Friday, March 27, 2015

Plane Crashes, Why, Black Swans and Mental Illness Stigma

This will be very brief as the news story of the crash of Germanwings flight 4U9525 two days prior to this writing is very much at the fast breaking stage which at this point appears to be not an accident but instead something the co-pilot planned and carried out.

First of all, this is unquestionably different from a normal air crash. Losing family, friends and loved ones in any accident is very difficult to cope with; if it does indeed prove that this was a deliberate act, there is no doubt this will make it all the more difficult to accept and cope with. I of course feel great empathy for those who lost family, friends, colleagues and loved ones in this tragedy. 

However, at this point all is conjecture. Any major airline crash investigation will take at least a year or more and given the unusual circumstances of this incident, this case could take much longer. Anything, therefore, one reads in headlines and news stories in these very early stages will be pure speculation and conjecture, however factual it may appear to be at this time. As well, whatever the facts may be, it will take the full length of the investigation to establish what facts played what role in this tragedy. 

So not only have facts not as yet been firmly established, investigators have not even begun to go through them and link any given prior fact to its role in the outcome. In other words, it is simply not possible for anyone - no matter how authoritive or close to the case - to draw any conclusions at this time. 

I therefore ask anyone reading here to please refrain from unfounded speculation and the drawing of any conclusion and remind that you are neither qualified to do so nor to understand the facts in this case as they come to light. 

*  *  *  *  * 

News reports are now emerging that the co-pilot had received treatment for "depression" six years ago. 

Via Reuters:

The pilot who appears to have deliberately crashed a plane carrying 149 others into the French Alps received psychiatric treatment for a “serious depressive episode” six years ago, German tabloid Bild reported on Friday.

Citing internal documents and Lufthansa sources, Bild said Lubitz spent a total of one and a half years in psychiatric treatment and that the relevant documents would be passed to French investigators once they had been examined by German authorities.

What does this mean? 

At this point it is very easy to jump to conclusions, however readily "apparent" they may be to those not trained to understand either mental health disorders or what roles they play in human behaviour. Again, any link at this point to the copilot's past mental health issues and this incident is pure conjecture. 

But lets look to understand what if it played a role. 

There are two basic issues here. One is an airline crash, the other is someone with a mental health disorder performing acts on this magnitude. 

Air crashes are exceedingly rare in today's age. Air crashes involving deliberate actions by either the pilot or copilot are exceedingly rare among total crash statistics. 

Which makes this a Black Swan Event.

Black Swan Events

The black swan theory or theory of black swan events is a metaphor that describes an event that comes as a surprise, has a major effect, and is often inappropriately rationalized after the fact with the benefit of hindsight
The theory was developed by Nassim Nicholas Taleb to explain:

  1. The disproportionate role of high-profile, hard-to-predict, and rare events that are beyond the realm of normal expectations in history, science, finance, and technology.
  2. The non-computability of the probability of the consequential rare events using scientific methods (owing to the very nature of small probabilities).
  3. The psychological biases that make people individually and collectively blind to uncertainty and unaware of the massive role of the rare event in historical affairs.

This incident clearly scores on all three counts:

Point one is self-explanatory.

Point two. An incident of this nature is obviously very hard to compute; for all intents and purposes computing the probability of something like this virtually impossible. 

Point three is of most interest to us here. 

This is a classic black swan event in that the magnitude of the incident that sears into people's minds blows out of all proportions the probability of it happening again. 

Psychological biases are also a form of cognitive distortions. Cognitive distortions are irrational thought processes that create undo anxiety and fear. They are considered irrational because there is no logical or factual basis for them. 

As I see things developing in this case, I can see two irrational fears taking root in people's minds:

- Fear of flying

- Fear of those with mental illnesses and resultant increase in stigmatization against them. 

First of all, let's address the safety of airline travel. 

Airline travel continues to improve in safety and set all time safety records in 2011, '12 and again in '13.

In terms of casualties to passengers carried, that ratio has been steadily improving for four decades. 

