderline Personality. She had a happy childhood, she is very intelligent, she writes and she paints. As a teenager she was in abusive relationships, she attempted suicide, and became addicted to heroin.

Today she has been sober for a year and a half, and is an incredible example of how a young woman has overcome difficulties which most people would never recover from.

**Bipolar-II** **Disorder** (Recurrent Major Depressive Episodes with hypomanic episodes)

Diagnostic Features

The essential feature of Bipolar II Disorder is a clinical course that is characterized by the occurrence of one more Major Depressive Episodes accompanied by at least one Hypomanic Episode. Hypomanic Episodes should not be confused with the several days of euthymia that may follow remission of a Major Depressive Episode. The presence of a Manic or a Mixed Episode precludes the diagnosis of Bipolar II Disorder. Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a medication, other somatic treatments for depression, drugs of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar II Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. They symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. In some cases, the Hypomanic Episodes themselves do not cause impairment. Instead, the impairment may result from the Major Depressive Episodes or from a chronic pattern of unpredictable mood episodes and fluctuating unreliable interpersonal or occupation functioning.

Individual with Bipolar II Disorder may not view the Hypomanic Episodes as pathological, although others may be troubled by the individual's erratic behavior. Often individuals, particularly when in the midst of a Major Depressive Episode, do not recall periods of hypomanic without reminders from close friends or relatives. Information from other informants is often critical in stabling the diagnosis of Bipolar II Disorder.

Associated mental disorders include Substance Abuse or Dependence, Anorexia Nervosa, Bulimia Nervosa, Attention-Deficit/Hyperactivity Disorder, Panic Disorder, Social Phobia, and Borderline Personality Disorder.

DSM-IV-TR pgs 392-394

is an "illness characterized by a pattern of depressive and hypomanic episodes. Indeed, it is the under diagnosis of hypomania that explains why the frequency of Bipolar illness has been so underestimated. This is scarcely just an academic issue, since the inappropriate treatment of Bipolar-II patients can lead to full-blown mania. Originally, the Bipolar-II pattern was described in patients who had been hospitalized for their depression. Now, appropriately, it encompasses patients whose hypomania alternates with depressive episodes of varying severity...specific symptoms of sufficient magnitude to be designated as abnormal by the patient or the family and to result in interference I normal role functioning but not severe enough to result in hospitalization

-Goodwin and Jamison 1990: 14-64

Anne's Story

My grandmother is Bipolar and she used to torture my father. Aside from torturing my father, she would also pretend to kill herself so everyone would freak out. But I had a really good childhood. My family was middle-class, my mom attended college, and as a child I was really happy. I was bright for my age. In the fifth grade I was reading at an 11th grade level. They used to bring high school books for me, and I was placed in the gifted program. I always wanted to fit in and be popular, but the fact is I just didn't fit -- I was a nerd.

Starting in seventh grade, I got depressed, and in the seventh grade I wrote my first suicide note. My parents found the note and they sent me to a therapist. I think when I wrote the suicide letter it was more therapeutic for me at the time. At the time I wrote the letter I had just lost a friend and everyone close to her glamorized her in death and made her legend.

I was so miserable that I thought in death I could get the love that I couldn't get in life. I was sleeping a lot, I didn't want to go to school, and even as early as the second grade I would fake stomach aches because I didn't want to go to school. My parents brought me to physicians and doctors, but there was nothing wrong with me.

My family was stable until about the age of 12 when my parents got a divorce. Slowly my life got out of control. I would get very angry at first, and this was my mania expressing itself, but no one called it that yet. I would lose control, break dishes, I cursed a lot, and I would call my mom horrible names. I started experimenting with drugs just to get outside of myself drugs at the age of 12 and at this point my parents finally realized there was something wrong with me mentally. Initially the doctors diagnosed with depression at first and ADD. They put me on amphetamines, such as Adderall, and I think that upped the manic state a lot more. Also, I would cut myself as means to control my emotions.

In high school, my life got progressively worse. My impulsivity was the main thing. I believed everything that I was thinking was a great idea, and I could convince myself that when I had insane ideas that my thoughts were brilliant ideas and that my ideas were appropriate. I can also usually convince other people to go along with my brilliant ideas. High school was up and down and I would look for trouble and find it. I had numerous abuse issues with the people I was hanging out with.

I attempted suicide at the age of 16 after I stayed up for five days straight and I became psychotic as a result. Leading up to the suicide attempt I had been raped by a close friend, and I was manic and had been out for three days. The mania didn't hit me until about week later, after I had been doing cocaine. It wasn't that the drugs were gone from my system, they just weren't working anymore and I crashed really hard. I took a lot of pills and I washed them down with alcohol. I guess I passed out because I woke up in the hospital the next day.

The suicide attempt was completely impulsive. It was a consequence of the crash that comes at the end of mania. It was awful. A lot of things happen during mania and everything builds up. Then the crash comes and I realized, "Oh, my and out of control!" I'm embarrassed and I'm ashamed, and the guilt and shame comes from the crash. The crash after mania is what happened to me before the suicide attempt.

SHAME

Manic-depressive individuals experience acute shame and humiliation for many reasons: because of psychosis (particularly manic) and shame for bizarre and inappropriate behavior, violence, financial irregularities, and sexual indiscretions, to name a few of the common problems. One patient state, "No one who has not had the experience can realize the mortification of having been insane" (Reiss, 1919). Robert Lowell, in "Home," described the indignities of psychiatric hospitalization: "we might envy museum pieces/that can be pasted together of disfigured/and feel no indignity" (1977). And Graves (1942) wrote:

While the intoxication of mania lasts, I for one have no disposition to embrace death. After the intoxication is over, my chief emotional reaction is shame and disgust with myself, and a wonder that my fear of death could be so wonderfully and idiotically twisted. That the facing humiliation, of despair, or deprivation should produce a desire for death is quite natural.

Goodwin and Jamison 1990:19

All of a sudden before the suicide there was a huge drop with me mentally and I just couldn't handle life anymore. I was institutionalized for the first time after the suicide attempt, and it was terrible because I was adolescence. I was the only adolescent in the ward, and it was all adults and me. They took me off all my medications and I was also detoxing off illicit drugs. But I was still very depressed because I had a failed suicide attempt. They would not let me smoke at the institution and I remembered that was a huge deal, because I was underage and was not supposed to smoke, but of course, I wanted to smoke.

I was freaking out and I called my insurance company. I refused to go to groups at the institution. And for some reason they just released me from the institution. They simply did not know what to do with me. After that I was in and out of therapy. I was medicated, and sometimes I would want certain medications from the doctors, because I thought I knew best. A lot of psychiatrists even refused to see me, because I was so manipulative. I'm diagnosed as borderline personality in addition to being Bipolar. They diagnosed me as Bipolar right after the suicide attempt, but the second time I was institutionalized at Silver Hill in Connecticut they diagnosed me as borderline personality at the age of 18.

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or Bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women.1 There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. `` Yet, with help, many improve over time and are eventually able to lead productive lives.

While a person with depression or Bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly Bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

The National Institute of Mental Health (NIMH)

I maintained a pretty manic state for around three years, and during this time I had been taking large amounts of amphetamines. During this three year stretch I was painting a lot, and I was also writing a novel. I would write every single day. Even if I was at a party I would have my notebook with me. I was obsessed with the idea of writing the great American novel. On my notebook it even said: "The Great American Novel." I was going to write this book and I have boxes and boxes of notebooks that I still haven't looked at to this day.

I would stay up for days and days writing this book, sometimes for five days in a row and then I would sleep. I was in an abusive codependent relationship, and since I'm borderline, I attach myself to men who were very disturbed individuals. That's who I'm attracted to. I have a savior complex with men or something. In this particular relationship, I liked the fact he would push me, and he would encourage my insanity. He would encourage me to believe that these insane and grandiose thoughts in my head were right.

My mom used to know when I was manic and she wouldn't let me leave the house because she knew that I was manic. When I was manic I would dress differently, and I would wear more makeup and dress sexier and I would always come home completely blitzed. I simply did not have a stop button. It was like when I was manic I was invincible and this personality would scare my mom. She didn't know how to handle my mood changes.

I use to take myself off the mood stabilizers, although I always stayed on the antidepressants. They put me on a mood stabilizer when I was 16 when I was diagnosed as Bipolar. Because the mood stabilizer would curve my creativity I would take myself off of it because I enjoy my creativity. By only taking the antidepressants it caused me to be more manic.

What led up to me going into an institution for the second time is I had the realization that I had a drug problem. During this time I was living with my father, and he's an alcoholic, so he would let me do whatever I wanted and that's why I lived with him. He would just let me do whatever I wanted, and living with him I had a lot of freedom and I would through parities almost every night.

I was 18 at the time and one night my boyfriend and I went to see Bruce Springsteen in New York City. I had been up for three days. We were at a friend's house and my boyfriend and I got into a physical fight over my drug use. My boyfriend said if I got off the drugs our relationship would be a lot better and he wouldn't be so abusive. And this motivated me to going into going to an institution for the second time. I had a breakdown and I called my mom for help, where I disclosed to her that I had a problem with the prescription drugs.

The institution I went to for the second time was an incredible hospital. I learned a lot and it was phenomenal. I was put on the proper medication and I left the hospital very stable. I was there for about 45 days and I lived in the dual diagnosis house. At the time I didn't think I had a problem being Bipolar, rather I thought if I got off the drugs I would be fine. It was difficult but it was a lot better experience than what I experienced the first time. My first experience in the hospital was horrible, but this place was like a resort. At this point I was anorexic and I was a cutter and I really didn't have any control over myself.

After I left I was clean and sober for about six months and I was still with my boyfriend. My boyfriend was Bipolar too but he was unmedicated. I was really happy and everything had been going really well, but I had not been able to write and this was a really big deal for me. Writing was such a big part of who I was. I thought I was going to be the next Sylvia Plath and I really believed this. I believed that I was a literary genius at my 18-year-old naïve self. Then, one night I got really upset and my boyfriend freaked out on me and he tried to kill me. He broke my nose and my cheekbone and knocked out some teeth.

After this the doctors put me on opiates and that's when I realized I didn't have to feel anymore. That's when my love of opiates began at the age of 19. A month or two later I was up for a week straight and I started seeing things. I was convinced my house was haunted and I was seeing ghosts and I would talk to them. This is really the only psychotic break I've ever had, and it wasn't really from a lack of sleep, because it started three days before insomnia took over and it just got worse and worse and worse. When I get manic I don't eat, I don't sleep, and I forget about all those necessities for life. I started seeing ghosts and talking to them, and then I decided to call my psychiatrist and she institutionalized me for the third time.

Gender

The overall incidence of Bipolar disorder is approximately gender neutral. However, epidemiological studies indicate that Bipolar II disorder, a condition in which depressive episodes predominate, may be somewhat more common in women.

-Keck and Suppes 2005: 2-3

This time they focused more on the Bipolar and less on the drugs. I did a lot of therapy and I started to do dialectical behavior therapy. Dialectical behavior is more of a non-medicated approach. After I got out of the institution this time though, I felt really hopeless. _I thought okay the drugs I can get rid of but the Bipolar illness I can't._ So what's the point!!! I was put in a partial hospitalization program for two months and I was using the whole time. I was refusing to take my medication, and the people there told me I was going to die if I didn't take the medication. And my attitude to this was very negative.

Even to this day I romanticize my Bipolar illness. _I think insanity is beautiful._ All of my heroes have some type of mental illness or addiction. I knew at a young age I wanted to do drugs and I knew at a young age I wanted to be crazy. I wanted to be an artist, and I wanted to be different, and because of the Bipolar illness I was different. When I'm in a manic state you can't tell me anything. I used to justify that I'm okay, because I was looking up to people who had mental problems and I thought they were brilliant. _But the fact is the people I looked up to were just insane_. I was like, "Oh Sylvia Plath put her head in the oven and killed herself, that's so beautiful! And _I didn't want to be different; I wanted to be something special._ Therefore, I convinced myself that I was something very special.

Famous people who have a mental illness led me to believing that there is a reason for me being Bipolar. _I needed a reason to have this illness and that was the main thing_. That's why I paint and that's why I write. Because I have a mental illness, I believe I'm going to be better at it as a result. That's a common misconception with people who have a mental illness, that because their crazy with a mental illness that they are a genius. And truthfully we do think different from ordinary people. There is something beautiful about being Bipolar, but I take it to great extremes. Romanticizing the Bipolar illness drives my friend's nuts today. But I do it regardless. Sometimes I love being Bipolar, because I think differently from other normal people. That's what I love -- that my mind is not the same as everyone else.

My mind is different because of the extremes in mood that I experience. _I experience pain, and I experience happiness to such a level that most people will never experience in their entire life_. _When I get manic I feel it -- I feel this physical sensation_. It's like all this energy is in my chest and that it's ready to just burst like a supernova. _I can do anything, and I can be anyone, and I think I'm the most beautiful, the most brilliant girl in the room and everyone is looking at me and it's this amazing feeling, it's like high_. It is a high. You do eventually get that low in the crash which is similar to if you're coming off drugs. But during the time when you're high you just don't see it though, and the world is just an amazing, beautiful place full of possibilities that you can take advantage of.

Lately, I've been going through a manic state and for instance last night I went out to a club. People were taking my picture last night and I decided I was going to be the next "It Girl." I believed I can be the next "It Girl," and as a result, I can break into any scene and that I can do whatever I want, and I'm going to take the world by storm. I believe I'm meant to be better than everyone else.

When I'm manic I use people and I believe everyone on this earth is put there to serve me. I'm manipulative, I'm mean, and I think I'm better than you, and really it's a great feeling. _It's like this evil, great feeling, that you are better than._ In contrast, when I'm depressed I feel as though I'm the shittiest, ugliest, most horrible person in the world. My diagnosis is hypomanic; therefore, I get depressed more and really don't experience much psychosis. With my illness I'm a lot more energetic than I am depressed.

Hypomania

Mood in hypomania is usually ebullient, self-confident, and exalted, but with an irritable underpinning. Most clinical investigators emphasize the elevated, volatile, and fluctuating nature of hypomanic mood. Campbell (1953 describes, on the one hand, the euphoric aspect of mood:

Associated with the euphoria there is a genuine feeling of well-being, mentally and physically, a feeling of happiness and exhilaration which transports the individual into a new world of unlimited ideas and possibilities... When a 19-year-old manic was advised that he was indeed ill, he replied, "if I'm ill, this is the most wonderful illness I ever had." (pp. 151-153)

Kraeplein (1921) described the euphoric aspect of hypomanic mood but also emphasized the quick changes, irritability, and rage that are integral to it:

Mood is predominantly exalted and cheerful, influenced by the feeling of heightened capacity for work. The patient is in imperturbable good temper, sure of success, "courageous," feels happy and merry, not rarely overflowing so...

On the other hand there often exists a great emotional irritability. The patient is dissatisfied, intolerant, fault-finding...he becomes pretentious, positive, regardless, impertinent and ever rough, when he comes up against opposition to his wishes and inclinations; trifling external occasions may bring about extremely violent outburst of rage. (p. 56).

-(Goodwin and Jamison 1990:22-23)

When I'm depressed it's like **a black hole**. There's nothing that can get me out of it. _I just want to die, I want to sleep all day, I don't want to deal with anything, I think everyone's out to get me, I'm paranoid, I'm useless, and there's no point to living_. When I'm depressed I'm needy, and I need someone to love me because I hate myself so much. During these times I need love to overcome these tough feelings. I'll do anything to get out of it, and I think that's why I began cutting.

I'm supersensitive and I take everything the wrong way. I can be very self-absorbed. For example, _when I'm manic I think everyone loves me, and when I'm depressed I think everyone hates me and everything everyone does is to hurt me, and all everyone's ever done in my life is hurt me._

Its two very different worlds that I cohabitate in, I'm bicoastal only in my brain.

What led up to me going into treatment the fourth, and final time, was I got addicted to heroin. When I was doing heroin I really didn't have any Bipolar symptoms. I thought I had found my cure for the Bipolar illness because I simply did not have to feel anything. When I used to be on speed I wanted to do everything, but with heroine I didn't want to do anything. I just stayed in my house and I was afraid to leave. I say I wasn't feeling anything but really it was just a three-year depression I went through. I never allowed myself to get manic and if I did it was very rare. Then someone very close to me, my grandfather, passed away and I retreated into my old world. I just wanted to drop out. _Instead of wanting to do everything I didn't want to be a part of anything anymore._

Heroine simply brought me to my knees and I realized that I had to change because I wasn't living anymore. Drugs weren't enjoyable anymore, and I stopped doing all the crazy and fun things I used to do when I first started doing drugs. I just existed and that's basically it. Eventually, I was arrested and forced into treatment. I was arrested for heroin. I was so desperate and apathetic that I shot up in front of an off-duty cop. This was just the stupidest thing to do _but I just didn't care anymore_. And when I was arrested I said "Thank God," because I realized that it was going to be another week or so until I did die. I was at the end of the road and I figured I would just die crazy on drugs. I hit a spiritual and emotional bottom more than any depression ever brought me.

After the incident with the cop I went to a scary state run detox and I was freaking out there. Coming off the drugs my brain was messed up, and I was screaming and crying, all the time, having panic attacks and throwing up. Without the drugs I mentally could not deal with the world. I had stopped taking medications when I started doing heroine, but at the state run hospital I was put on a new medication that really stabilized me. They put me on Cymbalta. And I'm still on Cymbalta to this day. This is a miracle pill for me. I take 60 mg of it daily.

I've been on almost every medication and nothing has ever worked before like Cymbalta has. I know being stable on medication is a big reason why I'm sober today. I went to a 30 day rehab and I had this incredible therapist who had around 12 years clean and sober. He specialized in trauma and Bipolar and he really pushed me because he saw something in me. He decided it would be a good idea for to relocate to Florida for my recovery. He said I would die if I stayed in Connecticut. And I believe he was right.

I don't have insurance and I get my medication anyway possible. My mom is a nurse and she gets free samples, and I also get medication from my friends. I don't even know how I've been able to live and get medications not having insurance. I just know I've scrapped by for the past a year and a half.

Getting clean and sober there have been numerous ups and downs. _The closest I've ever come to relapsing is when I'm not taking my medication_. One time when I got off medication I went through a deep depression and I was so close to relapsing. I know sobriety and taking medication goes hand-in-hand. _If I don't get my Bipolar illness straightened out, I will relapse, and if I do drugs, my Bipolar illness is going to get out of control._

Stopping Medication on Your Own

The main reason that stopping your medication is inadvisable is that it is associated with a high risk of reoccurrence with episodes. It also greatly increases the risk of suicide. In fact, not taking medications as prescribed is the greatest single factor contributing to when an how often bipolar have reoccurrences.

-Miklowitz 2002: 132

_No matter what medication you're on, life is still going to show up_. Medication does not make me happy all the time and I think this is a big misconception among people. I think the medication just evens me out to where I'm not as depressed and the medication just brings me up a little _. I can still cry, I can still get upset, and I can still get manic_. My antidepressants, however, don't do anything for my mania. When I get pushed into mania I eventually collapse into a depression and it becomes a vicious cycle. Any little thing in life can just set me off.

The most important thing for me aside from taking medication is **being aware**. _Awareness for me is the most important thing, because the second I don't know that I'm manic or that I don't say I'm manic out loud that's when I get out of control._ If I don't tell you I'm depressed that's when I hide things. It's like when I'm using drugs, if I hide the way I'm feeling I can convince myself that what I'm thinking is normal, and this is right, and this is the correct way to think. I have to constantly be aware of being Bipolar, and realize that at any time, I can lose control. Therefore, awareness is very important for me.

_I create a lot of wreckage in my wake when I'm manic. I use people, I'm selfish, and I'm not considerate of other people's feelings. It can be me, me, me, me, and me._ I have to be really careful not to hurt other people when I'm manic. I say things that are wrong, I do things that are wrong. So making sure I don't have too much wreckage in my mania is very important to me. I have to keep myself a little bit grounded.

I'm in recovery in alcoholics anonymous, and I do a 10th step every night, which is important for me in my daily life. The 10th step is taking a daily inventory of all the different things I have done during that day -- if I've lied, if I've hurt someone, if I've been selfish. The 10th step in A.A. is like a graph of where I am mentally. I can look at the 10th step and know that something is wrong with my illness, even before I may be in a manic state. But people notice it usually before I do.

My friends are very instrumental in keeping me from going out of control, because I'll say an idea that I want to do, and my friends will say no that's the stupidest idea that I've ever heard in my entire life. And I'll realize, yeah that is kind of dumb. My friends help me because they don't judge me. My entire life I've always felt judged by others because I was mentally ill. I've had a lot of people leave me because of the Bipolar illness so to cope I used to tell people I'm fine, I'm fine, I'm fine. _But my friends now, I've chosen them for a reason, because they don't judge me at all, and they help me no matter what_. They never push me away, never, no matter how out of control that I am, and they will hold me closer when I'm sick. Since so many people have encouraged my insanity in the past because I was fun, my friends now don't do this and they want the best for me, and it's important for me to look for these types of friends.

I have to find an outlet for my energies so I paint and I write. When I'm really manic I start exercising, and I try to tire myself out running. I try to find a physical outlet for myself mentally, and running has been really helpful. Actually, I find that running is crucial.

The idea of having children is a big concern to me. _I'm afraid to have children because I'm afraid I'll pass it on to them._ **But I wouldn't wish this on anyone else.** For so long the Bipolar illness was my devil, and for this reason I don't think I'll ever have kids. And truthfully this makes me sad.

Often, too, patients (and their spouses) agonize over the possibility of passing on the illness to children, Joshua Logan, in his autobiography, wrote about this fear, expressed in a conversation between Logan and his first wife:

I asked her if she wanted to have children with me. She said no. I asked why, but she refused to answer....she would never children by me, and I should know why. I look at her blankly, and she added: "I have no wish to bring insane children into this world."

Goodwin and Jamison 1990: 19.

But being Bipolar is something I can live with. Even though it is an illness, it's not something that's going to kill you _if you learn about it and you're educated about the illness._ I've had a lot of friends who were Bipolar that have taken their own lives, and that's been the hardest thing for me is to see friends commit suicide. Whenever I was suicidal, I can always look back on it, and be afraid today that one day I might not be able to look out of the black hole and I'm just going to be stuck.

If you feel suicidal you should always inform your psychiatrist, therapist, family members and other significant people in your core circle...Don't stop disclosing your suicidal thoughts because you are afraid of worrying people or hurting their feelings...Err on the side of informing your doctors and significant others, even if you're not sure how serious you are about suicide.

-Miklowitz 2002: 241

In educating myself on the Bipolar illness I've read a lot, and I've discussed it with a lot of people. I discussed it with my therapist and I have become educated by her. I've extensively researched the medication that I take. I think education is a huge part because once you understand yourself it's not as scary. _An Unquiet Mind_ by Kay Jamison was really helpful for me. I like memoirs because they really help me.

The Hope

The hope for other Bipolar people is you can live a full life, and you don't have to hide away, and you don't have to let the Bipolar illness control you. For so long my Bipolar illness has defined who I am. Now it's just a little extra perk. The illness is not who I am. Today I use it to my advantage. _I think that's a big point for other Bipolar people to learn is to mold your mental illness for the way you want to live your life_. Because the illness can be a huge asset. The illness can be an asset because when I am manic I am more creative. When I'm depressed I know what it's like to be depressed, and therefore, I'm more compassionate, and I'm nonjudgmental. You can tell me anything and I wouldn't judge you because I've probably done that and worse.

