Stir Crazy?

I've been feeling a little irritable lately.  Maybe even a little on the down side, now that I think about it.  It's not that there is anything wrong, I just don't feel like much is right.  The days have seemed to require a little more effort getting started.  Taking care of the kids has worn on me a little more than usual. I have been feeling very fatigued at about 4pm every afternoon for the last several weeks.  There have been problems to work out, mundane tasks to do, and absolutely nothing to get excited about.

I turn 40 this week.  One might think this would contribute to the problem, but surprisingly it doesn't.  I actually don't mind turning 40.  Turning 39 bugged me, but in my head I've already been 40 for the last year.  I just accepted it when I turned 39 instead.  So that's not it.

So what is this?  Is it just the blahs?  Am I still working my way out of my depression?  Am I falling back into a depressive episode?  What about the irritability?  Am I getting hypomanic or do I really have an axe to grind?  I think I have some legitimate issues, but then again, maybe they just seem like it.  I just don't really know if I'm thinking all that clearly.

Maybe I'm just feeling a little stir crazy being home all day.  Things have become very mundane, and I have nothing to get excited about or to which I can look forward.  I don't know what that could be, but I feel like there should be something.  It's just all kids, TV or computer all the time.  I've needed Ativan a little more often lately.

I am going to have to figure out if there is something I can do and if it will make me feel better, or if there is something chemical at work here. 

The Paralells Between Bipolar and Alcoholism

I didn't want to get into too many details yesterday for the reasons I stated, but in order to blog today, I have to get in a little deeper.  The problem I was trying not to discuss is Alcoholism.  A very close loved one of mine is an alcoholic.  Of late, we have had cause to examine our ailments together. While probably not a groundbreaking discovery, it is remarkable at how similar the symptoms of Alcoholism and Bipolar can be.

We've mainly compared the effects of mania and alcoholism.  First there is the intoxication of it, of course.  The primary difference is that the alcoholic's judgment skills are affected before the intoxicated feeling, ours are affected after the mania sets in.  Their disease sets in and wreaks havoc on their minds, tempting them with all sorts of reasons as to why it's ok, why they should have a drink.

There is the notion of choice.  Conventional wisdom says alcoholics can choose whether or not to have a drink.  People who are Bipolar have no choice whether or not they are going to have an episode.  On it's face it seems to be true, but given that Alcoholism is an actual disease, this isn't exactly fair.  Given the rationalization process I described above, how much of that truly involves a choice?  I know it sounds like I'm the one who is rationalizing now, but I'm not.  I realize that there are millions of people who have successfully achieved sobriety and are successfully able to make that choice.  The point is they have to make that choice every single day.  They are never free of that rationalization process, they have only become skilled at working their way through it.  It takes tremendous effort and practice, and relapse is only a heartbeat away. 

There's no actual beating it, it's forever a fight.  Just like Bipolar, you can be in remission.  You cannot be cured.  In comparing it to a Bipolar episode, it's true that we cannot prevent an episode from setting in on us if we are not medicated or if our medication fails us.  For those of us who are in treatment, being compliant with our treatment regimen is a must to delay or prevent aggravation of our illness.  Additionally, we should all be aware of our warning signs and have informed our loved ones of those signs.  There should be a relapse plan and everyone should know what they need to do should an episode come on.  These are the choices we are able to make.

Intoxication.  Now, I've been drunk before.  I've been manic.  I've been drunk AND manic.  I think I know more than a little about impaired judgment.  This is where it's hard for me not to rationalize my own behavior, hard not to say that Bipolar is far worse than Alcoholism.  Simple truth is that I'm that even though I've been drunk, I'm not an Alcoholic. I can relate, but I don't necessarily understand.   I think about the commonalities: infidelity, gambling, uncontrollable spending, shoplifting, anger management issues, and so on and so forth.  Which behaviors are exclusive to Alcoholism and which are Bipolar?  Uhhhhh...

More...the intoxication of mania is not something that 'wears off' the way high does, or a bender ends.  We are completely at the mercy of the illness, and medications aren't a quick fix.  Our option?  Hospitalization until our illness is sufficiently under control.  Counterpoint is that many Alcoholics also face hospitalization for detox and rehab.  In both cases, the need for hospitalization depends on the severity of the situation.