This incident does nothing to change that. 

Given the purpose and nature of this blog, we now get to the real point:

As soon as I saw the news reports about the co-pilot's prior mental health condition and year and a half of treatment, I knew that this could do for mental health suffers and the stigmatization thereof what 9/11 did for the stigmatization of and prejudice against Muslims. Not on the same scale of course, but given the already dreadfully and widespread ignorance of and stigmatization of those with mental health disorders, this has all the potential to further distort in the minds of most that mental health disorders lead to violence, incompetence and other erroneous ill founded conclusions, much to the detriment and improved mental health of those with any ongoing or past history of living with a disorder.

Stigma against mental illness has devastating consequences for individuals with mental illness and their families. Empirical findings and qualitative evidence indicate that stigma against mental illness remains rampant in many nations and cultures, constituting a significant barrier to successful treatment, reducing key life opportunities, and predicting poor outcomes over and above the effects of mental illness per se.
In this article we define stigma, examine relevant theoretical perspectives, summarise evidence regarding the pervasive negative impact of stigma on individuals with mental illness, and discuss underlying mechanisms. We focus in particular on assessment issues, highlighting the need for transcending explicit attitudinal measures of stigma, which are susceptible to social desirability concerns and are likely to underestimate true levels of stigma, to include unconscious/implicit indicators and direct behavioural appraisals. A primary goal is to facilitate means of accurately measuring stigma against mental illness as an important step toward reducing its pernicious effects.

Aside from a person's inner struggles, stigma will be the worst thing the sufferer of a psychiatric disorder will endure. In fact, I'll argue at a future point in this blog (and book), it may become the most defining factor in the long term outcome of their given disorder. Along with substance abusers and the homeless, mental illness sufferers are already one of the three most stigmatized demographic groups in the Western world according to experts in the field (1). 

What role did the mental health of the pilot play in this tragedy?

In truth, at this point we have absolutely no idea. As I said, an investigation into this incident will take a year or more. 

And even if it does prove to have played a role, what does this mean?

Essentially nothing.

Again, it is a black swan event, an event of such low statistical probability it is virtually meaningless. 

Look, tens of millions of people around the world live with a mental health disorder. 

Again, the percentages of them or probability of them (or us, to my readers) performing an act like this is so statistically improbable as to have no practical bearing on society's outlook on mental health disorders whatsoever. 

But linking an event like this to people's perception of a given demographic group is exactly what happens. 

People leap to conclusions. They see a tragedy like this, the loss of life, the pain of those who lost family and loved ones and the immediate urge is to appoint blame.

And one of the greatest faults of the human brain is that it wants to appoint blame to a "them" group so as to make their own group feel better and more secure about themselves. Which is what I see happening here already. Perhaps consciously, more likely unconsciously as this link between "depression", "mental illness" and this event gets burned into their minds by 24/7 sensationalized news coverage.

This event is already a great tragedy. And I  understand people's need to make sense out of something like this, an incident that if is ultimately to have been proven true (a deliberate crash) is beyond our grasp to understand. But sometimes there just is no why. Sometimes there just is no knowable answer, no satisfying answer. 

And this is what creates fear - not knowing. 

Which is why we must apply a "black swan" explanation; there is no real answer but the occurance of the incident is so out of the ordinary, so improbable, that we must just let go of ever having an answer, let go of the fear  of it happening again.

Meanwhile, to appoint blame to an entire demographic (those with a mental illness designation) - and thus further perpetrate stigma against that group - based on irrational conclusions and statistical improbabilities would be a worse - and much greater far reaching - tragedy. 

(1) Citation source coming

Thursday, March 19, 2015

Life as a Living Hell - The Art of Living Through Hell on Earth

Every now and again I'm reminded that I'm living through hell. Or my worst nightmare (sort of the same thing in actuality). 

