O Captain! My Captain!

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“I’m moving through my personal life like a hemophiliac in a razor factory.”
– Robin Williams

This week’s blog is a little late and a little short. I wasn’t sure what to write about; as I had nothing planned and didn’t get to write much during the last week. I was looking for topics, but I saw some of them appear on other people’s blogs and I didn’t want to be seen as copying. Then, early this evening I heard about Robin Williams’s apparent suicide. It’s the first time I remember crying over the death of a celebrity.

Why am I so devastated by the death of Robin Williams?

Aside from being a tremendous fan of his acting and stand-up comedy, Williams was a sort of personal hero for me. He was bipolar, but more importantly for me, he seemed to make the illness work for him for so many years. His mania brought forth some of his greatest moments and his depression and addictions provided him with material. He had overcome his addictions to drugs and alcohol, but eventually relapsed and went into rehab shortly before his death.

I saw him as someone who overcame his bipolar disorder and became a success. He rode the wave of his mania to a brilliant career, not only as a comedian and comic actor, but as a dramatic actor also. He could move people from laughter to tears, sometimes in the same film.

Granted, there are better actors and arguably better comedians, but his work and his success continued after he had battled through his addictions and his personal problems that were certainly related to being bipolar. I don’t know if his talent was despite his illness, or because of it, but I saw him as a success story. Maybe I was wrong. Not that he was success, but that he had somehow tamed his illness. The more I read about him, the more I found out how he constantly had to deal with his depression. In the middle of a brilliant career, at the age of 63, he committed suicide. Someone I thought of has a success story could not defeat depression.

This is why I’m devastated by the death of Robin Williams. It’s something to which I can relate. I’ve made it personal.

After so many years and so many successes and so many accolades, it still wasn’t enough to keep his demons at bay, to stave off that same dark depression that haunts me as well.

Here’s the truly devastating part for me: If Robin Williams finally succumbed to that depression, how do I ever stand a chance?

The Strange Case of Me and Me

872250a Film Dr Jekyll and Mr Hyde

“Well when the game is over, I won’t walk out the loser
And I know that I’ll walk out of here again
And I know someday I’ll walk out of here again
But now I’m trapped”
–Bruce Springsteen, “Trapped”

Yesterday wasn’t one of my best days. I’ve previously written that one of the symptoms of bipolar is mood intensification. Another is irritability. The combination of the two is unbearable. I woke up in a truly foul mood for no reason and it proceeded to get worse as the day progressed.

Imagine the anger that sets in when you’re in a supermarket or on some other shopping excursion. The checkout line is too long. The person behind you keeps pushing and bumping into you with their shopping cart. The person in front of you has two full shopping carts and a screaming child pulling candy off the shelf. At the front of the line is a person old enough to have sailed on the ark with Noah and is taking forever to get the groceries on the conveyor. Then they have an envelope full of coupons. Then they have the nerve to pay by check. You know this feeling. A temporary hatred for humanity, all of whom seems to have gathered with a 20 foot radius of you as you are simply trying to buy some milk and thinking this would be a quick trip. These feelings of consuming anger build until you exit the store, take a deep breath, retreat to your car, and head home.

On this particular day, this how I feel when I wake up. Except there is no deep sigh of relief or quiet place where I can calm myself. There is no relaxation. There is no reason for this irritability and anger. It merely is; and I have to deal with it. I try to sit and use deep breathing but it doesn’t work. I keep bouncing my heel off the floor, shaking my whole leg. I can’t sit still, which makes relaxation impossible. This is psychomotor agitation at its finest. I want to claw my way out of my own skin. I want to scream and throw a tantrum like a child, do anything I can to exorcise this rage until I can collapse, thoroughly exhausted, and finally rest. I can’t. I have to manage myself responsibly. I have to watch my six-year old and not lose my temper with him.

My son isn’t making it easy. As we sit on the couch watching TV, he insists on lying right up against my arm. Normally I don’t mind and I take comfort in it. Not today. Every time he moves and accidentally kicks or elbows me, I become angrier. I am able to maintain composure and ask him to move over. He does – for about five minutes – then he is back to leaning on me yet again.