I can toss this ball back and forth until I go mad.  It seems there are far more similarities than there are differences.  Though Alcoholism has long been called a disease, this recent experience has made me see it truly in this fashion.  By comparing it to my own, I know it now as it truly is.  As much as a non-alcoholic can, I guess.

What does all this do to reconcile my current situation?  Absolutely nothing.  This person's Alcoholism is a trigger for my mania.  My mania and the recollection of my manic episodes are a trigger for this person's alcoholic behavior.  We can talk it to death, we can relate to each other as much as we can, but the problems divide us more than they bring us together.  Maybe it won't always be this way, but the memories may always linger.  Will we always be on edge?  Will there always be a fear of an episode or a break in sobriety?   Stupid Illnesses.

Circular Triggers

I apologize in advance for the ambiguity of this post.  It involves a third party, and I'd like to protect his/her anonymity.  I hope you understand.

I had a situation happen the other day that has left me feeling discouraged, dejected and deflated. I'm heartsick. Without going into details, it is one of the major triggers that has brought about manic episodes in the past. Obviously, I'm concerned. Especially considering I'm taking the Zoloft, and because it was just increased. Crushing depression always immediately follows my manias. So far, my medication seems to be working, as I only feel what I imagine is a healthy response to a bad situation. I function normally, but have this sad feeling. My thoughts are not consumed by what happened, though it is very present in my mind.

Now what do I do? I wouldn't have known what to do before...I would have just had this chemical response with no choice but to surrender to it. Now that it seems I do have a choice, I am at a loss as to how to approach the situation. I've been doing some talking with a supportive person, but to what end? It doesn't allay my fears, it doesn't provide me comfort, it isn't reassuring. Do I just keep talking? Is that the only way to resolve it? I am a proactive person. I cannot rest until I think I am doing something about a problem (although in a manic state my judgment was consistently poor, I still thought I was doing something). Removing myself from this particular problem is not an option.

The circumstances of this problem are a HUGE trigger for me. The irony of the situation is that something I did, albeit innocently, triggered it. Quite the predicament. It's also not something I can prevent from happening again, so far out of my control is the nature of this problem.

This is a time when I really feel Bipolar ruins my life. I feel angry and...I don't know if there is a word for what else I am feeling. Helpless? Hostage? Impotent? All are true, but they don't quite capture the hostility that is intertwined with them. I guess hostile is the right word, now that I think of it. I should clarify that these feelings I describe are not toward this issue, but the illness itself. Even if I am stable, it is still affecting me in a negative way. It still has the power to impact my life and do harm to me and the people around me. It limits how much I can say, how much I can share, how much I can reveal about it's effects on me. It hurts the people I love. As much as they might love me back, and feel for what I go through, they have their own feelings about it.  At times must protect themselves from me. Bipolar still alienates me, even if it is in remission. These are the battles Bipolar always wins. I do not have an effective defense.

So in short, someone else's trigger triggered my manias a few times. Recalling those manias recently ignited the trigger that had triggered my past manias. Now I'm worried about it triggering the mania again, all the while worrying about that initial trigger that sparked my manic episodes and the harm that it is doing to the person involved. It's this circle that I'm afraid can't be broken. I'm afraid I will break in some way instead.

There has to be a way through this, out of this. I refuse to let this battle be lost.

The Thrill and The Fear of Mania

Recently, I saw my psychiatrist for my monthly medication management visit. She increased my Zoloft by 50mg due to some lingering issues I have. Of course, I'm always wary of the potential for a manic episode due to such a change. So far, I haven't noticed too much of a change, but something caught my attention the other day.

My last post, although having nothing to do with Bipolar Disorder, detailed an endeavor that I had attempted several times over the last year and a half. This time, I approached it with a singular determination I have not had with my prior attempts. It was not like I steeled myself to do it, or had made a firm plan to do it. I just decided in the middle of the day I was going to give it a shot, and then was determined that he was not going to outlast me. While someone might not find this odd, for me it can be disconcerting. I just did it. There was no thinking about it, nor planning, not even a decision involved.