When I was younger, in my early twenties to be exact, and I was beginning to get serious about life (IE; stop partying, binge drinking, wasting days sitting around smoking dope, etc), I began to look around and look forward in my life and decide what I wanted, didn't want and where I wanted my life to be in the future. Pretty basic stuff. 

I did all the normal things; what career/job/vocation could I do and make some decisions there, started savings plans (long term, short term), look towards buying a home and building equity and so on. 

All of this was spurred by a sight I saw whilst pissing away a gorgeous sunny day suntanning on a popular Vancouver beach (its famous Kits Beach). On that day, among all the heartachingly beautiful young women and bronzed stud muffin young men, I saw the future. The future was a man I saw among all the golden youth, a man of perhaps sixty-five to seventy, a man who looked like he'd actually had a good life, and there he was picking up bottles. It was easy to see in an instant that he hated doing it, that he was humiliated and that he was doing it because it was the best he could do at his age to scrape together some extra income and get by. 

It took only another instant to see that that was my future if I continued to piss away my life on beaches thinking that the perfect tan was all there was to life. 

So from then I endeavored to spend my life making sure I wouldn't end up being that age and needing to spend every waking hour scrounging for bottles to exchange for 5 cents a piece just to scrape by. That was my nightmare, the hell on earth I had to avoid.

The full grips of bipolar had yet to descend on me at that point and for the rest of my twenties I proceeded to do all the right things in building a financially secure future for the day I faced retirement. 

Fear is a powerful motivator and the fear of living that future vision of hell I saw on the beach that day never left me and I worked my ass off. 

The nineties (my thirties) saw some of the full horrors of bipolar introduced to me and things got quite challenging. At one point I returned from an ill-fated business trip to Japan flat broke with nowhere to go but my sister's couch (an arrangement that lasted only very briefly) and then my car. 

Things got a bit loopy (this is a mild understatement) for a couple of years but I forged through it, righted the good ship Brad and back to the grindstone I went. 

I managed to buy a condo, got lucky with market conditions, continued to work my ass off (this was in Taiwan where I worked as a teacher putting in twelve hour days, six days a week (and often time on Sundays). I built equity, savings, and security against having to scrounge for bottles. 

Things were never not challenging. Bipolar loopiness can spring upon one at any time (well, not any time, under times of some kind of stress but I'll get to that in enormous detail later) and that created no shortage of difficulties (though the upside of bipolar is that a nice little manic burst can get you through some unbelievable tight spots). I'd later learn that I battled Borderline Personality Disorder and a host of other mental difficulties but I muddled through them all in an ignorance is bliss sort of fashion and with the enormous support from an unbelievable network of friends. 

I came home to my daughter and her mother in 2006 and set about creating a family life (my life had no shortage of colour, but perhaps stories for another day). I bought another condo, got more savings going and generally had the best year of my life. I worked hard, played harder, got to know my daughter and things looked grand and rosy. I sat on the deck of my beautiful condo, my beautiful family around me and thought to myself, "It was a hell of a ride, old boy, but look at what you've done." I was very proud of what I'd accomplished. The hellish future I'd seen twenty-five years earlier seemed very far away.

In the summer of 2007 the demons (or polar bears to stick the blog's metaphor) began to stir. It was barely noticeable, not at all noticeable at the time, but life began to change. I began to change. My mind began to change. I did not know then that the descent into hell - the nightmare I'd spent a lifetime insulating myself from - had begun. 

I struggled and fought, struggled and fought, struggled and fought. I fought hundreds of battles great and small. I won some, lost most. 

By the spring of 2009, I'd lost my home and all my savings, about a quarter million dollars of equity was gone. I also knew I was losing my ability to work. At that time I was already feeling the debilitating aspects of long term bipolar and though I didn't understand it, I could sense it deeply. I knew I was no longer mentally or physically the man who could work twelve hours a day six days a week to work his way out of this mess. 

The insulation I'd spent a lifetime building against the hellish future was all stripped away. Hell on earth was staring me square in the face. 

But the fun had only just begun.  

