Sunday, June 30, 2013

The Psychology of Bipolar Disorder

Like my book (Dancing in the Dark - Why? coming - hopefully within a year - to a digital bookstore near you), in this blog I switch between the "micro" (me) and the "macro" (a greater understanding of mental health disorders in general and in particular bipolar disorder). My last two posts were of the macro variety, today is of the micro variety.

I have, as I've mentioned, experienced "bipolar-like symptoms" for about thirty years. I'd go back earlier (to my teens) but I am not a believer in bipolar in youth (a topic for another day). By "biplar-like symptoms" I mean swinging from states of extreme elation, optimism, energy, drive, focus, motivation, elevated thought and clarity and elevated self-esteem to states of incredible sadness and negativity, zero motivation and drive, low and very negative self-esteem, almost zero energy and mud like thinking ability. "States", by the way, is an important distinction and a preferable and more accurate word than "moods". Classifying bipolar as a "mood disorder", I strongly believe, is one of the things that confuses the general public's understanding of what bipolar is. This is because almost anyone can identify with "mood swings". Hey, who doesn't feel happy one day and sad the next? They then think that bipolar is some bullshit disorder cooked up by doctors for a normal human mood variation. Believe me, I've had people tell me this to my face. (that some doctors do sometimes cook up a diagnosis of bipolar for perfectly normal mood variations will be a topic for another day). But this is a complete misunderstanding of what bipolar states are. They are not just "moods", they are entire different states of mind. So different that they feel like entirely different personalities within you. There were many times (years ago, long before I had any idea what was going on or had even heard of the term bipolar) that I swore that I must have had some sort of split personality disorder. And they are not just fleeting "moods"; they generally settle in for days, weeks, or months at a time (though the ratio between being manic and being depressed definitely is far greater towards depression, generally speaking). For the sake of brevity in today's post (and to keep it within the average person's reading tolerance), I'll describe better in future posts what these two states may be like. Today we just need to understand that they are polar opposite to each other and work in cycles (cycles beyond the sufferer's control ... yet another topic for another day).

There is a third state known as a "mixed episode" that I will tackle separately. I have a lot of issues with this state, how it's understood and defined and how it leads to the diagnosis of bipolar disorder. That will require a good number of dedicated posts on its own, however. For now I'd prefer to focus on the classic "high" and "low" states of bipolar.

Beyond how either state - mania or depression - feels and manifests itself at any one time, there are, I'm going to argue, psychological factors as well. To be clear, I am not arguing that mania or manic depression (a form of depression different than uni-polar depression, just to remind) is merely "psychological". That is to say that it is an organic condition which is further to say that it is no doubt neurochemicals running amok in the sufferer's noggin. (that this neurochemical process is not currently understood and that the old "chemical imbalance" theory of bipolar is outmoded and not applicable is yet another topic for another day and future post). So what I'm saying is that neurochemical chaos aside, there are psychological components to living with the disorder that either get overlooked, are poorly understood or are ignored and missed entirely. This will take several posts to explore and establish so today is just a primer. Today I'm just going to touch on the psychological impact I suffered (and am currently working to overcome).

The psychological factors are (among others but I'll just start on these three today):

  • confusion
  • frustration
  • and what we'll call the nocebo effect
Confusion: I talked in the previous two posts how confusing it is to find accurate and up to date information on exactly what bipolar is and this is certainly part of the mix. But what I mean here is identity confusion or in other words, "just who in the fuck am I?". Am I the outgoing, gregarious, brilliant, energetic, highly motivated, positive, optimistic, wonderful, sexy Brad or am I the mopey, dull, brain dead, sad, introverted, zero motivation and energy Brad? This alone would drive me utterly and literally mad sometimes (mostly in the insane sense of the word but the anger sense as well). These states invade your brain at will and there's nothing (seemingly, yet another topic for another day) you can do about it. This, for me personally at least, was a huge factor. I suspect it is for most bipolar people as well. 

Frustration: If you go through true bipolar state swings and do a lot of the things associated with mania, I can guarantee you that there will be disruptions in your life. I'm talking lost jobs, destroyed relationships, multiple and serial sex partners, financial losses, possible violent outbursts and so on. Manic depression - when taking a shower can seem to require Superman like heroic effort - can also lead to lost jobs, relationships and financial losses. There will be days when you have no fucking clue who you are, what you are or how you got there. If life is frustrating at the best of times, try it with all this fun thrown in for good measure. I personally have struggled with frustration all my life. It's just one of my personal weaknesses (and one of my main focuses of self-improvement these days ... this alone has made a big difference for me) but dealing with the whirlwind chaos caused by constantly shifting inner landscapes amped up my frustration levels off the charts. 

