More on Cognitive Therapy and Mindfulness

“If you hope to make use of the force of your own problems to propel you in this way, you will have to be tuned in, just as a sailor is tuned in to the feel of the boat, the water, the wind, and his or her course. You will have to learn how to handle yourself under all kinds of stressful conditions, not just when the weather is sunny and the wind blowing exactly the way you want it to (Kabat-Zinn, p.3, 1990).”

I was not always a person who looked inward for explanations. I was young and I was angry. I spent a lot of time shaking my fist angrily at God wanting an explanation for all the bad things that happened to me. And there were many bad things that happened, to be sure. Yet, I somehow failed to see how intact I was, how relatively whole. I survived. But instead of rejoicing, I disdained. I was sullen and my heart withered under the tremendous load of maintenance that was required to stay so angry.

When I began my battle with mental illness in earnest, all the above changed. Actually, it paled in comparison. I had no time to feed my anger. I had no time for self-pity or just plain selfishness. I was on a slippery slope, grasping for my life, but sliding quickly into the black pit of despair and death. That may sound dramatic, and so it is. But it is also what I know to be very real.
The swirling, dense fog that I was lost in for a decade tortured me with every kind of pain known to the human psyche, leaving my mind shattered and my sense of self ultimately lost. I was drowning and no one seemed to be able to extend much of a life rope. But somewhere, in the midst of the never-ending night, I found a light and I found me.

My sister Kelly calls it a “God thing,” that thing that happens when one is taken down a road never before known to that person, yet holding the answer to their big question. In my case it was the answer to a need and one of many unknown roads He has taken me down. It is what I later discovered was a theory called mindfulness-cognitive therapy. But I did not know it at the time. I just began to do what seemed to work in getting to a place where I could know myself again and function in the world again. I needed control over the ever-roaming fragments of my mind that seemed to not really be attached any more, but to merely float next to each other. For when any outside pressure was applied, they would fly apart like a startled school of fish.

What worked to some degree along with medication was the idea that whatever thought that came into my head could be remade to look a different way as it entered into the court of my mind, much like an improperly dressed citizen is made over to present before the king. I have an active imagination, and I utilized it to imagine a negative thought into something better. It didn’t matter if it wasn’t reality. Maybe, in reality, there was little that was positive about my immediate interpretation of a situation. What mattered was that I reframed it to be more acceptable for my mind to receive.

I apologize for all the metaphors, but in exploring the workings of my mind, visuals are what I see and how my mind functions with concepts. It is yet another way it adapts to the world it perceives through the senses that provide information. Much of what is taken in is not acceptable to my mind for reasons I don’t even know. And so, again, to combat the difference between the outside world, its in put, and my fragile mind, I discovered a way to provide a buffer between the two.
The type of cognitive therapy that I have been adhering to for the past decade plus is that of taking an irrational thought to one of more rationality—my paraphrasing from my understanding of Albert Ellis’s theory (Albert Ellis Institute.org, 2007). My thoughts are generally negative and irrational so I focus on turning them into smaller, more positive thoughts. This brings me to mindfulness.

Mindfulness is a concept is all about being in the moment, experiencing what is happening right now (Kabat-Zinn, 1990). If I am taking a shower, I am concentrating on taking a shower, not whether or not I bought enough lettuce for the dinner salad I’m serving later. I am not as adept at this concept as I am at the reframing that occurs in cognitive therapy. But I need to be able to utilize this concept because if I am unable to parcel my life picture down from the whole view into the present moment, then I will be unable to reframe when I am under stress at many levels. It is easy to become overwhelmed when you have too much to concentrate on. If I am able to learn to concentrate on the moment I am in and not block out other events or thoughts, but rather allow them to slide out off the peripherals of my minds eye, I will be better able to reframe what I am needing to because I will have trained myself to focus. I will be able to clear the court of my mind, to go back to a previous metaphor. I will be able to maintain some control over what is happening in my mind.

This is my reasoning for introducing mindfulness to my use of cognitive therapy. I have found that I already use it to some degree when I am trying to pinpoint whether emotions I am experiencing are coming from my illness or from my true personal reactions. I want to develop further, however, and practice the technique just as I exercise every day. I believe mindfulness can be a very effective tool in the longevity of control I may have over mental illness. It is not a cure but another tool. One can never have too many tools.

Sources:

Albert Ellis Institute, (2007). http://www.albertellisinstitute.org/aei/index.html


Kabat-Zinn, Jon (1990). Full catastrophe living: Using the wisdom of your body and
mind to face stress, pain, and illness. Dell Publishing: New York.

Lessons on Mastering the Beast...For Those Who Have It

When that diagnosis is rendered, the most important thing that can be done to conquer bipolar is to believe in it. Accept that it exists and it exists in you. Everything in you will scream out a denial, but if you can refuse to believe the denial, you
will have won the most important battle of your life.

You will most likely be terrified. Why not? That is a natural reaction in human beings who face something they don’t understand or is life threatening, and bipolar is both. The way to combat fear is with knowledge. Understanding what you are up against is crucial, especially with mental illness, because you will hear all kinds of things from people you know, the media, and just about every venue, about mental illness that is completely incorrect. Know your facts. Know what you have. And when someone says something that is rude and ignorant, cram the truth down their throat. Not literally of course, we want to embrace peace and love here.

