My medications paint a pretty palate:
Zyprexa® (olanzapine) (15 mg) light blue
Paxil® (paroxetine) (40 mg) mint green
Paxil® (paroxetine) (20 mg) soft pink
Eskalith® (Lithium carbonate) CR (450 mg b.i.d.) pale yellow
Lamictal® (lamotrigine) (200 mg) light blue
Every night my husband and I embark on the ritual of laying out the pills just so, arranged by color. This is a constant reminder that I am bipolar and that I will be taking these meds for the rest of my life. I lay out the next morning's dose in a silver heart-shaped pillbox that has my initial on one side and ‘Love Always, J’ on the other. This pillbox is all about my husband's wholehearted acceptance of me as a bipolar woman.
In high school, I was wilder than my parents, or anyone, would have suspected. I was a straight A student and I had my own set of good friends and good mentors. Although I was not diagnosed until age 18, I think that my illness began around my junior year. On Saturday afternoons, my parents and my sister would go to the movies around 4:00. I would have several hours to myself before my friends would pick me up for an evening of late partying at whoever's house. They had to pick me up because by 6:00 I was drunk on my parent's rum mixed with Diet Coke. I was feeling overstimulated, like my antenna was exquisitely sensitive to images and sounds and I was frightened by the feeling as it was so new. I used alcohol for relief. I was miserable at high school parties and I would binge drink until I was on the bathroom floor wailing in emotional pain. I was terrified that I could feel so wrecked inside, terrified that something was horribly wrong with me and terrified that I didn't know how to tell anyone that I was slipping into a dark place. I felt tortured by my mind and I thought I could not contain myself or be contained by those I loved. But nobody clued in to what was happening in my brain because everything else in my life seemed so right. I was angry at my parents, my teachers, my friends for not noticing, and (in retrospect) for not intervening.
I was accepted to Brown University and I began freshman year with a positive outlook. But by the time of my 18th birthday in October, I felt myself slipping. I cried into the Chin Chin (a well-known Chinese restaurant in Los Angeles.) Chinese Chicken salad that my mom Fed-Ex’ed for the occasion. I drank too much. I stayed in bed and missed class. I ate a whole Domino's pizza and made myself throw up afterwards. I became a full-fledged bulimic, abusing 12 ex-lax extra strength blue pills every morning and gagging as I tried to get them down. I experienced the feelings that I had at 16, but now they were hitting me so strongly that I would wake up in the middle of the night in a cold sweat and labor downstairs to smoke a cigarette in my nightgown and winter coat. Then, I acutely experienced the depression and despair that had been brewing in high school. My roommate became my best friend (although she later betrayed me) and she insisted that I make an appointment at the university mental hygiene clinic.
My therapist was a nightmare. She was inexperienced and I could tell that I was too much for her. She said that all I ever did was tell her how many times I had vomited during the week. When she recommended me to a psychiatrist for antidepressant medication, she said she was afraid that I would take the entire bottle. That was my first brush with suicidality, and certainly not my last. I was bewildered and angry. How could this happen to ME? I was raised in a loving home. In the midst of my emotional pain, I was guilty for my feelings, like somehow I was being ungrateful for my life. I could not get thoughts of cutting out of my mind, of the crimson blood dripping down my numb arms. I did not consider the physical pain.
I came home to my parents in the spring for Passover and I never returned to Brown. My pediatrician recommended Dr Susan and I loved her instantly. In my journal, I wrote that she cooed with empathy when I told her about my pain and utter confusion and horror about what was happening to me. I dreamt that I flew back to Providence and suicided in the snow at the baggage claim. I dreamt that I cut my wrists with an airplane knife. I learned later that the Prozac (fluoxetine) was inducing a mixed state, and that is how it became clear to me that I was manic-depressive. I learned that my cousin had the same diagnosis and took lithium. I learned that my dad had been depressed and took imiprimine.
I packed only my pajamas. I thought that I would be in an adjustable bed with rails, resting and receiving visitors. When I arrived on Unit A-South at the Neuropsychiatric Hospital of the University of California, Los Angeles (UCLA), I was introduced to my anorexic roommate who was pouring her apple juice into her wasting plant with an emphatic ‘see how it likes 2000 calories a day’!