The Nocebo Effect: this is the opposite of the well known other side of this psychological coin, the placebo effect. Briefly, the placebo effect makes you feel better, the nocebo effect makes you feel worse. There is controversy over these in the scientific community. No such controversy exists in my mind. Both are absolutely real and both can be clearly demonstrated. Well known Canadian neuroscientist Mario Beauregard explains the placebo and nocebo effects in great detail in his book Brain Wars. How I believe the nocebo effect works with bipolar disorder - and schizophrenia - is that the more one believes the negative long term outcomes of bipolar, the more one will live that. Put in another term, it becomes at least partially a self-fulfilling destiny. This was, until I temporarily rejected the mental health system diagnosis of bipolar, a huge factor in the decline of my mental health, functioning and mental faculties. 

I also need to establish and tie in the psychological factors to the high suicide risk that exists for bipolar peeps. But again, in the future. 

I'll devote separate posts to each of these soon. For now though, I've probably taken up enough of your mental band width for one day. 

Saturday, June 29, 2013

What the F**k is Bipolar Disorder - Part II

To understand bipolar - or manic depression disorder - we first have to understand mania and this is where the fun starts.

Mania can be so many things that any one attempt to define it is meaningless. It can be great for you. It can be connected to artists, artistic expression and great artistic expression. Mozart is said to have been bipolar (something I've been meaning to investigate further but haven't gotten to yet). This is what the most excellent book, The Human Brain (by Rita Carter and others) has to say about this connection between mania and creative output:

Biographical studies suggest that bipolar disorder may be more common among accomplished artists than the general population, and some artists seem to be able to utilize periods of mania as a spur to creativity. For example, the musical output of German composer Robert Schumann (1810-56) - illustrated on the graph below - shows a link between his bouts of mania and the number of compositions he produced. He was most productive during manic phases and least productive when depressed. However, the quality of his work was not affected by his moods.

First of all, I'm not sure how Schumann was diagnosed as manic depressive nor how it was known he was manic - or "hypomanic" as the graph says - during those phases but I'll track that down another time and we'll just give his diagnosis the benefit of the doubt for now. You'll also note that Schumann's life didn't end well but that - how bipolar often ends - is a topic for another day.

Ted Turner is also said to be bipolar (another claim that I'm trying to track down but this is according to the author of Psychology Today's Taming Bipolar). Ted Turner is bipolar? Last time I checked, TT seems to be doing pretty well. If that's mania at work, I'll take two scoops, please.

So it seems that mania can be a Good Thing (at least for a while, not in the end for ol' Schumie).

But there are many known cases of mania leading to ... well, acting simply as a maniac and maybe ending up strapped down to a gurney in a psychiatric ER getting a needle full of drugs pumped into your ass. This is what's known as manic psychosis. This would appear undoubtedly to be a Bad Thing. I have some case studies to present on this when we look into this deeper. I have my own stories about this. It's all very instructive.

Those are the extremes and of course there are all shades and hues in between. Which may or may not exist in the same person at any one time. Then you have concepts such as "rapid cycling", hypomania, cyclothymia, mixed episodes, Bipolar I and Bipolar II and on and on it goes. If you have "mood swings" (a euphemism if I ever saw one), good luck in getting all that sorted out. Maybe you're luckier than me but thirteen people with "Dr." in front of their names (and I could expand that number if I threw in the various GPs I've seen over the years and even more if I included psychologists but "lucky" thirteen - a baker's dozen - seems like such an appropriate number here) couldn't figure mine out to any kind of consensus. I apologize for the word "luckier". "Lucky" is probably not an adjective that can apply to mania (except when you're in the throws of Good Mania and on top of the world ... just mind the step down).

All we can really take from this is that mania is a many splendored thing. Or cursed thing. Or ... well fuck, you get the point. Or at least I hope you do. Confused yet? Good, welcome to the club.

Reading people's personal accounts won't do you much good either. There's a reason for this. It's called embellishment. You see, here's the thing about personal accounts of mental health disorders - they're mostly written by famous people and often from people in the entertainment industry (Kay Jamison is an exception to this but I'll get to her and her books another time). And what do people in the entertainment industry do? They entertain. It's in their blood, they can't help it. Embellishment, therefore, is just part of what they naturally are. Celebrities, to anyone who pays attention, screw up a lot. It's part of the lifestyle (sex and drugs and rock'n'roll and all that). Then, when they grow up, they feel guilty about it. Then they write a tell all book to explain themselves. And this leads to another thing people have a tendency to do - they scapegoat. People have the hardest time owning their own shit. They can't just come out and say, "sorry, I fucked up. It's all on me." So here's one of the dirty little secrets about mental health "disorders" - they're used an excuse for deplorable behaviour. "It wasn't me, it was the mania". And they'll have doctors that go along with all this. It all looks very boo-hoo and impressive. Except some, or a lot, or who knows, is bullshit. It's just all too convenient to live like a complete shit most of your life, do a lot of stupid regrettable shit and then, one day when you grow up and maybe have kids to explain yourself to, to blame it all on some illness.