_I think the most beautiful part about the Bipolar illness is I have an open mind_. I have a very, very open mind, and I'm very accepting of a lot of different things, because I've put myself through hell and back. _There's a lot of hope for Bipolar people, because there's a lot of functional people and it's not the worst thing in the world because it can be managed_. I think I'm doing pretty well now, as I'm still young, because I'm still learning. I'm glad I've discovered this all now.

# Chapter 5

## Ronald's Story (Bipolar II)

He began communicating with his doctor truthfully, started taking his medication as prescribe, and changed his way of living to develop a happy and full life.

Ronald's Story (Bipolar II)

My childhood by all means should have been fantastic. My parents were very loving, I had a younger sister, and even though we fought a lot, it was mostly sibling rivalry. I seldom ever saw my parents fight, and I think there were only a handful of times in my life that I've ever seen my parents screaming at each other. My parents were loving, very supportive; and we never had any financial concerns. As a child I never had anything serious to worry about -- except something was wrong with me. Some of the first memories I have, and really for as long as I can remember, I've always had very dark, dark, disturbing thoughts.

Thought Disorder, Perception, and Cognition

Disorders of thinking are central to manic-depressive illness. Changes in the rate, quality, and fluency of thought and speech, alterations in associational patterns and logical processes, and impairments in learning and memory are as fundamental to depression and mania as are changes in mood and behavior....

Thought disorder has been used as a general phrase to describe problems in the ability to attend, abstract, conceptualize, express, or continue coherent thought.

At one time more generally described -- "Kraepelin thought of the patient's thought and speech as a train which kept derailing, Bleuler's image was that of a torn and poorly mended fabric" (Andreasen, 1984)

Goodwin and Jamison 1990: 248-249

My mom was diagnosed as being Bipolar long after I had been diagnosed as Bipolar. My family history is my grandmother was treated with electroshock therapy long before I was born; my uncle killed himself at the age of 19. So mental illness is prevalent on my mom's side of the family. When I was seven or eight my grandmother died, and I remember one day hearing her voice in my head, and an hour later I found out she died. After this when I would hear someone's voice in my head of someone I knew, and I would get freaked out thinking they were going to die. But I never heard voices of people talking to me, or telling me, to do anything.

After my grandmother died, a year later another grandparent died, and during my childhood there were deaths every single year. I've never been to a wedding, and instead, I grew up going to funerals. This led me to become very dark and morbid, as death was a big event for me in childhood.

Growing up I always had trouble sleeping, and I've always been a night person. My biological clock is opposite of other normal people. Even as a baby I would be up all night in my crib. Also, I used to complain of stomachaches all the time. I would get this physical feeling in my stomach. My mom took me to the doctor and the doctors actually thought I had ulcers. I was put on some medication I had to drink for a long time.

Looking back though, I think it was just my depression that caused me to feel this way. It's almost as if I had really disturbing mental images that manifested themselves as a physical feeling. A predominant disturbing image I've had, for instance, was I would imagine what it would feel like to have an ax put into my forehead, like someone literally put an ax in my head. My memory today is very poor, and I only remember bits and pieces from my child hood, but I know I was tormented quite often by my thoughts as a child, which I felt in a physical sensation.

In elementary school I always had a lot of friends, but I was not the most popular kid in class. I had a close circle of friends, and we were not the jocks, we were not the preppy kids, but we just fit into our own little group. We used to have sleepovers, and oftentimes before I went, I got these stomach aches, and I would become so nervous sometimes I wouldn't go.

I also used to have an almost running dialogue with God. Because I thought I was doing something really wrong because of my thinking, I would say to myself something like "I promise, swear, and vow, God over these really horrible dark thoughts that I have." I thought because of these dark thoughts that I was doing something wrong, and consequently, I was trying to convince God that the dark thoughts were not true. I grew up Catholic, so there was a lot of shame and guilt handed down to me.

I wasn't always miserable, and sometimes I was happy. In fact, there were times when I was incredibly happy. I cried a lot as a kid though, and I was always very emotional. In fact, still to this day I cry very easily. My mood was never consistent though, and for the majority of my life I've had disturbed thinking. My thinking was obsessive as a kid, such as, the running dialogue thoughts I had with God. I was obsessively honest as a kid, but I was also very worried and very afraid. I was afraid of germs, and I would ask my mom, "I touched this am I going to die?" "I ate this am I going to die?" "There is a spot on my arm is it going to kill me?"

For some reason death was always a predominant thought in my head. I thought about suicide before I knew what suicide was. I don't remember at what age, but at a younger age, my mom told me my uncle killed himself at the age of 19 or 20 by killing himself. By learning that my uncle died from suicide it changed my mentality; and it put the idea of suicide in my head. Later I think my mom regretted telling me this.

From then on the idea of suicide became my escape, and it was something that made me feel better. For me the idea of suicide was the ultimate power, and I told myself if things got really bad I could do it. I would say to myself if this happens I can kill myself. I felt better knowing that I had that kind of power. If a certain situation occurred I knew I could kill myself and suicide was the way the solution for my troubles. It made me feel-good and at ease considering it as an option.

When I was 12 my grandfather, who I was very close to, came to live with us because he had cancer, and he couldn't take care of himself. Once he was there I saw him dying slowly over time. He moved into the downstairs bedroom and we had a hospital bed set up for him. One night we were sitting around the dinner table, and I just broke down in tears for no apparent reason at all. At this point I finally admitted to my parents I was depressed. I had held this feeling inside me for so long because I thought I was crazy. Since I believed I was crazy I was fearful if I told other people how I was felling I would be placed into a psych ward for the rest of my life.

Following the incident with my grandfather my parents took me to a doctor, and I was diagnosed with depression, OCD, and ADHD.

Prevalence

It is difficult to determine the prevalence of Bipolar Disorder. This is because the diagnosis is not usually established at the time of initial presentation. While mania is clearly a core feature of Bipolar I disorder, hypomania (a core feature of Bipolar II disorder) may be missed or dismissed as a personality characteristic. Most patients with Bipolar disorder seek help from primary care physicians when they are depressed, thus, a possible diagnosis of Bipolar disorder may be overlooked.

-Keck and Suppes 2005: 2-2

The doctors put me on Prozac and Ritalin. The Ritalin helped me a lot in school. The Prozac helped me immensely with the depressive side most of the time but not always. But I hated seeing the doctors. Once I got put on the medication and had to see the doctor, my goal was to get in and out as quick as possible. Consequently, I don't remember being completely truthful with my doctors.

The medicine was not perfect but it did help. Especially with the obsessiveness. I quit washing my hands as much, and I used to wash my hands until the knuckles bleed. I used to also pick very heavily at my fingers. For the next several years of my life there were lots of ups and downs. Things in my life were not bad after I'd been put on medication for several years. I would still have dark thoughts sometimes, and I was probably on Prozac until I was 19 or 20.

As a kid I moved back and forth from Maryland to Colorado because of my dad's job. I grew up with half my life in Colorado and half of my life in Maryland. From fourth grade until eighth grade I lived in Maryland, and I was in Maryland when I first got depressed starting around the fifth grade.

Growing up I had a lot of fears and insecurities. I went to an all-male high school which first was intimidating because I was wondering how I was going to meet a girl. After ninth grade I got a girlfriend, and once I was with her I was never alone again, moving from one relationship to the next. I got into heavy metal music, and I wanted to fit in but I wanted to be different at the same time. Because I didn't fit into any group with other people -- to compensate, I took to heavy metal music which fit in with my personality because I was a very angry kid.

I'm not quite sure what exactly I was angry at, but I remember being very angry at the Catholic Church. Looking back I guess the Catholic Church just gave me something to be angry at. I never felt God took anybody from me, and I never God took anything from me, but I found faults with the Catholic Church such as priests molest children. The Catholic Church gave me a channel to funnel my angry through. I took theology my freshman or sophomore year in high school and that's when my hate for the Catholic Church began. I even wanted to go through the process being unconfirmed, and even though I never went through the process I denounced the church anyway.

Around the age of 16 substance-abuse entered into the picture. During this time I was still taking Prozac, and the first time I drank I blacked out, and I blamed the Prozac for the black out. Eventually I stopped taking Prozac altogether and I used substances to regulate my moods. I smoked marijuana every day and I had conducted research on the Internet which said marijuana would help regulate the Bipolar illness. As a result, I self medicated and later on I found out that this is somewhat common.

My first girlfriend was gothic in high school and she was a big influence with me. I patterned myself after her. But I never fully committed to becoming Gothic. I never wore makeup, I never wore all the jewelry, and I was just somewhat Gothic. A big part of the story after this is self mutilation. My girlfriend was a cutter and the first time I began to cut was the age of 17. However, before this when I was 15 I burned myself a couple of times. I did it because I could, and I thought I had a high pain tolerance, and I would do it to show off. I used to heat up Bic lighters and hold them against my skin, and I thought this was cool because I can do it -- I could take the pain and I would enjoy it. One time I remember heating a pair of scissors with a lighter, and I just pressed against it my skin for a long, long time. Still to this day I have a big scar from it on my arm.

One night outside of a movie theatre I remember dragging my knuckles against the concrete. I dragged them until they were all bloody. After this I would hit things as well if I didn't want more scars. 99% of the time I would cut myself over a relationship, and I would do this as a way to say, you hurt me, and now I'm going to hurt myself to hurt you. I would cut myself in visible places to make sure my girlfriend would see it. I would cut myself on my arm, or my forearm, and I wouldn't try to hide it whatsoever.

I was never good at lashing back out of my girlfriends, so I hurt myself because I knew it would hurt them. I would say "Look at what you did to me. Look how bad you hurt me." Cutting myself became a copping mechanism. Still to this day, I'll want to cut when something goes wrong. Although, I crave cutting myself some times in my life now, I haven't cut myself in over two and a half years, but I still get almost a physical craving for doing it. I can feel a spot on my arm where I want to cut, and the cravings for cutting are very strong.

When I was in college at the age of 19 I was in a car accident with my girlfriend, and I took the blame for my girlfriend crashing the car. A woman who was a motorcyclist got seriously hurt. I ended up being charged with four felonies, including vehicular assault and drug charges. It was a complete mess, and I faced going to prison for 13 years.

After I got bailed out of jail I went back to college. Following the car accident I became clinical depressed. I barely ever left my dorm room, and I did nothing but play video games. I found my escape in videogames and I would play them eighteen to nineteen hours a day. I would eat the bare amount I had to live and it wasn't always one meal a day. I wasn't showering, I didn't brush my teeth. I basically stopped living. A couple months before college I had one or 2 pre-cavities, but after this depression when I stopped brushing my teeth, I had 14 cavities four months later.

There is a period of two weeks when my depression was so bad that I could not get out of my bed at all, and I did nothing but play video games. Eventually I did get out of my bed to use substances. Once I started abusing substances taking medication was something I did very little -- if I did it all. I was convinced I didn't need any medication.

I had a lot of different sleeping pills which I'd been taking for years, and one night I took three different types of sleeping pills. My rationale was I wanted to go to sleep for several days and I wanted to be knocked out for a long time. I knew very well that taking all the sleeping pills could kill me but I didn't care if it did. My attitude was if I die great, and if I wake up a week from now perfect. At this time I just didn't want to be present in my life.

This was my first suicide attempt and actually it was a cry for help. I cut myself on my forearm and there was blood all over my room. My roommate found me and he took me to the emergency room. When I went to the emergency room, they pumped my stomach with charcoal. Because I'd broken my nose several times the bone structure in my face was not shaped right and they had trouble getting the tubes in my nose to my stomach. When I woke up in the hospital my mom was crying and she said I looked like a ghost. I think my dad was crying but I'm not sure. To this day I don't want to ask him if he was crying because he is a person who shows very little emotion.

_My suicide attempt is something that really upsets me to this day_. It upsets me because **no mother and no father should be subjected to their children committing suicide**. When my mom lost her brother to suicide, I know for a fact it tore her family apart. Her family was never the same after her brother committed suicide. My mom witnessed her brother killing himself when she was a child, and I tried to kill myself. Sometimes I start crying when I talk about this, because it upsets me so much.

After the suicide attempt I had my first experience in a psych ward and I hated it. There I was diagnosed as being Bipolar. I don't remember caring very much with being diagnosed as Bipolar, and I thought, oh well, whatever. The doctors changed my medicine regime, and he told me I was Bipolar II. The bouts of mania I experienced were much shorter and more of my life has been on the depressed end. Sometimes I experienced extreme ups and I felt like I was on top of the world. One summer I remember having a couple of weeks of being manic, and I remember feeling like I was the man, and life couldn't get any better. I was on top of the world, and I had an extreme purpose for what I was going to do with my life.

When I was diagnosed as Bipolar I was put on new medicine which made my life somewhat better, but I still had many ups and downs. At this time because of the legal situations, I suffered major anxieties, and the doctor prescribed me valium, which I used heavily as well. The doctors gave me lamictal and seroquel which seemed to help. My life during this time period was crazy, but I do think the lamictal helped stabilize me.

Several months later I was working at a job and I was miserable. I was living in my parent's basemen, I quit taking my medication, and I started using drugs again convinced that I did not need medication. I was drinking one night and I got into a fight with my girlfriend. I went home and I slit my wrists in the bathroom. I believe this was another cry for help. I didn't care if I died, but I don't think I really thought I was going to die from doing it because I cut across my wrists across, instead of up-and-down, and I didn't cut my wrists the way which would guarantee I would die. But I didn't care anymore. I was benevolent about death.

My mom found me in the bathtub, and it was completely red from the deep cut into my wrists. My mom drove me to the hospital and once again I got committed for another three or four days. I was going crazy in the psych ward and I hated it. I actually told my parents if they didn't convince the doctors to let me out I was going to kill myself, which is ironic, because I was in a psych ward. This shows how bad I really was.

Robins and colleagues (1959b) found that 73 percent of the manic depressive patients in their sample of 134 suicides had received medical care in the year before the suicide, and 53 percent had received it within 1 month. Likewise, within a year before their deaths, 15 percent had been hospitalized in a psychiatric facility, and 11 percent had been hospitalized in a medical facility with symptoms of a psychiatric illness. Among Barraclough's sample (1970) of depressed patients who committed suicide, 70 percent had been in touch with a physician with 30 days of their death, and nearly 50 percent had seen their doctors during the preceding week. Of the 49 suicides in Murphy's study (1975a, b), 71 percent had been seen by a physician within 6 months of death. To our knowledge, only one study examined these issues specifically among Bipolar patients. James and Chapman (1975) found that 50 percent of the Bipolar patients and their first-degree affectively ill relatives who committed suicide had been seen by a psychiatrist in the 3 months before their death.

Goodwin and Jamison 1990: 237

The doctors took me off the current medications I was taking, and the cat was out of the bag about my drinking and using which my parents made me stop doing as well. They changed my medication to Depakote, which I understand is more for mania. Over the summer while I was on this medication I wanted to kill myself daily. My dog was sick that summer and he was prescribed some medication. I looked up the medication my dog was taking and discovered this drug is one of the easiest drugs to kill yourself with. If I took only a handful of my dog's medication I would fall asleep and die. I remember someone wrote a book on suicide and this medication was in there as one of the top ways to kill yourself in the book.

I thought excellent; upstairs in my cabinet is my way out of life if I ever needed it. I was 20 years old then, and eventually I couldn't take it anymore. This was at the end of the summer and I told my doctor what was going on, however, I minimized the extent to how bad it was. _I was never completely honest with doctors my entire life, and as a consequence, my doctors never knew how bad it was_. I don't think I told my doctor I wanted to kill myself; I simply told him I was miserable. Then my doctor explained the Depakote is just for mania and it doesn't treat depression. I remember being very angry. I thought this doctor is a complete idiot, because he prevented me from becoming manic, and meanwhile I've been depressed and I've wanted to kill myself for several months.

Shortly after this I went to jail for a month for the charges from the car accident with my girlfriend that I took the blame for, and they kept me medicated in jail. After I got out of jail I was still very depressed. After being out of jail for a month I got drunk one night and in a blackout I was arrested. I was underage, I was intoxicated, and I ran away from the cops. I don't remember any of this. I woke up in the hospital, and I was told I needed to get picked up, or I was going to have to go to detox.

I decided right then and there that I was going to kill myself that night. I thought I'm arrested and I'm going to prison, because it was made clear to me if I violated my probation I was going to be sentenced to the fullest which was six years in jail. I was living in an apartment in downtown Denver, and I knew my dog's pills were in the cabinet at my parent's house. My best friend picked me up from the hospital and I had him take me to my parent's house, instead of my apartment, because I knew that's where the pills were.

Through a series of events I set off the burglar alarm because I didn't remember the code. Of course, the alarm company called my parents. I got on the phone with my parents and I told them what had happened. I tried convincing my best friend Brian that he could leave me, and my parents called him, and said, please will you stay with him all night to make sure he doesn't hurt himself.

My parents took the first flight out and arrived in the morning. Although I told my parents I was going to be fine they insisted my friend stay with me all night. For some reason I passed out in the middle of the floor in my living room, and my friend Brian sat there and watched me all night. I always had some amazing friends in my life and my friends were with me through everything, even visiting me when I was in the psych ward twice. That night my friend Brian literally saved my life.

Following this incident I was sent to rehab in 2005. I got sober at the age of 20, and they put me on lexapro, and some other medications which did not work at all, or I would have bad reactions to the medications. But the lexapro and lamictal combination got me stable. I still take these medications to this day. I've been sober for almost two and a half years now and I am now 23.

There are still ups and downs though in my life though. _Thoughts of suicide still pop in my head a fair amount, but these thoughts no longer scare me because I've been dealing with them as long as I can remember_. To me a suicidal thought today is nothing to be concerned about. Thoughts of suicide are only a problem when I really focus on them, however, if it's just a passing thought I shrug it off as no big deal. For the most part since I've been sober and stable on medication, the thoughts of suicide have lessened a great deal.

Among the specific factors involved in the ability to survive suicidal inclinations:

1. Capacity to control behavior -- that is, the ability to stand the pain or impulse

2. Capacity to relate readily and in a meaningful way to someone else; presence of family members and friends who are supportive

3. Motivation for help and willingness to work actively on the problem

4. Variety of resources that facilitate the therapeucatuic process and the transition back to a stable life pattern -- for example, job skills, intelligence, physical health, communication skills, a capacity to trust , close ties to a church, or freedom from severe personality disturbance or addictive problems.

Goodwin and Jamison pgs 771-772

I try not to use the word depressed anymore, because in comparison to where I was before it is nowhere near that level. I get these brief moments of mania of where I feel amazing. Sometimes it's not even for a day but just for a few moments or a few hours. I feel high when I get like this, like I'm high on life to sound cliché. It's the best feeling because I feel like life is perfect and everything is great.

But when I get like this I also have the feeling that it's not good to be manic because I know deep down I will eventually come back down and crash -- which always happens. Generally I'm a pretty happy person now. I've developed awareness today and I feel like I know the difference between when I'm manic and just being happy.

Communication with my doctor today is honest and I tell him how things are in my life accurately. Until I came to Florida to get sober my communication with doctors was to get in and out as fast as possible, and this was from the ages 12 to 20. I was never completely honest with my doctors until recently. But now I take the suggestions my doctor gives me, and I communicate honestly because I'm an honest person today.

Today my life is good and I am happy. I'm happy more than I'm not happy. For a person who was so miserable, and who wanted to kill himself for a long time, things are drastically different today. _Today I have happiness in my life, and I attribute being happy as a result of being on medication and being sober, and not disrupting chemicals from working._

My message to other Bipolar people would be _it's very important to stay on your medication, and to not drink, or use drugs while on medication, because you will not get the full affect_. When I was under the influence drinking it gave me the courage to kill myself, but today that is not the case.

**It wasn't until I changed how I lived that things got better in my life**. I live a good life today, I live an honest life, I don't hurt people anymore, I work on myself today and I'm in therapy once a month. Today I have great relationships with my family and with my friends. I help out a lot of other people today, other people who are suffering. _Helping others is the best way for me to get out of my head and get out of myself_. I know today that I can't stop taking my medication and being Bipolar is a fact that I've had to accept as a part of my life.

_I accept that I'm going to be on medication for my entire life, and I know it's vital that I continue taking my medication because I will die if I don't_. Also, I never want to have to live like I was before because _I know I will eventually kill myself if I'm not medication_. When I'm off of medication killing myself becomes an option very fast. It becomes a reality to me. _Aside from medication what I do to help myself is I stay very busy. I make sure that I'm always doing something, whether its work, or school, or being social with others._

Also, it's very important to _listen to what your doctors have to say_. It's been over three years since I've been in a psyche ward, and during this time I haven't tried to cut myself either. I don't deal with being Bipolar the way that I use to. Today I view it as a maintenance portion of my life. I don't even think about it. _I don't think about being Bipolar everyday, rather it's just something that I have, but I don't allow the Bipolar illness to define who I am_. I don't walk around with the Bipolar illness on my shoulder and I don't have to tell everybody that I am Bipolar.

I compare being Bipolar to someone who is diabetic who has to take a shot every day to take care of themselves. I'm okay as long as I take my medication, and my medication keeps me stable. _I want to tell others do not stop taking your medication, even when things get good, because even though you are feeling good it's almost an illusion within you, because the illness is still there waiting to rear its ugly head_. If you stop taking your medication it's a recipe for disaster, because that can lead to mania, hypomania, and just because you're doing okay today, it doesn't mean tomorrow, or two or three days from now that you will still be doing good. _The illness almost tricks you because once you're feeling good you feel like you no longer need the medication but you're still Bipolar_. You still have a portion your brain which can simply switch.

How Can I Manage My Disorder?

• Track your mood through a daily chart.

• Maintain regular routines and sleep-wake cycles.

• Avoid alcohol and other mood-altering substances.

• Develop and maintain social supports.

-Miklowitz 2002: 153

_What's significant for me today is that I live in the middle ground; I live in the middle of life. I try to stay a five, and I try to stay out of 10, and I try to stay out of the one -- I simply try to stay in the middle_. I'm not going to lie because I still have fucked up thoughts, however, I don't act on things, I talk to other people, and I stay med compliant. My therapist tells me I have a right to say no to my doctor regarding what medications I take. It's important for me to remember that I'm the one paying the doctor, and I don't have to take anything I feel like I don't need. Remaining sober and taking my medication is the most important thing for me to do to be all right.

_The hope I can offer other people is that life will get better_. You might have to change the way your living but it will get better if you make those adjustments.

# Chapter 6

## Jane's Story (Bipolar I)

From a deeply emotionally disturbed childhood, Jane has risen from the ashes to live a life chasing her academic aspirations and living a full life with other friends.

Jane's Story (Bipolar I)

I've seen doctors and psychiatrists since the age of four. As a child I had night terrors, and I really don't know many details about the night terrors. Apparently, my mom would catch me walking, or running around the house at night, screaming, and crying, and I'd still be asleep. So at the age of four my mom took me to therapy for this problem. I continued with the therapy once I hit depression in middle school, and I've seen psychiatrists and therapists since.