A phenomenon that used to puzzle me was that sometimes I was able to just pull this amazing self discipline out of nowhere. For example, if I had put on some weight, I'd make half hearted attempts to take it off, but was just too lazy to stick with anything. Then somewhere, out of the clear blue sky, I had it. There was no thought put into it. It's like I was on auto pilot. I'd be at the grocery store and just buy the right things to go on a diet. I'd get up the next morning and go to the gym. Suddenly I was off...and in the space of 2-3 months, I'd have lost 15-20 lbs., or however much I wanted to lose. One time, I got really heavy. It happened and I lost 50 lbs. within 3 months.

When I get hypomanic, it sets in differently. I want to make things beautiful and am likely to start a home improvement project. All the while, I will feel resentful that I'm the one doing it, that I can't rely on anyone else to get anything done. I'll be grumpy and spiteful, downright angry that no one would even bother to help. Funny thing is if anyone tried to help, I'd be even more pissed off. As if they didn't think I was fully capable of doing it on my own, or that they were trying to horn in and destroy my vision.

Once I learned I was Bipolar and began looking back and examining my behavior in the past, I realized this was the first sign of the onset of mania for me. I don't start with pressured speech. In fact, I don't have that much at all. I have flight of ideas, but that's mostly at night. I have competing thoughts all the time, manic or not, so that's not much of an indicator. For me, full blown mania involves the sense of a constant thrill, a heady, intoxicated feeling. My skin tingles. I smile a lot. I become the quintessential party girl. Anything to pump up that intoxication, make it go higher and higher. I feel grandiose, and for once I feel like I truly love myself. I also feel like everyone else should too. When I'm not manic, I feel very embarrassed about it, because I know I was so over the top it must have seemed weird or tiresome to everyone else. I must seem very conceited.

I don't feel any of those things now, but it does take some time from the onset of discipline to the elation. My worry then becomes "Will I say anything about it?" Will I secretly hope no one notices? Will I hope that they not have the courage to take my happiness away? I admit, these things have already entered my mind. That's how seductive mania is. Then there is the desire to think "Please, just let me feel it a little while before anyone notices. I won't let myself go too far before I say anything." It's like being a junkie. Just let me have one little hit and then I'll go straight, I promise. I even feel ashamed for having these ideas and feelings. It's that much like being an addict.

On the other hand, I'm terrified. What if it turns into a psychotic episode? That scared the shit out of me. It is something I never, ever, ever want to suffer again. It hit out of nowhere and crashed down on me like a tidal wave. To keep manic feelings to myself and then sink into the madness of delusions and hallucinations? Not only is that terrifying, it becomes very dangerous. I'm completely out of control and God knows what could happen. What if I hurt someone this time? Not a risk I'd like to take.

Then the junkie raises her head again. But it's not like that...you're not traumatized by surgery this time. You're not on all those pain meds, antibiotics, anesthesia coursing through your veins. I have already asked my husband to keep a vigilant eye on me, but the sneaky addict thinks she can conceal it, or at best convince him that everything is fine, or guilt him into doing nothing. See, classic junkie behavior. It's sickening and shameful to me.

For now, I'm just keeping an eye on it, and praying for strength. I may be worried for nothing, but I'm watching out for myself.

As a footnote, (and totally irrelevant to this post), I logged a lot of miles on that potty train with my youngest. We had some success this weekend. Unfortunately for me, my oldest son decided to put him on the potty just one time, and reaped the benefits of all my hard work. Sigh. That's irony in action. I'm disappointed I didn't get to have that moment all to myself, but I'm so proud of my oldest. It was such a mature thing to do. I'm also proud of my youngest, it was the harder of the two things to do in potty training. Not that you wanted to know that part. It's just a major breakthrough (as anyone who has ridden the potty train knows).

C'mon Ride the Potty Train

Ok, so this post has absolutely nothing to do with Bipolar. I am making my 900th attempt to toilet train my youngest child. I have been trying for the last year. This child has a stubborn streak larger than the State of Texas and has steadfastly refused to train although all the physical signs of readiness have been present.

I am now determined to win. He remains just as firmly determined that I will not succeed as always. Did I mention his bladder is larger than his stubborn streak? It exceeds the size of the State of Alaska. I missed getting him on the potty first thing this morning, so he filled up--and I really mean filled up--his Pull-Up (we had a nasty stalemate all day yesterday). At present, he is running around nude from the waist down because I know he won't go without his Pull-Up. He has not gone since he woke up this morning. He is also a drinker--well I don't mean that the way it sounded--but he takes in a lot of fluid. Twice as much as my other two, so I'm really pumping them into him today. Yet, he still doesn't go.