Medication should either go right before education or directly after. If you have educated yourself thoroughly on bipolar you will know that the most effective way to live with the illness is on drugs, the legal kind. Do no embrace alternative methods of medicating. Alcohol and drugs have side effects that will kill you. Find a psychiatrist who can prescribe you meds, not an M.D. Psychiatrists can better assist you, even if it sometimes seems like they don’t know what they are doing. And that will happen. Finding the right meds for your body takes time and trial. The more you tell them about how the meds make you feel, the sooner they will get you correctly medicated.

Then after you have connected with a psychiatrist, get a referral for a therapist. This assuming, of course that you are independently wealthy and can afford all these things. But if you are an average American, you may only be able to afford what I could and that is the psychiatrist and the meds. Good enough. Go to the library. Go to www.nami.org . Go to the Internet and type in bipolar disorder. You will find what you need. I did. I did it all on my own. I had very little support from anyone for years. That’s okay. My illness was my problem. Your illness is your problem.

You need to immediately start working on the three areas of your life that need to be balanced. They are the biological, which you will manage with meds, plenty of sleep, eating healthy, taking vitamins, and exercising. Exercising is so good for the brain, not to mention the body. Then there is the environmental. This one may be a bit tricky for a while but basically you need to make sure you are putting healthy things into your mind, and kicking negative things out. You can create negative thoughts all on your own without fostering them. You will find as you go what kinds of things you need in your life to help you feel comfortable in your space.

Then there is the sociological aspect. This area involves all your relationships with others. It is important to weed out relationships that drain you, for you need all that energy for yourself now. The very fact that you have a mental illness is probably why you are drawn to needy people. There is something about mess and drama that stimulates the bipolar mind. But that is negative stimulation and you do not want that.

Next you want to start journaling, writing down your thoughts. This may be difficult. It was for me, but it will help you over time to find patterns in your mood cycles. Get in the habit of journaling. It is very therapeutic and will help you to begin to reframe your thoughts during dark days when you want to simply disintegrate.

I recommend you simplify your life for a while until you can get all these things put into practice. I would give it all a year in terms of creating solid habits. Do not start anything new like a job or a relationship if you can at all help it. You need to get regulated and that takes time and consistency.

These things are basics. Remember not to let anyone define you by your illness. I would not be afraid to speak very openly about your illness, for that is the best way to eradicate stigma. Someone else’s problem with your illness is just that, their problem, and just as you face the consequences of not taking care of yourself, so they will face consequences for discriminating against you. Do not be afraid to fight for yourself. I have fought back a couple of different times when I have been discriminated against. It just didn’t sit well that individuals would be allowed to change the course of my journey due to their own paranoia. And too, if you are able to fight back, it is good, for someone might come along after you who might not be able to.

Most importantly, I encourage you to find your spiritual nature—that part of you God designed to respond to Him. I promise leaning on Him is the best way to get through whatever dark roads might lie ahead. If you could not read a map, but you knew where to find the one who made the map, wouldn’t you go to him for directions? You were made, designed, therefore go to the One who made you for help figuring out your particular design.

The one thing I’ve been told most in all the years I’ve been hollering, “Hey folks, I’m bipolar,” at the top of my lungs is that I do not fit people’s idea of what a mentally ill person should look and act like. I do not fit in with those who do not have bipolar and I do not fit in with those who do. I have been told quite often I am very “high functioning.” I do not fit in with people’s understanding of what bipolar should look like. I fully and completely contribute that to the presence of God in my life. If there is any great thing in me from this illness it is the Master working with His Creation that has made it so.

What is Co-Morbidity?

What makes bipolar disorder difficult to treat...well one of the things...is that there are usually others issues in play--co-morbidity. These co-morbidities often occur as a result of bipolar or in duality with it, often making it difficult to effectively treat the bipolar disorder or even diagnose it.

The top three psychological ailments to accompany bipolar disorder are anxiety disorder (93%), substance abuse (71%), and binge eating disorder (30%). I wasn’t surprised at the first two as I have battled both in my long experience with bipolar, but I was surprised to find binge eating to be next in line. And finding that more men than women binge eat was even more surprising (Preston, 2006).

Next are the medical ailments. Migraine tops the list, followed by obesity, and type II diabetes. I was not really surprised by any of these, though I had thought heart disease might be one of them (Preston, 2006).

Sources:

Preston, John D. (2006). Diagnosis & treatment of bipolar spectrum disorder.
Wisconsin: PESI

Let's Talk About Agoraphobia

I spent a year in my home. I rarely left and if I did it was in the middle of the
night. When I did venture out, I would suffer extreme physical side effects.

What I was experiencing was part of my anxiety disorder called agoraphobia. Agoraphobia is “derived from two Greek words: agora, meaning marketplace or place of assembly, and phobos, meaning terror or flight” (Garfield, 1984, p. 128). It is the fear of being in an open space where one might find it difficult to escape (Healthtouch, 2004).

