Wrong Side Out The Bipolar Experience By Benton Savage 1 Foreword Before I was diagnosed, I thought manic depression meant someone was a depressed maniac. I have since learned that it describes the cycles from the polar opposites mania and depression that are separated by symptom free intervals. The term “manic depression” was replaced with “bipolar disorder” by the medical establishment in 1980. The best reason I can uncover for this metamorphosis is many people were confused over what manic depression meant which subsequently led to the negative stigma perpetuated by such popular phrases like “manic Monday” or “homicidal maniac.” The term “bipolar disorder” is believed to be a more clear diagnosis, but for all practical purposes if someone tells you they are bipolar, they could interchange the words manic depressive and be considered the same. I was diagnosed with bipolar when I was twenty-five, which is the average age of onset though many people are not diagnosed until many years later. In fact seventy-five percent of bipolar have been misdiagnosed at least once, and many struggle for years not knowing what is wrong, but knowing full well that something isn’t right. Many bipolar people are initially diagnosed as depressive and are subsequently given antidepressants like Prozac or Paxil rather than a mood stabilizer. This mistreatment exacerbates the condition by thrusting them into a dangerous mania. In that case I should have been one of the lucky ones. There are three types of mood episodes in bipolar disorder: mania, depression, and mixed, which is the worst. While I think most everyone understands what depression 2 means, mania and mixed are more complex and often difficult to determine especially by the patient. Reasoning with a person who is manic is next to impossible. It is an alluring condition, and many sufferers long for those fleeting moments when they believed themselves to be omnipotent, invincible, and destined for greatness. To this day, I still look back on my manic days as some of the happiest in my life. Don’t get me wrong. I don’t want to return to that irrational thinking, but at the time my optimism about my life was off the charts, and it was difficult to come to terms that I am simply human like everyone else. A mixed bipolar episode is the worst and most confusing to those close to the sufferer. It is defined by symptoms of mania and depression occurring at the same time, which doesn’t make sense, but I have learned through experience that very little concerning mental illness does make sense. A person who is in a mixed episode may not be eating because he believes that he will live forever if he doesn’t pollute his body with toxins. Not wanting food is a symptom of depression, while feelings of immortality are characteristic of someone in a manic phase. Most patients who have mixed episodes are considered to be bipolar I. Characterized by inflated self-image, hypersexuality, and more than likely substance abuse, these people are hard to reach in their manic phases which last anywhere from a few weeks to several months until they cycle into depression where they feel remorse and embarrassment over their past indiscretions. Bipolar I patients can’t miss medication for even one day without risking a venture into mania, and the longer he is off the more manic he becomes, usually believing that he is ‘chosen’ or on ‘a mission from god.’ 3 Bipolar II is more difficult to diagnose for a couple of reasons. First, bipolar II patients tend to spend more time in a depressive state and are diagnosed incorrectly. Though Bipolar II is more manageable on a day to day basis, due to the excessive time spent in depression, the suicide rate is higher. It is speculated that as many as fifty percent of bipolar II patients will attempt suicide in their lifetime. Secondly, bipolar II patients don’t experience full blown manic states, but instead the lesser form known as hypomanic. Because this person is functioning at a high level and exciting to be around, in short the life of the party, some people actually claim this condition is an advantage to the artist. Ernest Hemingway is considered to be bipolar II and obviously used it to his benefit for the greater part of his life until his death by suicide. Although medicine wasn’t available at the time, Hemingway probably wouldn’t have taken it anyway, instead opting for alcohol. I can’t find any clear scientific evidence that having a family member being an alcoholic contributes to a person being bipolar, but many doctors speculate that genetically it is a circumstance. One of the first questions a doctor asks a patient is whether there is a family history of illness. When I reply,”No,” the next question is inevitably whether there is alcoholism, which I reply, “Yes. On both sides.” This is followed by a nod of the psychiatrists head and a check on the chart. While there may be no genetic evidence to connect alcoholism in the family to bipolar in their offspring, more than sixty percent of people with bipolar have drug and alcohol issues. With so many people misdiagnosed for a large part of their lives, many turn to alcohol and drugs to self-medicate, which only worsens the symptoms. Besides 4 Hemingway, other heavy drinkers who are considered to be bipolar include Vincent Van Gogh and Winston Churchill. Lithium is the most prevalent of drugs used to treat bipolar. Although lithium was recognized in the late 1800’s to have mood stabilizing attributes, it wasn’t until 1949 when John Cade published the first paper on the use of lithium in treating acute mania that it was widely used. For almost fifty years, medical experts didn’t know why it worked until 1998 when researchers at the University of Wisconsin discovered that lithium held cells in the neurotransmitter glutamate at a healthy and stable level. While lithium, which is just a salt, is hailed as the savior for many bipolar patients, I experienced tremendous side effects including hand tremors, increased thirst, increased urination, weight gain, impaired memory, and poor concentration. The last two of which were especially troublesome for an aspiring writer. Of course we are living in the Golden Age of mental health pharmaceuticals, and there are other drug options, and it is important to find the right fit. I took everything from lithium to Depakote, Lamitril, Paxil, Haldol, and Lexapro. Some worked better than others, but no time in the last ten years did I feel stronger than I do now. Currently, I am taking 30 milligrams of Zyprexa Zydis, 40 milligrams of Celexa, and 300 milligrams of Welbutrin. If your medication does not have you or someone you love fully functional, I recommend the patient try another until he finds the right mix. However, there are some people with bipolar for whom no medication is effective. Fortunately, I am not one of those. But keep the faith. More drugs are coming out. 5 Treatment has come a long way. In the early days mental health sufferers were considered to be possessed by demons and were treated by chaining, bleeding, or even euthanasia. It was connected with wrongdoing, and many people believed that mental disorders were brought on by the patient. I believe a person is born with bipolar. It may lie in dormancy until a crisis arises like death in the family or the break-up of a relationship, but it was always there. Whether a person is fifteen or fifty when it initially hits, the most important treatment is medicine. Although having a good therapist can help you come to term with the illness, therapy with no medication will not cut it. Why did I come to terms at the time it did? Certainly, timing had something to do with it. A person in my position has to eventually understand that he is powerless over the disease. I could no longer see any arguments that I was not bipolar. There were no more loopholes left. I no longer could see ways that I could make a stab at life on my own. The only combat I have is my medication and my support group. I can’t tell you how much it means to find the right medicine for your body chemistry. For nine of the last ten years I was on lithium. There was never any discussion of ever getting off. I never questioned my doctor’s decision. It is not their fault. I should have taken a more active role in my recovery. The madness we experience is just as much a mystery to them as it is to everyone else. My advice to those suffering: stay involved in your treatment. Talk honestly with your doctor. If you or someone you love is suffering from bipolar, join an organization like the National Alliance for Mental Illnesss (NAMI). At the very least you should educate yourself about the illness. There are many books written on the subject, 6 and there is tons of information on the Internet. Which brings us to the big question. Would I rather have the wild life of a bipolar person or the relative safety of being a ‘normal’ person? My advice to those that are bipolar. Don’t bother thinking about it. It’s never going to happen. Even with medication I think about my illness all the time. It makes me question my own judgment. I don’t fully trust myself to do the right thing anymore.