The transition from elementary school to middle school was a big shock to me and I did not handle it very well. It got to the point where I thought about hurting myself and I came up with very creative ways to accomplish this. I was placed in a psych hospital at the age of 12 just before turning 13. The stress and transition from going from one school to another, being around more people in middle school, changing classes, and changing friends overwhelmed me to the point where I just couldn't function anymore. I didn't want to go back to school, I was scared, and I wanted to die. It was really bad.

My mom didn't know what to do, because this was the first time something this major had ever happened to me. So she took some advice from the pediatrician, and took me to the Miami Children's Hospital to have a psyche consultation. I was placed in the hospital, where they diagnosed me as having depression and anxiety. I was in the hospital for about three weeks.

I was placed in a Severely Emotionally Disturbed Program which is inside a normal school, but it's more like an emotionally handicapped place for children. It was a very small room, you dealt with the same kids every single day, and it's an entirely different environment from normal school classes.

At the age of 13 I was depressed, but at the age of 14 and 15 I was given the diagnosis of being Bipolar. I was placed on meds during my first hospitalization right before I turned 13, and I've been a guinea pig on medicine for years. The doctors changed the medications I was on, and there were different side effects which came with the medications. I think I gained 80 lbs when I started lithium, I had severe acne, and the combination of the medications, and the side effects, lead me to becoming agoraphobia. I sunk so low that I wouldn't leave my house.

Side Effects from Medications

The most important point is that side effects represent a problem for which there are solutions other than simply stopping your medication. Informing your doctor on a regular basis about you side effects will help him or her consider and discuss with you the alternatives to your treatment plan.

-Miklowitz 2002: 140

Throughout my teenage years, there were a lot of hospitalizations. The hospitalizations started at the age of 13, and have lasted until this past January when I was 26. I believe there were six in total, and they were all scary -- especially the first one. Being a young person it was difficult being around other mentally challenged people who were older than me. The first stay in a mental institution, seeing the other patients with their different behaviors was hard for me to deal with. I remember having a roommate who put things in the electrical sockets, and she would also get very angry and scare me.

During my first stay I was still very pure as a person, and the whole experience was very different for me. I've hated every hospital I've gone to. At night I would stay up as long as I could, just to make the night longer, because the days were so painful to me, having to go to the therapies and everything else that I had to do while there. One hospital that I stayed at, four people had to share a bathroom, and you had to shower in a hallway in a little room, and this was very awkward for me, because I was not used to having to do this sort of stuff. I always liked my privacy; therefore, it was very strange for me.

After graduating from middle school, the transition into high school at the age of 15 was also a problem, and high school was overwhelming similar to middle school. I was placed in a gifted severely emotionally disabled program. I was doing 12th grade work when I was in ninth grade, but I was also dealing with being unstable with the Bipolar illness. I finished my year there, but I just couldn't go back. I tried a couple other different schools, and finally became so frustrated that I decided to give up. I ended up staying in my room for a year, or two, and I did not want to leave the house. I kept eating, and watching TV, and I really had no life. When I wouldn't leave the house for a couple of years, if I needed new clothes my parents would have to bring them home, and I would try them on, and I would send them back if they didn't fit. I wasn't doing much during this time period.

Around the age of 16, or 17, I went back to high school. At this point they had changed my medications, and I had lost some weight, but I went through a manic episode, and I became very promiscuous, engaging in negative activities. I would communicate with people online and then I would go meet them in person to have sexual encounters. This was really crazy. I don't know if it was low self esteem, or the mania, or perhaps it was just the hormones. I think it was just an act that came along with the mania, and it was simply thrill seeking behavior.

Changes in sexual desire, thought, and behavior during depression and mania were observed centuries ago. Aretaeus of Cappadocia (150 AD), for example, observed that "a period of lewdness and shamelessness exists with the highest type of (manic) delirium" (Jelliffe, 1931, p. 20). In our century, Kraepelin (1921, Bleuler (1924), Campbell (1953), and Mayer-Gross and colleagues (1955) also have described heightened sexuality during mania and decreased sexuality during depression.

-Goodwin and Jamison 1990: 310

I set myself up in a lot of bad situations, and I put myself in danger with the people I met online. For instance, I met people in secluded areas and during one encounter they had guns in their car. I continued these defiant acts, placing myself in bad situations until the age of 18. Right before I turned 18 there was a big rape scenario, and it sort of changed the way I thought about my life.

I had met a girl on the Internet and I was going through a bi-curious phase in my life. We decided to meet and her male friend brought her to my house. We went back to the girl's house to hang out, and then she got into a car with her boyfriend, and I got into another vehicle with some other people. We headed out to Fort Lauderdale. Of course with the medications I was taking you shouldn't drink on them, but I took a swig of rum and then ended up drinking the entire bottle.

Before I knew it everything was blurry, I couldn't see anything, I was very hot and I was laughing my ass off. We arrived somewhere in Fort Lauderdale, and when they opened the door I fell out of the car. I was laughing hysterically, and the girl that I met over the Internet kicked me in the head, and she said to the others let's leave her here. The guys told her no we will take care of her. They threw me across three guys in the back seat, and I blacked out until we got back to the house.

Once we got to their house, I was vomiting, and one of the guys grabbed me and took me into the back room and raped me. The next morning they took me home and threw me on the doorstep to my house. A good friend of mine took me to the emergency room, and the people at the hospital avoided what I claimed happened by saying I was a drunk teen who did something stupid. As a result I was unable to report the rape with the authorities. After this incident I decided I could no longer live the way that I was. I knew I had to do something different. I no longer met random people over the Internet as I knew in my heart I could not go through another situation similar to the one I just went through.

I ended up getting into a relationship with a person who was not that great, but at the same time it was nice to know that someone cared. He was cheap and took advantage of me in many ways. I had low self-esteem, I had gained back some of the weight I lost previously, I wasn't stable, I was depressed, I was not functioning to the level that I could, and I was unaware at the time that I could do better than the person I was with. For all these reasons I ended up staying with my boyfriend for a considerable amount of time dealing with all of his crap and negativity.

Next, I started college taking one class at a time. I was very scared of the whole college scenario, to the point that I would have my dad drive me to college, and wait in the car while I was in class, and afterward he would drive me home. I was afraid of people, I was afraid of being looked at, I was afraid of being judged by other people, I didn't think I was good enough, and there was just fear in general with lots of anxiety. I feared everything; I feared the entire world and its entire people.

At first I took prep courses in college which weren't that bad, but as soon as I advanced, I had such a fear of not doing well, that if I didn't think I was going to get an A in the class on the first day I would drop the class. I was a straight A student my entire life, and it scared me to think of not doing well. As a result I dropped many classes, and I dealt with a lot of depressions in between. Eventually I got more comfortable going to school, and even though I was not 100%, I could still manage to get to class. Yes, I was a nervous wreck but I would still go and do my thing.

Then, my boyfriend and I had a fight and he hit me and that was the end of that relationship. When I turned 21, I lost some weight and got cocky. I moved on to dating a guy who was younger, and he was a virgin. Our relationship became all about sex. He had problems with his friends, because he would spend more time with me than he would with them, and we fought constantly. He finally broke up with me and this lead me into self-mutilation, severe depression, and taking pills.

The self-mutilation was a way to make the pain go away. In one case, I smashed a mirror, and took a piece of glass and cut myself. This event put me in the hospital again, and one of the doctors said something that really hit me. He said if you love someone let it go, and if it comes back to you it's meant to be. I started to think about that statement and it made a lot of sense to me. This time in the hospital they knew I was Bipolar and they weren't saying much else to me about it. I was just dealing with the depression at this point.

For most of my life it seems like I've been a guinea pig with medications. One combination doesn't work, so the doctors switch you around, and then you experience side effects from the new medications, so they put you on more medications to combat those side effects. You're constantly being juggled with medications. The side effects range from weight gain, to acne, even more depression, hair falling out, and tons of headaches. I used to get headaches to where I couldn't function and migraines that lasted 24 hours a day.

The med changes have really frustrated me since I started taking them. I'm the type of patient that goes home and does the research on the medications. I know about my background as a patient, I know everything about being Bipolar, I know about the medications, and I make sure I read up on the medications before I take them. All the medicine changes have been difficult to deal with. I've always told the doctors I'm not a fucking guinea pig. I would explain at times that you want me to take these medications, but they are only making me feel worse. The doctors would reiterate to me we have to find the right combination, and my attitude was just finding it all ready.

Manic-depressive illness can push patients to the limits of their resources. It is a complicated and frustrating illness, seemingly impossible to sort through. It takes a heavy emotional toll on family members and friends, the repercussions of which add further psychological stress to the patient. The illness often seems within the patient's control, yet it is not. It often carries with it a psychotic diagnosis, an uncertain course, and a lifetime sentence of medication. Especially when not treated and aggressively, it is costly in loss of self-esteem, disrupted relationships, secondary alcoholism and drug abuse, economic chaos, hospitalizations, lost jobs, years consumed by illness, and suicide.

Goodwin and Jamison 1990: 728

When I thought we had found the right combination of medications, and I could deal with the side effects, something happened to where I couldn't take the medicine anymore. For instance, I would fall into another depression, and I couldn't function anymore. Medication issues are hard, and dealing with different doctors is just as hard at times. The doctors would write scripts for whatever I wanted. The doctors were Looney Tunes just like me and they really didn't care about my well being at all.

Money issues with the medications are an entirely different issue. For a time period I had been using my mom's private insurance until I got on Medicaid and Medicare this past year. I would spend over $400 to $500 a month on medications. Now I'm on Medicaid and Medicare and it's an AARP program for people who have very little money.

I've been on disability since I was 18 years old, and on disability they check up on you every couple years to make sure that you don't need any more medications or to see if you are functioning better. My dad had set up disability for me because he was on disability so he knew how to go about that. So for a long time I have been living on disability, and I was not aware of all these extra medical plans that were available. Now I pay no more than a dollar to three dollars per medications, and everything is pretty much covered. This has saved me a ton of money.

_The questions I've learned to ask doctors_ are, "Will this medication interact with these other medications I'm on?", "What are the side effects?", "Will the medications cause me any long term damage to any organs?", and other questions like that. I will also ask "Will this medication stable me out?" or "Will it cause me not to function?", "Will I be able to drive?" I always want to know what I'm getting into with the medicines I take.

I've always been curious to know if the medications were something necessary, or if there was something better out there instead. Most of the medications I'm aware of all ready because of the research I've done, therefore, if the doctors mentioned a medication for me to start, I would question why they wanted me to be on it, because I've read about it and maybe I didn't think it's necessary. Then they would explain why they wanted me to take it.

My therapist says that I'm very insightful and he doesn't have many clients that bother asking questions. _Asking questions to my doctor is important for me to do, because it's my body, and I care about myself, and I want to know what's going to happen._ I also believe questions are important because I don't want to feel any worse. I want to make sure there are benefits that are going to come, and I don't want to fall into another severe depression, and not be able to function.

Honestly being Bipolar is one of the hardest things imaginable. I know people have physical issues, cancer, paralysis, and this and that, but the Bipolar illness is a blind disorder, _and not only does it affect me, it makes it difficult to deal with other people_ , because most people have little knowledge of mental illnesses. When other people hear about a mental illness they put a label on you that you're crazy. _Being Bipolar doesn't mean that I'm crazy; it means that I have a chemical imbalance, and I need medications just like diabetic needs insulin._

The Bipolar illness is hard because when you fall into a depression you don't think things are ever going to get better, and it's over with, and you don't want to live anymore. You think you've hit rock bottom, and you don't think you'll ever rise up, and you can't see the light anymore.

Krapeline (1921) gives a graphic description of the profound despair and hopelessness of depression:

Mood is sometimes dominated by a profound inward dejection and gloomy hopelessness, sometimes more by indefinite anxiety and restlessness. The patient's heart is heavy, nothing can permanently rouse his interest, nothing gives him pleasure. . ..

He feels solitary, indescribably unhappy, as "a creature disinherited of fate"; he is skeptical about God, and with a certain dull submission, which shuts out every comfort and every gleam of light, he drags himself with difficulty from one day to another. Everything has become disagreeable to him; everything wearies him, company, music, travel, his professional work. Everywhere he sees only the dark side and difficulties, the people round him are not so good and unselfish as he had thought; one disappointment and disillusionment follows another. Life appears to him aimless, he thinks that he is superfluous in the world, he cannot restrain himself any longer, the thought occurs to him to take his life without his knowing why. He has a feeling as if something had cracked in him, he fears that he may become crazy, insane, paralytic, the end is coming near (p. 76).

Goodwin and Jamison 1990: 37

There were times when I thought the depression would last forever, and I didn't want to live because of the pain that I experienced when you can't function in your everyday life. Sometimes you can't even get out of bed and do a stupid errand. You don't even want to brush your teeth because you're so depressed, and showering is too much of a hassle. Sometimes you don't even want to function and you can't function. _Now I'm at a point where I can actually say to myself that it will pass, and even though it's hard at that time, and I still have a hard time functioning, I try to push myself even more, especially now. In my heart I know it will get better. I've gotten to this place so many times that I'm at the point now when I do fall into a depressions, I realize yes it sucks, but I keep telling myself this will pass, this too will pass. I have to keep reassuring myself that it's not going to stay like that forever._

I know with depressions I not only have sadness but I have anger and irritability as well. I've learned there's times when I need to keep my space so I can remain calm. I will take little breaks from people here and there, but a lot of people don't understand my need for space and they get upset. But I've learned I need to backup to protect them. _Sometimes you just need to go take a breather, and sometimes it's best not to associate with people at a particular moment._ Sometimes you just need to step back and take a couple moments for yourself.

I've learned that as much as it as it may hurt, and that even though I don't want to move, and I don't want to function, _the more I push myself the further I get._ _I push myself by telling myself, let's take baby steps_. I'll say, "Okay maybe I don't want to go out, but let's first start with a shower and see where that takes us." Little by little, I'll say let's go make something to eat, because sometimes I'm so depressed that I don't want to get out of bed to eat. By pushing myself eventually I'll wind up in the car and in the sunshine and see the light and it would change my mentality so much.

Music tends to be an outlet for me. _Going in the car, getting fresh air and listening to music helps me tremendously._ I was one of those people who ate food a lot during depression which doesn't help you, and essentially it ends up hurting you. Now maybe I will splurge on a Snickers bar here and there, but I'm not going to a fast food restaurant, and get a bunch of take out. I can't say that my eating habits are great but I've learned to think before I do things now.

_To live a healthy functional life today I try to avoid as much drama as possible._ Of course, there will always be something, and you will have an argument with someone about something, maybe school will stress you, and other things will come up. _But today I just deal with each situation one by one, and not as a whole anymore._ If I allow things to build up it overwhelms me, so I deal with one thing at a time. I'm constantly working on keeping my stress level down.

Stress and Bipolar Disorder

Your level of stress may also affect how long it takes you to get over a bipolar episode...If you have bipolar disorder, encountering a major life change -- whether positive or negative -- increases your likelihood of having a bipolar reoccurrence.

-Miklowitz 2002: 90

I make a list of things to accomplish, because I've been scatterbrained my whole life, and I'm not the most organized person. Therefore I work on being more organized and set up schedules and plans.

_Today I avoid negative people_ because I'm at a better stage in my life, and when you have negative people around it tends to drag you down. This doesn't mean I'm not going to listen to one of my friends problems and discuss an issue with them. What I mean is if someone is constantly negative I don't want them around, because it does affect me _. I have enough of my own issues to deal with, and maybe it's a little bit selfish by not having negative people in my life, but it's about me now; it's about me staying healthy and what I need to do._

I need to take medicine to be healthy. I see a therapist to help me with daily living. I work on self-esteem issues constantly because self-esteem seems to be the biggest issue with me. _To improve my self-esteem it's an ongoing process where I focus on the good._ I will look in the mirror and even though I may be overweight I will say to myself, "Wow your eyes look pretty today," or "You have a nice smile today," and I focus on the good, rather than focus on the bad. I realize today that people aren't looking at you, and they aren't judging you. Other people really don't care about you, and after the moment they see you they aren't going to think about you again.

Personality is assumed to be altered by the experience of affective illness. Changes in self-esteem, social interactions patterns, ability to sustain meaningful relationships and employment, and frequent fluctuations in moods, energy, perceptions, and thinking are all thought to cause and reflect short-term or long-term personality changes that can be reversible or irrepressible.

Goodwin and Jamison 1990: 283

I realize I have a great personality. I have tons of friends now because I've become such a social butterfly and I was never like this before. I meet people at school and I make an effort to have friends today. This is a huge change for me, because in the past I used to be the girl that walked with their head to the ground. I was the one who hid on the weekends and never went out.

Before I basically avoided life, and people, and now I talk to everyone, I'm very friendly, and outgoing. I don't care what people think to some degree. Of course I'm always a little concerned, and self-conscious about physical stuff, but when it comes to speaking my mind, and being open on certain topics, that's something I have going for me.

For anyone who has suffered like me the hope I can offer is if they turn out to be half as good as I am now, their life will be great. I'm not even done healing and that's what they need to focus on: **healing**. I've gone from not leaving the house for long periods of time, and crying myself to sleep, to where now I hate being stuck at home. _Today I need to go out and see people and face the world, and life does get better, it truly does_. Things get better by staying constant with the doctor, and if you're not satisfied with them you need to change your doctor. You need to keep yourself informed on your medications, know what's going on, and be aware how you're feeling.

You need to keep a journal and log things in so when you go see your doctor you have things to discuss. You need to stay on top of your medications and the side effects you experience. You need to be aware of what's going on daily in your life, and you need to communicate with other people.

As much as you may be afraid that you're being judged by other people there are many people who have the same feelings that you have. By communicating with other people I've learned, for instance, being in school, and you will meet someone, and you start talking about your life, the things that bother you, then the other person starts opening up to you, and you realize, _Wow other people have issues too_! Other people get depressed, and other people feel the way that I feel. _Once you realize you're not alone it helps you tremendously._

I never thought I'd get pass the pits of hell that I experienced during my teenage years, _but you just got to keep going and keep pushing yourself._ Don't isolate because that makes things worse. While there are bad people out in the world, there are other people who are there to help. Life is too short. _Take your medicine, go to therapy, join little groups to be active, and do whatever you can to keep busy and keep your mind going._

You need to be open with your psychiatrist, and talk to them like a therapist, and if the doctors are in too much of a hurry to listen to you, you need to tell them you just can't just write scrip and send me on my way. You're going to listen to me, and you're going to hear me, and you are going to analyze me, and not just write me scrip and send me out into the world. I don't tolerate a psychiatrist seeing me for five minutes at a time. I've learned to be strong and firm. I need to tell them everything that's going on, whether its side effects or what concerns me about the medications. You need to ask questions about what he's prescribing you before he gives it to you, and you need to learn why he wants to put you on the medication, because you never know what you're getting into, and you don't know if it's going to make you worse.

If you're with the doctor and he just writes you a scrip, you don't need to be with them. I don't care if you have to change your doctor 20 times, you want someone to see how you're doing, and listen to you, and make sure that your meds will keep you stable. There are medications which don't have side effects which are severe, and you can learn to live with them, so you need to know what the side effects are with the medications and how they will affect you.

While I may have some relationship problems today, I'm in school, I'm functioning, I have friends, I'm out doing things on the weekend, and I'm happy the majority of the time. If I have a bad day I cry, and let it go, and it passes. I never thought my life would be like it is today. I never thought I would drive a car, I never thought I would be in college, I never thought I would have an Associate's degree and I never thought I'd be working towards a bachelors degree, and I'm dreaming of going on to get a Masters or a PHD.

To be where I'm at in my life is remarkable. Even though I'm almost 27, and I'm still working on a bachelor's degree, I don't care because it took a long way to get here, and I'm so happy to be at this point. Today I feel like an entirely different person. Yes, I still deal with little depressions here and there, but today I know how to deal with them better. While my self-esteem still bothers me at times I'm able to function and manage it. With self-esteem as long as I don't have a mirror in front of me I love myself. I love my personality, I love the person that I am, and I'm very open, and I don't care if other people don't like that. It's the physical aspect about myself that I don't like the most, but when I don't look in the mirror I have a great day.

I still have little bits and pieces of anger but it's how I deal with it now. I have issues with road rage, and if I'm going out with other people I tell them that they need to drive, or I try to avoid rush-hour traffic. Sometimes when I drive I put on certain music and I sing along with it and that keeps me calm. When I get upset with other people I try not to talk to them at that moment, because it only leads to more anger, and I will take a break, and explain to the other person I don't want to argue and I just stop.

_My final thoughts for other people are just don't give up_. **Once you get the right cocktail of medicine, once you find the right therapist, everything in your life comes together**. It really does. I'm probably happier than most people who don't have a diagnosis as Bipolar. I've been through so much, and it's really true what they say; what doesn't kill you only makes you stronger. Just stick with it, find the right combination of medicines, use those coping methods, use a therapist to vent, and do what you have to do because it does get better.

# Chapter 7

## A Spouses Love

The story of how a husband lives a marriage full of love with his Bipolar wife.

Tristan's Story

I had some experience with Bipolar people in the past because I had been in eight dual diagnosis treatment centers. I went to the first treatment when I was 18 but I didn't get clean until I was twenty-four. Now I've been clean for just over three years. So being in treatment I encountered a lot of people who were Bipolar and who had other similar problems. I personally believe there are a lot of misdiagnoses with people related to this, especially in drug addiction. In fact, I was diagnosed as Bipolar, and I was put on lithium and zyprexa. All the medications seemed to do was make me gain a lot of weight -- zyprexa especially. And the weight gain did not do much at all for my self-esteem, and I struggled with this as well as my drug addiction.

While I was in treatment you heard people commenting they were Bipolar, and when everyone took their medications, I would say about fifty to sixty percent of the people were on lithium. _Lithium seemed to be the badge of honor in treatment_ and this has been true in all of the treatment centers I attended. I always went to dual diagnosis treatment centers because my psychiatrist told my parents I was Bipolar.

But I don't think my psychiatrist knew how much of a role drugs played in my life. I was a garbage head with drugs -- I did heroine, a lot of pills and cocaine. I would steal for the drugs and blame it on the illness. When I was in the last treatment center I was meeting with the psychiatrist and he said I don't know how much of what you have is the Bipolar illness or the drugs. So they took me off all medications in my last treatment center and I haven't been on any psychiatric medication sense then.

Cassandra and I first met in the room of Narcotics Anonymous 2 ½ years ago in the middle of 2005. I knew from listening to her talk that she had another illness aside from addiction. I knew she enjoyed school -- biology especially -- and that's how we first started meeting, Cassandra tutored me in general biology. From there we had a lot in common. We talked a lot, and we started calling each other more on the phone.

As time passed Cassandra and I started dating each frequently, and we got more serious, and we developed a relationship. We became an exclusive couple and we got along great; I spent most of my time with Cassandra. I used to stay at her place four or five days a week despite the fact that I had my own apartment. Our relationship continued to develop further. I got to meet her family, and following that I became very involved with her family and her personal life.

I knew she got sick from the Bipolar illness, and soon after we started seeing each other I experienced what that was like. We started seeing each other in August and she got sick for the first time in November. So about two to three months after we began dating she went through her first manic depressive episode where she was not sleeping well, not acting the same, and she was walking around pacing a lot, wanting to clean obsessively. She got a little snippy with me when I asked questions, and she wasn't really there mentally. While Cassandra was there physically, I would ask her something and it would take a few times to get through to her. When I would get through to her, she was indecisive and she did not give me an answer. I was worried for her the first time I saw her like this, because I had never really dealt with anything like this before.

