Beauty for Ashes part 5

Upon Entering the Labyrinth

I felt a cleaving in my mind

As if my brain had split;

I tried to match it, seam by seam,

But could not make them fit.

The thought behind I strove to join

Unto the thought before,

But sequence raveled out of reach

Like balls on the floor.

(The Lost Thought by Emily Dickinson)

            I have previously described what I would term my external experience in Minot, North Dakota.  But it is only one side of the coin, for the other side requires an explanation of my internal experience.  I explain my adventure with bipolar disorder as similar to finding one’s way through a labyrinth.  Overall, that is what I feel has happened to me.  One day I stumbled upon a labyrinth and was driven into it by outside forces, never to completely find my way out. 

            At one time my memories of what was happening inside my head were vivid.  I remembered how losing sanity felt.  Now, however I must admit it is somewhat difficult to recall with the intensity I once had, the moments of extreme encounter with bipolar disorder.  I have made it a point over the years to try to describe what the illness feels like as it is marching through my head so that others who do not experience it may have some idea of what it is like.  My goal for a long time was to come up with the perfect image that would personify the experience. But then everyone is different, and what might bring it home for one person may do nothing for another.  Indeed, even those who also have bipolar use different imagery than I might use.  So I have learned to explain it the best way I know how, allowing that the listener’s imagination may help them identify.

            When the world first started going dark, it was a gradual thing.  As I mentioned before, I experienced depression more than once.  So I was not really alarmed to find my thoughts growing more negative and my perception grayer.  It had happened before.  In the past, however, I had plateaued out and then moved back to normal.  This process is called cyclothymia.  Cyclothymia is when a person experiences depression but does not dip down into severe depression.  Then the individual will return back to a more balanced state.  This type of depression happens more than once and can either stop completely at some point or become more severe after a time (DSM IV, 2000).  For me the latter was the case.  The outside world and my experiences created a kind of dark pressure on my mind, and when I went into therapy thinking I would obtain relief, the therapy compounded my situation causing more distress.  The sessions plunged me further and further into depression as we delved into the different catastrophes of my life. I withdrew from social settings and began to skip classes. My sleep patterns were erratic at best, and it became more and more difficult for me to sleep at all. I could not concentrate in class and my grades began to drop. I just could not keep all the balls in the air. I felt like a ribbon unraveling from a spool.

            I had the appointment for testing for disabilities, mentioned previously, where I cried all the way through the tests. I was so exhausted, depressed, overwhelmed, and frustrated that it was difficult to make my mind focus for such a lengthy period of time. It was too much. The tests came back with severe clinical depression. Surprise. Surprise.

 The lady at the vocational rehab center kept in contact with my counselor. She had me come in once a week just to check in. By this time I had lost color in my vision.  I pivot most every detail off that one moment, for it was the turning point for me psychologically.  Obviously, things had to be pretty bad already in terms of mental psychosis for me to experience a psychotic feature, but it was after that moment of losing perspective to a gray world that I began to lose feeling as well.  I just simply quit feeling anything at all. 

            At first the numbness that had taken over was a beautiful thing.  I had been so tormented by the fire of anger, and the constant pressure from traumas that were fighting to get past the wall I had them trapped behind, that to feel numbness was wonderful.  I thought, “Finally.  A rest!”  What I did not understand was that numbness has a price, for it is not about feelings being anesthetized, though that is a part.  No, there is a chemical problem in the brain and that problem has an effect on the body and the soul as well as the mind itself.  Now I could split hairs here about what is the mind, soul, brain, and so forth, but really what it all boils down to is that the price paid is the loss of control.

            Break it down any way that feels right but when you wake up one day and the essence of who you have known yourself to be has been taken hostage by a rogue mind, titles have little meaning.  I have described depression as clouds, a blizzard, and many other things.  Every analogy fits.  Some days I feel as though I am covered by a heavy blanket of dark clouds.  Other times I feel I am in a blizzard, my equilibrium obliterated.  But when I was in Minot, every possible description weighed in and then, finally, I was trapped in a car as it raced out of control.  There was no way out, no steering wheel, and no brakes. Most of that time I felt that way.  My mind raced at the speed of light, yet my body moved as though in slow motion, every muscle screaming in pain.  It was as though someone was in my head flipping switches, shutting everything down.  Flip!  Flip!  One switch after another was turned off without my permission.  As I fought to wade through the black sludge of depression, there was a part of my mind that was whizzing like a racetrack, while the rest of my mind seemed to be suspended in confusion as all the stimulus from the world slammed through.  Only the dulling of my own senses made the experience doable—like the way a snowfall seems to localize sound.  Then there was the flipping of switches.  My motors skills were flipped off and that was terrifying.  One day, my ability to walk seemed to just vanish.  Then it became difficult to move my hands and arms with any kind of fluidity.  I had so little energy that physical movement rendered me exhausted.  I could not comprehend what was happening to me.  My body was literally shutting down. I couldn’t form complete thoughts and it was difficult to speak.  When asked a question it took an eternity, it seemed, for me to understand what was being asked.

