Friday, July 27, 2007

The Bipolar Life

A year or so back, an e-mail came to The Agency where I work from a middle-school student writing a report on Mental Health. She wanted to know about being bipolar. I took on the task of answering her. Because I had to write simply for the middle-school age level, I produced one of the best descriptions of bipolarity that I have ever written:

Dear Amanda:

I am a customer service representative at The Agency. My job is specifically for people with mental illness and I personally am bipolar. I will do the best to answer your questions that I can.

A bipolar condition is one of extreme mood swings, from being extremely sad, depressed, and confused, to being irrationally happy, excited, and overconfident. It is caused by biochemical imbalances in the brain. Sometimes people can lose touch with reality and have delusions, if the condition is severe enough. I am lucky enough to have never had this happen to me. Depending on the type of bipolar illness, these mood swings can last as long as several weeks or be as short as a few hours.

My own experience of it is like trying to sail a boat in a hurricane. Everything you encounter becomes an enormous and overwhelming problem when you are depressed, and an amazing and thrilling adventure when you are over-excited. You never know from one day to the next how you will feel about things and not knowing this can make you very frightened and angry and you can act out your anger towards people, like your family, who don't really deserve it.

I take several medications. I'll give you more detail in a moment. But when I take them, the mood swings are not "cured", they do not completely go away, but they become much less severe. It is like having to drive a different car every day for your company--the buttons and dials are never in exactly the same place, and the car does not quite feel the same when you drive it as the one you had yesterday.

If you live with someone bipolar, and they aren't taking medicine, their behavior may tire you out or make you frightened or angry. When they are depressed, they may start telling you all the time that everything is bad and worthless, even the things you know to be good. It can be hard to have sympathy for them, to understand it is their illness that is talking like this and not the real person. The depression can be so severe that they may even talk about killing themselves. If you love them, hearing such things can be awful.

On the other hand when they get over excited they can do crazy and destructive things like go on spending sprees they can't afford to pay for, drive recklessly and too fast, or go for whole nights without sleep. They are often quite entertaining and funny when they are "on" but eventually, even if they don't do something destructive, they crash back into the depression.

The first thing necessary to cope with bipolar disorder is proper medication. This has to be prescribed by a medical doctor specializing in psychiatry. You have to discipline yourself to take your medication regularly. This can be hard because the "excited'" half of being bipolar can feel very, very good, despite the fact that it's bad for you, and you have to give up that good feeling. Also, the medication itself can make you forgetful and miss your regular dose. I have this problem sometimes, and missing a dose can feel really awful about 6 hours later.

Beyond this, you usually need to have counseling by a counselor, because the condition itself can lead you to do things that are very traumatic and make you feel hurt and worthless inside.

The second thing you have to do is to pay attention to what "triggers" your mood swings. For example, if I am in a place like a crowded shopping mall with all sorts of colors, lights, people, music in the ceiling, and noise, I can become disoriented and suddenly feel horrible, like I want to run away from the place. So I have to cope by knowing how long I can be in such a place without having problems, and leaving before they happen.

If someone you love is bipolar, you have to understand their limits and work within them. They may be taking medicine so strong that it is dangerous to their liver. Because of this they may have to be going to clinics to get blood tests all the time. This is necessary for them and you have to plan your schedule around it. If they need rest and quiet, you may have to avoid disturbing them.

In my case, my job is part-time and I have to be careful not to work too many days in a row. On occasion I can work a full forty hour week if my supervisor needs me to fill in for her vacation. But usually, I have to limit myself to three eight hour days in a row, or I get too tired to do my work properly. The Agency has to cope with this limit that I have. They have done so by hiring three of us to do the same job so we can replace each other when needed.

I take three medications, two anti depressants, Welbutrin XL and Prozac, as well as a mood calming medicine called Lamictal. I take two anti-depressants because the Welbutrin [which is a timed release tablet] keeps me awake if I take it in the evening. The Lamictal is very dangerous. If you are allergic to it you can die from taking it. It took me several weeks of gradually increasing doses for me and my doctor to know it was safe.

Finally, I'd like to say one final thing about coping with mental illness. One of the worst things we have to cope with is what we call "The Stigma". A great many people are afraid of us or hostile to us for no good reason. Mental illness is not contagious and the majority of us out in society are dangerous to no one, even if our condition causes us to have delusions and say strange things.

I talk to all sorts of mental health clients on my job, both in the hospital, and out in what we call "Recovery", or functioning effectively in ordinary society. And what I can tell you is that the most precious thing to most of them is someone who will listen to them without judging them. I try to cultivate my capacity to listen every day on the job. I occasionally hear some very strange things, but, other than thinking them very strange, I really don't need to pass personal judgement on the people who say them.