It's important to understand when Cassandra had her first manic depressive episode I had a lot of emotions already staked in her. I felt we were a couple, and I had strong feelings for her, and I wanted to do whatever I could to help. But I wasn't really sure at the time what that was. Now, I realize some of the most important things I can do for her _is to listen, and be there,_ _and make sure she is taking the right medication, you know, almost watching her._

The first time she got like this it didn't scare me, and I didn't want to run. However, I was a little nervous at first but you know it's something when you are talking about a marriage later on down the road; it's something you know is going to be a part of the marriage for your whole life. The illness is never going to go away and it's part of her.

You know I prepared myself by reaffirming to myself that I love Cassandra _and this is a part of Cassandra_. _The Bipolar illness is such that you never really know when it's going to occur_. It's not like you can plan for it, and say "Oh, I think I'm going to be sick next week." One day your fine, and the next day you're not. _A problem sometimes with the Bipolar illness is that when your planning something to do, you can't also plan for the illness occurring._ You might have a trip a month from now and you don't know if the illness will flare up. The episodes just come when they do.

Although I was always nervous for her the first time when she went through an episode, _I never viewed it as a big problem for me, because she is the one suffering._ Understand, I've never viewed her illness as a problem for me. _I've always viewed at as Cassandra is sick, and it's my time to help_. For the past two years she had manic episodes bi-yearly, and the episode she gets in November is always a little bit longer. But I remember when we first started dating she was manic for like a week, and then she went home for Thanksgiving for ten or twelve days so I had a little hiatus from the illness. I didn't get to see all of what happens when she was manic the first time.

When Cassandra comes out of the episodes there is usually a few days of down time, and you see she is feeling a little bit better. Yet there are still some residual effects from the episodes. The illness never occurs where she is magically 100%. Usually she goes to bed one day and she feels better eventually. It seems like sleep kicks out the Bipolar illness and then it's almost back to normal. But you know, _everyday you deal with the Bipolar disorder_ , it's not like you just deal with it a couple of times a year. While she experiences manic episodes a couple of times a year, there is a lot of depression which comes throughout the year. _Out of all that she goes through, depression is one thing that I get sad over; because when she is depressed she will say she doesn't want to live anymore because she is in so much pain_. Also, when she is depressed she doesn't enjoy the same things. But she always tells me _it has nothing to do with me_ ; you know her illness and being depressed.

Once every couple of months she goes into a depression. This is hard to deal with. I know it's her illness, but I don't like hearing her talk bad about herself. Although I suppose I have before _I don't take this personally_ anymore. **My biggest attitude and asset is what I can do to make her feel better.** Sometimes I realize there is nothing I can do, and that it's in her head for the moment. The best thing I can do when she gets like this is be supportive, and help her in anyway externally if I can. I do whatever I can to make her time easier.

One thing I can do to help when she's depressed is walk with her outside. When she isn't feeling well, it actually helps her to go for a long walk, about two miles. We do that a couple of times a day when she isn't feeling well. Sometimes driving helps and she really enjoys going for a ride in the car. But at other times there is nothing really tangible that you can do. When this happens I simply just be with her by her side. _Sometimes just sitting next to her, and watching a movie is the best medicine for her_.

Honestly I do get concerned when she gets sick. I'm invested in her. _I love her and I want to help._ Some people wouldn't want to deal with the Bipolar illness and all of what it brings. But not me! I love her and I want to make our marriage work! When you love someone, you don't separate the two. _It's us, we have to deal with this; I've always kind of had that view in our relationship_.

It was hard telling my parents about Cassandra. My family had dealt with me when I was troubled with addiction, so when it came time to explain to them about Cassandra's condition, they already had some experience with me having some psychological problems, and addiction. My parents have been supportive my whole life. My dad donates a lot to the psychiatric association every year. He's been a big believer in this area. My parents have always been supportive and when Cassandra is sick my mom asks me every day if she is doing better. In the past I had a friend who had a Bipolar girlfriend, and the way he would talk about his girlfriend's illness was mean -- like it was more of a hassle for him to deal with it. I never really related to him in this area, thinking the illness is a hassle to deal with. I've never said "Oh, I have to deal with this today." I've always seen at as a hassle Cassandra has to deal with.

There are some people who dedicate their lives to helping people, and there are other people who don't want to help other people, and they want to do other things. I've always been the type of person who wants to help people. I think that's where my heart is -- serving others. From the beginning Cassandra has been there for me when I was a struggling student getting an associate's degree, to me graduating from college last year, and then applying to go to medical chiropractic school. _She has always been there, and she has helped me become stable more than anything else._

I remember the first job I worked with a doctor, who was a role model for me professionally. When I told him that Cassandra is Bipolar, he said, "Are you sure you want to sign up for that? Is that what you want?" I said, "Yeah I love her!", and he said "Really -- even with her being Bipolar?" He almost couldn't believe it, and this is someone within the medical community! While I looked up the doctor professionally, I've always separated his private life, and his personal opinions, from his professional life. This doctor is twice divorced and obviously that's not something I want to emulate.

When I first got to Florida I had an issue with telling other people I was an addict. I was afraid of the stigma of being an addict, and I thought people wouldn't want to be friends with me, or thought they wouldn't want to hang out with me. So maybe it was easier for me to relate to Cassandra, with me being an addict.

The second time Cassandra went through an episode I was better equipped to deal with it, and it wasn't as long as the November episode -- it was like a week or a week and a half. I don't know how we do it, but we just get through the episodes. It's never gotten to the point where I think, "Oh my god I can't believe we are dealing with this right now!" _I always view it as Cassandra is sick_. When I had the flu, Cassandra took care of me. When Cassandra gets sick I take care of her.

I didn't go to the doctor with Cassandra until we had been together for about a year and a half, and she had gone through three or four episodes by this time. What prompted me to go the psychiatrist with her the first time was her dad asked me if I would go with her, because Cassandra was sick and when she is sick she forgets to do a lot of day to day activities when she isn't feeling well. Therefore, her dad said it would help having two pairs of ears at the doctor, especially since I wasn't sick and I could better focus on his instructions.

_Her psychiatrist and her psychologist told me that it would be better for me if I was more informed by someone who is a medical professional_. When I went with her to the psychologist Cassandra told her some things she was dealing with me at the time, and the psychologist helped me established a perspective in limens terms. _I learned how to communicate better with her, and I learned to not take things personal,_ which I kind of always knew, but the psychologist helped reiterate this concept to me again more than anything else.

When I used to talk to Cassandra and she wouldn't answer me, I'd get upset when she wouldn't answer me fully. Sometimes I would repeat her name when she wouldn't talk and say "Cassandra, Cassandra, Cassandra," _and the psychologist told me I can't keep asking her to talk when she doesn't want to_. I have to let that go, and know that she isn't feeling well at that moment and she isn't going to answer me. While I liked her psychologist a lot, I didn't care much for her psychiatrist. Her psychiatrist was short and rude. I had a few questions for him, and he kind of brushed me off. I would ask him something and he would reply with quick responses to them, and I was looking for more information from him.

Eventually we went to see her psychiatrist with the purpose of maybe taking her off some medications. When we suggested taking her off some medications. He actually put her on more medication, which was confusing to me at the time, and I still can't make sense of it. Even Cassandra's dad who is a physician got a little peeved at that. The consensus was everyone in the family thought she was on too much medication, and we weren't sure which medication was doing what. We've actually got her off one medication now, but she still takes a lot of medication which we know she needs. However, one thing that is up for discussion right now is detoxing her off all of her medication and starting over, but we don't know if that's going to happen yet.

Today, I go along with what the doctors have to say. She doesn't have insurance, and you know it's not up to me to decide where she is going to go. She has to pay office visits out of pocket, and I can't afford for her going to any other doctor right now. Doctors are very expensive to the point of six or seven hundred dollars a visit. I can't afford these expenses so a lot of it is up to her dad where she goes because he helps with the expenses.

_I am learning is this is a lifelong process, there is no quick fix, if there ever will be_. It's just an obstacle. If I had diabetes that would be a big issue in the family -- how we eat, exercising, etc. I view the Bipolar illness as similar to diabetes, and as a couple we have to make certain sacrifices, and there will be obstacles we have to overcome. No marriage or relationship is ever one hundred percent perfect and there are always things with relationships you have to deal with, whether it is money, health or something else. Right now our focus is on health.

Cassandra is amazing and she takes care of me every day. Even when she is sick she still takes care of me. She does laundry for me, she makes sure I'm all set for work, and she calls to check up on me making sure everything is going well. Cassandra is very supportive. When I first started a new job as a teacher I wasn't keen to the idea of public speaking, and of course teaching is all public speaking. But she encouraged me and reassured me I was going to do well at it. She reminded me that I had done great at everything else I had done before in my life. So it's all the little things she does things like that to support me \-- things that a partner for life would do. Cassandra is great when she is feeling well. She is my best friend and we got along great. Even when I'm at work we talk on the phone a few times a day. We have so much fun and she is a joy to be around. We do a lot of things together. We go on walks regardless of how she feels. We go to the gym. She cooks dinner, and we eat together. We watch TV, we go to the movies.

When Cassandra is manic though, little things, like going to the mall or going to the grocery store aren't good and during those times we need to be at home. When she isn't feeling well she doesn't sleep well, and sometimes it's hard getting her to take a shower. She is not motivated to do things and I have to be the person to give her a little push. She gets angry at things she would never get angry when she doesn't feel well. For instance, if I leave the toilet bowl open, she takes it to mean that I don't care about her feelings or something like that. But I realize that's not a normal response for her. Even when she isn't feeling well, you can still rationalize with her, and say "Cassandra I know you are upset and I know you are not feeling well. Let's sit down and not fight." When I rationalize with her she usually sits down and we are civil.

It seems when she is not feeling well she gets a little bit more extreme and gets mad over smaller things. For instance, one time I was playing a video game, and she didn't want me too, and she called her mom and told her she didn't like me. Also, she can't take joking very well either when she isn't feeling well. Although I'm totally joking with her, and teasing her, she will go right to crying or getting very upset at me. She has always been more of a sensitive person, which I think is some of the illness too, and it's not good to tease her. Sometimes she takes it too serious.

We get into fights like any couple, and the fights occur a lot of times because we can both be stubborn, more or less, and we don't want to bend the others way. But always by the end of the day, we have always made up. _We never go to bed angry_. That's always been Cassandra's rule: Never Go to Bed Angry. When we first started dating I used to go stay at my place when we would fight, and I would tell her I can't take this, I'm going home right now. Since marriage we realize that's not an option anymore and I can't do that. We are a team and I can't leave her.

I don't remember the last time I cried. Although I get sad, I just don't tear up. I've always been like that though. I'm not saying that I don't cry trying to be a man -- I wish I cried more, but I don't cry. I get sad, and I know I'm sad, but I don't get to the point of crying for some weird reason. I've never been in touch with my feelings really, and Cassandra is \-- Cassandra is very in touch with her feelings. And that's something... _I've learned through Cassandra to become more sensitive_. For example, Cassandra and her parents say they love each other frequently. When they talk, it's I love you, I love you. Me and my parents, while we love each other, I've only said I love you to them handful of times.

It was hard for me to tell Cassandra I loved her for the first time even, but now we say it all the time. And with her parents I'm telling them I love them a bunch before I hang up the phone. That's something different for me with the feelings. Cassandra has allowed me to become more sensitive. And sometimes when she is sick sometimes, she's not there emotionally, and I can't expect her to be there when she is sick. I simply accept that she's not always going to be there mentally and emotionally. That's something I've had to learn how to deal with. Cassandra is a very sensitive person and she is always emotional and she feels bad if you are hurting. But when she is sick it's almost like she doesn't feel something. It's hard for her to show love.

_Sometimes being with Cassandra is like being with two different people_. When she first went through an episode I think I was confused a little bit, because I didn't know what being Bipolar entailed. I knew it was ups and downs but I thought it was more ups, and that they (Bipolar people) acted the same way -- I didn't realize that they don't act the same way. Now I expect it so it's not confusing anymore. My expectations entering the relationship were I knew there would be times where she was not feeling well, and that sometimes they (the episodes) were a little more intense than I envisioned the first time. But I still expected certain things when she was sick, I guess, like listening to me and my feelings.

When she gets depressed its hard listening to her, because she will talk about not wanting to live. She _never talks about wanting to end her own life but_ she will say " _I don't want to live right now," or "I hate myself_." Me, I don't like hearing that someone hates themselves, especially when it's someone you love. During these times _I just try to hold her and comfort her_ **.** _When she is sick that is my time to put her first -- and my feelings have to go on the back burner_. I can get support from another friend if I need to talk and vent. I don't argue with her feelings anymore, and maybe that's something I did in the beginning, but once I talked to her psychologist _I learned to not argue with her feelings and not to go along with her feelings but realize those are her feelings at the time -- so there is validity to them_.

Even when her feelings are not a hundred percent valid, they are still real to her. When Cassandra is not feeling well she does not like to be touched. Sometimes this can be confusing because Cassandra likes touching usually, and she wants to snuggle, and hold hands, but she is totally opposite of this when she isn't feeling well. When she is sick sometimes she likes to be held, but there are times when she is sick and you go to touch her and she doesn't want to be touched. She even recognizes it. And she say's I'm sorry, I don't want to be touched right now. I just respect her and the space she is in at the time.

The hardest thing about having a loved one with a mental illness is _there is no cure for it_. There are medications that can make it a little better and easier to deal with but it's unpredictable. It's like if I have diabetes you can check my glucose everyday and my blood sugar -- but with Bipolar _you can really check anything tangible_. You don't get a number that say's Cassandra is down a little bit let's give her some medicine. It doesn't work that way. _You can go to bed one day and everything is okay, and the next day you wake and she is not feeling well_. The illness happens and _you still have to do things in your life_. **Life doesn't stop just because she is sick** , so we still have to do life when she is sick.

The way we live our lives is being supportive to one another and having a family that is supportive. Her whole family knows she is sick, and _no one makes her feel bad for being sick_. My parents have realized this too. One time when we went back home to Massachusetts she wasn't feeling a 100%, and Cassandra took her meds and we dealt with it. It was actually a very fun time for us. My parents love hanging out with her, and we have _the attitude that it's family and we help family out_.

Cassandra is very good with her medication. When she is sick I kind of oversee it more. For instance, when she is not feeling well she takes zyprexa which helps her acute symptoms when mania is occurring. She can take the medication three times a day when she isn't feeling well, and I kind of oversee that. If I'm at work I'll give her a call and remind her to take her medication. The whole goal of her taking zyprexa when she is not feeling well is to knock the symptoms out. Because she gets fidgety and she can't sit still. When this happens I start to monitor it and remind her when it's time to take her medication.

ADVICE

The advice I would give to people with a loved one who is Bipolar is to get educated about the illness. I knew a lot about the illness before I met Cassandra because I was misdiagnosed as Bipolar, so my dad bought a lot of books on it, and I learned a lot. Me, I've always had the attitude that if you are in a relationship you have to be in it for the long run. It's not like, you can't love them when they are sick and not want to be around them, but then come back when they feel better. A good judge of character is when things are not going well. Everyone can deal with things when they are not perfect and sometimes relationships are hard work.

Get educated to know if you want a relationship with someone who is Bipolar. My dad has diabetes so my mom and I got educated on it. As a result she has tweaked her diet; and she has made sure he keeps doctor's appointments. _That's the way I view it with Cassandra: that she has an illness_. I make sure she goes to the doctor; I monitor how she is feeling. The main thing is to be committed for the long run. It took me a little while, about a year to learn to give her space when she is not feeling well and to be supportive.

The most important thing I've learned is _to not view Bipolar people just as ill people._ No, I view Cassandra, as Cassandra, and she has the Bipolar illness, not vice-versa. But some people will say look at that person, and define them as Bipolar and view them as a person. I would encourage people to be aware of the unpredictable nature of it all. You just don't know what you are going to get sometimes. It could be fine for three months, or she could be sick for three months. You never know. Life doesn't stop going. You are still going to have bills, and you still have life, and you are going to have to deal with it whether she is sick or is healthy. Cassandra's parents help us financially which is great. Even though I've got a good job, and make descent money, I still couldn't come close to supporting some of her expenses. It's a shame that the insurance companies don't cover more with medications because medicines are so costly.

When I first started dating Cassandra I wanted to go out more, and hang out with my guy friends, and they would invite me to the movies and they would want to do this and to do that. In the beginning, sometimes Cassandra would get sick and would not want to go out, and I might have held on to some resentments. As our relationship grew I changed my perspective more. _I started putting her before myself,_ and a lot of things changed in my mind. When I realized she was going to be my wife, I realized it wasn't me first -- it's the family first. Today I put Cassandra before anything like that, so my priorities have changed.

_I realize today that it's not me anymore, that it's us as a team, and that there is no me._ You have to think that way _. I have always taken on the illness this way. It's us, not her or me_. I know it's her dealing with an illness, and I view it as something we have to get through together. For the people who really know Cassandra her illness is not a big deal. They really like her. I love Cassandra. I want a life with her, and I realize she is Bipolar, and therefore, it's different than a relationship that doesn't have the Bipolar illness present. There are certain sacrifices that you have to make when someone is sick -- but to me the big picture is marriage, family...and that I love Cassandra. _The illness we will deal with as a couple and as a family._

Having Kids

Who Develops the Bipolar Illness?

Who develops manic-depression? Unfortunately there is no clear cut method, or tests available, which can identify who will develop manic-depression. The best indicator to know if an individual is at high risk is being knowledgeable with family history, and knowing if anyone in the family has mood swings, or if they are manic-depressive. If either of these statements is true for a family member it puts an individual "at fifteen time's greater-than-average chance of becoming manic-depressive" (Hershman and Lieb 1998: pg 22). There are genetic, neurochemical, and environmental factors which interact at many different levels to play a role in the onset and progression of manic-depression. "The current thinking is that this is a predominately biological disorder that occurs in a specific part of the brain and is due to a malfunction of the neurotransmitters (chemical messengers in the brain). As a biological disorder, it may lie dormant and be activated spontaneously or it may be triggered by stressors in life" (Haggerty, _2005 :pg_ 1). Some behavioral indicators of manic-depressives in families are people who have an addiction to alcohol, drugs, or gambling. These behaviors, along with suicide, are usually the most common and obvious underlying symptoms of a person who is afflicted with the mood disorder. Alcohol is widely used by manic-depressives to alleviate depressive states, used for sleep during manic episodes, to extend euphoria, or just as a means of celebration (Hershman and Lieb, _1998:_ pg 23).

Although no one is quite sure of the exact causes of manic-depression, researchers have discovered important clues. Manic-depression tends to "run in families." Almost half the people with manic-depression have a family member with some kind of mood disorder, such as depression. A child who has one parent with manic-depression has a 15 to 25% chance of having the condition (Haggerty 2005: pg 2).

-Haggerty, _2005:_ 2

Tristan continued on having kids...

We do plan on having kids. Cassandra has said that she would feel bad having a kid who was sick, _and I always say look at you. You've had a good life_. If our kid, boy or girl has the Bipolar illness there is someone out there for them. _It's definitely a life worth having_ and she wants kids. She definitely wants kids, but passing on the Bipolar illness to another person is always in the back of her mind. She knows the mental illness runs on her side of the family. Even though Cassandra would feel guilty giving it to her kid, and I always tell her that that's not a way to look at it. There are kids born with genetic abnormalities all the time. If our kid has Bipolar disorder we will deal with it, and because of Cassandra's illness, we will be prepared for what the symptoms are. Maybe they will be able to diagnose it earlier than when Cassandra was diagnosed. Cassandra and I know what to look for.

She's had a good life really. I'm definitely glad she's in my life, and definitely glad she was born. I would feel the same way about our kids. I hope someone else would too.

Cassandra and Tristan Discuss Sex and Each other

Cassandra:

I know Tristan doesn't like when I don't feel well.

Tristan:

I usually have a hard time distinguishing between caretaker and as a lover. I've told her that I'm willing to go talk to her therapist again to help me distinguish because once I go to the caretaker role; it's hard for me to shut it off.

Cassandra:

I'm turned off and turned on. I'm Bipolar. The minute I don't feel well, I'm on the couch. It's terrible but I know I don't feel well. I agree though. It's hard to distinguish between the love we have for each other, and then to my illness which kind of takes over everything.

Tristan:

It's not like I want sex elsewhere. I want to take care of her, but it's just at that time going from one minute making sure she is all right and tucked in properly, to being romantic is difficult. I know sometimes she gets mad at the fact that I can't be turned off and on like a light switch.

Cassandra:

I know it's hard. I have a hard enough time dealing with my own feelings, compared to adding his feelings on top of it. I pretty much ignore his feelings when I'm not feeling well, and I want what I want when I want it and then its leave me alone. I take me meds and some days I don't fall sleep for an hour and sometimes ten minutes after I take the medicine I'm losing it and slurring and falling over.

How many times Tristan have I fallen over the past couple of days?

Tristan:

Well, I want to bed early last night, and I was tired, but I woke up because Cassandra crashed into the wall.

Cassandra:

I went to get in bed and I was short of the bed by a foot!

Tristan:

It's funny, well not really funny, but I was like, "Cassandra what was that?" and she said I just ran into the wall. She doesn't even remember falling out of bed.

Cassandra:

I think the one thing that is good about our relationship is he never takes advantage of my feelings. Tristan is very cognizant of where my feelings are. Even if I want to do something a little damaging. Although He doesn't take care of me every day, but he will take care of my feelings even when I won't. I think that's the best part of our relationship.

Tristan:

I think a relationship is thinking of the other person a lot. That's my view. A relationship, it's just not you anymore.

Cassandra:

When I had my ECT and I got sick, really sick, I was a mess. I was an absolute mess. When I finally got over my anger (from the damage the ECT did to me), I was a better person than I've ever been, and I met Tristan at the time when I became a better person. So I can't compare him to anyone other relationship I've ever had. _Because the relationship being good was based on me_ ; I was not the best of people before. My entire life I was always using someone in some way to either help or cure, you know anything like that, and it just became different. I got better and I was able to meet him.

Tristan is my best friend. He makes me happy. He never laughs when I cry.

There is nothing I can keep from him. _There is no minute I wouldn't want to spend with him_. He knows me, and I know him. I love him more than I thought it was ever possible to love someone. He is just the greatest. I know this sounds too cute, but I think it's good and I'm happy with our relationship. I'm really happy we didn't move in together before we got married, even though we were pretty close.

# Chapter 8

## Through the Eyes of a Child

Sally's Story

S **ally first noticed that her Mom was different at the age of six. Her Mom stopped sending her to school, because her Mom was afraid other people were going to harm Sally. Her Mom used to wake her up in the middle of the night to make sure Sally was okay, asking her if anyone had touched her, and checking to see if she had any bruises.**

After several attempts by her family to help Sally's Mom, including trips to mental intuitions, Sally's mother refused taking medication, and distanced herself from the family, believing that her family was out to get her.

After dealing with drug and alcohol problems Sally began attending Alcoholics Anonymous meeting to recover, and today she has been sober for over five years. Sally works with other suffering alcoholics, and she constantly works on improving herself therapy.