Agoraphobia s is considered to be a result of environmental and physical factors. There may be chemical problems in the brain and certain social situations, such as grocery shopping standing in line at the movie theater, may contribute (Smith, 2005). People with agoraphobia tend to have panic attacks that can cause serious trauma in social situations. A panic attack happens when a person becomes very anxious quite suddenly and for no apparent reason. A person who is having a panic attack may experience worry over losing control and may develop a fear of having a heart attack. It may become difficult to breathe. An individual who suffers from panic attacks will attempt to steer clear of places where they may feel they may have one (Healthtouch, 2004), which for me was just about everywhere. When I somewhere that was overly crowded with a lot of noise and commotion, a panic attack would most likely ensue.

The first panic attack I had was when my sister and I went to an amusement park with the corporation I worked for. We were having a good time and were walking past the kid’s rides when we were stopped for a moment in a sea of people. All of a sudden the world started to spin and my vision became distorted. I couldn’t breathe and all I could think of was getting out and away. I remember thinking that the people that were pushing and crowding around me didn’t have the right to invade my space. I pushed my way through, as though driven, heading for an open area nearby that had benches to sit on. I sat down and put my head between my knees until my breathing became normal. That was the first incident and I have had many more since that time.

People who have panic attacks may feel depressed and become upset with themselves because they have fears of going to places where they may have panic attacks. They may feel like prisoners in their homes because they are too afraid to leave. This is where agoraphobia becomes an issue. Individuals who suffer in this way may tend to self medicate with alcohol or may abuse medications in order alleviate symptoms (Healthtouch, 2004).

I know that I used to self medicate with cigarettes. Going to the grocery store, which was a necessary evil, was traumatic. I would use cigarettes to help control my anxiety. Even if I were at home, if I began to think about going somewhere I would begin to have a panic attack and I would then use a cigarette to calm myself.

One of the most embarrassing things about having a panic attack, at least for me, was the physical symptoms. My hair was very nearly to the middle of my back and when I would have a panic attack I would sweat so much that my hair would be soaking wet by the time the attacked abated.

Fear is the driving factor in both agoraphobia and panic attacks. In agoraphobics, there is a fear of crowds, of standing in line, of bridges, of having panic symptoms such as dizziness and or diarrhea, of being on a train or automobile (DSMV-I, 2003). Symptoms can come and go but many times agoraphobics are housebound for years, and sometimes for the entirety of their lives. First attacks usually occur between the ages of 18 and 35, and they happen suddenly (Garfield, 1984).

There are several theories on the origins of agoraphobia (Garfield, 1984, p. 129). One theory comes from Weekes, Chambless, and Alan J. Goldstein, Department of Psychiatry, Temple University Medical School, Philadelphia (Garfield, 1984, p. 129). They believe that stress is the precursor for panic attacks. Some of the events that could trigger such attacks are traumatic in value and include, death, miscarriage, and divorce, but do not exclude happy events such as marriage and birth (Garfield, 1984).

It has been determined that cognitive therapy is more effective and less costly than pharmacotherapy. Treatment choices are contingent on the skill of the therapist and what the patient prefers. Cognitive therapy is often used in conjunction with medication (Andrews, 2003). For me, cognitive therapy was something I was already practicing to keep my bipolar under control. I utilized my watcher in the area of my anxiety disorder as well. I later found out in the research I was doing on bipolar disorder that there is generally a co-morbidity that goes along with bipolar. It may be psychological or physical, sometimes both.

Sources:
Diagnostic and Statistical Manual

Andrews, G., Oakley-Browne, M., Castle, D., Judd, F., & Baillie, A., (2003).
Summary of guideline for the treatment of panic disorder and agoraphobia. Australasian Psychiatry, 11, 1.

Garfield, E. (1991). Why is the ancient and prevalent disorder called agoraphobia
A neglected research topic? Essays of an Information Scientist, 7, 128-137.

Healthtouch. (2004). Agoraphobia general information. Retrieved April 9, 2005, from
http:www.healthtouch.com/bin/EContent_HT/cnoteShowLfts.asp?fname=02431&title=AGORAPHOBIA+&cid+HTHLTH.

Using Cognitive Therapy With Bipolar--And What Is It?

Because I have bipolar II, I do not have the full range of manias that are present in those with bipolar I disorder. I have hypo-manias which are much less severe. However, I have very extreme depressions that are synonymous with a bipolar II diagnosis (DSM IV, 2002). Because of my penchant towards time in the bell jar (very severe depression), I have had to learn ways of managing my thought life. I was doing cognitive therapy long before I knew what it was. It is the single most valuable tool I have outside of medication. I began practicing cognitive therapy in order to control the daily aspects of bipolar that needed to be addressed in order to have balance.