How much and to what degree an illness like bipolar may or may not have played a role is virtually impossible to say. It's not like there's a blood test or an x-ray or a test of any kind to show how "bipolar" they were or were not. We have to take their word for it and maybe the word of a doctor. And doctors' words, as I'll demonstrate as we go along, can't be taken at full face value either. So I take these accounts with a grain of salt. Or a salt shakers' worth. I'm not saying - nor can I - that a disorder didn't cause some celebrity's behaviour, I just have trouble taking their accounts completely at face value. There's just too much fuzziness around it all (which I'll explore in more detail in future posts).

And part of my insight here is good old fashioned "it takes one to know one". This is what I wrestle with all the time with all the stupid shit I've done in my life - was it me or was it the mania? (or manic depression or mixed episode or whatever). There are no sharp lines between the two. I think I can look at my normal default behaviour and see a difference between illness affected behaviour and not but I can never be sure. And no doctor can help you figure that out either. That is for your own heart of hearts to examine. It is, I can tell you though, far too easy to just escape culpability and responsibility for your actions and blame them on something else.

Bloggers (and believe me, the irony here doesn't escape me) aren't much better. A lot of the understanding of what bipolar and mania are is urban legend I believe. What you see a lot of in some blogs, chat rooms and forums is what I like to call "magnetic symptom syndrome". This is when all kinds of perfectly normal (if imperfect) human behaviours and foibles get drawn in like metal shavings to a magnet as part of the "symptoms" for any one person's "disorder" (if you really want to see examples of this try following an ADD (or ADHD) forum for a while. Everything under the sun seems to become a "symptom".) So trying to learn what bipolar and mania are in the Internet world can be extremely confusing and frustrating as well.

And then there's drugs. Drug and alcohol use may or may not be part of the problem, triggers for the problem or exacerbate the problem. Where this all begins and ends is another nightmare to figure out.Oh, by drugs I don't mean illicit drugs (though that may be part of the mix too), I mean psychiatric drugs. I bet you didn't know that psychiatric drugs could cause mania or that "anti-psychotics" could cause psychosis, did you. Some of the the very drugs they give you to "control" bipolar symptoms could cause them and/or make them worse.

Hey, didn't I tell you this would be fun!

What the F**k is Bipolar Disorder?

I've lived with this for - as far as I can tell - about thirty years. Or at least I had my first manic experience about thirty years ago (which I'll detail in another post). I started researching and reading about it three years ago. I really ramped up my research six months ago. I have all kinds of books that I've read inside out, frontwards and backwards and cross referenced and tracked down most of the "facts" they present. I've read dozens of websites. I've looked at dozens of research papers as published in scientific journals. I've discussed this with neuroscientists. I've researched this back to the days of ancient Greece. And you know what the answer is to the question in the title of this post?

Nobody knows.

OK, maybe not nobody but I'm convinced that nobody knows exactly what it is. They certainly haven't found what causes it. They certainly haven't found what exactly the process is in the brain. All that's "known" is vague ideas about outward symptoms. And I'll tell you this - mainstream psychiatry sure as hell doesn't know.

If anyone tells you that they know what bipolar disorder is they're either lying, full of shit or someone with a "Dr." in front of their name suffering from the God complex. People who have bipolar disorder may know what it is. Maybe. At least they know what it's like to have whatever it is in their brains. But as confusing at it is to have two, three or possibly more entirely different personalities in your brain at any given time and as clueless as the medical community is about it, I suspect that at best someone with bipolar disorder (if indeed that's what they have; misdiagnosis, as we'll learn, is rampant) only thinks they know what it is. At best they only know what it's like for them which may or may not help anyone else.

If you've researched bipolar disorder and aren't completely confused, you either haven't researched enough or are too easily satisfied. I'll get to this in more detail as we go along.

I've seen, over the years, thirteen psychiatrists. This includes my primary care psychiatrists, psyche ER psychiatrists, psychiatric hospital psychiatrists (in three different stays) and assorted others that have had their kick at the proverbial can. I've yet to find two that have even remotely similar opinions on my mind. This is kind of what I'm talking about with confusing. Pick any two autobiographical books on the subject and see how much crossover agreement you get. Pick any two books on the subject and not come across dozens of contradictory statements. Pick one book and read through it carefully with a critical mind and not find contradictory statements.