My hospital experience was surprisingly positive. The doctors and nurses and staff were kind and sensitive and empathic. I wrote poems and read them to Nurse Maureen. I went with Jack the recreational therapist on walks to nearby Westwood village to rent videos. I enjoyed being on the ward and feeling safe, like my thoughts couldn’t run wild.
I experienced brief periods of hypomania when I thought that I could pogo stick from the top of one Westwood building to another. I steered my car toward the airport several times, ready to literally hop on to a transatlantic flight and then call people from the sky. I experienced mixed states during which I was so agitated that my own skin became desperately confining.
However, my illness mostly took the course of soul-wrenching depressions where I couldn’t speak above a whisper. I was slow, so slow that even walking was an effort. I cried so much that I stopped crying completely. I saw Susan 5 days a week and more. I tried every medication known to psychiatry. When I was on Tegretol® (carbamazepine), I developed agranulcytosis. When I was on Parnate® (tranylcypromine), my mother accidentally cooked sausages for dinner.
She was overcome with guilt over the ruined dinner. She felt guilt for my genetic endowment, although it really came from my father's side of the family. Her initial reaction to my return from Brown and my first hospitalization was disbelief as I had not been open about losing my grip. Shortly after my return she threw her frozen yogurt cone to the ground as I told her about the bulimia. Anger was replaced by an acceptance and unwavering support that continued through the rough years and beyond that enveloped me and kept me safe. I will always remember how she softly gazed through the window of the unit sensitively carrying a pink rose.
On September 30, 1993, my hysterical mother yelled that I belonged in an insane asylum. It was Friday and she was flooring the accelerator to get to the UCLA emergency room. I had ingested probably eight pills of Wellbutrin® (bupropion) mixed with half a bottle of Synthroid® (levothyroxine). They forced me to drink activated charcoal from a purple tumbler. The police came. Susan came. My dad and sister met us there. I was placed in the CCU for arrhythmia overnight. Susan lobbied against a 5150 (California Code. Division 5. Community Mental Health Services. Part 1. The Lanterman-Petris-Short Act. Chapter 2. Involuntary Treatment. Article 1. Detention of Mentally Disordered Persons for Evaluation and Treatment. 5150. When any person, as a result of mental disorder, is a danger to others, or to himself or herself, or gravely disabled, a peace officer, member of the attending staff, as defined by regulation, of an evaluation facility designated by the county, designated members of a mobile crisis team provided by Section 5651.7, or other professional person designated by the county may, upon probable cause, take, or cause to be taken, the person into custody and place him or her in a facility designated by the county and approved by the State Department of Mental Health as a facility for 72-h treatment and evaluation.)
I went home, but was back on the in-patient ward several days later. I felt strangely satisfied but mostly numb to experience. I didn’t feel like I knew what had transpired. I felt activated and strangely hyper and alive as I was vomiting all over myself. I taped my emergency room bracelet to my journal. Overwhelming guilt crept in later and was to plague me for years. At Yom Kippur services, I used to repent for the anguish I caused my family by being suicidal.
At age 20, I was hospitalized for the fifth time and this one lasted a month. During that month, I was nearly catatonic with depression and enduring a grueling series of 12 treatments of bilateral ECT. My first treatment was on Halloween. I felt like I was living a freak show. I think the worst part (relatively speaking) was the retrograde amnesia. I can’t remember the 1994 earthquake to this day. My mom tells me that we lived at my grandparents’ house for 3 days. But my memory is completely intact for the horror of the actual experience, the oxygen mask making me cough, counting down from 10, the blood pressure cuff and the blood oxygen clip on my toe.
At 2 years after leaving Brown, I enrolled as a sophomore at Pitzer College where I easily chose psychology as my major. I was hospitalized again in my second year. Clozaril® (clozapine), the medication of last resort, turned things around. The weekly blood draws and the insidious weight gain were major issues, but I remained on Clozaril® for 8 years and it afforded me stability and peace of mind. I felt so stable and well that I no longer framed my self-image around being bipolar. I felt in control of my mood and of my life. I always showed up at the lab for my blood draw. I was happy and healthy and I started to date. I felt creative in a positive, healthy, focused, nonclinical way. Instead of dreaming up ingenious schemes about how to die, I was doing mood disorders research with a prominent doctor at UCLA.
