Tag: bipolar

My wife gave me that look again yesterday. It’s not really a bad look, but it is specific to certain situations. I like to imagine that at some point General Custer was talking about whether to ride down to Little Big Horn or to just go home and drink beer. And I like to imagine that during that discussion Custer’s aide looked at him the way my wife looked at me last night. It’s the look that says, “I don’t know why you’re saying these things, but I hope we end up having a party instead of pulling arrows out of each other.”

I started off by telling her I had an unimportant question, and then I asked what the idiom “the carrot and the stick” means to her.

“It means you reward someone to get them to do something, and you punish them if they don’t do it,” she said.

“Yeah, that’s the common definition,” I said, “but that’s not the way I learned it. The carrot is a reward, and the stick holds the carrot in front of the donkey where he can’t get to it. He just keeps pulling towards it.”

I paused to let my wife say something in response. Instead, she gave me that look.

“Nobody gets punished,” I said.

She kept that look trained on me, even though the cat chose that moment to dig his claws into her leg and launch himself across the den like a cruise missile.

“You don’t hit the donkey with the stick,” I went on. “The stick just hangs there.”

My wife rubbed her perforated trousers leg and said, “Is this for something you’re writing?”

“No, I’m just thinking about it.”

She leaned away from me a fraction, the way you’d stand back to get perspective on a magnificent tree, or to get perspective on a manic person who’s talking about pudding enriched with brain-strengthening vitamins.

“Really! Think about it!” I said. “If you hit a donkey with a stick, you may get bit. Even the stupidest donkey in the world isn’t going to think the stick hit him by itself.”

I paused again for my wife to speak, but she just gave me a glacial nod to continue.

“But if you just use the stick to dangle the carrot, the donkey won’t get pissed off and bite you. Even if he gets aggravated, he’ll probably just bite the stick. It’s better all the way around.”

My wife crossed her legs and said, “Okay. And why did this come up?” Followed by the unspoken, And were you stockpiling food and Geiger counters at the time?

“No particular reason. It’s just, you know, the donkey never sees the stick that’s holding the carrot. So, when I look around here I can see the carrots. Where are all the sticks?”

“Are you complaining because you can’t see invisible sticks?”

“No! But if I’m working for carrots that I can never get because some hidden something is keeping them out of reach, I want to know what that something is and do something about it!”

My wife leaned back another fraction. “Are you complaining because you can’t see invisible sticks and then bite them?”

“Well… yeah. Kind of. Not literal sticks. The sticks are metaphors.”

She waited for a bit. When I didn’t continue, she said, “Metaphors for what?”

“I don’t know! That’s what I want to find out!”

“Should I clean out another closet so you can fill it with bottled water?”

“No, you’re missing the point!”

“Which is?”

“It’s hard to explain,” I said.

“Does it have something to do with the donkey? You have to give the donkey a carrot before all this, or he won’t know he likes carrots.”

“Yeah, it goes without saying that the donkey likes carrots!”

“And if you don’t feed the donkey sometime he’ll die.”

“Just forget about the damned donkey!”

“You’re the one who wanted to talk about the donkey. I was watching TV,” she said.

The truth of that statement kicked me in the larynx, and I stopped talking for a moment. Then I said, “You were right, this is for something I’m writing.”

I saw her shoulders relax. That look disappeared from her face like a pricked soap bubble. “Oh, okay. Anything else?”

I shook my head, kissed her, and went back to my office, where I further contemplated the question of donkeys and invisible sticks. That question had become secondary, though. My primary interest had become appreciating the complexity of my wife’s job.

My wife contributes to our partnership in a lot of ways, and one of them is observing my behavior. She doesn’t so much observe it as she scans it with the diligence of a forest ranger. But she’s not scanning trees for signs of fire, she’s scanning what I do and say for signs of an irrational brain that needs tweaking. You could say that she’s a Brain Ranger.

It’s a hard job. People pay me to say things that no one would expect a normal person to say. Even when my brain is working fine, I sometimes say things that make everyone stop for a moment and then look away. How can a Brain Ranger tell when I’m malfunctioning and when I’m just being my normal, strange self?

I can’t explain how she does it. But I will say that for a person like me with an unruly brain, a vigilant, no-bullshit Brain Ranger is invaluable. There’s nothing like having someone who can listen to you talk about your metaphorical donkeys and invisible sticks in the context of your metaphorical forest and figurative fire, and assess whether your behavior is abnormally weird or just regular weird.