Long ago I began to develop a part of my mind that became an objective voice, detached and clarifying. It is what I call my watcher. This is the part of my mind that is constantly reformatting what is taken in and what is distorted. For instance, because I deal with depression at different levels for about eight months out of the year, most of what enters into my head becomes negative. As long as I am not in crisis, I am able to reframe what is entering into my mind and make it more positive or just more feasible. It may be that I am in a situation where there is a lot of noise. Noise is something that triggers very serious stress on my mind because it over stimulates me. The over stimulation causes an overload in my mind, which in turn causes me to shut down and become depressed. If I listen to that objective voice, my watcher, I can often talk myself out of the stress or at least alleviate it. It may be something as simple as telling my self that I may leave an environment if I need to. It may be that I can analyze the noise and accept the intrusion, or it may be that I can simply remind myself that the noise will not last forever. This process is a part of cognitive therapy.

Cognitive therapy was developed by Aaron T. Beck. The theory centers around the concept that negative thoughts can cause depression (Segal, Williams, &Teasdale, 2002, p. 21). The active part of the theory is to do a thought record. When a person experiences a shift in mood, they write down their thoughts. If I am depressed and my thoughts are those of feeling like no one understands me, that I am all alone, those thoughts will perpetuate the depression to both linger and become even worse (Segal, et al., 2002, p. 22).

I have become fairly proficient at taking a continual check at the state of my moods, which even though a mood stabilizer moderates them, are rapid cycling on a regular basis. They are much like a river flowing underground. Above ground are the thoughts that are continually moving through my mind. If I am not careful of what I do with those thoughts and how I perceive my environment, they are capable of causing rough waters below ground. Likewise, if things are already turbulent underground, I have to be very aware of that and know that the chaos underneath has a way of coloring my thoughts, which if negative or paranoid, cause even more problems underground. It can be a vicious cycle.

It is important to say here that I am referring to cognitive therapy in the context of mental illness. Many people do not have a mental illness but suffer from depression due to death or any number of traumas that assail human beings during life. These people may use cognitive therapy instead of anti-depressant medication, which is used to treat depression (Segal et al., 2002). This is not what I am referring to. I am talking about a person who has a mental illness and deals specifically with depression in the context of that mental illness. This type, like me, can use cognitive therapy as another tool in conjunction with their medication. The use of this tool has become as much of my daily routine as has taking my medication.

Sources:
Diagnostic and Statistical Manual

Segal, Zindel V., Williams J., Mark G., Teasdale, John D. (2002). Mindfulness-
based cognitive therapy for depression: A new approach to preventing relapse.
New York Guilford Press.

Grieving Bipolar--Part of the Process

Those who have bipolar and their family members need to be able to address their grief as they work toward management of bipolar disorder. According to Bipolar Illness and the Family (Hyde, 2001), there are several stages of grief that both the person with bipolar and their family experience. The first is called anticipatory grief. This happens at the beginning when the family and the person with bipolar first find out that the individual has the illness. This type of grief results in anxiety and depression due to imagining what could happen. Education and a clear understanding of the disorder are vital. This would also include future progression of the illness as well (Hyde, 2001).

The next type of depression is acute grief. This type of grief occurs when the individual actually manifests aspects of the disorder. This is the time when major decisions are made concerning the person with the disorder. These decisions span from whether to hospitalize the individual to how to aptly manage the individual’s bank account. These big decisions can disrupt the family unit and often cause hard feelings between any number of members including the person with bipolar. Communication is key during this time. Sharing the burden rather than leaving it up to one or two family members may more evenly distribute the load (Hyde, 2001).

The third type of grief is chronic grief. This grief is experienced by family and the one who has the illness. It is the sorrow that occurs when dealing with bipolar disorder on a daily basis along with all the changes that have to be undergone just to function for all involved. This may include medication and its side effects, therapy sessions, and the loss of life as it was as well as the knowledge that the illness will never go away. Communication is vital, and counseling may help the family sort through their grief as well as the individual with bipolar. It is important, however, that the grief is observed in order to move past it (Hyde, 2001).

Sources:
Hyde, J. A. (2001). Bipolar illness and the family. Psychiatric Quarterly, 72(2), 109-118.

Studies on Psychotherapy

Two of the most effective ways to meeting the goal for maintenance is medication and psychotherapy (White, 2007). Many tests have been conducted to determine whether psychotherapy in conjunction with medication is better than just one or the other. In an article interview by Michael E. Thase (2006), four forms or models, of psychotherapy were used in studies.

The first model was psychoeducational therapy, which is based on educating the persons involved in the study about their illness. The second model used was cognitive therapy. This is where a person learns to reframe their thoughts. This method has shown to be beneficial in those with depression. The third model was family-focused therapy where the family becomes involved in the person’s treatment and a support network is formed. The fourth model combined interpersonal and social-rhythm therapy. This is where an individual is taught personal rhythms in their every day life by creating daily schedules and learning to address what is going on inside them (Thase, 2006).

The results of the studies showed that psychotherapy does make a significant difference in those with bipolar disorder when it is applied with medication. There was a reduction in relapse and an increase in the amount of well-time where the person was not experiencing either mania or depression. What was interesting about the information gleaned was that even though there was evidence to show that psychotherapy makes a difference in the long-term outcomes of those with bipolar disorder, it was unclear about psychotherapy making a contribution to a more speedy recovery, or even increasing the likelihood of recovery (Thase, 2006).