I take a hydroxyzine, a non-narcotic I was prescribed for both anxiety attacks and mania, to calm down. This is the equivalent of throwing a brick in the Grand Canyon. Utterly useless, but I can’t take a second one for fear of falling asleep or being too groggy to watch my son. Everything culminates when my son accidentally breaks my glasses. I let out a “GODDAMMIT!” He bursts into tears. It takes almost ten minutes to calm him down. He apologizes repeatedly and promises never to play with my glasses again. I feel awful for yelling like I did and try to rationalize it by saying I wasn’t yelling directly at him, merely yelling in frustration, but it doesn’t ease my guilt. We forgive each other eventually and move on.

The worst part is that as this anger festers and grows, I recognize clearly what is happening, but I am unable to do anything about it. It is beyond my control and I am powerless to stop it. Anything I do to calm down doesn’t work and psychomotor agitation makes it worse. My wife asks several times what I’m upset about, but I can only tell her, “Nothing.” There is no specific event that has set this off. I feel completely helpless and trapped inside my own brain. I understand what’s happening and I can think rationally about it, but I’m locked away inside myself while the monster tries to get out and play. I feel as if some bizarre version of Jekyll and Hyde is being played out and I desperately want Jekyll to win. I want this day to be over.

Later that night (technically, early the next morning) I eventually get to sleep. I’ve never been so grateful for feeling tired.  Yesterday is finally gone and today, so far, has been very different. Yesterday’s crisis is over and I feel relatively average again. The next test is seeing what I can accomplish while the better mood lasts.

Inevitable Conflagration

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 “I had the shit till it all got smoked
I kept the promise till the vow got broke
I had to drink from the lovin’ cup
I stood on the banks till the river rose up
I saw the bride in her wedding gown
I was in the house when the house burned down” — Warren Zevon

By the time I was diagnosed with a mental illness I had already blown my life up.  It was difficult to believe that I wasn’t the person I thought I was, that everything I had done in my life may have been a result of a disease.  How did this happen?  Where did this come from?  How did I get it?  Why did it take so long to be problematic and noticeable?

My bipolar diagnosis came very late in life. I was 44 years old when I was finally diagnosed in 2012. Bipolar can be triggered by many different events or types of stress. No one is certain what causes bipolar disorder, but there are several theories. The obvious beginning of this is genetics. Bipolar disorder tends to run in families. About half the people with bipolar disorder have a family member with a mood disorder. I have a pretty good history of mental illness in my family. My father suffered from anxiety attacks when I was younger and looking back on his behavior, I’m fairly certain he was also bipolar. His mental issues were exacerbated by my mother’s death in 1996. My maternal grandmother also suffered from mental illness and spent time in a psychiatric hospital. I could never find out what her exact diagnosis was because “we don’t discuss those things” was the family mantra. All I could ever learn was that at some point there was an incident in which she destroyed all of her household furniture and both my parents helped clean it up. I now regret not getting the full story.

Also, a person who has one parent with bipolar disorder has a 15 to 25 percent chance of having the condition. As I mentioned, I’m pretty sure my dad was bipolar. Between that and his anxiety disorder my diagnosis feels like it was inevitable. Until my mother passed away, I never realized how much of a support she was for him and kept him from exhibiting symptoms.
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A mood episode can be triggered in a person who may be genetically predisposed to bipolar disorder. I remember several distinct episodes of depression when I was younger. I had a serious suicide attempt when I was 16 years old and another episode when I was a sophomore in college. That was more self-harm than suicidal. I considered suicide at several other points in my life, especially during the episode of depression that led to my three weeks at Four Winds. I can also remember distinct episodes of hyper-sexuality going back as far as high school and continuing in various forms until recently. If you’ve read my previous blog entries, my activities in strip clubs is pretty well documented.