Someone's Brain Ranger has some exciting times ahead.
Someone’s Brain Ranger has some exciting times ahead.

Public domain photo by Karen Murphy, U.S. Fish and Wildlife Service

via Wikimedia Commons

Inspiration sucks. It’s like that five dollar macchiato you drink every morning to get yourself going. Then one day the cat barfs on your shirt and makes you late, and you don’t have time for Mr. Macchiato. You can’t get yourself going without it, and at work you just stare at an imaginary point hoping no human comes near you before noon. The professional writers say that inspiration is for suckers. Just start working and let the work take care of itself.

So I felt really bad today when I sat down at the keyboard uninspired, depressed and communing with that imaginary point rather than attacking the keyboard like I was John Henry. I squirmed in my chair and felt shame that I was attempting to use the same alphabet used by Mark Twain. I’m a man of my time, so when I have a problem I do what the people of my time do. I go to Google. I searched Google for inspiration. By the way, the word “inspiration” produced 107,000,000 hits, and I don’t think any of them are at all inspiring.

After a while, like a lazy, willful mule, I started looking for anything I could use as an excuse for not writing at all. I landed on bipolar disorder. That was promising. I figured I could whine about it for at least a couple of paragraphs and be done. But then I found a page listing the best things about bipolar disorder, which isn’t your normal kind of post about a mental illness.

I think the “best things bipolar” list contained some fine and illuminating stuff, but it didn’t quite capture my experience with my friend bipolar. That’s what led me to create this alternate list of The Ten Best Things About Being Bipolar.

  1. Since you’re manic sometimes and depressed at other times, bipolar can be claimed as the reason for almost anything you’ve screwed up or don’t want to do.
  2. After being manic for a while, you can tell people what it’s like to write the sequel to Lord of the Rings, invent the perpetual motion machine, and fly without an airplane.
  3. You have a wide selection of pills in decorator colors, so there’s no need to remodel the bathroom.
  4. You can finish a day’s work when other people are still asleep, and you can think faster than reality occurs.
  5. When depressed, you get plenty of health-enhancing rest for long periods of time, in rooms darkened by curtains that block out harmful UV rays.
  6. You can openly pay someone to put up with your shit and react in a patient, thoughtful way, because it’s more acceptable to do this with a psychiatrist than with a prostitute.
  7. There’s no substitute for being the smartest, most charming, most articulate, sexiest and most creative person on Earth for a while. It’s worth the embarrassment of later looking back at what you did and wondering what the hell you were thinking.
  8. If you make bizarre money decisions, buy ten thousand pairs of bowling shoes, lose your home and possessions, and cause all your family members to abandon you, that’s just an unambiguous sign that God wants you to become a monk.
  9. You give your spouse lots of opportunities to develop patience, tolerance, and the discipline to not hit you in the face with a frying pan.
  10. You get to identify with scads of famous people who might have been bipolar too, like Abraham Lincoln, Marilyn Monroe, and Tigger. That’s got to be good for your self-esteem.

So there’s a poke in the eye for you, inspiration.

It sometimes surprises me how many people like their bipolar experience just the way it is. Yet plenty of people don’t like bipolar, and they can get pretty angry that anyone might say positive things about it. So, I’m happy to see your comments, but please try to keep them civil, or at least more civil than a religious war.

The suspected-of-being-bipolar President Theodore Roosevelt. Is he manic here? Depressed? You decide.

My brain and I are no longer on speaking terms. He’s given me the central nervous system equivalent of a sharp kick in the shin. Or to put it another way, if he were my roommate he would have just stolen the last piece of my birthday cake from the refrigerator. I’m quite put out, and refuse to have anything to do with him.

I used to rely on my brain’s unfailing companionship. He figured tips, and he remembered who Archimedes was, and he knew how to spell “eviscerate”. He once took over and completed a 3 ½ hour essay final exam on Differential Mortality, Gender, and Agrarian Economics while I looked at the cute girl by the window. That was real friendship. He even got an A.

But it hasn’t all been marshmallows and kittens. My brain has occasionally led me astray, like the time he said, “I’m 19 and smart enough already—who needs to finish college?” (That one was fairly painful to fix.) Or that time he said, “Three months is plenty of time to get to know each other—go ahead and get married!” (That one was extremely painful to fix.) He tends to approach all problems with an A + B = C mentality, and I suspect that’s not always the best choice.