I pursued my deep and developing love for psychology. I graduated a year ago from a doctoral program in Los Angeles with my PhD in Clinical Psychology. My husband was there to see me hooded. I am now a practicing clinician, doing psychoanalytic psychotherapy with children. I think that my experiences with mental illness truly enhance the work that I do and I feel extremely fulfilled in my practice. I think that I bring to my patients an empathy that only comes from knowing the impact of mental illness on a first-hand basis. In my work, a source of frustration is the DSM-IV because I understand so much about the experience of having a mood disorder, while its pages apathetically list isolated symptoms that do not really convey what the patient's experience.
I met Jeremy on an internet dating site. His profile popped up when I did a very elitist search for 20- to 35-year-old men with doctorates. Jeremy was the first and only person I ever emailed on this site. As we began corresponding over email, Jeremy and I quickly realized that we had been in the same class in high school, but had never met. On our second date, Jeremy told me that he felt he had been given information that he shouldn’t have known yet from a former classmate of ours. He said point blank that he heard that I was manic-depressive. It was out in the open from the outset. I immediately felt understood and nurtured and I knew even then that we would be together through the ups and downs of my life and of my illness.
Jeremy and I have been married for almost 2 years and we have been preparing to start a family. Preparing involves meeting monthly with a reproductive psychiatrist. I have always been anxious about being pregnant on meds, even dreaming that I have birthed a deformed baby. We crosstapered the clozapine with olanzapine, which has more data for pregnancy. I also tried to get off lithium, which resulted in the first real mood instability since my mid-20s and a seventh hospitalization in November, right after my 30th birthday. I realized again how fragile is the balance of my brain chemistry and again was slammed with my dependence on psychotropic medication.
I worry about the risks of our child having a mood disorder. I know from my studies and my personal research that bipolar disorder is the most genetically loaded of any major mental illness. My husband has assured me that if that is the case, we will deal with it. I wonder if I will be an anxious and hypervigilant mother for that reason, but I think that I have the emotional capacity to be a good mother. There is nothing I want more than that right now.
In September 2004, my mother founded an organization to support psychiatry. Her group has made a real impact in the community. She founded this up and coming nonprofit organization in my honor, because my family and I are deeply in gratitude to modern psychiatry for saving my life.
I have been blessed with a support group of my own. Throughout my illness, my family has been my rock. My mom drove me to school when I was in a medication stupor. My dad safeguarded my medications when I was not safe to have them in my possession. He also interfaced with Susan and was so effective because he had supported his nephew through depressions and manias. My parents together went to Clozaril support groups and family therapy. They loved and supported me unconditionally and with everything in their hearts and more. My younger sister's sensitivity cemented our adult relationship. I always wondered if she was afraid it would happen to her too.
I see my illness as a watercolor painting. My medications are the colors, which allow my vitality to show through. The water is my tears. The blurring and running of the paint represent the uncertainty that I lived with during those years. I imagine that this past episode will not be my last as that is the nature of my bipolar illness. The skies are stormy at times, but as in any meaningful painting, there is light and hope shining through.
Bipolar Disorder can be a very scary thing for people to go through. You can go from being extremely “happy”; to extremely upset within seconds, which is due to the serotonin levels in your brain. Bipolar disorder causes people to have mood swings which most of the time have nothing to do with anything going on in their lives. This disease is exactly that, a disease. People who get it cannot help it, just as people with cancer cannot help what they have received. Another name for bipolar disorder is manic depression, which is a very effective definition of the disease. Bipolar means 2 poles, in this case meaning mania and depression. When you have an increased level of serotonin on your brain, you are said to be hypomanic. When you have a low level of serotonin in your brain, you are depressed state. Bipolar patients have both of these going on at the same time throughout their lives, possibly even many times a day if they are what they call a rapid cycler.People with bipolar disorder may try to commit suicide or do things to harm themselves. Such things may include cutting themselves, drinking, using drugs, most popularly marijuana. People with this disorder, to relieve the symptoms of pain and stress, supposedly use marijuana. Although marijuana does have antidepressant properties, it can cause amotivational syndrome. This occurs when people who use it begin to perform at a very low level, lower then they were before using the drug. The person may feel relief from their symptoms but this may be just an illusion.When bipolar people are in a manic state, they begin to think in a frenzy.All of there muscles will tense up, and their shoulder blades and jaw will begin to ache. Their heartbeat speeds up. Physical activities become effortless and they feel very strong, yet doing simple things like tying their shoes becomes difficult. They