In my own opinion, the biggest trigger, and the one that led to my diagnoses and self-awareness occurred in 2011. I’ve never discussed this in my blog before and outside of a close circle of friends and mental healthcare professionals, I’ve never discussed this at all. One day at work I discovered a flash drive sitting in the computer I was using. I opened a file to see if I could discover who it belonged to. That was the worst mistake I ever made. What I found was a coworker’s photo collection. Suffice it to say the subjects and material were highly illegal. I will not go into any further detail, as this is already a trigger for me and I can’t dwell on it any more. The coworker was removed from the premises and later prosecuted. As a result I started drinking more than usual, but as the saying goes “What has been seen cannot be unseen.” I tried to drink so much that I would, hopefully, retroactively drink myself blind. No such luck.

In addition to an increase in drinking and depression, I started to spend time in strip clubs where I discovered cocaine. This was quite the discovery, because I had a substance that made me feel slightly better than alcohol, a depressant. Now I could really self-medicate by mixing and matching my drug of choice to my mood.

I found out later on that in addition to genetics, the event of discovering that flash drive, use of alcohol and drugs, combined with a lack of sleep could also prompt an onset of bipolar disorder. It was a perfect storm of crazy. Everything I did effectively was a trigger for my mental illness. For months I experienced an unbelievable hypomanic state. Every symptom was present.

Then the money ran out. The lies and excuses ran out. Then my family left.

The crash was unbelievable; the depression and suicidal thoughts lasted eight months until I finally got to Four Winds. There was a brief period in those eight months when I felt better. I was diagnosed as bipolar, taking my medication, and in therapy. Once I began to felt better I quit treatment because, well…I felt better. I think we all know by now how that movie ended. I really hope there’s not a sequel in the works.

No Self Control

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“If I could control tomorrow’s haze
The darkened shore wouldn’t bother me
If I can’t control
the web we weave
My life will be lost in the fallen leaves”
–David Bowie, “No Control”

I mentioned in a previous entry about the difference between mania and hypomania that there are other states besides those and depression that can affect a person with bipolar disorder. These states can be just as devastating, if not more so, than the expected swings between hypomania and depression. Some of these I’ve experienced and some I haven’t, so I can’t completely talk about them from a personal point of view, but what I can, I will. The one thing all of these other states have in common is that, just like bipolar disorder itself, there is no way to control them.

The first of these are what as referred to as mixed mood episodes. It is a combination of mania (or hypomania) and depression. These episodes can be very dangerous because they can combine the suicidal ideations of depression with the abundance of energy of hypomania. The thoughts of suicide and self-hatred mixed with manic restlessness can be problematic to say the least. Not only are there thoughts of suicide, but the energy to act upon them. Mixed mood can last anywhere from a few hours to a few days. On the roller coaster that is bipolar disorder, this is the most out of control part of the ride.

I’ve experience mixed mood on rare occasions, but luckily not for long and they ended before I was worked up enough to physically harm myself. I hated myself, my life, my actions and even my own uncontrollable thoughts. My brain kept hammering me with the fact that every shitty thing in my life was my own fault and nothing I did could ever change that. As is usual with hypomania, my thoughts were racing and constantly battering me with the fact that I was a worthless asshole and I kept replaying everything I had ever done to hurt not only myself, but those around me that I cared about. It was a repeating slideshow of painful memories.

Another danger to the bipolar person is called rapid cycling. Rapid cycling is when a bipolar person experience four or more hypomanic, manic, or depressive episodes in a 12 month period. This doesn’t mean, however, that episodes follow any predictable cycle. The pattern is quite random. The quick mood swings of rapid cycling can occur within a few hours or a few days. This roller coaster carries a high risk of suicide. Diagnostically, mania lasts one week, four days for hypomania, and two weeks for depression. These minimums are for the purpose of diagnosing bipolar disorder.

I’ve been lucky enough not to have experienced rapid cycling. My depression can last for months and my hypomania is usually several weeks. But again, they are not predictable cycles. Through therapy, medication, and educating myself on my illness I have become better at identifying certain cues as to what I may experience next. In addition tracking my mood, there are other signs as well. Sleep patterns are the most telling for me. If I’m not sleeping, I know something is happening. If I can’t sleep but don’t feel tired during the day, and I feel tense and restless, I know hypomania is to blame. If I can’t sleep and can’t bring myself to get up and get moving or begin sleeping during most of the day, it’s a sure sign depression is creeping in. Identifying what are called prodromal (early) symptoms is a key for me in trying to hold off a bipolar relapse. I can never control my moods or change the way my brain thinks, but as long as I continue with my treatment, I can manage the symptoms somewhat, and that’s about the best I can hope for.