So for a while my friend the brain has been yanking me around, as he sometimes has done in the past. I don’t know where the hell he goes at night, but during the day he walks around all the time with some kind of freaky hangover, which is pretty annoying. Don’t get me wrong, I understand that brains get a little weird when your body produces a smidge too much of something or other, or when things get out of whack in the lobes, or sometimes really for no reason at all. But there’s only so long you can go with your brain making you act like a crazy man before you say a dignified, “Enough.”

I’m not positive what my brain has to say at this point, because we’ve only been communicating through my thyroid. For example, I’ll say to my thyroid, “Hey, ask my brain how to calculate the distribution of a chi square test,” and the thyroid will come back a little later and say, “Your brain answered, but it was just a bunch of squiggly symbols I don’t understand. How about some extra hormones instead?” That’s not as helpful as I might wish.

I am now accepting applications from other organs interested in replacing my brain. I imagine there will be many fine candidates, because the job of brain is pretty prestigious, the hours are good, and you get excellent access to the eyes in case anything interesting comes on TV. I might even solicit an organ or two to get the process rolling. Is the uvula an organ? I’m not sure because I’m no longer talking to my brain. But it’s welcome to send me a resume anyway.

This is what’s left of me after five weeks of my thyroid running things.

 

 

I’ve been trying to understand mental illness for a long time. I’ve come up with some observations and opinions, but understanding is still bouncing around like a deer in the forest of my ignorance. Even though I’ve researched and directly observed mental problems, I have concluded that understanding mental disease is really hard.

Other people think that understanding mental disease is hard, too. I’ve heard them say so. They say a lot of the same things that I’ve said over the years. We’ve said that everyone’s got problems—the folks who are mentally ill should just suck it up like the rest of us. Or if they can’t do that, they should get some medication and stop doing these disturbing things. Sometimes we’ve said that there’s really no such thing as mental illness. It’s just a conspiracy between psychiatrists and drug companies.

I think these statements contain some truth, but they contain a lot of falsehood, too. Like I said, I have observations and opinions, not understanding. Certainly some people understand more than I do, but here’s my perspective for the heck of it.

I’ll start with whether mental disease even exists. After all, if it doesn’t then we can stop here and grab a drink. Some folks point out that no biomarkers or laboratory tests exist to diagnose mental illnesses. Therefore, there’s no proof that they really exist. That sounds pretty damning. But a little research made me ask myself whether Alzheimer’s really exists. Or Parkinson’s Disease, or angina, or migraines, because no biomarkers or lab tests exist to diagnose any of those. Heck, there’s no lab test for the common cold. So, I admitted to myself that just because you can’t perform a lab test for a disease, that doesn’t mean it’s imaginary.

By the way, sometimes diagnosis is shakier than we’d like. If you live long enough, you’ll probably hear a doctor say he doesn’t know what’s wrong with you, despite blood tests, x-rays, brain scans, and cameras up your bottom.

I’d gotten past the biomarker/lab test objection, but that still didn’t convince me that mental illnesses really exist. In fact, I had to ask myself why anyone would even come up with the idea of mental illnesses in the first place. I’m going to slide right past Freud and the super-ego here in favor of something more down to earth. I suspect that two things led us to the idea of mental illness. First, someone saw a bunch of people doing the same strange and harmful things over and over for no obvious reason. Second, a bunch of people described having the same strange and harmful experiences for no obvious reason. I agree that this explanation seems pretty weak. Watch people do stuff and listen to people describe stuff? Come on.

Yet I was shocked to find that doctors watch what people do and listen to what they say in order to help diagnose physical diseases. Doctors do this a lot, and they have for hundreds of years. Chronic fatigue, hallucinations, confusion, sleeplessness, loss of appetite, pain, and many other symptoms are good enough to diagnose physical illnesses, even though a doctor has to see them happen or ask the patient to describe them. So I expect that these kinds of symptoms may mean something when we’re talking about mental illnesses too. If a hundred men hallucinate because of brain tumors, and another hundred men hallucinate without brain tumors, does that mean the non-brain tumor guys hallucinated for no reason at all? Or maybe there really is something organic going on with these fellows, but we just don’t have a lab test for it.