I have offered every imaginable bribe to this child. I have withheld dessert. I have turned the faucet on. I have put his hand in warm water. I have poured that warm water on his pee-pee. I have been the encouraging, patient, cheerleading mom. I sang to him. I did the potty dance. I have had my ability to hear high pitches decreased by a few levels, have been hit in a number of areas, had my glasses knocked off my face, had my heart tugged at, have been highly irritated inside, but my will has yet to break.

What the ***bleeeeeeep*** do I do? I refuse to give up, but Christ this child is going to kill me before he will pee on the potty. He says he doesn't want toys, he hates dessert now, and he really, really, really, really hates the potty. He argues that he is not a big boy, he's just a little kid. I tell him the operative word in that sentence is kid, not baby. I think he thinks I'm splitting hairs.

What do you do when they just don't want to do it? I've tried every suggestion that has been given to me. I will try anything short of duct taping him to the toilet (and even that is starting to look enticing to me).

When someone tells you it's much harder to potty train a boy, they aren't kidding. When you are trying to train the youngest boy, it's downright impossible. If he's a Capricorn on top of it, you might as well load up on tranquilizers or tequila. Either would come in handy. I don't recommend both...the combination is too tempting.

When Opportunity Presents Itself

I'm back on the subject of my friend again. Her Step-mother called my Aunt yesterday asking if I could call my friend to talk. As you know, I've been wanting to talk to her to see if I could help; maybe make a difference in what she is going through. I know she feels alone. Now that the opportunity may be here, I'm wondering what I should say.

My primary concern is whether or not she would welcome the call. I was told that it was suggested to her and she jumped at the chance. Later I was told that when it was suggested to her she "seemed receptive" to it. That's a big difference! I have concerns about how she will feel that her condition has been discussed as widely as it has been at all. I know I'd be a little pissed if I had been the focus of conversation independently without my consent, especially with someone I knew 100 years ago, bipolar or not. Then again, I also know my family and on some level am resigned to the fact that I'm going to be the object of discussion, whether I like it or not. I'd still be highly irritated by it.

I would not welcome such a phone call, myself. Maybe this is part of my concern. It's hard not to project yourself onto this kind of a situation. I'd resent someone intruding on my personal business. If I don't directly approach someone, then it's none of their concern. I'm intensely private that way. Maybe she is different. Maybe she needs someone to reach out to her. These are things I have to find out first, but I am also worried about whether or not I'd be given the complete truth. It may be one of those things that is being set up "for her own good." That could be disastrous.

Assuming those concerns are put to rest, then I wonder what I would say. Of course I would let things progress naturally, but I have to wonder what would come up and how I'd handle it. Are her struggles vastly different than mine? Have we experienced some of the same things? We are not all alike. I know there will be much we can relate to, but I don't want to screw anything up, either. I just feel like I might be jumping into the abyss. I like having a handle bar. I'm sure everything would work out fine and I'm working myself up for nothing, but this is how my mind works. How it doesn't work, rather.

I think I put a lot of pressure on myself not only because I want to help so much, but because I am genuinely concerned for her well-being. I know how hard-fought the battle for stability can be, especially when you feel so desperately alone. She has family that would do anything for her, but good intentions aren't enough. I've found that good intentions from loved ones usually lead to feelings of pain and guilt on the part of the Bipolar person more than anything else. Loved ones want so much for you to be well; they simply want to make you feel better. That's all you want too. In the absence of being able to give them that, you just feel guilty and like a failure for letting them down. Then comes the inevitable anger at them for being so damned demanding. How can they not see that you are doing your fucking best here? Just get off my back because you don't know what this is like!!!! Then comes the guilt again, only a thousandfold. If only I could snap out of this...if only I weren't such a phenomenal loser. I am so sick of myself...I am tired of being trapped in this head of mine...and a litany of other self-flagellating thoughts.

I can only hope that I can provide her some comfort and a safe place to express what she's feeling. I don't have a magic cure (as we all know but wish we had) to make it all better. Maybe, just maybe, I can make some small difference. Fingers crossed.