Try to find agreement on which medications or combinations thereof work. Try to find agreement on whether medications work at all.  What "works", I'm afraid to report, may just be a delusion. Or deadly. Or brain damaging. See how much fun this is?! Much more on this in future posts. If you're a proponent of mainstream medication therapy you may not want to read along. Or maybe you should.

It is, I can assure you, extremely frustrating to really, truly understand this disorder. And if it's confusing and frustrating to try to understand, it's even more so to live with it and try to get your life going in any one direction.

I got so fed up with what psychiatry and their books and websites tell you about bipolar that I discarded all of it. I also discarded what most bipolar people write (in their books and blogs). Then I started from scratch. There's a lot of bullshit out there about bipolar. I'm trying to cut through all that bullshit.

So what is bipolar disorder?

Tear it down to the roots and it is two things - mania and manic depression (which I define separately from uni-polar depression ... they are different I believe ... more in future posts). So what is mania? And what is manic depression (as in a manic depressive episode)?

Haha, this is where the fun begins. Read along.

Up Shit Creek in My Canoe

Navigating our ways through life is a little like rowing a canoe. How life goes then depends on how you row your canoe. Life can be like the calm waters of a Canadian Prairie lake on quiet summer evening or it can be like the white waters of a river coursing its way through the mountains of BC. You'd better be prepared for both.

It also depends on who you have in your canoe no matter the waters. Whether the waters you are currently paddling through are mirror smooth or rapidly frothing past car sized boulders, we still need to get to where we want to go and to get to where we want, or need, to go you need the paddlers in your canoe to be paddling in harmony with you. Even in the best of life conditions - or waters - if the people in your canoe aren't paddling with you, you are going to have trouble getting anywhere. Life is challenging enough without having people in your canoe paddling against you.

It's great to have people paddling with you in life. Asides from getting to where you want to go more quickly and powerfully, there's the camaraderie and joy of being with like minded people. But if they're not paddling in your direction even the most well intentioned of family and friends can leave you ready to weep (or worse) with frustration. So while many paddlers can be a great and wonderful thing, if not in harmony you are better off paddling solo. This is especially true when navigating white waters. If you're on a mirror calm lake and your canoe's going around in circles, hey, it's not so bad; it all still feels good and the view's fine! But if you're in white water having paddlers not in sync is big trouble. In my logging days we had an expression for being in trouble in life - "up shit creek without a paddle". It's an apt expression. It might also go, "up shit creek with a bunch of assholes paddling in the wrong direction". Or maybe, "up shit creek with a bunch of assholes thwacking you upside the head with their paddles because they don't even know how to handle one". Or maybe, "up shit creek with a bunch of dead weight assholes who don't even have paddles because they didn't know what to do with them, panicked and threw them away (or just lost them)". I could go on. The point is that you can see the appeal of paddling solo sometimes.

You might say I'm up shit creek these days. Times have been better. Though I think I may at least have a paddle. Or not. I'm still testing out different models I'll say.

Shit creek, life, mental health disorders, they all kind of meld together after awhile. The water gets rough. I've learned many times in life that when the water gets rough the last thing you need is people in your canoe not in sync with you and the situation you're in. So I go solo. Hey, don't get me wrong, I'd love to have help but most people's idea of help is to paddle in their direction and not yours. Or to just be riding along dead weight shouting useless directions in your ear. Hey, thanks but no thanks. I'm better off paddling alone if that's the case. So I find it's often necessary to kick everyone out of my canoe. I don't discriminate; family, friends, offspring - boom, out they all go. Many don't like it (while some are no doubt relieved) but that's the way it goes. I don't feel bad because I know I've been kicked out of many a canoe in my day. It hurts but later you can see the wisdom of what that particular paddler had to do at that point in their lives. Sometimes you get invited back in, many times not. Such is how life goes.

I've needed a lot of help since "The Struggles" began and I've experimented with various fellow paddlers over the last several years. So far none have passed the test (well, there was one but she had to go off in her own canoe and our canoes are an ocean apart now). White water canoeing is dangerous and there is no doubt I'm in white water. You dump a canoe in white water and it can be fatal. So I keep kicking people out of my canoe. I recently made yet another attempt to get people into my canoe - I really could use help paddling out of this mess - but people whose actions threaten to dump you into the waters you just don't need in your canoe. So out everyone goes.

Solo isn't always best and I keep looking for the right kind of paddlers to work with me but until I find the right ones, solo it is.