By this point I was nearly convinced that mental illnesses exist, but my nasty, skeptical brain had to wonder if they’re just a concept invented by the pharmaceutical industry. Drug companies are making an ocean of money from the armada of drugs they sell for mental diseases. These companies aren’t known for turning down a buck, and they might have marketed some unnecessary drugs once or twice. Based on the explosion of psychiatric illness and medications, I suspect that mental illness is diagnosed too often, and psychiatric drugs are over-prescribed. Not every unruly child has ADD, and not every person with ups and downs is bipolar.

But drug companies also push all the drugs they can for physical illnesses—it’s not just a mental illness phenomenon. Doctors observed mental illness long before drug companies sold drugs for them. Hey, drug companies didn’t invent bipolar disorder—manic depression was identified in the late 1800s, long before anyone thought about selling Depakote. (Actually, manic depression was identified and named in 1875 by Jules Falret.) Despite my skepticism, I can’t buy the idea that thirst for profits has led to a gigantic mental illness hoax that practically every medical professional is in on.

So which folks are saying that mental illness just doesn’t exist? I skated around the internet for a while—admittedly a dubious source of information. But I wanted to see what these guys said about themselves. I found some organizations whose sites explained that mental illnesses are no more real than sugar plum fairies. They mainly said it was all a drug company conspiracy, and they used the biomarkers/lab tests argument as evidence. They tended to be a little lax about their research—one cited “a Surgeon General’s report.” I suppose it could have been the Surgeon General of Botswana—no way to tell. Some sites promoted the owner’s tell-all book. Sometimes I had to dig four layers deep to find out the site was owned by a noted research organization such as the Church of Scientology.

And who goes around saying that mental illnesses exist? I wasn’t surprised to find the usual suspects: government organizations like NIH and CDC, research hospitals, medical journals—and of course, drug companies. I understand that just because a lot of people say something’s true, that doesn’t make it true. But overall I found what seems like a lot of evidence on the “yes, mental illness exists” side. So I was convinced. Apart from the other arguments, I couldn’t swallow a giant conspiracy among almost everyone, leaving the Church of Scientology alone in the wasteland preaching the truth.

So if mental illness is real, why don’t the mentally ill just suck it up and stop bothering everybody else? I hear people say they’ve dealt with pain just as awful as any pain the mentally ill might have, and in my opinion they’re probably right. Mental illness doesn’t deepen someone’s capacity for emotional suffering. Most people deal with the pain in their lives and move on sooner or later. Why can’t mentally ill folks just decide to do the same?

Actually, a lot of them do. Some mentally ill people don’t realize or accept that they’re sick, even if the symptoms make them miserable. Others know they’re sick but decide to live without treatment for one reason or another. They may find ways to live a reasonable life. Some hold it together at work and go a little crazy at home—or a lot crazy at home. A few find jobs where outrageous behavior is accepted or maybe even expected. Some drink, or snort coke, or drive fast to self-medicate. There are lots of ways to more or less cope, some pretty benign and others pretty destructive. A lot of these behaviors are the ones that the rest of us find frustrating and that make the lives of mentally ill people unpleasant. Some people don’t cope so well, and they just bounce along out of control, wrecking their lives in colorful ways.

In some cases people will keep going like this their whole lives, and never consider treatment. Others tough it out for a few years or a few decades before they decide that doing something different would be better. Some try treatment and abandon it.

I learned a fascinating thing about mental illness and pain. Mental diseases are incurable. You have them forever, like that candy dish you got as a wedding gift. So the pain from mental illness isn’t exactly like the pain of grief. We know that grief will end; that’s part of what helps us get through it. Pain from mental illness isn’t any more intense, but it’s not going to end—or at least it’s always going to come back, and the owner of that pain knows it. The pain’s more like chronic arthritis and less like slamming your hand in a car door.

Now millions of people deal with arthritis pain without snorting coke or engaging in other bizarre behaviors. So what the heck’s wrong with all these mentally ill people? Can’t they do the same? Here’s another fascinating thing about mental illness. It affects your mind. It literally impairs your thinking machinery so that it can’t function at optimum efficiency. That doesn’t mean that mentally ill folks can’t think and make good decisions. But sometimes, when the disease is slamming them hard, their decisions may suck. It’s a bit like asking a diabetic person to make decisions using his pancreas. They won’t always be good decisions.