The last thing I would like to share is the concept of what have been called “breakthrough events”. Breakthrough events usually occur during days when I am feeling average. I may be having a good day by my standards and something happens. It could be anything, a song on the radio, something on TV, or even a comment someone makes and it sends me into a completely irrational emotional state, usually depression. Whatever progress I’ve made or episode I’ve overcome is just shattered. Everything just gets shot to hell without any warning and I wind up sitting and crying over something I’ve read or heard or watched. Again, this is part and parcel of bipolar disorder. It is an irrational disease and the breakthrough events can be lasting. I have to accept this as part of my illness and learn to deal with it. My brain fucks with me on a daily basis, sometimes sending me into self-loathing with no warning at all. Like I said, I can only manage as best I can and keep trying to make it through. I take my meds and stay in therapy and track my moods. These are my weapons in this particular fight.

Pants on Fire

liar

 

“Everybody lies.” – Dr. Gregory House

 

I recently read an article on myths about bipolar disorder. Number one on the list was bipolar people are liars. This is a myth because lying is not a symptom of bipolar disorder. Sometimes, however, bipolar people do indeed lie. For example, I lied. A lot. Intricately,  with a great level of complexity, and I was good at it. I lied to cover my hypomania. I had to come up with reasons why I was out all night, doing drugs, and spending every cent we had. I often dragged my friends’ names into it in order to make the stories believable. I got away with it for a long time until finally the money  ran out and there were no lies I could conjure up to save my own ass.  This led to an abrupt, ugly, devastating end.  These lies, for all their complex deception, were not a symptom of bipolar disorder, I was just trying not to get caught.  It didn’t work out particularly well.  Really.

I still lie fairly regularly, but not at the same level or for any devious reasons.  Instead, they are white lies that prevent me from getting involved discussing my mood swings. Ask me how I am in the midst of depression and the answer is “Fine”. You’ll get the same answer when my mind is racing and I’m bouncing off the walls with hypomania. Ask me what’s bothering me, “Nothing”. It’s terse and simple.  I dislike having to explain my moods, that I can’t just get over them,  like people tend to suggest, and be like everyone else, so I lie.  That’s the truth.

Another reason I tell these white lies is because not only do I not want to explain my moods, people don’t want to hear it. Who, aside from my therapist, wants to hear about how worthless or self-aggrandizing I feel, depending on my mood? I’m not going to discuss my thoughts of suicide or self-medicating, or any of the other nasty little secrets my brain likes to run through and torture me with. It follows then, that I lie in social settings.  I hate crowds and I strongly dislike people.  Well, most people, specifically strangers.  I can be, however, a particularly social person when necessary.  I know how to play nice.  I put up this facade to avoid any preconceived notions about what others may consider bipolar behavior.  I can indeed carry on an intelligent conversation when I have to.  Honestly.

There are some people I am completely honest with, people in whom I place complete trust. It’s a very small group consisting of a couple of friends and my therapist. Even then, with the exception of my therapist, no one believes me all the time. I have torn my credibility and reputation to shreds by lying for so long. Many people will no longer believe most of what I say, or they will assume I am lying all the time. Trust is nearly impossible to regain, and I understand why I’m in that position.

Obviously, there are things in past I’ve lied about that I haven’t mentioned here. I limited it to events relating to being bipolar and, of course, this is just my side of what happened and why. I’m sure those to whom I lied will have different versions of what happened, although I have tried to be as truthful as possible.  As a final reminder, just because I’ve lied doesn’t mean all bipolar people lie.  It’s not a symptom, it’s just how I’ve tried to cover up my symptoms.

Honest.

I wouldn’t lie to you.