Sally has not had much contact with her Mom over the past seven years, even though she has repeatedly looked for her Mom in the shelters, hospitals, and streets of Philadelphia. In her story, Sally elucidates how she lives a healthy life being the daughter of a Bipolar mother. Sally's story is awe inspiring, hopeful, and touching.

Sally's Story

My mom and I were very close until the age of six when she stopped sending me to school, and when this happened I realized something was different about her. My Mom didn't want anyone to get close to me, and this caused her to not send me to school. She didn't want anyone to harm me, or touch me. She just wanted to keep me sheltered and hidden from the world. She wanted to smother me. I guess I didn't understand that at the time, because I was kid, but I remember I did want to go to school. I wanted to interact with other people, and other kids. However, despite this she wouldn't send me to school. I think my family noticed something was not quite right with her either around this time.

We had a very close relationship and for me she was normal, until I started seeing some behaviors in her, which made feel differently toward. For instance, she would wake me up in the middle of the night and ask me if anyone had harmed me. She would ask me if anyone had touched me, or if anyone had done anything to me. Sometimes she would literally stare at me while I slept in bed, and she would just wake me up out of the blue, and I didn't understand why she was acting like this. This caused me to become a little bit scared of life because I didn't know what was going on. She would touch me and ask me, "Do you have any bruises?" and she would just freak out. My Mom always thought that people were trying to get her and people were trying to get me. Eventually she started becoming very distant with the family, as she felt our family was after her too. These are the type of Moments I remember as a kid.

Then, I started to act out to get attention. I would tell my family I was going to run away, and this is when my family noticed the erratic behavior with my Mom, and they started to pull me away from her. I was told by others in the family that I was a very bad kid. I would try to run away, or try to do anything so people would actually recognize me.

At a very young age I went through stages of watching my mother going in and out of mental institutions, and I never understood what was going on with her. I simply did not have any comprehension of my world. I remember I just wanted my Mom. And, I was angry because she wasn't normal, and she wasn't there to take care of me and she wasn't there to be a Mom. As a kid I didn't know why things were they way that they were. I was very confused, I was flustered, and as a result I acted out for whatever attention I could get.

_I watched my Mom go in and out of institutions, and I was angry at her, I was angry at my family, I was angry at myself, and I even blamed myself because I thought I was the cause of her mental disorder or whatever was different about my Mom_. I remember longing for a normal Mom. But you see, I wasn't educated at all on the Bipolar illness, or anything surrounding mental issues, therefore, I didn't know that my Mom was acting the way she was because she was sick. Ultimately, I was just being a kid.

There are definitely episodes where I saw my Mom act out and try to harm herself. There are times when I saw my Mom sleep for days and days and she would sleep all the time. There were other times when I knew she didn't take her medication, because when she didn't take her medication, she wanted to be away from our family, because she was paranoid the family was out to get her. Another thing when she didn't take her medication she would speak to herself, and she would hear voices.

My Mom had me when she was 22, and all of her eccentric behavior probably started in her late 20s early 30s. I don't remember when my Mom got on medication; I just know that they put her on medication when she went to mental institutions. Even then though, I knew my Mom needed to take something to kind of help her when she was acting out. I just thought Mommy has to go to the hospital, or she needs to be on something to help her. That's how I looked at the situation. Nothing was ever explained to me so I just kind of had my own ideas as I grow up. Honestly though, I really thought my Mom was just crazy.

Growing up surrounded by all of this it made me feel very angry, and I remember being fearful at one point because I thought I would be just like her.

Another typical concern derives from the heritable component in manic-depressive illness. Many patients, having grown up in an environment of extreme mood swings, express fear they will end up like the affected parent, especially when that parent has been severely disabled repeatedly hospitalized, or alcoholic. The fear is even greater if the parent committed suicide.

-Goodwin and Jamison 1990:19

And I didn't want to be like her. Thinking that I would be like her would make me sad. I think I was more angry and sad because I was there watching this go on. My Aunt took responsibility of me, she removed me away from seeing this, and I was able to focus on being a kid. But I would say I was very angry as a kid, and sad, and I remember crying a lot whole lot, because I just didn't understand. I didn't understand. I would say to myself," Why does Mom have to be crazy? Why her?" I just remember feeling that way.

I felt this way for a really, really long time. Honestly, I remember thinking why her and not my dad, because I wasn't close to my dad at all. But my Mom is not the only one who has Bipolar in my family. I have another Aunt who has the illness as well. However, I never saw this other Aunt throughout my childhood. Growing up I felt very alone. I'm an only child, and therefore, _I felt very abandoned and sad growing up because something was different, and something was missing from my life_. I didn't have the Mom and Dad that I saw other children have, and my Mom wasn't normal.

There was a time period when I was a teenager when we lived out of my grandmother's house and my Mom lived upstairs. I think this was probably the worst time for me because one day out of nowhere she came down stairs and she was trying to harm herself. My Mom tried to stab herself in the chest. This was very scary and I had probably only seen her go to one other mental institution prior to this event. It was almost like my Mom was crying out for help by stabbing herself, and when she stabbed herself, she admitted she needed help. Leading up to this I don't think she had been taking medication for a few years, and I think this incident was the worst I had ever seen her, because until then she had never before tried to harm herself, or harm other anybody else.

My grandmother was very abusive to my Mom when she lived there, and my grandmother didn't understand why my Mom was sick either. Rather she simply thought that my Mom was acting the way she was on purpose. My grandmother didn't understand the illness, she would call my Mom stupid, and she would say what's wrong with you! The more my grandmother would do this, the more my Mom pulled away from her, and my Mom would do the opposite of what she was supposed to do, and she wouldn't take her medication. I recall hating everybody in my family, because everyone in the family was against my Mom. But the incident where my Mom stabbed herself was the worst I ever saw her. When she came downstairs, it was horrific, and she was crying out for help and she had given up. For me this was very sad to watch.

When my Mom is off of medication she thinks nobody loves her, she will talk to herself, and the Bipolar illness tells her she's okay. My Mom is very smart and when she has to talk to a police officer, or someone working in the hospital, she's capable of behaving very normal. She's a very intelligent woman. But despite her intelligence the Bipolar illness simply tells her she doesn't need any medication. And when she is not taking anything she's not in touch with reality.

My Mom would always get on medication for a while, but I guess the Bipolar illness told her she didn't need it anymore. I don't think she takes medication today, and I don't think that she is around my family at all still to this day. She basically lives in shelters I guess. And she's been doing this, living in shelters, for at least the past seven years. I know she's been in and out of hospitals and jails, and when she is in these places they might give her medication, but I don't know for certain. I know it's been a long time since she's been on medication for any significant amount of time. When she's not on any type of medication she doesn't want anything to do with anyone. Especially not her family because she thinks her family is out to get her.

I have made several times to find my mom, but I can't find her. It's very scary for me, and I'm afraid that one day I'll get that phone call that she's dead, because I don't know what the Bipolar illness will tell her to do. During this seven-year period, my mom has been going in and out of shelters and she, may have been on some medication but not for any length of time to be helpful. My Mom might show up here and there, but the only way my family has seen her is if she has been in jail, or if they receive a letter that she has been in hospital. Sometimes she will show up in downtown City Hall where one of my family members will run into her. They'll try to get her to come home, and get her something to eat, but then my Mom will just disappear; my Mom will figure out a way to disappear.

I used to blame myself for a long time for my mom's behavior. In the past, I can honestly say I didn't understand what she was going through at all. I was kind of angry at her in the past because I thought she knew better. Or maybe I thought I knew better because I didn't understand. It wasn't until about four or five years ago that I had the realization that my Mom has an illness, and accepted that it's a mental disorder.

_I no longer blame myself; I understand the situation a bit more._ Today I understand that it's an illness, a disease. To know my Mom is out there right now though, I guess, I guess I just put it in the back of my head and pray about it. I wish I could fix it but I know I can't. I have to say that even though I didn't want to be like my Mom, ultimately I kind of wanted to be like my Mom.

_To help me deal with all these issues I'm in therapy, and I've been in therapy on and off for a least four years_. I've learned in therapy that Bipolar is an illness, which is helpful, because for a long time I thought my Mom being sick was my fault. I realize today that it isn't my fault and that it's nobody's fault. Rather, it's an illness like any other illness. I can accept it today. _I can accept her, I can accept where I'm at, and I can accept all people with a mental illness._ Before I couldn't share openly about my Mom and her illness, and I would avoid discussing it simply explaining she's sick. But today I can talk about my Mom because I understand the situation more.

My own disease of alcoholism has helped me understand my Mom's sickness more. I know that my Mom's Bipolar illness is one of progression, and I know that it's an illness which if you don't take care of it gets worse. I've seen her in the very beginning of her illness in the early stages, and I've also seen her progress and get worse as she has gone through the different stages. I know that this progression happens with people of alcoholism, and I know that with people who are Bipolar if it's left untreated it gets worse. _Furthermore, I understand that people who are Bipolar need counseling, medication, and therapy to live a healthy life_. At the same time I recognize that everybody is different and there are different levels. If you don't treat the Bipolar illness it gets worse. It's like any other untreated illness.

The biggest help for me I think has come from attending Alcoholics Anonymous meetings and my support group of friends. It's funny but most of the people that I associate with, the people who are closet to me are either Bipolar, or they have some other mental illness. My mom's illness helps me better understand them.

I believe that being a child of a Bipolar person has affected my personal relationships, in that, for a long time I was shy and I remained very isolated from others. I used to not be able to share about anything, even how I was feeling with other people. _But I've been able to improve relationships in my life now by being more understanding and being open in my relationships._

I would tell other people in similar situation to mine that there is hope. _The main way been able to live my life is by talking about it, and sharing it with someone else, whether it's with a therapist or with other people_. I think at one point I was ashamed of my Mom's Bipolar illness but today I'm no longer ashamed of it, and I'm no longer ashamed of me. I have my own issues but I can accept who I am today. I would tell other children of Bipolar parents like me that it's okay. It's okay.

_The advice I offer is to learn about the Bipolar illness and to talk about it. Read about it, learn about it, and become educated._ I think that if you are close to someone who has the Bipolar illness that you will inevitably learn about them, and the illness, because you're there and you are going to see it. _Bottom line though is you have to have experience with it to know how to remedy it and deal with a loved one who is Bipolar_. **I think a therapist helps, but I think someone who has seen it and lived with it is the best way to get help with understanding the illness**. People with experience are the best way to become educated

_People who have experience are the most important because they know the truth._ Someone with experience of going through a similar situation helps you understand it better, because people with experience allow you to see another side with it and can offer you greater insight. But someone who doesn't have experience can philosophize all they want, or say I think this, but nothing beats hand on experience. _If you have experience you can pass along what you've learned and you can trust that your experience is true._

Right now I accept I have no control over my Mom's illness and I have no control over what she does. _I'm powerless over it and all I can do about it is pray about it and work on myself, work on making my world better._ I go through waves of feelings, and sometimes I can just say she's okay because God put her here and my Mom is here for a reason. I love my Mom to death and I just pray for her, but there are times when I can be in self-pity and wish I could do more to find her, or to fix her, or wish that I can get in contact with her, and help her make some sense, and say something to her that maybe will click in so she will get back on her medication. Sometimes I just want her to be with me here, and I wish I could figure out a way to take care of her, but that makes me afraid too, because what if she decides not to take her medication? What if she disappears again?

I go through spurts. I experience sad times, and depression, because I wish I could do more. But I don't know what else to do. I go through waves of emotion. Sometimes I get angry. Sometimes I get a little sad, and a little envious of people who do have a normal Mom. _But for the most part I must turn the whole situation over to God and just pray about it_. **I turn it over to God by realizing it's beyond my control, and I have no control over the situation.**

I just accept the fact that the situation is what it is' and whatever's going to be is going to be. It's not up to me. I don't have that power to change the situation. I don't have a magic wand to change it; and for today I don't have the ability to change how things are. Who knows, she could be in a shelter living quite fine, but I don't know. So I just accept it.

My life is not always happy, but I don't like that word either. I don't like that word happy because I live my life the best I can on a daily basis, _and all I can do is become a better version of who I am._ I can only be the best person that I can be of my capacity. Everybody has different levels of what is best for them. The best thing that I can do is accept me and except everyone else's level of who they are. _I simply live my life and become a better version of me. This is my main goal_. I become a better version of me by working on myself in different areas by being in therapy, having a support group, helping others, and doing what's in front of me at that moment.

And I struggle with this sometimes. _Being a better version of me is whatever it is for that day, not what somebody else wants me to be or what I envy in somebody else. Becoming a better version of me is what's in front of me at that moment and what's good for me_.

Also, I meditate and I meditate in the form of taking a time out, and going to a quiet and happy place, whether it's lying out on the beach, or lying in my favorite spot in the inner coastal area, and it's just me, no phone and no anything. _Just enjoying the earth, the sun, or the trees or whatever it is_.

_I write which is very therapeutic for me_. I've been doing a lot more writing lately. I write about how I'm feeling or how my day went or what happened in the day. I write about what I did in the day to help somebody else, such as, listening to somebody else, because I'm not a good listener at times.

But the hope is that you can't say it's always going to be okay, but I live my life to the best of my ability and that's where I'm at. That's the hope:

To live your life to the best of your ability.

# Chapter 9

## A Friend's Perspective

John watched his best friend from childhood changed from loving and friendly, to erratic and out of control. John's friend eventually became so manic that he threatened to kill him. John then made the most difficult decision in his life. He sent his best friend to jail to avoid his friend from hurting himself or other people.

Three years later John developed a new friendship with the person he spent his entire childhood with.

A Friend's Perspective  
John's Story

Starting out we were best friends from birth. We live down the street from each other so Landon was my first memory I have of another person aside from my family. The earliest memory I have of him was the age 5, and Landon's house was the first house I remember going to. Both of our parents have told us they were friends during pregnancy and after birth. Landon and I always played during our entire childhood. We lived 1500 feet from each other, and it didn't matter what was going on we could just walk to each other's house. We were in school together until the age of 12, so not only were we together in school but during the summer we were together as well.

In July of 1993, Landon was hit by a car. Following the accident I noticed changes for the first time in Landon. There was a total reconstruction of his mind and body. Landon didn't remember anything, even simple things, for instance, such as he didn't remember why you need to go to sleep, and other things of that nature.

After Landon was in a coma for four days, there were some changes in him, but I kind of expected there would be different things about him, which were not going to be the old Landon I remembered from childhood. Examples would be highs and lows in his mood. Some days Landon was really upset. Sometimes Landon would say things to me which I just simply shook off citing maybe that's a side effect of the car accident which will last for the rest of his life. Certain aspects about his personality I learned to accept. But I never encountered situations after the car accident in high school where I thought I didn't like Landon, and I certainly never thought, or believed, I don't think I can be around him any longer.

The memories I pull of Landon are eight years before the car accident and then there was another six years after the accident before the next big changes I saw in him. I remember at the end of our senor year in high school Landon checked himself into a rehabilitation center for the weekend. This was the first time that I realized that there were something more going on beneath the surface. For me, it was very hard because I was so close to him, and it was hard to admit Landon was really going through big changes. I suppose I was in denial. After the car accident Landon had to learn how to redo everything in his life, and when he checked himself into the institution I just thought he was mentally exhausted from it all. That was just my assumption, and it's a result of the ignorance I had with the whole illness of Bipolar disorder. I've never known anybody to suffer from Bipolar disorder, and it was very hard for me to think of my very best friend suffering from it.

Obviously I knew there were changes after the car accident, and for instance, I remember Landon would scream and cry when his parents told him he had to go to sleep because he just didn't grasp the concept of why you had to go to sleep. So when these other changes occurred it was hard for me to admit to myself that more was going on.

I remember Landon's mom calling me when Landon checked himself into the institution, and I had no idea that anything serious was wrong with him. There was no warning to him checking himself into the Institution. From what I remember I was told that Landon believed there was too much pressure on him at the time and he could not handle his life. All I member really is him checking himself in on his own terms. I know I was shocked when he did this and I really couldn't believe that it was true. At the time, I knew he had gone through a lot of challenges in his life. During high school there was the car accident and issues with his mom's second divorce which was traumatic. After the divorce he had to move from his home and change his lifestyle once again. The car accident and the divorce all happened in a three year time span and I thought Landon had a nervous breakdown; Landon definitely went through more in this period than most people go through a lifetime.

As to the changes that lead to Landon going manic, I started noticing these changes in 1999 after I returned from college. We went back to the same routine where we were hanging out frequently. I started noticing small changes at first, and these were simply small behavior patterns which were different from the person I grew up with. In retrospect, _the behavior changes I noticed did not really register with me as to being a part of a larger problem. I remember noticeable changes, though, with the stability of his emotional state_. Looking back you could tell Landon was not quite the same as in high school, but at the time my barometer was set to whom we were when we were children, therefore, it was tough to recognize.

Obviously Landon had mental scars which were deeply ingrained in him. There were some apparent things which were left in his personality from these events. So I thought all these things caused him to have other changes in his personality every now and then but I never considered anything as severe as Bipolar illness. When he checked himself into the institution I realized that the things he had gone through were a little bit harsher. But when I came back from college everything seemed to be a lot better with him. I just believed that what happened in high school when he checked himself into the institution was a direct result of all the other personal things he had gone through. Because eventually everybody cracks, so I was hoping that he had been through a lot in high school and that would be the end of it.

When I came back from college, I guess I didn't have a grasp on the things that happened to Landon when he was at the University of Alabama and went manic for the first time in his life. At the time no one had accurately diagnose him as manic. Because we were in different states, and colleges, I had no idea of Landon's behavior when he was at the University of Alabama, at least not until he told me what had happened.

I remember going to the restaurant/bar where Landon worked at, and sometimes, I would come up there to hang out, and Landon would be sitting at the bar by himself writing poetry. This was definitely a turning point with Landon's behavior. _What was different about the behavior, though, was the involvement and concentration, and the obsession with writing poetry_. I remember talking to Landon once about these experiences and he said that he felt invincible during this time, and I know that what he was doing was very different from his normal behavior. It was an absolute and complete change.

Landon would call me sometimes to meet him and when I arrived there was already a stranger agitated by him. There were a couple of times when a stranger had said to Landon, "What are you doing?" because other people thought it was absolutely crazy that he would sit at the bar and write by himself. This was totally opposite of the Landon I knew growing up, because growing up no one ever did not want to be around him. This was a big change when other people didn't want to be around Landon it was a warning sign. Total strangers would declare, _"What's wrong with him? Why does he act the way he does? Why is he so distant then so in-your-face at other times?_ "

So when Landon started going through these other changes I always referenced the car accident, and attributed that for the reason he was acting the way that he was. I never considered anything severe was occurring. I simply had no concept that Landon might be dealing with another illness, which today we know is the Bipolar illness. It never dawned on me.

I guess I knew the word Bipolar at the time; however, I had no conception of what that actually entailed. I had no idea the severity of the Bipolar illness, and I certainly had no idea that the illness could hit that close to home; therefore it was a big shock to me when I found out Landon was Bipolar. I have been shocked before in my life, but Landon being Bipolar was perhaps the biggest shock I've ever experienced.

Turning to November of 1999, that's when I really started noticing a major change in his whole personality. In November of 99, he was very erratic in his behavior, and he was very, very heavy with emotion at times. As a child Landon was always happy. But in November of 1999 sometimes he was inconsolable.

On New Year's Eve 2000 I saw Landon in a manner which I had never experienced. He was totally incoherent, and had no idea where he was, who he was, and what was going on. This was the first time I'd ever seen anything like that with him.

I do remember two different times in January of 2000 when his life spiraled out of control. There was a time when Landon was at Hooters writing by himself and the police came and john acted him. All I know is I had to go there, and get his backpack after this happened. I also paid the tab he accrued there. After I got back from Hooters I remember going to visit him at the institution where he was john acted.

My girlfriend and I went to visit him at the psyche hospital. I remember us being in a large room, and there was something scarily wrong with him. During the visit I could tell he knew who I was, and he was happy that I came to visit him, and he didn't want us to leave. _But I looked into his eyes I could tell Landon wasn't there_. Honestly, I couldn't tell for sure that he knew exactly who I was. I guarantee you I could've asked him when my birthday was and he would have no idea. Landon was not in reality whatsoever. Landon was looking around, and he was very paranoid.

The experience is almost indescribable. I'm not sure Landon even knew he was institutionalized, and that he was somewhere with other people who were mentally sick. Landon did not know what was going on. He had very little eye contact with me. He was a mass hysteria of paranoia. He was paranoid about everything. He thought it was a conspiracy to get him there at the institution. The conspiracy, according to Landon, was that he did nothing wrong to be placed in the institution, but he believed that people wanted him there, but, he couldn't state who wanted him to be there, only that someone wanted him to be there. He never said a family member, or a friend wanted him to be there, only "someone" wanted him there.

Landon was convinced that someone was trying to make him be there with all those people. Landon thought that the other people there had problems, but he didn't think there was anything wrong with him. But I would've wholeheartedly disagreed with him that he didn't belong there, because clearly there were something wrong with him. I always cross reference Landon as how I knew him as a child, and the person he was in the psyche hospital was totally opposite of who used to be. Landon was nothing like he had been for the first 16 years that I knew him of my life, and was nothing like the person that I know today.

When my girlfriend and I left we were devastated, shocked, and amazed that this was Landon we spent 45 minutes with, because he didn't seem like the person we knew at all. My parents were scared to death of the situation. My parents were totally convinced that drugs were the problem, and they didn't want me even talking to him. My parents definitely noticed changes with Landon, and they were flat-out scared of him.

My girlfriend knew, however, that what Landon was experiencing was not just a result of doing drugs. My girlfriend, now my wife, had a great deal of background with therapy, and she knew that there was a much bigger picture going on. She could tell that I had no idea as to the severity of the situation, and she would try to make me be aware that there was something larger occurring with him. She believed that we needed to figure out the root of what was causing these drastic changes with him, and figure out a way to get Landon help.

In contrast to my girlfriend, I didn't know what to do, or what to say, to make things better for him. I know that I'm a good talker, but talking was not going to remedy this situation. I started getting very scared. Not scared for my safety, I was scared for Landon's well being. At this point I was worried that Landon was never going to be himself again. I wasn't sure and I didn't know what needed to be done, and I really didn't know what was wrong either. I knew all the things Landon had been through in his life which were not his fault. Landon experienced his biological parents getting divorced at the age of six, getting hit by a car at the age of 14, dealing with the traumatic issues with his step-father at the age of 16, his mom getting a divorce for the second time -- there were many circumstances which I placed as the cause for his eccentric behavior.

I didn't realize that all these events combined could cause someone to become Bipolar, and I certainly have never heard of head trauma causing someone to become Bipolar. At this time I was definitely fearful that Landon's situation could not be corrected. When Landon got out of the institution everything appeared to be fine with him, but not long after that Landon took a major turn in the wrong direction. Shortly thereafter it seemed like Landon didn't want to live anymore.

For the second meeting I had with him in January of 2000 we were just hanging out. We were at his apartment but very quickly things took a turn for the worse. Landon read me some of his poems, and we just talked and caught up on what was going on, having normal everyday friend talk. Probably about an hour into the conversation Landon started breaking down, and he started making me aware that nobody wanted him around, including family members and other friends. He said that no one liked him, that he had nothing to give in life anymore and that he was finished. I reassured him that these were false beliefs he was having, and that he couldn't be finished because he was my best friend.