Best Wishes

Joseph Marshall

Friday, July 20, 2007

Welcome To The Real World

We can begin with an incident that happened to me a few days ago. I constantly have to fight to obtain medication, for I am too poor to afford co-pays and must depend upon the charity of the drug companies to obtain the drugs which keep my bipolar moods stable. These are dispensed through my mental health agency, Lexington Counseling [of course that isn't it's real name, no real names will ever appear here except my own]. With the Ohio mental health system strained to the breaking point by Ohio politics, any agency is always in the middle of a comedy of errors with one or another of its patients. It was my turn this time around.

It was about the Prozac, which I take in the evenings because the Wellbutrin XL keeps me awake at night. The details do not matter, but I had been off the Prozac for a week. I had to spend over an hour waiting for a prescription in a frantic, over decorated, "postmodern" grocery store, with three forms of forced entertainment at once: blaring televisions, 1970's hits over the PA, zany fishing boat motifs on the unoccupied walls, and all the blaring labels on the food packages.

Afterward, while waiting for the bus, I noticed intellectually that it was a stunningly beautiful summer day and also that I had absolutely no emotional response to this in the least. All of a sudden, everything around me began to have an emotional aura of deadness and flatness, rather like well-used chewing gum. Then, on the bus, I began to sicken of the Columbus landscape the bus was wading through. Finally, every bright primary color in all the road and business signs became a torment to even look at. This is a common set of symptoms which I share with some other bipolars that I call "too loud, too bright, too much".

I felt absolutely horrible until I reached the streets where I live, which are full of only brown brick apartment buildings, and equally brown burned off summer lawns, with no primary colors to be seen anywhere except for the green of the trees. When I got here, the burning cloud eased off of me.

This is a commonplace of my life, and because of it, though I have almost nothing, there are some days when even this is far too much.

We can then turn to my main job. I work as a Customer Service Representative, about 12 hrs a week, for $9.00 an hour, on a toll-free mental health client and family hotline for the entire state of Ohio. I get to talk to some very interesting people: cons in prison, dual-diagnosis crackheads who also are psychotic; perfectly ordinary but terrified families confronting a relative's mental illness for the first time; citizen whistle-blowers reporting abuse and neglect of patients in mental health hospital wards; and, sadly, extremely exploited and violated recovering clients with no recourse and no advocate in a very hard world.

A good glimpse into my work is the call I once received from a polite gentleman in one of our State Hospitals. He wanted to complain that he was misdiagnosed and stated that all three of his personalities were in agreement about it.

My work is "accomodated" or "sheltered" work specifically for mental health clients and my accomodation is restricted and flexible hours. I am well trusted and am first on call to replace my non-client boss when she has vacation, emergencies, or outside conferences to manage. I seem to have a way with telephone crises and overwrought callers. For some strange reason people naturally calm down when they talk to me. I also have a bag of tricks for defusing callers with overly emotional demands. Later, in another post, I'll reveal some of the tricks of my trade.

I am also well liked. The mental illness has amplified my capacity for comedy considerably and I have been known to preface, straight faced, perfectly serious work requests to my superiors, such as Brandy Latour, with something like this: "Well, speaking as one of the zany supporting characters on the Brandy Latour Show..."

But the manic/depressive symptoms never quite go away. Every day when I get up in the morning I have to deal with the foggy, unsettling, and incoherant feelings of having the minimum amount of medications in my bloodstream. It takes a full hour for my morning dosages and my morning coffee to render me fit for anything but staring into space and being miserable.

As the medications hit, and flood the bloodstream to its maximum, I then have a space of about two hours where I am constantly fighting being distracted, and leaping over the gaps in my short term memory that the drugs induce: don't forget the ID badge for the guards at the front door of your job, don't forget your cane that you need to handle your morning osteoarthritis stiffness and for balancing on the lurching and shuddering old transit busses that you take everywhere, don't forget to turn off the stove burner when you remove the pan of hot oatmeal from it...

There was also a tiny crisis a few weeks back when I had what later proved to be merely a heat rash. Another of my drugs, Lamictal, can throw a rash before provoking a deadly allergic reaction known as anaphalactic shock. Lamitical is also an anti-seizure medication. The psychiatrist who prescribes for me stated over the phone that I had a choice. I could go off the Lamictal cold turkey and run the risk of it inducing an artificial seizure, even though I am not epileptic. Or I could run the risk that the rash was a real drug allergy and suddenly stop breathing.

Some choice, huh?