I truly believe I would have found balance and made peace with bipolar much sooner had I been able to afford therapy. I know I would have been able to deal with traumas in my past sooner than I did. And that would have made my overall health so much better. But a story is what it is and a life is lived the way it is lived. I have no regrets. I did the best I could with the information I had.

Sources:
Thase, Michael E. (2006). Examining the role of psychotherapy in managing bipolar
disorder. Medscape Expert Column. Retrieved on March 20, 2007, from
http://www.medscape.com/viewarticle/537113_1

White, Randall. (June, 2005). Bipolar disorder and women: Special considerations. Anexpert interview. Retrieved on March 20, 2007, from
http://www.medscape.com/viewarticle/506804

Accepting the Beast

It took almost a year to come up with a diagnosis of bipolar disorder. Process of elimination was invoked, and after eliminating physical anomalies, severe clinical depression (unipolar), and attention deficit disorder (ADD), I was awarded a diagnosis. I say rewarded, because having a diagnosis gave me a definitive clue to what was going on with me. It took me a while to accept it, for I was young and the idea of living my life taking a medication for a disease with no cure in sight was a bit difficult to comprehend.

Then there was the gigantic stigma attached. Stigma is the bane of effective treatment for mental illness and that includes bipolar disorder (NAMI, 2007). Because of stigma, it is rarely acceptable to talk about mental illness or admit to having it. Not admitting to having a mental illness keeps one from getting treatment. It seems it is more acceptable in this society to say one is an alcoholic than to say, “I have a mental illness.” Stigma is the reason there is poor funding for organizations that would help those afflicted, and stigma is the reason those who are sick cannot afford treatment. There is very little financial help for those with mental illness, and insurance companies fund only a fraction of mental health services if at all. I know this from personal experience.

I did come to terms with having a mental illness. I still struggle with it, and sometimes I am exhausted from battling it, but I did come to terms with the fact that it was real in my life and something that needed to be addressed. The ultimate goal for me was to get to a level of balance and once I achieved balance I would be able to maintain having a life and having a mental illness.

Links: nami.org

Naming the Beast

Bipolar is a mood disorder. As human beings, we experience a plethora of different moods from week to week or even day to day. When we are in a “good” mood we are happy, upbeat, and optimistic. When we are in a “bad” mood we are sad, down, and are more inwardly preoccupied. These are all examples of "normal" behaviors.

A general definition of bipolar disorder is that it is the experience and expression of extreme moods. But actually, it's not the extreme moods that define bipolar disorder; it's the inability to control these moods (Mondimore, 1999). Bipolar disorder is broken down into four parts: bipolar I, bipolar II, cyclothymia, and bipolar not otherwise specified (bipolar NOS). Persons with bipolar I exhibit the classic symptoms of bipolar disorder where there are extreme manias, plummeting into deep depressions. Individuals in this category have periods of time when they are in remission only to move back into the extreme highs and lows once again (Mondimore, 1999). Bipolar II consists of extreme depressions and not fully developed manias called "hypomanias." Individuals in this category have depressions so severe, they are often misdiagnosed as having depressive disorders rather than bipolar (Mondimore, 1999). Some develop full-blown mania while others continue to have hypomanias. Individuals who experience cyclothymia experience neither fully developed manias or depressions (Mondimore, 1999).

Sources:
Mondimore, F.M. (1999). Bipolar disorder: A guide for patients and families. Baltimore: The John Hopkins University Press.

Navigating the Medical World of Mental Illness

The realm of mental health is somewhat confusing in terms of which one should go to for a particular mental problem. It took me a long time to get it all straight, and even then I conferred with one of my professors, Dr. Kim Kjaersgaard. She gave me a clearer idea of the differences between titles. Counselors deal with every day issues. Counselors do not have to be licensed and range from summer activities counselors all the way up to counselors who have doctorates. They usually see clients over a short period of time.

Therapists deal with issues that are a bit more complicated. They generally have some form of licensure as well as graduate school in the degree of master’s or doctorate. They tend to have more long-term contact with clients.
Then there are psychologists. Psychologists usually have doctorates. They can work at just about any level of the psychology field from testing to teaching. They are generally better equipped to deal with those who have mental illnesses or other proclivities assessed in the Diagnostic and Statistical Manual (DSM-IV).

Psychiatrists have medical degrees with a semester of psychology added on top. They are able to prescribe medications where others in the psychology field may not. These definitions are what I use to help me keep track of the different titles. When trying to find someone in the psychology field to work with, it can be daunting if one has no idea what the different titles mean.

Therapy is very helpful for those trying to navigate life with bipolar. Therapy teaches coping skills and allows a safe place to vent or just discuss what is going on. Therapy is also a place that equips one with tools to manage behavior much better in a world that does not suit. It is important when looking for therapy, to remember that not everyone is a perfect match. It may take trying a few different people to find the right combination of “bedside manner” and technique that will work best.

I would have done much better with therapy, but it costs money and my psychiatrist prescribed me meds. He was not a therapist. So I was faced with a decision, meds or therapy. Early on that did not seem like such a big deal. I did not know I would need medication for the rest of my life. Even if I had been educated with some kind of inkling of what should come next, I would still have been groping in the dark because there is no rigidly set path for navigating bipolar.