begin to feel twitchy and want to move around a lot. People during mania often talk to themselves, or if talking to others, they repeat the same thing over and over. Often times, they over react to things or blow things way out of proportion, and tend to have short tempers. Driving while in a state of mania is one of the most dangerous things for them to do because they forget about the mental pictures of other cars and believe they are the only ones on the road. Even if things are irritating to others, they will continue to do them, such as poking people, interrupting others, or ignoring. The dreams manic people have are so vivid they feel as if they have lived them. Speech often speeds up and may be unintelligible to others. Productivity soars during this time, but they get easily confused if given more than one thing to do. When he or she is hypomanic, they are very good at lyrics and poetry, being able to come up with songs and things very easily. As you can se, many things can happen when you are in a hypomanic state. Although you may be asking yourself, besides the few obvious ones like dangerous driving, what could be so bad about this? The answer to that question is suicide. A little know fact is that surprisingly, more bipolar people commit suicide during hypomania rather than depression because they feel like they are on top of the world and nothing will hurt them, while as depression causes you to mope around.On the other end of the spectrum falls depression. People begin to lose understanding of what they should be doing next. They tend to wander around in a daze. Things begin to stay undone. Even the people he or she is around all the time begin to make them nervous. They can fight it for a while, but when it hits hard, everything becomes a burden to do. It’s a battle that is always lost because they cannot help it. By the time they realize they need help, the depression ahs taken over, and they cannot communicate clearly enough with others to tell them. They often stay inside and never leave and their sleep patters become odd, often staying awake for 20 or more hours. These people become so afraid of others that they disappear and go driving, sometimes for hours. The purpose is to escape and put their body somewhere else that is safe and comfortable to escape the terror. Days are spent with almost completely blank minds. Just enough of them is alive to make sure they eat and act as though others know nothing of the disease.In my surveys, I found the results kind of surprising. Almost exactly half of the 50 people surveyed knew someone who was bipolar, which I found amazing. A good thing about this is that the people who didn’t know anyone who had manic depression said that they would try to calm them down and be a good friend to them. The sad thing is that most of the people who knew someone knew of times they had tried to kill themselves.I chose to write about manic depression because a close friend of mine is bipolar and it is so hard sometimes to deal with him. But I do because I love him, and I know that without me, sometimes he would feel as if no one cared. He started out young doing the typical things that boys do, like drawing bloody pictures and stuff like that.He always thought about killing the person he was mad at as child, even though it was trivial at the time, to him it was important. But in no way is he ‘a crazy psycho that needs to be in an asylum,’ as one of my friends put it. He is a human being and just like any other, he should be treated fairly and not looked down upon. I have realized in the past few years that I’ve known him, most, if not all, of the symptoms he has displayed that I thought were just ‘him’, were really signs of mania and depression. He feels comfortable talking about his disease, so soon after we met, he told me. I was confused at first and wasn’t sure how to handle him. But then I realized that he should be treated the same, I just have to be careful of what I say around him, because bipolar people tend to get their feelings hurt or their nerves set off very easily. Luckily, he was diagnosed at 18, which seems like a lifetime ago for him. He is 21 now, and takes medication to help control the masked killer we call manic depression, which affect 2-3 million people in the U.S. I believe he is on the right track now; all he needs is the right motivation, and people to stand by him.I recently read a book by Danielle Steel, entitled “His Bright Light: The Story Of Nick Traina”, which was about her 19 year old son who was bipolar and killed himself. This has become my favorite book, and I love the way she told the story. What she says in the intro of the book almost brought me to tears because it is how I feel sometimes about my friend. She said: “There is no denying that it is a hard, hard road loving someone with bipolar disease. There are times when you want to scream, days when you think you can’t do it anymore, weeks when you know you haven’t made a difference but only wish you could, moments when you want to turn your back on it. It is their problem, not yours, and yet it becomes yours if you love the person suffering from it.You have no choice. You must stand by them. You are trapped, as surely as the patient is. And you will hate that trap at times; hate what it does to your life, your days, your own sanity. But hate it or not, you are there, and whatever it takes, you have to make the best of it.”Bipolar disorder is something that cannot be cured, but controlled, if in the right environment. I hope if I have taught you anything at all today, it is this: if you know someone who is like this, please, don’t turn your back on them. Stand by them and support them, because this is something that they will have to deal with for the rest of their life.
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