In Treatment

I watched a documentary over the weekend called "Boy Interrupted" on Saturday. It's about a boy who had Bipolar Disorder and took his own life at 15 years of age. It was a fascinating and moving tale. The child began talking about suicide when he was in Kindergarten. He was troubled for a long time, but if I remember correctly, he was stabilized somewhere around 9 years old. I'll get to my reaction at the end in a little while.

I also watched the move "The Soloist" this weekend. While this movie is about a homeless man who is schizophrenic, the scenes where he has episodes of hallucinations hit home very deeply. It reminded me of my own episode with hallucinations and delusions. It was a very realistic portrayal and I related to it on a very visceral level. It didn't mention how he came to be homeless or how it was that he was not receiving treatment, but there was the implication that he had at some point been hospitalized.

These films, combined with my thoughts about my friend that I discussed in my last blog post, got me thinking about treatment. Each of us has our own walk with mental illness, and approaches treatment in a different fashion. I am one of the lucky ones, who accepted her diagnosis immediately. For the most part I am 100% compliant with my treatment regimen. Where I falter and struggle is with my structure. It is a constant challenge to be disciplined in my daily life. Having 3 small children adds to the difficulty. That alone creates it's own brand of chaos. I am much better at creating and complying with structure when I get sick, because all I want is to be well. That is what makes taking my medication and seeing my doctors regularly very easy--the overwhelming desire to do what it takes to be well. It's not that I'm without sympathy for people who struggle with it, but as I have posted before, I do have a hard time understanding self-pity. Compliance is NOT surrender to one's illness. It's quite the opposite, in fact. It is the ultimate resistance. Your treatment plan is your weapon against Bipolar. To follow it to the letter is to launch a full scale war against it. Some battles you win, some you lose, but getting back up and getting right back in there is key. This leads me into my anger at the end of the documentary about the young man who killed himself...

The boy wanted to go off his medication when he was 15. From what I gleaned from the film, he was tired of the side effects of the medication, possibly tired of being different. He and his parents consulted his psychiatrist, who agreed to give it a try. During the weaning process, the boy went to his mother and told him she needed to "keep after him", so she immediately called the doctor and set up an appointment for the following week. Regretfully, the boy did not make it through until then. They interviewed the doctor on camera for the documentary, and he referred to BP as the "cancer" of the mental health community because it kills people. I don't necessarily disagree with that statement. He then went on to say "You can only keep [people with BP] alive for so long" and "they all go off their [meds]...". I was infuriated. The generalization notwithstanding, a medical professional certainly should not give permission to do so. There was no mention that he recommended or tried to convince this young man and his parents to try other medications with lesser or different side effects, or alternative treatments. No reference to a recommendation or counseling as to how very dangerous it could be to do so. It struck me as not only very irresponsible, but downright negligent of this man. How in the world he was not sued and/or reprimanded by the medical board boggles my mind. (Assuming he wasn't).

So, the question begs why is it that people do not accept their diagnosis and/or fail to comply with their treatment regimen? I'm sure that the foregoing is not very common (although I could be quite naive, too) but I do know it's very common for people to simply go off their medication and/or ignore their treatment regimen. It can be denial, it can be the desire not to be tied to a medication, it can be the love of mania, it can even be (regretfully) a financial issue and myriad other reasons.

Then, I started thinking about the big "S" word: STIGMA. Just how many people turn away from their diagnosis out of fear of being stigmatized? Have my opinions about stigma been wrong? For those who haven't been reading my blog all along, I am not one to get hung up on labels, for example. I'll be the first call myself crazy, looney, batshit and various other euphemisms. I've always taken the position that words only have the power we give to them, and desensitization eliminates any negative effect. I have pause to consider otherwise now. Have I inadvertently been contributing to that stigma? Have I been giving permission to others to perpetuate an improper posture toward the mentally ill? Worse yet, have I been so single minded that I've been selfish? While my ideas have worked for me, should I be approaching it differently? Should I be more straight forward and serious? It has begun to plague me. I think just by asking myself the question, I may already have the answer.

The inevitable question follows...What can I do to help? I never fancied myself as a social worker, advocate or activist. Yet, here I am thinking about these types of things. I may not be ready to be wholly involved in something right now, but as I'm taking my baby steps I think this might be a goal worth working toward. I have always lacked a passion for my work, and have never been able to think of anything I might be passionate about. I believe I may have just found one.