Another mental illness fun fact is that symptoms often hit for no obvious reason. Your average person may be devastated because his dog died, and that’s understandable. A mentally ill person may be devastated for no damn good reason other than his brain said it was devastation time. That’s hard to understand, especially when his thinking machinery’s impaired. I once observed a person with a severe mental illness, and I saw two things in her eyes: the realization that something was wrong with her, and the pain of not being able to understand what was wrong with her.

Before I talk too much about how difficult life is for the mentally ill, let me observe that dealing with mental illness isn’t about excuses. Any human can use anything as an excuse. Mentally ill humans are no different. In my opinion, dealing with mental illness is about decisions. That doesn’t mean that a mentally ill person can just decide to be well, or have no symptoms. And it’s true that his brain may not always produce the best decisions. And the options he has to choose from may range from reasonable to horrific. (A situation not limited to the mentally ill by the way.) But those are the options he has, and that’s the only brain he has handy to work with.

And that leads us to decisions about treatment, and especially about medication. Any mentally ill fellow has to decide whether to get help. That decision may seem more obvious if he can’t get out of bed for days, or he sees monsters that aren’t there, or he compulsively spends his family into bankruptcy. But even people with less severe symptoms look for treatment, and treatment is out there.

I personally have thought, “Hey, there are pills for this kind of thing. Take a pill every day, get this under control, and move on.” I thought that before the reality of brain chemistry revealed itself to me like a blossoming flower made of rancid Spam. How can I describe this? Say that prescribing cholesterol medication is like cooking a turkey. You’re dealing with just a few, well-understood factors like the size of the turkey and the oven temperature. You can still burn the heck out of a turkey, but it’s straightforward for the most part. Prescribing medication for a mental illness is more complicated. Instead of cooking a turkey, it’s like cooking a turkey of unknown weight in your neighbor’s fireplace by remote control from your own living room. You are dinking around inside a brain, so you have a lot more complications that are harder to see and less well understood. It’s often a trial and error kind of thing, maybe combining multiple drugs and trying different dosages before you find something that works. So it’s not exactly a “take a pill” proposition.

During the trial and error phase, the mentally ill person often feels worse than before, as an incorrect mix of drugs in the wrong doses careen through his brain like flying monkeys at a tea party. A fair number of people just give up on treatment at this point. Treatment that makes you feel worse seems like bad treatment, right? They go back to living their life without treatment and coping the best they can.

But some people stick with it and get to a drug combo that helps them a lot. That’s great, because now they’re not doing those things that the rest of us find so annoying, and they may be enjoying their lives more. Everything’s going smoothly, so naturally a bunch of them stop taking their drugs at this point and slide right back into all their awful symptoms.

Why the heck would someone do that? It seems crazy. Well, in fact there’s some bad decision making behind it, and we know he can have problems with his decision-making apparatus. But to put ourselves in the mentally ill person’s place, he now feels pretty good, so there’s a strong temptation to stop taking the $500 a month drugs that give him uncontrollable shakes and make him impotent.

As another side note, insurance companies are covering psychiatric drugs less often these days. The new ones are really, really expensive. The old ones are cheap but often have nasty side effects. So for people who can’t afford to pay a lot of money for drugs, there aren’t many great options.

Even with all of that crap going on, a lot of mentally ill people find a medication balance that works for them, and their lives get a lot better despite whatever side effects they’re willing to live with. That may or may not last. Brain chemistry changes, and the drugs that work for someone today may not work for him in five years. But if he hangs on for another round of trial and error, he can usually find another combo that works pretty well.

But there’s really no simple “take a pill” option. And the “just suck it up” option isn’t always realistic, depending on the severity of someone’s disease and their situation.

I still don’t have what I would call an understanding of mental illness, but I do intend to keep all this in mind the next time a mentally ill person is annoying me and I wish he’d just get his act together. As I said before, I think mental illness is about making decisions, not making excuses. A mentally ill person may have some great choices to select from, or all his choices may be appalling. That’s true of everybody though, mentally ill or not. The mentally ill have been metaphorically kicked in the crotch with regards to decision making ability, because their minds aren’t always in the best shape to make good decisions. But in the end, either they make the best decisions they can, or somebody else makes decisions for them, and I know which one of those I’d choose.