Managing bipolar disorder is very much about trial and error. Unlike most other illnesses, it can be better treated by active participation from the patient. People who have mental illnesses are redefining the way the doctor/patient relationship is geared. Patients have taken the reins and begun to let doctors know how they can help the patient rather than the other way around (Szegedy-Maszak, 2002, p. 55). I learned early on that I had to take control when I walked into the doctor’s office because they were most often relegated to an educated guess when making a decision about my treatment. I thought, “I can make an educated guess, and I have an advantage because I’m aware of what’s going on inside my mind!”

When I enter a doctor’s office, I am hiring them, and they are my employees until I terminate their services. That is now the way I view my relationship with the medical community. What a change in mindset that is from where I started!

Sources: Szegedy-Maszak, M., (2006). Consuming passion. U.S. News & World Report, 132(19), 55-57.

Psychotic Features

It was a rainy gray day. In my mind’s eye I can still see my foot extended in front of me, toe pointed, as I began to step off the curb, the yellow paint on the curb luminescent in the falling rain. I glanced up toward the car and the surrounding landscape of the parking lot, shrubs, and streetlights. Something seemed odd but I could not place a finger on it. I looked back down at the curb and watched the bright yellow slide out of my line of vision like watercolors running down a canvas. There was no color. The curb was gray. That is when I realized what was odd about what I had seen before. All the cars in the parking lot were the same color…gray.

I spent some period of time, weeks, in this state. And somehow it seemed natural to me. What I experienced was a psychotic feature with severe depression. A psychotic feature is a delusion or hallucination experienced during an episode (DSM, 2000). I did not know that at the time, however, and what is more disturbing than the lack of color in my vision, was my willingness to just accept it without much alarm or questioning.

Over the years with doctors and study, I’ve discovered that the lack of sleep triggered the psychotic feature. Human beings need sleep. We can go for a time without it but prolonged lack of sleep causes the mind and body to malfunction.
When I wasn’t working, I sat in the corner of my apartment on the floor rocking back and forth. As the days ticked by and I still could not sleep, I began to lose mobility. I reached a point where walking was difficult. I knew that if I crawled over 19 squares of carpet, I would have reached the kitchen. From there it was a mere four squares of linoleum to the bathroom. I did not worry about bathing. Just turning on the faucet was too complex an equation for my overtaxed mind.

For many with bipolar disorder, suicide is not really the biggest threat of death. Sometimes the mind is so powerful in its efforts to self-destruct, it actually starts the life-ending process all on its own. For me, when I experience the depression of bipolar unmedicated, my mind takes such liberties and puts me in a psychotic state of shut down called catatonia.

Sources: Diagnostic and Statistical Manual.

CAPD

I have a central auditory processing disorder (CAPD) that affected me from the time I started school. CAPD is like dyslexia of the ear rather than the eye. CAPD occurs when the ears and the brain are not able to fully coordinate with each other (kidshealth.org, 2007).

There are five areas that are affected by CAPD. The first is auditory figure or ground problems. This is when background noise makes it very difficult for a person to concentrate. The second is called auditory memory problems. This is when the person has difficulties remembering lists, directions, and the like. The next is called auditory discrimination problems. These problems occur when the person has difficulty distinguishing between like sounds such as cat and mat. The fourth is called auditory attention problems. This is when a person may have difficulty maintaining focus long enough for a task to be completed such as a lecture. The final problem is called auditory cohesion. This is when comprehension of higher-level listening functions such as riddles and verbal math problems are unattainable for the person (kidshealth.org, 2007).

CAPD was not diagnosed when I was a child. I have dealt with it my whole life, and while I have found ways to cope, it remains one of the bigger challenges I come up against in just about any social situation. I did not learn about CAPD until I was in my twenties and was tested for it. CAPD is one of the reasons my school career didn’t start off well and why my teachers decided I was not intelligent. My mom says she got a call my first day of kindergarten. It was the school telling her I had been standing in the middle of the room with my hands over my ears screaming at the top of my lungs. I am smiling as I write this because there are times even now, and all too frequently, when that is what I still would like to do. I was envisioning myself standing in the middle of an isle at Wal-Mart, hands over my ears, screaming my head off. How fun would that be, I wonder?

Links: http://kidshealth.org/parent/medical/ears/central_auditory.html

Physician Heal Thyself

My research on bipolar disorder is ongoing. Not only do I read hard copy and peruse the Internet, but my life is a never-ending real-time accumulation of information on the disorder. I learn from its presence in my life daily. Recently, however, I came upon new information about bipolar disorder that I have not seen in past research, and I also had conformation that many of the things I have been practicing for a number of years as a way of dealing with my illness are supported by research. I am very encouraged by what I have found.

My sister, Jayme, attended a seminar on bipolar spectrum disorder. I was too broke to attend or I would have, but she came away with lots of notes and a book produced by the speaker, Dr. John D. Preston. Dr. Preston is a professor of psychology at Alliant International University in Sacramento. He has also been on the faculty of UC Davis, School of Medicine. He has written many books on psychotherapy, psychopharacology, spirituality, healing for emotions, and neurobiology. Preston is the author of a chapter in The Encyclopedia Americana entitled Drugs in Psychiatry.