            The struggle against suicide was an ongoing battle. Every thought was a plan to end my life successfully.  I fought against it.  I quit driving my car and walked everywhere, because I was afraid I would hurt someone else in my need to exit gravity.  When I finally ran out of reasons to end it all, I had run out of energy to follow through as well.  I have a picture in my mind of a big shapeless monster glancing back at me with a sly grin as he takes over my mind, shutting it down.  I have no doubt I would not have lived until the end of the term because my body was quitting on me.  No one can tell me the brain is not an incredibly powerful organ.  Mechanical failure on the part of the brain allows the mind processes to become errant, which can ultimately cause one to be destroyed.

            While my time in Minot was the darkest time of my life, it was not the most painful.  It did give me tremendous clarity.  I came away from the experience a completely different person.  There would be no more rebounding from depressions like I had in the past.  My mind had shattered like a glass dropped on a cement floor.  I was broken, yet there was a new strength in me, for I was able to put things in life in their respective places.  I simply compared them to what had happened in Minot.  If they did not measure up in magnitude, then they were not going to destroy me.  Why be afraid of crossing a small stream when I had forded a raging river? 

            Most importantly, though, was what I learned about God and what I was continually learning about Him.  What I discovered there at the “end of all things” as Frodo says to Sam in The Return of the King, was that God had not abandoned me.  He was not disgusted by all my wounds and weaknesses.  He forced me to make a decision as to whom I would serve, Him or me, and He also began to show me He had not forgotten me.  I did not know what He would ask of me, but I decided that I had already come so close to being dead; if He were to require that of me, it wouldn’t be all that traumatic and it would end my life, which did not seem such a bad thing anymore.  A very cynical or morbid train of thought, I admit, but it is congruent with my state of mind at the time. 

            I rode home with my mom driving while a family friend drove my car.  I slept for two days straight with a sleep aid we had gotten from a psychiatrist I saw right before we left.  I had gone in to the school with the doctor’s note saying I must be withdrawn from school.  The dean told me he did not care if I was having mental problems, they would not assist me with my situation.  I would pay for an entire term of school without any credits.  He was a horrible man.  Uncharacteristically, I simply bowed my head and walked out of his office.  Putting one foot in front of the other was hard enough without exchanging verbal fire with an idiot.  I just prayed silently as I left the building that he would have someone in his life one day who suffered with what I was suffering with.

            Once I was home, life went back to “normal”, or at least that is what my family was hoping.  One of my sisters was getting married and things were getting a bit unsettled around the Clapp household.  I had no money, no job, and one prescription of medication that stood between insomnia, insanity, and me.  My family did not want to look at me any differently than they ever had.  They thought I was just temperamental and “Chief Thundercloud” as my parents called me.  What I was, was very sick, and I could feel it.  My mind was broken, and as with most broken things, no amount of pretending would fix it. 

            I had a good friend whose husband was a doctor.  Through him she found me a good psychiatrist who could get me pointed in some kind of direction.  I was lost as to what to do.  Our society does not talk about mental illness and how to get help.  We hear about cancer as children and know that radiation treatments and chemotherapy somehow go along with it.  We hear about diabetes and are familiarized with the word insulin, but somehow we are not taught about what to do when the old thinker falls apart.  The only terms I had heard in association with mental illness were crazy and insane asylum. 

I was lost in figuring out what to do.  All I had been told in Minot was that I had severe depression and insomnia.  I would not have known to go to a psychiatrist had my friend not taken care to make the appointment.  The realm of mental health is somewhat confusing in terms of who 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! 

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 awarded, 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. 

  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 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). 

            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.  What I discovered on my own armed me in a way few I have met with the illness have been armed. 

            I remember very clearly the day I left my doctor’s office having finally accepted my diagnosis.  The irony is that I was stepping off a curb just like the one I stepped off of in Minot the day my world changed.  Only instead of rain and gray, this day was sunny and I could see the light rays bouncing off the colored cars in the parking lot, creating mini sundogs as they illuminated and spun into the air.  The doctor said I must fight my illness. I must fight for the right meds, fight for a healthy life, and fight myself for sanity.  I watched my foot as it stepped off the curb out in front of me, my toe touching lightly the pavement as I put on my sunglasses and smiled.  Fighting was something I definitely knew how to do.