And the notion that Landon didn't believe I was his best friend anymore was something I couldn't accept. I just know Landon really felt like he wasn't needed by anyone. At the time Landon was telling me that nobody wanted him to be here alive on this planet. That nobody liked him anymore; Landon felt he had nothing to give, and there was no reason for him to be here.

I spent the next six hours explaining to him how much he needed to be alive. I told him I still loved him, and I explained I needed him to be alive. At that point he was not attacking me verbally, but he kept reiterating to me that he didn't want to be around anymore. I begged and pleaded with him, and I even broke down, and started crying.

A few days after this, Landon showed up at my house wearing a T-shirt and pajama pants in the middle of the day and I believe this was on a Sunday. I was told that Landon was very inconsistent with his behavior and that he was all over the place, wandering around the house. _But I remember on this occasion looking into his eyes and I knew it wasn't Landon -- it was another person_. Someone else was there, and this person frightened me.

Landon read a poem to my brother's fiancé at the time, and the poem was about how he was going to take my girlfriend, who is now my wife, away from me. At this point my mom walked in and she said she noticed something was wrong. She observed his speaking patterns were different than normal and he was very loud in his tone. This was clearly very inconsistent with his normative behavior. Typically Landon is a very grounded and mellow person. Not the temperamental person that he was displaying. And this got my mom's attention. Landon started walking around the house, and he was literally doing laps around the entire house, from the living room to the kitchen. I remember my mom telling me that she kept wondering, "Where was he? What is he doing? This doesn't seem normal for him at all!"

Landon was roaming around the house, and was acting completely different from the person he usually is. Then Landon told me he didn't trust me, and that he didn't understand what was going on with me. I said to Landon, "We talked about this last night, there's no nothing going on between the two of us and I'm merely concerned about you." After this, Landon stormed out of the house, and he walked down the driveway, walked halfway up the street, then circled back down to my parent's driveway and called me and left a message. _Landon left me a message where he stated he wanted me to die and he could not wait to watch my beating heart in his hand._

This entire time I had been thinking about the harm Landon would do to himself, and I never entertained the idea that he would do harm to me or anyone else. I never honestly believed that Landon would do anything to me, and that was not the reason why I inevitably press charges against him for threatening my life and sending him to jail. I can tell you I had reservations for around two months as to taking action to save his life. I knew that I really loved Landon and that if I wanted him to stay in my life I had to do something. So I pressed charges against him.

The decision I made to send Landon to jail was the hardest decision I've ever made in my life. Hands down. I literally had to go to a courthouse, and sit down with the District Attorney, and listen to the message Landon left me. I was asked if I wanted to press charges and I did. This was the hardest decision I've ever had to make in my life. It's not even comparable to anything else. Words really can't describe it. Landon was my best friend, and my brother, and what I had to do would be similar to a father doing this to his son. It's something that you would never want to do, or that you think could happen.

I was concerned about what Landon's feelings were going to be towards me for sending him to jail. I was very worried that if I saw him the next day, that he really might want to kill me, and with the state of mind he was in I'm sure this was a possibility. At the time he believed that I did hate him, and that nobody liked him. By sending Landon to jail it was an attempt by me to save his life for the future, because if Landon didn't kill himself somebody else was going to kill him. I honestly did not have too many qualms about my own safety; but I was worried about Landon's own safety. I was worried about what Landon would do to himself, or what somebody else would do to him.

After Landon went to jail I was very relieved that he was in a controlled environment and that there was no way he could do anything to himself. I was hopeful that perhaps the healing process was moving forward. I knew that they would give him the psychological treatment he needed in jail, and they would be able to examine him and figure out what was wrong with him.

I wasn't happy, but I was relieved, because I figured, things couldn't get any worse. I knew that Landon would not be in jail forever, and that was clear from the beginning. The reason in sending him to jail was that he can finally get help, all be it forced help, but forced help was what he needed at the time, as nothing else was working.

The chaos was finally over with. For a few weeks it was hard for me to deal with the idea that I set my best friend to jail, but once I sat back and thought about it I realized it could've been a lot worse. It most certainly could've been a lot worse. I was reassured after hearing that Landon was doing well. But then with the death of our other best friend, Taylor, who died from a heroin overdose brought new clarity for me. The death occurred 13 months after I sent Landon to jail and it convinced me wholeheartedly that I had done the right thing -- because Landon could have very well been dead as well. And I don't need two best friends' dead.

I probably heard a year and half after sending Landon to jail that he officially had been diagnosed as Bipolar, and that was the problem which caused him to undergo such an entire personality change. However, I had no conception of what that actually meant. To this point when I thought of the term Bipolar, I thought it was similar to being schizophrenic.

Why would I want to continue friendship with Landon? He was my best friend from birth, and I think of him as a brother, even more so than my biological brother. _I love him and that's exactly why I would want to continue a friendship with him_. He was involved in my life from the very beginning, we were always great friends, and _I know that what happened to him was not his fault_. The things that happened with Landon were beyond his control and not his fault. Initially when everything was happening I knew it wasn't Landon that was doing those things. I wanted to do whatever I could to help him and unfortunately what happened was probably the worst case scenario, since he was forced to get help by going to jail. There were no other options however at the time.

Things would've been totally different if Landon and I had only known each other for a couple of years. But I had known him forever and I knew there was no way in hell that Landon could believe the things he was doing. Because of his erratic behavior it made it easy to accept there was something else going on. Even though I didn't understand what the diagnosis of Bipolar meant in the beginning, or what the symptoms were, it actually made perfect sense to me. I just knew something wasn't right with him.

After hearing Landon was Bipolar I was thinking I'd officially lost him forever. Before maybe I believed that I wouldn't have the same Landon again, but now I feared I would never have Landon ever. Naturally I was scared that Landon would never want to talk to me ever again. After jail Landon and I had no contact for three years -- until I called him in February 2003 to be the best man in my wedding. I never questioned whether I wanted to have a friendship with Landon; there was never a doubt my mind in my mind about that. Obviously I wanted to wait until he was healthy before continuing the friendship. Landon is my best man and I've always felt this way about him. Hands down.

Getting to know Landon since he's been on medication for the past five years, I knew there was going to be differences and I knew I would never have the exact same person I had before. Clearly they're going to be ups and downs and I always know there is something else Landon is fighting, which he tells me about, and most of the time I don't understand these things at all. For instance trying to regulate his medication to where he can perform as well as he possibly can -- I've never to deal with anything like that. But it's always interesting to see how Landon does.

Obviously Landon is a million times better than he was eight years ago and it's been interesting to watch how he progresses in his life today. I think it takes a strong person to continue to fight, and to make yourself well, and I can't imagine having to do this. I know anytime Landon does something, he does it well. _I know you can't overcome being Bipolar but I've seen Landon regulate the illness to where he can live life and be happy._ And Landon has always seemed happy over the past five years, except of course with the day to day stuff which can stress anybody out. Everybody will have a bad day every now and then.

It's been very educational over the past five years, because again, I had no idea this illness existed beforehand. Previously I was totally ignorant to the Bipolar illness and I had no clue as to the fight that a person suffering with the Bipolar illness must go through on a daily basis.

Because of my inexperience with the illness I had no idea what a person goes through trying to get regulated with medication, and the other additional challenges a Bipolar person must go through to make themselves well. For instance finding the right medication I know is very challenging. In addition to this, there are the side effects which the person must deal with which is another problem in and of itself. Maybe Landon will feel better on this medication but then he's not able to sleep, or you take this medication and he will gain a lot of weight but it makes you feel good. It seems to be a catch 22 with the medication and the side effects. I don't even take Tylenol, or aspirin, so it's difficult for me to grasp what Landon is going through.

The additional challenges Landon faces with the illness shows how strong of a person he really is. Even with all the adversities Landon faces with getting stable on medication, he is able to deal with the rest of his life in a remarkable manner. He paid his way through college and graduated with honors which is amazing. Now he's in graduate school, that's phenomenal. That's why every time I speak with him I tell him he's the man, because the majority of people in the real world couldn't do what he does. It's simply amazing to me.

Really and truly there are not too many changes I've noticed with Landon since he's been on medication. Usually when I talk to Landon it's very normal and there's nothing unusual about the experience. There's nothing really that stands out to me. I know sometimes he gets moody and maybe has to go to bed earlier because of the medication, but aside from this there's nothing major that I see. I think that it's amazing and it clearly goes back to how he works on himself with his doctors.

Because of the way I saw Landon eight years ago _I never expected that things would be this well with him_. That was the scary part when Landon was going through his mania, I questioned if he could really come back to resemble any of the person I knew before. Maybe I'm somewhat blinded by the fact that I love Landon, but he is very much a normal person to me, although there are times when he tells me he doesn't feel this way, and during these times when his thinking is erratic I help encourage him that life in reality is okay.

At the time when Landon was going through his mania I wasn't aware that he needed medical help, and at the time I thought I would be able to talk to him to make things better. I thought I could talk him out of some of his behaviors and I thought I could make him feel better and that would make the situation as a whole better. But that's not possible. _The Bipolar illness is an illness that has to be medicated_.

I would tell other people who are going through a similar situation that I went through with Landon, _to try to_ _as gently as possibl_ e _to explain to the other person that they need to seek professional help_. When you talk to the person you don't want to back them into a corner and make them think that there's no other choice. If you back them into a corner then you're going to fail at getting them the help they need.

You have to be very conscious of the way you express to them that you think there is something wrong with them; _because I guarantee you that the person suffering from the Bipolar illness does not think anything is really wrong with them_. And they're going to think you are crazy and they are going to think that you're out to get them in some way, shape, or form. Trust me the last thing that you want to do is escalate the situation, like I experienced with Landon. Most people would not remain friends after what happened between Landon and myself. I sent Landon to jail, and nobody else did that. I was nervous that he wouldn't want to remain friends with me, but I knew in my heart that I wanted us to remain friends forever.

I was concerned that Landon would not want to remain friends with me after I sent him to jail; even though I was doing what I thought was in his best interest to help him. Most friends would not make it through an experience like this. If someone else has a friend who is Bipolar you don't want the situation to get as bad as it was between Landon and myself. If you can't convince the person by themselves they need to get help, perhaps you want to get other family members and friends involved. Do whatever it takes. You also want to try not to hurt anyone else's feelings. My advice is you definitely want to take care of the situation before it gets out of control.

_Finally it's important for the friend to remember how the other person was before the Bipolar illness_. Essentially that's what you want to get back to, because if you really care about the person you want to re-create how they were before the illness struck them. You do whatever you have to do to save the other person's life, because eventually the Bipolar person will lose their life. _As a friend that's your job -- to save their life when they are incapable of making rational decisions for themselves_. Because a person that is sick doesn't know it and even if the Bipolar person does recognize the illness they will have little comprehension as to the debilitating nature of it. _Ultimately it goes back to the question, "Do you really care about this person_?" If the answer is yes then _what you need to do_ is _help the other person_ because the person with _the Bipolar illness cannot help themselves_. That's the unfortunate reality of it.

Do not remain ignorant regarding the situation, research and educate yourself as much as you can, because we're not doctors, rather we are just regular people dealing with a very serious situation. It's definitely been a roller coaster on my end, and I can't even imagine what Landon goes through. I would encourage others to not hate the other person because of the Bipolar illness which affects their everyday life and their feelings. Don't hold that against them. Being Bipolar is not the person's fault, it's really not.

Remember the person that you love.

The ultimate goal is to get them back.

So for anybody else out there don't think your situation is special. Landon and I are just regular normal people. I understand that everybody else's situation is different, and unique, but I don't understand how Landon and I can still be best friends and anybody else going through similar situation could not remain best friends. Because again I don't see a situation being more extreme than others.

If you don't know about the Bipolar illness, then go learn about it. It's always best to have as much information as possible when you're dealing with something that you don't know about. Educate yourself as much as possible, because there are going to be situations which arise which you don't know about or understand, and when that happens you need to figure out as much as you can about the situation, so you know how to handle it.

Honestly the most I've learned about the illness has come from conversations I've had with Landon. He has helped me the most by telling me what he experiences on a day-to-day basis and how he feels. My personal contact with Landon has been the greatest education I could possibly have. This shows how good of a person Landon is by opening up to me and saying look at me I'm flawed, this is what's wrong with me -- but despite all of this I will be fine.

The hope I can give other people is, look at the situation I had with Landon. I cannot imagine anything worse, or more traumatic, or dramatic, than what we went through. The situation was absolutely crazy. We were best friends. Landon was in my parent's house and left and stood in my driveway threatening to kill me. And then three years later he's the best man at my wedding! We speak on a weekly basis. So if you're looking for hope, and your thinking you couldn't be friends with the other person, you're crazy. I'm just a regular person and so is Landon. _If we are able to remain friends anybody else in the same situation can to_.

# Chapter 10

## From a Parent

Jane's Mom Connie's Experience Raising A Bipolar Child

Connie's Story

Looking back I thought I had a normal family. For ten or twelve years I thought culturally, professionally, and morally, that I had the ideal family and everything was normal. My expectations of my life were fine and I thought I had "The happy family." Everything changed, though, when my husband became ill. I had to leave my children for about six weeks to go attend to my husband's needs. He was having problems with his heart, and we had to go to Duke University in North Carolina to deal with his illness. At this time my daughter Jane was 10 years old and my other daughter was 8 years old.

This was the first time I had really left my children alone, and I think this affected both my daughters tremendously. Not only was their father sick, and something was wrong with his heart, but their mom was gone as well. They were left with their grandmother and this was very terrifying for both of my daughters. When I came back from North Carolina, everything had changed, and that's when a lot of things that used to be normal became abnormal.

I first saw signs of Jane's illness at 12 years old. I was shocked because up until this point Jane was the perfect child. Jane was the perfect student, she was very bright, and she was always able to take care of herself and her needs. By the sixth grade Jane was in the top four of her class and she won many awards in school including a science fair award. To me she was brilliant, well rounded, she was pretty, and she had lots of friends. However, just before six grade she seemed to go through a great change.

Jane began to develop great fears. She developed fears of going out of the house. If she wanted McDonald's I would have to go and get it and to bring it home; if she wanted new clothes I would have to bring them home, instead of her going to the mall to get them. I took her to a therapist and it wasn't very successful. At the time I really felt deep down Jane would grow out of this phase of not wanting to leave the house.

The summer before Jane went to middle school Jane began to break down. For example, we went away for a short vacation and I remember when we came back she got her hair tangled while combing it, and I had to wash and condition her hair in order to get it untangled. Jane became hysterical when this happened and she feared that her hair was going to have a bald spot.

I had seen small signs of her illness up until this point, but I did not know what I was seeing. For some reason when she started middle school Jane didn't want to go back-to-school. She was beyond control. She threatened to throw a hairdryer in the bathtub to kill herself. Whether she saw something like this on television I don't know, but this is when I realized we have problems. Everything hit me smack in the face.

_I didn't know what to do; I didn't know where to turn to for help_. Naturally this was an absolute shock to my planning for my family's life. You know parents have a plan for their family's life. The plan according to me of how my family's life was to go was: the kids are going to go to school, become teenagers, go to prom, go on dates, and all the other special moments. But when Jane threatened her life it seemed like it was the turning point for my rose-colored glasses, and my life, which soon after became absolute hell.

I went to Jane's pediatrician when she was 12, and I told the pediatrician that Jane threatened her life if she had to go back-to-school. I still didn't know what I was dealing with and I guess I was still thinking this too shall pass. My life was very frightening. I took Jane to Miami Children's Hospital where we saw a psychiatrist and they immediately admitted Jane to the children's unit there. I freaked out. Me being separated from my child was just as painful as my child being separated from me.

She was in the children's unit for three weeks, where she was given a diagnosis of agoraphobia -- the fear of being in crowded places and leaving the house being around lots of people. They started Jane on some medication. During this time I also learned about the Severely Emotionally Disturbed Program (SED) for students like my daughter. But this was still beyond my comprehension.

_I can't tell you how painful it was for me to see what I thought was a perfectly normal child being suddenly told she was absolutely sick and disturbed and in need of a special classroom._ I thought, "No my daughter can go to school. She can do this." None of it seemed real. None of it seemed real. But it was.

Following this Jane had therapists, doctors, psychiatrists, and everything you could name. I was still in denial that my household was slowly becoming insane. I was still looking through rose-colored glasses believing that everything was going to go back to normal. I think this was the hardest thing for me -- accepting that things were not okay. Accepting that my fantasy of the perfect family was not real. _It was harder for me to give up my fantasy because if I gave up my fantasy then I would actually have to face the reality that I had a sick daughter_. At this point I still thought I was a normal person and I had trouble facing the fact that something was going wrong.

Within six months of Jane being in the SED program, they gave her the diagnosis of being Bipolar because they saw the rapid cycling and the highs and lows. There were behavioral problems too with Jane. For instance, I used to have to go to school for counseling and the school would call me and tell me Jane was missing, and they couldn't find her. After the first time they called me I stopped panicking because I would tell the school to go look in the infirmary because Jane would be sleeping in the bed. That's what she would do, Jane would go to use the bathroom and then go to the school infirmary to sleep!

There was a lot of humor in Jane's antics but her behavior was also terrifying, and out of control at times. There was one time when Jane went into the school bus, and turned on the ignition, because she wanted to listen to some music. The school gave her an in-school suspension for this, and later this incident would become a family joke, but it was not funny at the time.

Slowly I found a therapist and I took Jane along with myself. This therapist was one of the greatest gifts of my life _because she helped me realize that Jane is sick and we need to deal with her illness_. The therapist recommended family therapy. But within three years, everyone in the family stopped going to family therapy, and that's when I realized how ill I had become with my entire family. The therapy was now mine.

Family Education and Family Therapy

Family members and close friends often find that the educational information given to patients is useful to them as well. Families are, of course, in a unique position to observe the behavior and moods of Bipolar patients. Education about the illness can increase the awareness and acceptance of patients and underscore the family's role in encouraging the patient to take prescribed medications and to live sensibly...

Family members, in addition to being educated about medications and the illness, should be informed about the importance of recognizing the early signs and symptoms of hypo-manic, manic, and depressive episodes. Changes in sleep patterns, sexual and financial behavior, mood (expansiveness or undue enthusiasm, pessimism and hopelessness), involvements in excessive numbers of projects, and changes in judgment are all highly characteristic of impending affective episodes. Often these changes are first noted by family members and can be crucially important to the patient in early intervention. Strategies for contacting the clinician should be determined, if possible during times when the patient is normal. To the extent feasible, general contingency plans and agreements should be made in advance to cover possible emergencies, hospitalization plans for mania, and financial protection for the patient and family during hypomanic and manic episodes.

-Goodwin and Jamison 1990: 738-739

One thing I noticed being in therapy _was once I got better, the rest of the family got better_. I had never recognized how ill I was with the entire family and I had to go for my own therapy to get better. The therapy was very intense and at one time we did an almost hypnotic type of therapy which allowed me to bring up painful issues from my childhood. I was able to uncover issues from way back in my childhood and this helped make me healthier as a person. _There was a lot of pain and self-examination and growth that I had to do on my part before I could work on making my family healthier_.

It's important to understand that I was dealing with a sick daughter, my husband was sick, and I was trying to be a mother while working a full-time job, and dealing with a sick family. So therapy was very helpful. I also began to attend Al-Anon meetings and through Al-Anon, and therapy, I began to understand my family dynamics, and my role in the family. I learned how much I was contributing to the family illness.

What I mean by contributing to the family's illness is _if you keep tying the child's shoe lace, then you don't have the right to yell at your child when they're five years old and they can't tie a shoelace_. This is an example of what I learned in therapy and Al-Anon. In the past, I was always fixing things, such as, I would do my child's homework and they wouldn't learn anything except to go to mommy to fix it.

We got Jane through middle school and she went to high school in the SED program for gifted students. She made friends there but she was always lonely, she was always depressed, and she felt she couldn't handle the gifted program. The school thought Jane could handle the program but she didn't. I was always searching for the next place I could put her. I can't begin to tell you all the places that I searched for but one was a city program, one was at another high school, and one was in a hospital.

I was a registered nurse and for a long time I was operating on survival skills. There is one time when my other daughter threatened suicide and she cut her hand and I grabbed paper towels, and wrapped my daughter's hands up, and I knew she had to go to the emergency room. And to tell you how sick I was, I had just bought her some pants and she had gotten blood on the pants and I told her you need to take the pants off and put on another pair. And before I took her to the emergency room I scrubbed and scrubbed her pants in the sink with soap. I know that what I was trying to do was erase the blood, and the pain, that I was feeling from what I was going through at the time. I was trying to wash it all way, although I didn't realize it at the time. Then when I gained control I took her to the emergency room.

Jane spent one year of her life with me screaming at her at seven in the morning, saying, "Get up, get up! You're going to miss the bus!" We were miles away from where she had to catch the bus and there was no way I could take her by car and be able to make it to my job. Words can't describe how stressful my life was. It was absolute hell.

The Al-Anon helped me the most in dealing with a daughter who has an illness that is not her fault. _I was driving myself insane trying to control my daughter's disease and get her up and get her out of bed and get her functioning and get her to do what I wanted her to do, which was to go to school_. Jane was going to a therapeutic school -- not just a normal school \-- where they would give her therapy, they would give her doctors, give her medicine, and they would also give her school work. But the school would give her assignments at her pace.

Here I had a child who was sick maybe every day and I could never get her up, and I would go to work feeling ill every morning from trying to get my daughter up and then having to get myself ready. I thought I was going to lose my mind. I was probably more depressed than Jane was. There is such a thing as a functioning alcoholic but I was a functioning depressive. Because there was no one else around to help my family do what they needed to do. I had to do it. I had to go to work, I had to make the money, I had to get the kids to school and everyone around me was getting sicker.

I was blessed by going to Al-Anon and getting a sponsor who had twenty-five years in the program. She was one of the original ones and she made me work the 12 steps, made me do the traditions, and she had me meet with her every week to do the work. I had to go to meetings and I had to do everything else that Al-Anon entailed, including sponsoring other women. I did Al-Anon for eight years

The first year of Al-Anon gave me the ability to _Let Go and Let God_. I learned I could not control people, places, and situations. I dealt with my husband being sick and Jane's illness. _I learned I had no control. And I think surrendering to the fact that I had no control helped me the most. There was nothing I could do to change my husband's illness, my daughter's illness or to change the family as a whole._

I learned to "Let Go and Let God" with Jane's illness by stopping screaming at her. I would read my literature in the morning, pray and meditate, and go into her room calmly and tell her, "Jane it's time to get up." I would explain to her I will give you five more minutes to wake up and then you need to get up and get on the bus. If she hadn't gotten up I would tell her I'll give you five more minutes to get up and get on the bus, and by the third time if she hadn't gotten up, I would tell her "I'll see you later today after I get back from work." And then I would leave for work and just let her lay in bed while I went to work.

It tore my heart out that my daughter was in bed for a year. However, on the other hand the insanity in my mind was over. Previously I had been the one going insane, screaming and raging, and being out of control. But after attending Al-Anon I was calm in the morning. I didn't get out of control, I didn't rage, and I didn't lose my sanity; I stopped screaming and carrying on like a maniac. I was able to go on and complete the other responsibilities in my life. Al-Anon gave me the ability to function, go to work, I could provide for the family, and I was getting healthier as a person. But I never gave up on Jane; don't doubt that for a moment.