I have been aware from other research I have conducted that there is a need for a revamp of the Diagnostic and Statistical Manual’s criterion for bipolar disorder (Phillips, 2006). Preston reiterated that a change was in the works for the Manual and that bipolar disorder would be called bipolar spectrum disorder. There would also be an addition of a bipolar III. Bipolar III would consist of highly reoccurring symptoms that dip from mood balance to severe depression. Changing the way bipolar is diagnosed will help everyone involved because it allows for co-morbidity that most often accompanies it. It is often these other ailments that cause instability.

The top three psychological ailments to accompany bipolar disorder are: anxiety disorder at 93%, substance abuse at 71%, and binge eating disorder at 30%. I wasn’t surprised at the first two as I have battled both in my long experience with bipolar, but I was surprised to find binge eating to be next in line. And finding that more men than women binge eat was even more surprising.

Next are the medical ailments. Migraine tops the list, followed by obesity, and type II diabetes. I was not really surprised by any of these, though I had thought heart disease might be one of them.

Preston offered statistics on morbidity & mortality that I found interesting. The lifetime suicide rate in those with bipolar is the highest of any other mental illness at 15.5%-19%. The lifespan of someone with bipolar is decreased by nine years and they lose eleven years of good physical health. I feel that these numbers are fairly accurate base on my other research and personal experience with the illness, though nothing is beyond questioning.

Another piece of information I learned about was the way in which antidepressants can have and adverse effect. First there is activation. There is a sudden onset that shows as agitation and anxiety. Then there is switiching. Switching happens in the first 2-3 weeks of taking an antidepressant. It provokes hypomania, mania, and increases not only agitation, but also insomnia and restlessness all within the parameters of depression. An indication of switching is racing thoughts that prevent sleep. From there comes cycle acceleration. Symptoms of depression exacerbate. I have had this experience many times over the past decade while trying to find medications that would work together to balance out my moods. It is helpful to see a definite pattern so that I can identify it with my own symptoms if they should ever occur again.

I discovered through Preston’s information that thyroid plays a large role in bipolar II depression. I often have my levels checked because I am on lithium. What I didn’t know is that there is a level call the TSH level. This is a particular way of measuring thyroid that needs to be looked at by the physician if an individual is on lithium and has bipolar II. Normal for the TSH level in most individuals is between 1.3 and 3.0, but in those who are on lithium, the level should be below 1.3. If the level is higher than that it can make depressive episodes very difficult to regulate. My level was at 2.535 last time I had a chemical panel done. I am in the process of getting something done about that. My depressive episodes are very hard to manage, and maintain a somewhat productive lifestyle.

Another thing I learned about has to do with anxiety. When we are under duress, say a bear is chasing us, our hypothalamus produces a chemical called CRF or corticotrophin releasing factor. CRF goes to the pituitary, which sends a message to the adrenal cortex. The adrenal cortex produces cortisol. Cortisol is what empowers us to go beyond our usual levels of endurance. Once we have outrun the bear and are safe, the hypo campus sends a message to the hypothalamus to stop the cortisol. Cortisol is good. It increases our glucose and our cardio output so that we may perform at the level needed. Unfortunately, in bipolar II cases, with every depressive episode, the brain becomes damaged and is unable to shut off the cortisol. When that happens cortisol becomes hypercortisol in the brain and body. Depression is increased dramatically, brain cells or nerve endings are killed, the kind of sleep necessary for rest is impaired, and vascular damage is done. Cortisol pumps through the entire body and if not stopped damages blood veins, causing increase in cholesterol and other heart issues. Because of this there is twice the risk of cardiac death and increased risk of stroke.

Kind of depressing. But I had some very good news. First off, I finally understood statistics saying that those with bipolar have increased risk of heart disease. I wanted to know why. What was the correlation? Well, cortisol damages arteries, and a lifetime of that pumping through the body would cause heart problems. But cell repair can be done. Brain-derived neurotropic factor or BDNF must be restored to the brain for it helps in cell repair, reduces impact of cortisol, reduces major depression, is responsible for neurogenesis, and helps in reducing major depression. It may be restored to the brain by antidepressants, lithium, and exercise. I’ve been doing all three of these things for years and I didn’t even know they were saving my brain. Lithium is the only medication that is proven to regenerate nerve endings, and this information I have not just read about from Dr. Preston (Morgan, 2007).

The process where cell death occurs is called apoptosis. Lithium is the only thing that has been shown to reverse such brain damage. Doctors in the United States are not prescribing it because they have made deals with drug companies to push their newer medications and to down play lithium. Countries in Europe, however, are using lithium more than most other medications because it is so effective with all types of bipolar, including rapid cycling, and especially mixed states. It is very inexpensive. I think I paid 28 dollars for my last prescription versus the 100 dollars I paid for Neuronton. That is not to say that lithium works for everyone but I’m sure glad, way back when, I stumbled into a lifetime use of it. I was thrilled to know I’ve been doing things right and there is evidence to support it.