Thanks for the Suggestion

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“Sometimes I think you
Don’t know what you say” – Jesus Jones, “I’m Burning”

I’ve gotten a variety of responses from people when I tell them I’m bipolar. My favorite was “Bipolar? Is that really a thing?” That’s one example of someone totally uneducated about mental illness. Needless to say, this response came from someone who felt that therapy and medication were useless and you should deal with issues on your own in a completely logical manner.   Sorry, but my brain literally does not and cannot work that way when it comes to depression and hypomania.

My least favorite response, the one I absolutely despise because it shows a total lack not only of understanding, but of empathy and compassion, is the ridiculous “Just snap out of it!” or the equally useless, “Get over it”.  Well, thanks a bunch there, Einstein, I wish I’d thought of that. Maybe next time you can tell a diabetic to produce more insulin naturally,  or a cancer patient to stop growing all those tumors. “Get over it,” is one of worst things to say to a bipolar person. For me, it makes everything so much worse; it increases my sense of worthlessness and self-loathing, that I’m not as good as everyone else and I’m just not “normal”. It’s  a dismissive and pointless statement that’s about as helpful as hitting someone in the balls with a five iron.

Anything that minimizes my illness or makes me feel like less of a human enrages me. I’ve had people tell me that everyone gets depressed, or that everyone has bad days and I’ll get over it eventually. I have to try to explain that my depression is very different, which of course can sound to others as if I’m being defensive and using it as an excuse for my moods and actions. I have to continually explain that I have a disease and my brain isn’t wired the same as everyone else’s. My depression and hypomania cannot be willed away.  My moods can change quickly and there are days where can’t even manage to get off the couch, shower, get dressed, or, worst of all, interact with my six year old son. That last one is the worst and it causes the depression  to feed on itself and there is nothing I can do to stop it or get past it. It’s an incredibly soul-crushing depression that leaves me a fetal-positioned mess with dreams of knives and warm baths running through my head.  I also can’t control my cycles of hypomania which are accompanied by an almost complete lack of sleep, racing thoughts, and extreme irritability.  This is just a short list of symptoms which show how much my brain hates me.

I’ve also been informed that, “We create our own reality.” In all honesty, I don’t even comprehend what the hell that means. If I created my own reality I’d be a billionaire living on a private island far away from idiots telling me I create my own reality. Similarly, people have offered me a host of new-age type treatments as well as homeopathic and “alternative” medicinal cures. Nope, no thanks for the hoodoo. I prefer trained professionals with real degrees and medications that have gone through clinical trials and are documented to work. I don’t need my chakra realigned, my third eye fitted for contacts, my aura polished, or an all-natural tea made of tree bark, lawnmower clippings and squirrel semen. To quote Tim Minchin, “Alternative medicine…has either not been proved to work, or been proved not to work. You know what they call alternative medicine that’s been proved to work? Medicine.”

I’ve even been told that I choose to be sick, or just as good, that I can choose not to be sick. I won’t even dignify that with a response. Some people obviously choose to be intellectually stunted.

The one thing all these responses share is that they are dismissive, belittling,  and discount the idea of mental illness as an actual disease. Just because I see a psychiatrist and some else sees a cardiologist doesn’t mean my disease isn’t as real. Like any serious illness, bipolar disorder can be fatal. 20% of people with bipolar disorder commit suicide and 50% attempt it. Those numbers are terrifying to me. I know I feel fine now, but anything can happen in the future.  It’s a coin flip as to whether or not I may try to kill myself. I know it’s not going to happen today or tomorrow, but somewhere down the line it may happen, and  it may be one cycle of depression away. That thought alone has kept me awake nights and it scares the shit out of me.

I know most people are trying to help, but some just don’t grasp the concept that bipolar disorder is an illness, just like the flu or cancer. In a recent survey, of 40% of the respondents said they didn’t believe mental illness is real.  This is why we need more awareness and education on mental illness.  Even though I have no physical symptoms I have a very real disease and I shouldn’t have to keep trying to prove it.

Let’s Party!