As I got better one of the things that I learned that made me better in my life was being able to see the problem, and in my mind my therapist would be on one shoulder and my sponsor would be on the other shoulder, and I would hear them saying things which would guide me back to sanity.

Again, Al-Anon and my therapist has been the biggest help in raising my Bipolar child. My therapist told me that when I could look at a situation and see it from the right and see it from the wrong and then come up with my own answer than she would no longer be needed. So after four years of therapy my therapist "Graduated" me because I was now able to make healthy decisions. My therapist told me "We are done with our work and you don't need me any longer." She said "You can now think things through as an adult, and you can process the situation, and come up with a solution."

There was always the good the bad and the reality. _I think when I learned that the more I tried to control, that is when I lost control_. In contrast, when I provided more options and let Jane make her own decisions things got easier for me.

When Jane wanted to drop out of school at the age of 16 it broke my heart. I knew how brilliant she was. I knew Jane could go so far in her life yet here she wanted to drop out of school. Instead of saying "No!" I let her drop out. My husband and I suggested that she attend night school for her GED and Jane did that until it became overwhelming. Jane said "No, I'm going to take the test and I'm not going to go back to night school. Jane passed everything except for one part and it was amazing.

The man who administered the test let her retake it. This man really inspired Jane. He told her he had a brother who was Bipolar and his brother had gotten a Masters degree. But his brother had done it in his own space and time. This gave Jane the courage that she could do the same one day.

After Jane got the GED we began to talk about her going to college. But I told Jane it's one thing for me to drive you to school when you were a child but if you want to go to college you are going to have to learn how to drive. And Jane did learn how to drive! Jane took baby steps. Oftentimes it was one step forward two steps back, two steps forward and one and a half steps back -- BUT SHE DID IT.

Jane did things in her time, not in my time. To me this was another lesson I have learned: _that my timeline could only work for myself and not for other people_. I can't set timelines for other people. Once I realized that it doesn't matter if Jane gets her college degree in four years, which was my expectation, or in 10 years, the main thing I learned was she is going to get her degree. _Whatever the road is that people need to travel, it's the journey that is significant, not just the end, and realizing that we get to the destination when we get there_. Life is not done in my time; rather, it's done in God's time.

Acceptance is perhaps the biggest thing I've learned. I had to accept myself, accept my limitations and accept the fact that I'm not perfect. _It was harder for me to accept that I'm not perfect than I am perfect_. My sponsor and I used to laugh about me and my ideas of trying to be perfect. I couldn't ever miss a meeting -- because then I wouldn't be perfect. After about six years of attending Al-Anon meetings I deliberately started to miss meetings just because I wanted to practice not being perfect.

Before in my life I had to be perfect, and have everything in my life be perfect and I think is carried over into the children. _I had to learn to accept my children as not being perfect. I had to accept that Jane's illness is an illness just like any other illness_. **If Jane had leukemia wouldn't I be patient with her? Would I not have the same patience with Jane being Bipolar**? It was such a growing experience for me.

The advice I would give to other people is to never give up hope. _As long as there is breath there is hope_. It's imperative that as a parent you always go and get support. I don't care if you have to get it from your church, or from your temple, a 12 step program, a therapist, or support groups for Bipolar people -- you have to have support. _You cannot do this alone._ You must find something spiritual in your life, and find a way to keep your own sense of self; you must find a way to keep your own life. The more I was me and the more I became a healthier me, the healthier my family became.

After being in Al-Anon for two or three years Jane didn't realize it but she knew all the slogans that I was taught. Jane used to get frustrated with me and say "Oh mom you are talking in your Al-Anon voice!" Jane knew Al-Anon and she got it through osmosis. And as much as she hated it, she was also growing. As I got healthier, Jane got healthier and then slowly the family changed from being sick to becoming healthy. It was amazing.

The most important thing I've learned is Bipolar is an illness. _Maybe you cannot cure it, but you can treat it._ They're going to be wonderful times. And they're going to be horrible times with the illness. I've learned that this is an illness that Jane will have to deal with for the rest of her life.

I've learned that Jane will have to recognize when she is really out of control and learn when she needs to go get help. It's similar to taking your car in for a tune-up. Every now and then Jane is going to need a tune-up and go see the doctor. _But the Bipolar illness is something that Jane can live with and she can have a wonderful life._

I would tell other parents who are struggling with their child being Bipolar to go and get a second opinion because there are a lot of children who are misdiagnosed. I think the first thing is to make sure you have the correct diagnosis. Then _when you have the correct diagnosis, make sure you have the correct medications_.

_I like to compare the Bipolar illness to making a cake_. When you have the illness of being Bipolar you're missing a couple of the ingredients. For instance, you may be missing salt, and when Jane had to be on lithium it's similar to adding salt to the body. And by doing this then you have the correct amount of ingredients. If you leave out the baking powder then the cake is not going to rise, and if you leave out the sugar it's not going to be sweet. Anyone that has the Bipolar illness has a chemical disorder in their body. But by adding the correct chemical you will stabilize the symptomatology of the illness. If the chemicals get off slightly they are going to become high or low or whatever.

**Ensuring that the right doctor is prescribing the right medication in the right amount is critical**. In my experience this illness can be managed beautifully with the right medication. While the illness can act up sometimes, the right medication will keep it manageable.

My mother once said to me "Connie, I don't know how you do it? Where do you find the strength to manage two sick child? One Bipolar and one addict. God bless you, I don't know how you do it." I replied, "Mom don't say 'God bless me', say 'Thank you God for only giving me two sick children. He could have given me three." I truly believe that God never gives us more than we can handle. And when we can't handle situations, God carries us through them.

I don't care if other people believe in God or not, but a faith in a Power greater than yourself is essential in rising a Bipolar child. Because I do believe I've been carried by God through a lot of years. Literally carried by Him and I'm so grateful for that.

I see Jane as a success story. I see her getting stronger and better, and more insightful, and brighter, and as age kicks in, and as she matures -- it's a blessing to see her blossom.

# Chapter 11

## Donna's Story

Donna gives her experience of dealing with her sister's struggle with the Bipolar disorder which leads to her suicide. Donna explains how she overcome the loss of her sister and offers her on how others can get help.

Donna's Story

One of my passions in life is helping those who suffer from depression. My heart was first broken with the reality and cruelty of depression when I saw it consume my sister's life. My journey with this began over twenty years ago when I came home to face flashing police car lights, devastated parents, face flashing police car lights, devastated parents, and a cold, white sheet covering my sister's body. Soon, I found out the shocking and disturbing news that my sister had committed suicide. Although May 7th, 1986 began as an ordinary spring day, it turned out to be a day that my family and I wish we could forget.

At the time, it seemed like a terrible nightmare, and I desperately wanted to wake up. However, the harsh reality soon set in, and I finally realized my sister and best friends was gone. I encountered my uncle when I first entered the house, and he kept saying "yes" and shaking his head forward while I said "no" over and over again. As I proceeded further in to the kitchen, I knew it must be true when I saw the painful look on my father's face and the tears streaming down his face. I knew something horrible must have happened because I had never remembered seeing my dad cry before. Then, my mom embraced me with hugs and did her best to console and comfort me. There was nothing we could do to bring her back to us and our grief was indescribable. She became another sad statistic of suicide due to Bipolar disorder.

My emotions were in total disarray. I kept asking myself "why" and "how could she do that?" There were so many questions that I wanted to ask my sister, my parents, her doctor, our pastor, and even God. I was the last person to speak to her on the phone that afternoon and the last to tell her goodbye. If I had known it was our last goodbye, I would have told her so much more. I wanted someone to tell my why this happened.

Years later, after childbirth, I understood for the first time, a glimpse of the severe suffering my sister dealt with for years. Until I walked in her shoes, I did not truly understand the agony of her daily situations. I experienced major depression myself and felt like I was trapped in a deep, dark pit and could not get out. I felt lonely, fearful, hopeless, and despairing. With the love and help of others, and many prayers, I got through the most difficult time in my life. My desire is to share with others that there is help for them, hope for their, and that they are not alone.

Where to Get Help

If you or a loved one suffers with this problem, seek help as soon as possible. You can seek help from local counselors, medical care and possible medication, pastoral and church support, local support groups, or fitness and nutrition experts.

Symptoms of Depression

• Prolonged sadness

• Unexplained crying spells

• Significant changes in appetite and sleep patterns

• Irritability, anger, agitation

• Extreme worry and anxiety

• Extreme pessimism, indifference, apathy

• Extreme loss of energy, lethargy

• Unexplained aches and pains

• Strong feelings of guilt, worthlessness, and hopelessness

• IN ability to concentrate, indecisiveness

• Social withdrawal

• Excessive consumption of alcohol or drugs

• Reoccurring thoughts of death or suicide

# Chapter 12

## Creative Imbalance:  
Artist, Genius, and Manic-Depression

The first recorded mention of mood disorders was made in fifth century B.C. by Hippocrates in Greece more than two thousand years ago. Hippocrates was both aware of the tendency for mania and depression existing as a medical problem in people, and he also observed that mania and melancholia were more likely to occur in the Spring and Autumn. At the end of the eighteenth century French psychiatrist Phillipe Pinel described the seasonal patterns found in "intermittent insanity" (Jamison, 1993: 131). In the twentieth century, a German psychiatrist named Emile Kraepelin was the first to use the term "manic depressive insanity" in his book _Lehrbuch Der Psychiatrie_. During the same time period in a book, Kraepelin documented and provided a clear description of the thought patterns, moods, and behaviors of manic-depressives, especially describing his clinical experience with the seasonal patterns of mood (Hershman and Lieb 1998: 19).

The purpose of this chapter is to take a look at manic-depression, and discover how it has been the guiding force in some of the greatest achievements in history. The term "manic-depressive illness" has been changed to "Bipolar Disorder" in the DSM-IV TR, but is used interchangeably throughout this chapter. The paper will begin by considering the significance of manic-depression as a source of inspiration. The focus will shift to depression, and more importantly, how depression inhibits artists, as well as how it aides them in the creative process. The work habits of artists will be explored as manic-depression is a seasonal illness which occurs precisely like clockwork. Finally, manic-depressives interests in religion will also be explored.

The term "artist" refers to any human being who creates with their work. In the context of this chapter, it refers to writers, artists, scientists, musicians, and four people in particular stand out -- Charles Dickens, Vincent Van Gogh, Beethoven, and Sir Isaac Newton. By examining their lives, it will be clear how manic-depression allowed these people to accomplish the impossible in their line of work -- work which encompasses every great field explored by humans -- the arts, science, written work, and music. The endless stream of manic energy allowed these individuals to work tirelessly, far beyond what ordinary people are capable of, thus extending their creative output to extraordinary levels.

Manic Inspiration

Changes or extremes in mood and experience, combined with imagination and discipline, appear to be the formula for creating lasting and sustaining art (Jamison 1993: 117). While mania serves as the ideal state of mind for creating, and generating new ideas, melancholy and mild depression function as the editorial state for the work produced in a feverish state. Thus, while the amount of new work produced during depression significantly decreases; depression is used by artists to improve, fix up, or edit work which has already been produced in a manic state. Jamison notes "The slightly melancholic perspective is meaningful in its own right. The sensitivity and compassion afforded by depression are for the most part, absent in the unbridled self-assurance and hectic pace for hypomania. The tendency to gaze inward, to ask why and of what avail is on the other hand, deeply embedded in the depressive view" (Jamison 1993: 118).

The driving force in all artists, scientists, and innovators, is inspiration. This quality is pivotal if any extraordinary creation is to occur, and inspiration is associated with extreme mood states found in artistic creativity. One of the key qualities found in a genius is the third eye which grants them with the insight which is not present in ordinary people. "The notion of a special access to a power beyond what is ordinarily known to an individual or his society has extended across many different kinds of inspired states" (Jamison 1993: 103).

There is agreement by early Greek philosophers and twentieth century specialists that artistic creativity and inspiration must be accompanied with the ability to access unconscious streams of thought while also maintaining contact with reality. There are two aspects of thinking which are of particular importance: rapidity, fluency, and flexibility of thought and the ability to link and combine ideas "to form new and original connections" (Jamison 1993: 105). The talent to transform seemingly chaotic thoughts and connections to make meaningful work is known as the Aristotelian sense of "dissimilarity." This is achieved when the grandiosity in manic-depressives join forces with sharp observational skills which result in remarkable intellectual leaps that otherwise would not be possible.

Whether it is writing, painting, or composing, working provides an escape from sadness and depression for manic-depressives. Furthermore, creative work not only acts as a means of escape from turmoil and pain; but it offers a way of structuring the chaotic emotions and thoughts, thereby offering artists relief and creating a safe distance from the very despair which sucks the life from them. In fact, research has proven that the beliefs and observation which are produced during mildly depressed states are closer to reality than normal mood states. "It is undeniable that familiarity with sadness and the pain of melancholy -- as well with the ecstatic, often violent energies of the manic states -- can add a singular truth and power to artistic expression. To the extent that an artist survives, describes, and then transforms psychological pain into an experience with more universal meaning, his or her own journey becomes on that others can, thus, better protected, take" (Jamison 1993: 121).

Suicide attempts and suicidal thoughts are indicators of depression, which are found within most creative people. "All last winter...I was on the continual verge of suicide," wrote William James, an American philosopher (Hershman and Lieb 1998: 178). Though not all severe depression brings suicidal impulses, depression may make the person too agitated to concentrate on doing work, or upset to the point where they are unable all together to focus on anything other than their misery (Hershman and Lieb 1998: 178).

The delusions which accompany suicide and depression, lead a depressive to a place where they believe they are worthless as a person, and life is hopeless. Furthermore, delusions bring the depressive so low that they withhold their work from others in order to avoid criticism and rejection. The fear of criticism may even lead artists to give up on their career for years or terminate it, because depression brings such low faith and low judgment in an artist's work. In fact, creative people can become pessimistic to the point where they expect to be greeted with harsh reception to their work. The lower the mood sinks in a depressive, the more they exaggerate the faults within their own work. As the depressive sinks lower in depression, they hate to even begin new work; because they fear failure, and have no confidence whatsoever in their own ability (Hershman and Lieb 1998: 179).

Anxieties are another factor which arises from depression; and while it does not usually end careers, it makes creative work and life in general difficult. For instance, the Polish composer Chopin frequently said about his depression, "I wish I were dead," and "There are no words for my misery; how can I bear this feeling," (Hershman and Lieb1998: 180). Samuel Johnson felt such strong anxieties at times that he bought fetters so he could be chained up in order to prevent himself from going berserk. In 1936, Picasso was in an automobile accident, and he did fewer paintings as a result of imaginary injuries which stem from hypochondriacal delusion, a manifestation of depression (Hershman and Lieb 1998: 180).

The effects of depression are staggering for a depressive to achieve creative work. Symptoms include a lack of energy, an increasing need for rest and sleep, working fewer hours, loss of will power, procrastination which causes the depressive to take longer in finishing work, thinking slower, lack of concentration, and loss of memory. All of these bring the depressive to a mindset where they are waiting for words, ideas, and solutions to problems. Depression makes decision making difficult as a one thought does not lead to another, and connections to ideas are not made. The effects of depression may also lead the creative person to simplify their work, or omit important aspects -- just so they can remain productive during these periods of depression.

Additionally, starting new projects becomes difficult as depression deepens, and anything requiring originality, or sustained thinking, is pushed to the side. "I have always been regarded as a man specially favored by fortune...But...I might go so far as to say that in my 75 years I have not known four weeks of genuine ease of mind," remarked The German writer Goethe (Hershman and Lieb 1998: 180). For some individuals, the day to day events in life, while less dramatic in manic-depressive temperament can still provide artistic advantage. Life becomes a "tempestuous experience" for those who have moods which change often and intensely. Since manic-depression brings the capacity to react strongly and quickly it is comparable in a biological sense to an alert and excitable system. "It responds to the world with a wide range of emotional, perceptual, intellectual, behavioral, and energy changes, and it creates around itself both the possibilities and chaos afforded by altered experiences and fluctuating tempos" (Jamison 1993: 125).

Perhaps, the most defining feature of manic-depressive illness is the cyclic and contrasting nature, which ebb and flow along with the seasons in nature. Life itself occurs at regular intervals, and this is seen with the rotations of the earth around the sun and moon. There are pronounced seasonal patterns found with poets, novelists, and visual artists, and studies have shown that during mania there is an increase with rhymes, punning, and sound associations in manic depressives. Poets and novelists display their greatest artistic productivity during September, October, and November, whereas painters and sculptors exhibit not only a fall peak (although September and October only) but one in the spring (April, May and June) (Jamison 1993: 130). Scientifically, there is little disagreement as to the regulation of life on the cellular, biochemical, physiological levels. Jamison notes, "Rhythmic patterns and disturbances in manic-depressive illness are clinically apparent in many ways: diurnal variations in mood, pervasive disruptions in sleep, and seasonal recurrences of episodes. The illness is itself an important kind of rhythm. Daily oscillations in mood are a common feature of mood disorders and have been noted clinically for centuries" (Jamison 1993: 130).

An interest in religion is a common development in the lives of manic-depression, and this interest at times becomes an obsession which leads the person to a place where they believe to have been appointed to be on a special mission by God. Newton devoted much of his time to interpreting prophecies in the Book of Daniel and the Apocalypse, and he attempted to compute how many generations had been born since Creation. One of Newton's closest friends, John Craig, believed he gave much more time to religion than science (Hershman and Lieb 1998: 48). Delusions of grandeur produced during the psychotic stage of mania led Beethoven to discover he was on a mission from God, a "holy cause." Beethoven even announced "I am now the real physical father of my deceased brother's child," which he literally meant (Hershman and Lieb 1998: 83).

Hershman and Lieb made this observation regarding religion and manic depressives:

Religious leaders have long been aware of connections between religious phenomena and the psychology of the individual. Saint John of the Cross was skeptical about those around him who aspired to sainthood: "I am really terrified by what passes among us these days. Anyone who has barely begun to meditate...goes about proclaiming "God has told me this," or "I have heard that answer from God." But all is illusion and fancy; such an one has only been speaking to himself." Gautama Buddha compared his own religious experience to that of the mentally afflicted. He said, "Like one who is driven mad by spells, I know not by whom I am crazed, or who possesses me."

-Hershman and Lieb 1998: 143

This connection with religion appears to be quite significant for a few reasons. Primarily, it is important with the subject of artistic temperament, as it seems to give manic-depressives more of a sense of purpose with their work, as well as providing them with more drive in completing their work. Take for instance, Vincent Van Gogh, whom was a failed saint. He was willing and able to give all of himself, all of his life, in order to meet what he believed to be God's demands on him. He had great compassion and warm feelings for all living creatures. In fact, one family whom he stayed with said Van Gogh would rescue caterpillars from being trod upon (Hershman and Lieb 1998; 142). Van Gogh's strong religious convictions never left him, even after he failed to make a place in the religious community as a man performing God's work. However, he did build his life around worship; and he instead dedicated his life's work to a higher purpose. "I can very well do without a benevolent deity in my life and also in my painting," Van Gogh said. "But I can't do without something which is bigger than myself and constitutes my very life, the capacity to create" (Hershman and Lieb 1998: 143).

During mania, there is an increase in bodily and mental activities, with the need to continue doing things. A person is able to work much longer than normal, and they work without feeling fatigue. Additionally, in mania a person has little awareness of other forms of physical discomfort, including heat, cold, hunger, thirst, or pain (Hershman and Lieb 1998: 27). Commenting on his own behavior, Beethoven recorded "I live entirely in my music; and hardly have I completed one composition when I have already begun another. At my present rate of composing, I often produce 3 or 4 works at the same time" (Hershman and Lieb 1998: 76). Hershman and Lieb noted this description on the manic behavior Newton had:

Mania not only kept him going night and day, but it also kept Newton from feeling hunger and deprived him of the patience to sit down for a meal...In addition to the seasons, another factor set Newton's cycles from mania to depression: his scientific work. He began a new project or ventured into a new field of inquiry in a manic state that flooded him with ideas and energy. Apparently his intellect worked night and day, for he claimed that many ideas came to him in his sleep. Mania gave him the confidence to undertake the largest and most difficult problems: universal gravitation, the nature and behavior of light, and a new mathematics.

-Hershman and Lieb 1998: 45

One of the greatest secrets of success for manic-depressives is the high level of discipline which accompanies their personality. Charles Dickens is the epitome of a manic-depressive who did not merely work, rather he overworked. "I should have never made my success in life if I had been shy of taking pains, or if I had not bestowed upon the least thing I have ever undertaken exactly the same care and attention that I have bestowed upon the greatest. Do everything at your best" (Hershman and Lieb, _Manic Depression and Creativity_ pg 120). His brain operated similar to a machine that ran both day and night, and his mania did not allow him to sleep. Dickens wrote innumerable short stories, speeches, articles, edited magazines, went on reading tours, and he acted in and directed fifteen plays. Similar to other manic-depressives, Dickens's heart had a soft spot for other people. He raised funds for orphaned children, set up a home for "fallen women," and he developed a plan to improve sanitation in tenement areas (Hershman and Lieb 1998: 108).

To treat his manic impulses to continually move, Dickens walked great distances daily. In 1843, Dickens was struck with a blaze of manic emotion; and he begun the story known today as _A Christmas Carol_. It took him two months to complete the story, and in thinking of the story he walked the back streets of London 15-20 miles many nights (Hershman and Lieb 1998: 113). By 1865 Dickens's foot became painful and swollen and would remain so for the rest of his life. However, he did not let it interfere with his long walks he was so accustomed to taking. Speaking on his manic energy and his lack of awareness of physical discomfort, Dickens said, "I got frost-bitten by walking continually in the snow, and getting wet in the feet daily...My left foot swelled, and I still forced the boot on; sat in it to write, half the day; walked in it through the snow the other half; forced the boot on again the next morning; sat and walked again...At length, going on as usual, I fell lame on the walk, and had to limp home dead lame, through the snow, for the last 3 mile" (Hershman and Lieb 1998: 133).

Throughout history, creative individuals have suffered beyond what ordinary mortals endure, under the assumption that suffering is a prerequisite to creativity. The poet de Musset observed, "Those who afford us our highest intellectual pleasure and our sweetest consolations appear doomed to weariness and melancholy" (Hershman and Lieb 1998:197). Research has proven that writers and artists display higher rates of depression, manic-depressive illness, and suicide. "Yet there is strong scientific and biographical evidence linking manic-depressive illness and its related temperament to artistic imagination and expression. Biographies of eminent poets, artists, and composers attest to the strikingly high rate of mood disorders and suicide -- as well as institutionalization in asylums and psychiatric hospitals -- in these individuals, and recent psychiatric and psychological studies of living artists and writers have further documented to the link," notes Kay Jamison whom is the premier authority of the manic-depressive illness in America (Jamison 1993: 240). Changes in mood, thinking, personality, and behavior, all occur at elevated levels in manic-depressives, and these characteristics seem to be the magic elixir which "add depth, fire, and understanding to artistic imagination" (Jamison 1993: 102).

Manic-depressive people have a high level of confidence, an inflated ego and inflated self-esteem. Furthermore, they are extremely grandiose, and therefore, thrive off undertaking complex and difficult projects -- projects which most sensible people do not even consider. Occasionally when a manic accomplishes the impossible, mankind takes a giant leap forward. Very often manic-depressive people are labeled geniuses, and their work has changed the course of history. Behind some of humankind's greatest achievements, such as Beethoven's 5th Symphony, the invention of calculus by Newton, and Charles Dickens _A Christmas Carol_ , the common thread for the unexplainable and the invisible hand is manic-depressive illness.