People who have bipolar should not do shift work, have time zone changes, or have interrupted sleep. Our circadian rhythms get thrown off very easily and take a very long time to level out. Daylight savings messes me up for a month, and flying to a different time zone is hell. I don’t feel good the whole time I’m in the other time zone. It is not worth it to me to even do it. Apparently people who have bipolar disorder have very delicate systems. Balance is not easily attained for us in all areas, and is very easily lost. Sleep patterns can be disrupted very easily and once sleep is lost, it is difficult to maintain control of moods. All this I knew from my own experience but was glad to have some outside information on it.

Much more was addressed in the seminar and book, but what I’ve outlined here is what has most impacted me. I felt real assurance that I am on the right track. I’ve spent most of my war with this illness finding the answers on my own and trying things out as a way to see if they were right. When you go to the experts and they have no answers, you still have to go home with your illness whether they help or not. That means you are the one who has to play physician to yourself. I was just never sure if I was doing things rightly or if I was going round to the back door when I could have been going through the front. Now I know I was practicing the best of medicine on myself.

Bibliography

Morgan, Mark. (2007). Bipolar patients on lithium show brain-tissue growth.

Psychiatric News, 42(10).

Preston, John D. (2006). Diagnosis & treatment of bipolar spectrum disorder. PESI:

Wisconsin

Phillips, Mary L., M.D., Frank, Ellen, Ph.D. (2006). Redefining bipolar: Toward

DSM-V. American Journal of Psychology,163(7), 1135-1136.

Introducing...Me

For those of you who know me this may be a bit redundant, but I thought I should give a bit of my background and sort of where I’m coming from for my new friends.

I have bipolar II disorder with what is called “mixed state.” I also have a very severe anxiety disorder called “agoraphobia,” and an auditory processing problem that basically gives me bionic hearing, while not allowing me to block anything out. Howz that for the genetic lottery? My bipolar follows a seasonal pattern (mania in summer, transition in late summer and early fall, depression in late fall, winter, and early spring, transition in late spring into mania). I was diagnosed when I was twenty-three, but I had the auditory processing problems all my life, and feel that when I entered school that and the over stimulation began moods instabilities at an early age. There was physical abuse, sexual molestation, and discrimination. The gambit. What save me was that I simply have fabulous parents.

When I was diagnosed, the temptation was to head straight for denial and bury my head in it like an ostrich. But then I thought of the phone ringing at my parent’s home and my mom answering to find out I’d offed myself. I couldn’t live with that. So I decided, for my mom, I would fight. And that is what I did. I spent a decade sliding down the slippery slope of trial and error. My depressions are not severe, they are catastrophic. I have what is called a psychotic feature when they are at their worst. My body begins shutting down, all of its own accord. Like the lights at a theater, my mind begins flipping switches off one by one. Complex thought processes…flip! Memory…flip! Motor skills…flip! The first time I experienced a psychotic feature, I lost color in my vision. I saw in only black and white. It didn’t scare. I seemed appropriated based on my thought processes. Unfortunately, if not stopped, my mind will put me in a catatonic state.

I discovered that I had to know about my illness. I had to be the expert. When I knew about the illness, I was able to make better decisions about my treatment and I didn’t feel so much like a guinea pig. I took on the mindset that I hire a doctor as my employee to render me a service and if I did not like what was rendered, I fired them. I knew what medications there were and what they might do. I had a deep-seated distrust of the psychology profession in general. So what did I do? I decided that I should be able to lay or sit on both sides of the couch. I finished my bachelor’s degree in psychology, so I could be informed about it. Along the way I fell in love with the science of human behavior. I got my master’s degree in psychology as well. My focus was on bipolar, treatment, education, advocacy, and just about everything but the kitchen sink. I never thought I’d ever be functional to complete such a task but here I am almost fourteen years after being diagnosed, and I’m about to start working on my PhD.

There has been so much healing in my life along the way…the making of peace with bipolar as a part of my life, but not all of it. I have lost everything according to the world’s standards and my twenties are lost in the haze of the war I was fighting just to stay alive. I’ve been regulated for almost five years now. I still ride the roller coaster in the spring and fall, but I’ve a simpatico with myself and this illness I never had before. I will never be normal and you couldn’t sell that to me if you wanted to. I like me. I like that I have a different view and often am the only one, but I’m okay with that too. I still struggle heavily with the agoraphobia, but I don’t fight that I have it. I fight to keep it from running my life.

I am no one special. I give God all the glory for anything good that my life has become. I am not for everyone. I am an acquired taste and sometimes I wish that weren’t true, but it’s the way it is. If you ask me, “if you could undo it all and not have bipolar would you do it,” I’d have to say, “No.” It has made me who I am and kept me humble. Long ago I had a choice to make. I had to decide to give up the extremes for a more level ground, which is difficult for those with bipolar to do. We like our highs. I chose with all my might to walk the level ground. That decision has humbled me, taught me about love, made me so strong, and introduced access to the wild storm within without loss of sanity. I have never regretted it. How could I? How could I ever repay my family and friends love and faith in me by giving up? It’s still a struggle many days. I am a puzzle piece that does not fit the puzzle I’ve been placed with. I take it a day at a time, fight the battles as they come, and thank God He loves me and is with me always.