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Let’s throw it all into the mix
And open up our bag of tricks
And party for the rest of the night”
  – Warren Zevon

Being bipolar isn’t all bad.  Yes, there are unpredictable highs and lows.  The depression can be crippling, but the hypomania isn’t always a bad thing.  It’s also not as fun as people think it is when they learn what the symptoms are.  First, let me explain a little about what hypomania means and the difference between that and mania.

The diagnosis of bipolar I or bipolar II lies in whether a person experiences mania or hypomania. Both manifest themselves in the same ways:  an excited or even irritable mood, racing thoughts, lack of focus or concentration, a decreased need for sleep, being more talkative often with a rapid change of topic, hypersexuality, an increase of productivity and/or psychomotor agitation (pacing, hand wringing, general restlessness), an increase in self-esteem with possible delusions of grandeur, and finally, participation in pleasurable activities that can or will result in devastating consequences.   Additionally, both mania and hypomania can include hallucinations.  I’ve never experienced that particular symptom and I hope I never do, but in all honesty, there are some things I’ve done that I wish had been hallucinations.

The difference between mania and hypomania, and bipolar I and II is the severity of the manic symptoms. Mania is the more severe of the two and is symptomatic of bipolar I. Mania results in a definite impairment in functioning, being a danger to self or others,and possibly psychotic features. Episodes of mania must last at least seven days as part of the diagnostic criteria. Mania also necessitates hospitalization. As a sufferer of bipolar II, I have to deal with hypomania, which is less severe. There is no marked impairment in functioning, no necessity for hospitalization, and no psychotic features. Diagnostically, hypomania must last at least four days. Mania is more dangerous because it can put the life of the person and possibly those around them in danger.

Overall, bipolar disorder involves three possible moods, mania, hypomania, and depression (there are other conditions such as mixed mood and rapid cycling, but I’ll save those for another time).  For me, hypomania is the preferable condition, but it is a double-edged sword. Sometimes it can be fun and other times it can be torturous, and sometimes it can have devastating consequences because of the fun. My hypomanic episodes have covered a wide range of experiences. I’ll discuss the bad ones first and get them out of the way. My activities, which I’ve previously blogged about, cost me my family, my job, my savings, and my dignity. I burned my entire life to embers and ash and I am thoroughly embarrassed by the things I did. This actually occurred while I was chasing the pleasurable experiences.  I was able to stay up all night partying and spending absurd amounts of money.  Although it seemed fun at the time, it was my lack of impulse control that led to destructive results.

Racing thoughts and irritability are troubling as well. I can have extended periods of anger, even approaching the point of rage, and the racing thoughts are a constant assault; a barrage of disjointed, repetitive, and uncontrollable ideas. I feel as if I’m being assaulted both externally and by my own mind as well. These  are definitely not fun.

Paradoxically, there are times when I enjoy my hypomania. It is a welcome break from depression and I feel infinitely more energetic and creative. As an example, I began this blog in November of 2012 in a flurry of hypomanic behavior. I was sleeping less so I would write until the wee hours of the morning and as a result, I was posting nearly every day.  As I began to cycle down out of the hypomania  I posted less, and then eventually stopped altogether when I sank into depression. Now as I’ve restarted the blog, I’m back in treatment, on my meds and the hypomania is much less severe, so I have set the more realistic goal of publishing once a week rather than daily. Making use of my current hypomania, I’ve already completed several weeks worth of posts and scheduled them to be automatically published weekly (new blogs are posted Mondays at 6am if you want to read the latest while having your coffee).

Medication alone does not stop either depression or hypomania.  There is no magic cure, but the symptoms can be more manageable. I still feel  restless during my hypomania. I’ve had nights where if I don’t get out of the house I feel like I’m a prisoner. I begin pacing and I get irritable and easily agitated. Since medication is not a cure-all I need to find other ways to channel this excess energy.  Obviously I write, but that’s not enough.  I try to do constructive things like run errands; something productive to get me out of the house.  I’ll go to the store or do laundry while listening to my iPod.  It distracts me and drowns out my brain for a while.  I get to accomplish things.  I never would have thought that going grocery shopping or going to the laundromat would have therapeutic value, but it works. It’s also a hell of a lot cheaper than vodka, cocaine, and strip clubs.