# Chapter 13

## Bipolar in Therapy

Remarkable therapist Cathy Guyer gives a telling and insightful interview which explains the value of why Bipolar people need therapy for recovering and living with the Bipolar illness.

Interview with Cathy Guyer

What's the most important thing Bipolar people can do aside from medication?

I think lifestyle is a big part of that. The importance of exercise; proper rest, and proper diet. Recently I attended some workshops on the brain -- her brain versus his brain \-- and the doctor emphasized over and over how the majority of Americans are sleep deprived. As a result of that we are over stressed, between that and our other obligations in the world and the more stressed we are the more cortisol we release into the brain. We are bathing the brain in cortisol, which is the stress hormone, and this causes other things in the brain to not function the way that they should. It increases the risk of Alzheimer's, and other kinds of issues.

The Bipolar illness is a biochemical issue that we are dealing with. Obviously, any brain chemistry issue that we create, by what we are doing, and what we are not doing, is going to affect that person's ability to be stabilized on medication in order achieve the functional life they wish too.

_Support systems are extremely important as well_. Not only the support system but having the people -- family members, friends -- the people around you that care about you, that are living with you with your illness, must really be educated on the illness itself.

The family members must be educated or the Bipolar person must be educated?

Both. _I think it's very important for the Bipolar person in a lot of cases to be able to explain their illness to the people that love them, so that people around them understand exactly what it is the individual is going through_. I think that's the hardest part about, because _one of the things about Bipolar illness that is key is its unpredictability_. You may be doing very really well, and then all of a sudden have a rough patch. _Some people have the illness more seasonal. Some people have it in cycles. Some are rapid cycles_. We have all kinds of different combinations.

But there is also those little surprise situations where you are doing really well, and then all of a sudden you take this noise dive and you're not sure why. So I think if the other people around you know what the signs and symptoms are, and know what your particular symptoms -- not patterns -- might be, they can sometimes head you off. Because by other people knowing the symptoms they are able to recognize it before you enter into a manic episode. As a person becomes educated -- as much as they can be for a lay person -- they can say, "You seem busier than usual. Or you seem to be on fast forward. Or you don't look well rested to me." These are different things people can bring to your attention, and help that person realize that, "Uh oh, something may not be right."

Symptoms people would recognize would be...?

Decrease need for sleep, the person is hyper verbal...A family member that knows you well, a good friend who's known you for a long time, they know the differences. Let's say you have a person named John Smith, and John Smith is a person who works, comes home, and has a pretty set schedule in the evening, and by 10pm or 10:30pm he gets ready for going to bed. Starting at this time they sit around and watch TV or read a magazine, or anything else to start preparing for getting some rest. And all of sudden at 10 at night John Smith is starting to call everybody he knows, or trying to make plans to go to a midnight movie. And John Smith is all over the map. People are going to notice, and those are extremes, but _it's the extremes that people pick up on. It's the little sublet's of changes with the behavior patterns that are a good indicator that something may not be right._

Can you give examples of the subtle changes that are not extreme?

The fact that John knows not to call people past 10 pm at night, and all of a sudden people are getting calls past 10pm, 10:30 pm, midnight, 1 am, I think that's a subtle change that may not be extreme, or maybe going on a shopping spree, or really anything extreme, but you're most panicked when he calls because it's so out of the usual that you think, "Something must be wrong if John is calling at 10:30 pm at night." And then you find out John's just chatty and wants to talk, and you think this is just not normal. This is not his pattern of behavior. _Human behavior is usually patterns that we look for. That's how we determine things. That's how we get to know a person is through certain patterns that we anticipate in their behavior repertoire_.

Why is therapy crucial for Bipolar people along with medication?

I think that anytime, anybody is on any type of psychotropic medication that therapy is essential. And most of my colleagues that are on the psychiatric end of it are strong believers of this as well, for many reasons. I think one of the most important reasons when you are going through the throws of any emotional, psychiatric issue it starts to affect the person with the very depths in believing who they are. _It affects their self-esteem, thinking that somehow because of this illness there somehow they are less than._ There is a great deal of psychological turmoil, a lot of guilt in a lot of cases in things that they might have done or said in the throes of their illness.

Having a therapist as a support, and having that person to bounce things off to, and work through these painful experiences, the therapists will be able to reassure them that things will get better. _That yes we all make mistakes that we all do things, but we can heal and we can move on_. With proper medication, and treatment, someone with a Bipolar illness can be functional and have a happy life. If they make certain modifications, and then know where they have to tend to themselves maybe a little bit more vigilantly than someone else, a full recovery is possible.

I think it's also the issue that the therapist has some of the responsibility to educate the individual on their illness, and to the symptoms and the behaviors and the whole spectrum of what they're going through. I think also a lot of times the therapist is in touch with the individual more frequently than the medical doctors and that sometimes folks in my position are going to pick up on the beginning signs of someone starting to cycle, and going into an episode. Sometimes we can head them off, and have that patient understand that we are starting to pick up on some things that are of concern, and say _"When is the next time you are going to see the doctor again? How are you feeling? Are you noticing any major changes?"_ Sometimes we help that person deal better going through an episode, assuming their episodes are not totally controlled by the medications.

What challenges do Bipolar people face with relationships? How can they improve their relationships?

Well, I think relationships are challenging on a good day for everyone. There are ups and downs. There are moods that we all go through. We're all human. With the divorce reaching one out of every two couples, challenges with relationships is part of society to start begin with. Add into this the pressures of financing, housing, careers, life in general; as people are dealing with their families, these factors are present with the average couple. Put on top of that a mental illness which can rear its ugly head at any moment, any partner who may be as loving and as knowledgeable as they might even be of the person's illness is still in the position of understanding what the heck is this intellectually.

Understanding the illness and seeing it firsthand is totally different for a person who is living with this illness. It's difficult for them to deal with, "Oh my gosh I can't believe I did this or said that," when a Bipolar person is in the throes of an episode, the partner might wander, "Where did this person come from?" The partner might think, I've never seen this side of this person, then they start to question different aspects of the relationship, because who they fell in love with is still the same person but there are the behaviors that come with that person during an episode that are very different when they are stable and the medication is working the way it should. I think that's the additional stress on the relationship and unfortunately there are a lot of folks who are not willing to stick it out for good. _That I think is part of why we have such high divorce rate, because folks just can't handle the work, and it's too easy to walk away and it's not easy to work through the problems and to take the time to get to know a person and understand the full entire package that's on both sides before they make the commitment to go onto the next level which is marriage._

As a result of that all of a sudden they're like, "What did I get myself into?" and at that point they either need to walk away or do the work. Then there are the extreme cases of people who get into relationships with people who are Bipolar, and the Bipolar illness gets out of control, and the insanity becomes more than what the person can handle, and a lot of times that's when the person decides, "This is not what I signed up for!" and that's when they terminate the relationship. It's not because they don't love the person, or care about the person, they don't know if they are the best thing for that person. I think it's also very true that if you're with someone who's not stabilized with any kind of mental illness, that the people who are with them sometimes start decompensating emotionally themselves, because they're trying to second-guess the person with the mental illness and the insanity and that just doesn't work.

If you're a love one of the Bipolar person what can you do to support?

Unfortunately, while we have Bipolar support groups for Bipolar people, I've yet to see anything out there supporting family members, and loved ones and friends of people who are Bipolar and I think that's a shame. I think that's something that's very much needed, because when you're in the throes of that as a partner, or a family member, you feel very alone. You feel as though you're the only one in the world that is truly going through this _. I think that loved ones of Bipolar people can get support in talking to other family members of Bipolar people, and form bonds with friends of Bipolar people, or partners of Bipolar people, and children of Bipolar people to learn designated responses to the illness._ I think sometimes for loved ones of Bipolar people their own therapy is the other kind of support they can get. There are 12 step meetings for support of alcoholism and drug addiction, and Bipolar folks tend to have lots of substance abuse and sometimes that's a matter of self-medicating. Al-Anonon meetings might be helpful and that would give those afflicted by the Bipolar illness a place to talk about what's happening with the whole spectrum of what they're dealing with. However, there's not a whole lot out there for the Bipolar community in terms of support. We need more of that to help everybody afflicted with the illness and by the illness.

If I'm in a relationship and I'm Bipolar what can I tell the other person to help them understand me? What can I do as a Bipolar person to help make the relationship better?

_I think to be very up front about it very soon when you're in a relationship_. Not to scare people off but because they notice a difference in the mood, that one day you are more moody than others, or that you're a little bit more fatigued on a given day which could be a result of the medication. Dealing with some of the pressures of the disorder can be a lot of different things, _but right from the beginning the Bipolar person should educate the other person in a very loving way about what you're living with_. It's the same as someone who is living with someone who is diabetic. As a partner of a person who is diabetic you want to be darn sure what they have to eat, when they have to eat, and if the person starts to get headachy, or confused, the partner better know to get that person a piece of candy, or fruit, to bring that blood sugar backup or down.

You do all this through getting to know the person, and to know the condition of what they are dealing with. That's one of the ways that you can support the person and help that partner to be part of your life in a healthy way. Not that you're trying to get into the relationship to have a caretaker. This would not be the purpose if you're in a spot where someone has to take control of a diabetic high or low. Sometimes diabetes disorients you to such an extent that you can't make the correction yourself, but if someone else is aware of it, sees it before it happens, and gets a piece of cheese, or whatever to help the blood sugar stabilize, then you can relate to them what you need.

I think it's a fair analogy because with the Bipolar illness sometimes there are things that are going on that at the moment that you can't explain when the thoughts are racing. Sometimes when the person has thoughts that are negative, the Bipolar person might be scared to say something to another person because you don't want them to think ill of you because of the types of thoughts that you're having. At a calm time, however, a Bipolar person might want to say that, "Sometimes my head goes to very weird dark places and I need you to understand that if I talk to you about some of those things I'm okay." It's just that this is the kind of stuff that goes through my head and sometimes I just need to be able to express it to you. It's not that I'm going to act on it, or that it's the way that I really perceive the world, but for that particular moment I'm in a dark place. If they understand than it's better for the both of you. If you don't say any of this, and all of a sudden you go into an episode, and you're in a very dark place, and you start talking very dark things, and you have a strong meaning towards Kurt Cobain, people will kind of go, "Well you know what happened to him." So then they start wondering if you are going to hurt yourself or are you at risk to do so. It scares people, especially your average individual who has not been exposed to any kind of psychological or emotional illness. By them knowing more up front then it doesn't all of a sudden catch them off guard if they do see any of the difficulties you live with.

Can you give example of what dark things might be? Can you give an example of what dark things might be going on in a person's head?

Suicidal thoughts, looking at the world as a very dark, fearful place. Paranoia sometimes, that believing that person in the car over there is following you and is out to get you. These kinds of things disturb people who don't understand the basis of them and they don't know what to do with them. _Most things that are fearful to folks are things that they don't understand._ And if you're walking down the street and you're just an average Joe Schmoe and you at Starbucks buying coffee and the guy behind you is saying the FBI's outside and they got their guns pulled out and they're here to get me so you better hit the ground before they open up fire -- that persons going to think WOW! I think I will remove myself from the situation because this person is not sounding stable because what they are saying is totally out of context with reality.

When you're their loved one, and you are educated about your illness, they understand, yes it's a little bit concerning when they hear things that are unpleasant or unhappy thoughts, but at the same time they understand, and they are coming from a place where they are trying to work through what's going on in your head during the time when you're possibly in a cycle or an episode of your illness

If I don't have Bipolar Disorder and I'm getting into a relationship with someone that's Bipolar, what can I do to make the relationship healthy?

_I think that a tremendous part of that is communication, communication, communication, and trust._ Those are the biggies. _Trust is absolutely vital._ If you don't feel you've built the level of trust with the person you're entering into the relationship with, how in the world can you communicate with them in an honest way to let them know about these kinds of dark things and secrets. If there is no trust, how can communicate about these places which will make you feel vulnerable if other people knew about it? This is especially true if you don't know if people are going to misuse the information

What is the hope for Bipolar people, for friends of Bipolar people, loved ones, and significant others -- what is the hope that you can give them?

Well, the hope is I think we're discovering new things every day. We're gaining a much broader understanding of the human brain. Constantly things are being developed and there are medications that deal with the illnesses that we never thought anyone would ever find a cure for or to be able to treat. These things are starting to happen and I think that's one aspect, and we just don't know what the future is going to bring. We know more now than we knew 20 years ago about Bipolar illness. There are probably triple the medications that we have at our fingertips to use to treat the illness. Therapy has become much more main stream and accepted, and it doesn't have the same stigma attached to it in most places. People feel more freely to get help and get that support. That's all very hopeful because the more people are talking about these things in therapeutic situations, not just the designated Bipolar patients, but the family members, spouses, siblings and the parents. Whoever can receive that help, and the more we talk about it, the more we can communicate about it, and the more it's open, the easier it is to start to find ways to help and to make people's lives more manageable across the board

Are there any other following up thoughts that you'd like to give?

_I think the biggest thing in my years of working with individuals who have Bipolar illnesses is the sense of that person not giving up hope_. I think hope is crucial because without hope we don't have anything. **There has to be that need to continue to hope that things will continue to get better, that their lives will be more functional, more manageable, and to realize there's always ways to deal with things**

I think a perfect example would be somebody like Michael J. Fox and his Parkinson's. That man has not stopped, and he has not given up, nor has he lost hope. He continues to fight for research, he continues to educate people, he continues to bring this illness to the forefront to folks, and say's this is not something to be afraid of. The only way were going to fix it is if we deal with it through research, and through understanding. I think that's true of just about any illness that anyone faces; you have to kind of tackle it face-to-face.

# Conclusion

We all want to live better. Everyone wants to live happily, and everyone wants to have a meaningful life. Until now there have not been clear cut directions for bipolar people in achieving this goal. Now, we have unlocked the door to the road for freedom. The stories in this book have documented various people's experience in living and functioning with the illness. The truth will set you free, and the truth found in these personal stories hold the answer.

We learned from Cassandra the importance of creating a schedule and sticking to a schedule daily. She also taught us that we can make our manic episodes worse by the decisions that we make. Anne taught us to choose the right friends who will support and aid us in our recovery, and she taught us the importance of finding an outlet for our illness. In Ronald's story, he explained why it is essential to communicate honestly with our doctor, and taking medications as prescribed. Jane showed us to ask questions to our doctor to know about the medications we are taking and how they affect our lives.

We all want to live better, more fulfilling lives. The key we have discovered for a full life with the bipolar illness is action. Action separates us from staying stagnant and becoming happy. A wise person said, "I believe God can move mountains, but I must bring a shovel." Our experience is we must not soak in self-pity and despair, but we must take an active role in the healing process, and we must take an active role with the Bipolar illness.

If nothing changes -- nothing changes. If, however, we take action to change our lifestyle toward living healthy, if we change our attitude and perception of our illness, ourselves, and the world around us, everything takes a new color in life. We have learned that we have no control over what other people do, and quite often, we have little control over our feelings. But for the people in this book we have learned we should not surrender to these intangibles. We have the power to take action and change our choices, and most importantly, we have the power to change our attitudes.

Ask yourself, "Where do you stand?" If you are tired of getting beat down by the illness, follow the instructions in this book to live the life you dream. Anyone can change their life for the better -- but it takes work. While we are different from most normal people, we are not defective. Rather, we simply must live our life in a different manner.

While our path to recovery is narrow, we at least have clear cut directions for what actions to take in living an excellent life. We are not alone. As soon as we accept that other people are in a similar situation things become easier for us. We no longer have to carry the weight of the world on our shoulders. Our experience has taught us to fight, to adapt, and to persevere through our troubles. We have also learned love and understanding are crucial on this journey. Love and understanding first for ourselves, and then for the other people in our lives. We will succeed with this type of mindset just described.

Being Bipolar is difficult; but it is not an impossible illness. Although, we must modify our lives to take specific actions and work with the illness, we no longer have to succumb to it rendering ourselves helpless. Every day is a day of change, a day of possibilities, a new opportunity to get things right. Even if you are in the hells of depression, or you watch as a loved one is spinning out of control, there is an opportunity to improve the situation, whether you must change your outlook or you must surround yourself with other people who understand.

The Bipolar illness can be frightening, and it can breed fear where you believe nothing will get better, and no one can help you. But the fear is not real; fear is not the truth. Fear is **F** alse **E** vidence **A** ppears **R** eal. The truth, however, is we have an illness which is very serious, but it can be managed if we work for it. Our lives change when we are willing to take action and do the foot work.

Some of you may be thinking, "Yes, but my situation is different. I can't see a way to make things better, or I don't think I can do the work."

It's okay to feel this way, but it's not the truth. No one is terminally unique with the Bipolar illness. All the people in this book have been where you are. Maybe one day you can't see your way through the madness. That's when you slow things down and love yourself. Some of you may think you have no one in your lives to love you, but the truth is there are plenty of support groups where you can find the strength, love, and inspiration to carry on.

Our biggest enemy lies within. We are the problem. But we are also the solution. Tear down the walls which are blocking you from moving forward. Tear down the walls which are keeping you from receiving help. We are not different -- rather, we are a garden variety. Whether you suffer from the illness, or you are afflicted by the illness, you can set yourself free by taking action and applying the techniques offered in this book.

You no longer have to suffer. We can put those days behind us and make a new reality, and a new day, where we live in the solution. Move away from staying stuck in the problem and move yourself into the solution.

While the Bipolar illness is unpredictable in its nature, the people in this book have demonstrated that to live healthy, fulfilling, free lives we must strive for consistency in our lives through exercising, communicating with others, keeping our lives organized with a schedule, and living in love for ourselves and others. Consistency in our personal lives is crucial in managing our illness. When we keep our living space organized we breathe easier. When we stick to a schedule, when we commit ourselves to waking up at the same time, and going to bed at the same time, our lives become easier.

We have further learned that medicine only works, if we work with it. No pill is going to magically fix all the problems in our life. Rather, medicine will help level the playing field so we can live a life.

Today we have found that our lives can be a place to chase our dreams. Through self-examination we learn about how the illness affects our lives so we may live in accordance with it. The Bipolar illness does not control our lives. The illness does not prevent us from reaching our full potential. We limit ourselves from our full potential. In order to live to our highest level we must first map out the destination we want to arrive at. A journey cannot begin until we decide what we want to do with ourselves, which means we must set goals for ourselves, and take action toward reaching our goals.

Like the tide which goes in and out, the Bipolar journey is one of highs and lows, good times and bad times. Learning to live with the ebb and flow of the illness is vital. Living with the illness is difficult. Some days living with the illness may mean that you are not capable of functioning and interacting in the world. Some days the best you can do is simply get through the day and pull the covers over your head that night. That is okay. We have all been there.

We have all experienced days where we are dysfunctional and not capable of doing the things we usually do. We may have to skip out on work, or school, or our other normal activities. This is okay. On these days we shut it down and pray tomorrow we have the strength and courage to rejoin the race of life.

There will be days where we do not feel well, days where we are negative and in a bad mood. On these days we push ourselves through the day gently, and slow things down in our mind. Days when we are negative, and we are off mentally and emotionally, we make sure that we don't create any wreckage in the world around us, for this will only complicate matters.

Once we gain an understanding of how our illness hits us, when we gain an awareness of the illness, we can then work on ourselves. The easy way for us is to blame our illness on all of our actions, whether it is overspending, or lashing out at people. The correct way to live is to realize we are responsible for our actions, and we are the only ones who can change what we do with our actions.

The people in this book no longer desire to step on the toes of everyone around us, blaming the world for our condition. Although we have an illness which is debilitating, we also have the ability to live healthy. It's challenging managing an unmanageable illness. We are dealt with greater difficulties than most normal people -- but we still are capable of living a good life by taking certain actions.

Abraham Lincoln once said, "A man is about as happy as he makes up his mind to be." How true this statement is for our lives. Although we may not feel happy all the time, and although we may not be able to change the way we are feeling, we can make our minds to be grateful for our situation. So if you don't feel great today, you can still take action to make things better, whether it is staying close to others, journaling how you are feeling, watching a funny movie, or by changing your scenery by going outside for a walk.

Gratitude we have found is essential for a successful recovery. The people in this book are grateful for the important things in life:

We are grateful for others, for love, forgiveness, compassion, understanding, experience, action, for attitude adjustments, we are grateful for choices, opportunities; help, for good days, bad days, and everything in between.

We have learned that every day is a good day \-- some days are just better than others. When we approach our lives from this perspective we will see we've never had it so good.

# Tools for Recovery

• _No matter what medication you're on, life is still going to show up._

• _Be aware. Recognize your body and yourself. Recognize what it all means._

• To be aware of what's going on with your body it's important to be honest with yourself, and knowing what is good for you and what is bad for you. To be honest with yourself, you listen to yourself.

• It's not all about medications. It's about _taking care of you._ You take care of yourself by

1. Listening to your body

2. Being verbal with what's going on with you

3. Not letting anyone run over you

4. Doing the right things.

• Good living starts with good choices.

• Do not get too hyped up or get too sad.

• Work on living a stress free life. When your world begins to get out of control, take a break and focus on your breathing.

• Eat properly and exercise

• _Communication with doctors starts with everybody around you. Communicate with everyone around you daily to know when your illness is off._

• Ask your doctors questions. For example:

Will this medication interact with these other medications I'm on? What are the side effects? Will the medications cause me any long term damage to any organs? Will this medication stable me out? Will this cause me not to function? Will I be able to drive?

• Create a schedule, and stick to a schedule. Wake up at the same time in the morning, eat meals that are healthy and not too sugary, work out; go to bed at the exact same time. Be in the sunlight each day for a little bit, which will help you be a little less sad. Just a regular schedule you can stick to everyday basically.

• Find an outlet for your Bipolar energy, whether; it's painting, writing, or exercising.

• Manic episodes happen, but you can make the episodes easier on yourself. Learn what agitates you and gets you upset. You have to learn, and discover, what frustrates you and then do the opposite of that.

• Your life will become easier when you love yourself, love your body, and when you do what's best for yourself.

• When your mood starts flaring up work on calming yourself down.

• Stop beating yourself up! Change your thinking and perception on life to improve how you view your life and the world.

• Mold your illness to how you want to live your life, and view it as an asset, not a liability.

• Educate yourself on the illness. Read and learn about it as much you can. Know what medications you are taking and what they do.

• Have a strong support system that is educated on the Bipolar illness.

• Understand your illness. How does it manifest itself? What are the first signs of the illness? Is there a decreased need for sleep? Or is there some sleep disruption? What's the cycling pattern? Do you go from a depressed phase to a manic phase? How long are you in a normal phase before you might switch \-- how rapidly do you switch? Does the weather or the climate affect you? Is there a seasonal pattern? Is it more apt for you to get depressed in the wintertime or more in the summer time? Is there some specific pattern you know about with your illness?

• Use a therapist as a support, and use the therapist to bounce things off to, and work through painful experiences, because the therapists will be able to reassure you that things will get better.

• Hope is crucial because without hope we don't have anything. **There has to be that need to continue to hope that things will continue to get better, you're your lives will be more functional, more manageable, and to realize there's always ways to deal with things.**

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