I hung on through the rest of 2009 and into 2010. I managed to hold a job of sorts and to make rent, though every month was a struggle and threats of eviction a near monthly source of stress. 

Things exploded (in my mind) with my first episode of psychosis and attempt at suicide. 

Reasonably, I thought, I entered the mental health care system with my first hospitalization in a psychiatric facility. 

The next thirty months was a whirlwind of living on the brink of suicide, numerous episodes of psychosis, long, long periods of drug induced fog. I suffered the drug side effects horribly. I lost all capacity to work properly (though I did manage to put in periods of work of a few weeks to a month or so). 

Many more hospitalizations were to come. A nightmare had come true. A living hell. 

Eventually I lost everything. All my loves, all my pleasure, my ability to work. And then my very mind itself, by which I mean days upon days for months being capable of little more than staring out a window all day listening to music. I could not even do my greatest love - read. 

A year after that I was living out an unheated van in a Canadian winter. 

Yet I was having some of the happiest times of my life. I'd put most of the horrors of the past behind me. I was loving life. I was tackling life. 

As I sit here typing this out, I feel like the most blessed, happiest man on earth. 

I sometimes have to - as I started out saying - remind myself that I am in fact living the hell I'd feared all my life; broke, homeless (1) and alone. 

But despite being in - living - the hell I envisioned thirty-four years ago on a gorgeous beach among gorgeous people, I am mostly at peace, content, full of industry and dreams and plans and there are some very wonderful people in my life. I am grateful for everything I have. Every day I love life as much as I possibly can. I experience great pleasures.

It's still hell I'd spent a lifetime fearing and working to avoid, but ...

Anyway, this is life. Hell may very well happen. Hell may very well be happening to you or a loved one. The trick then is to make slices of heaven out of hell. Every day. Create enough slices and one day your life is mostly heaven. Or as close to it as possible. 

There are many things that this blog is and will be. It occurred to me this morning that maybe it's mostly about the Art of Living Through Hell on Earth. 

I learned that when life puts you through hell there's not a lot you can do about it. I suffer and have suffered horribly (which you'll understand when I get into the details of things like psychosis, bipolar mixed episodes, hallucinations and voices, and the blackest black of suicidal depression) but the fact remains that there's no going back to Kansas. I - nor anyone - can just click my heels three times and go back to Kansas, to get out of hell. 

So you have to learn how to get through hell on earth. 

Ol' Winnie knows a thing or two about getting through hell. He not only had to guide himself through it (he reportedly often suffered great depression), he had to guide the great city of London and an entire country through the hell of the Blitz. Giving up was not an option. There are a lot of people who drop bullshit quotes who don't really know what's behind the words spilling out of their mouths (sort of a pet peeve of mine you'll come to see) but not ol' Winnie. He knew what he was talking about.

So this is what we'll look at in this blog, how to keep going through your private hell. Or how to help and support a loved one through their private hell. 

It's an art form, I discovered. There's all the science behind it - and that's tremendously important, of course - but all the day to day stuff is an art form. We'll learn those arts. 

As I've said many, many times, there is not a single aspect of mental health, the mental health care system and the psychiatric/pharmaceutical approach - the whole great picture - that I have not investigated, examined and researched in great deal. 

I have also lived almost all of it - bipolar, hallucinations/psychosis and all of that, ADD, crippling anxiety, Borderline Personality Disorder, and of course some of the darkest and crippling depression you can image (or not want to imagine). I knocked on death's door many, many times (or it on my door I suppose). 

So I'll talk about how to get through all that. I'll talk about psychosis and what that is. I'll talk about depression and what that is (and more importantly, what it isn't). I'll talk about mania and what that is and how to deal with it. 

I'll talk a lot about full body health. I'll talk a lot about mental health. I'll talk a lot about spiritual health. 

I'll talk about pharmaceutical drugs, who prescribes them and why and why they are proving to be ultimately ineffective. 

I'll talk about psychiatric hospitals and how to get the most possible out of them. 

I'll talk about how to get through acute crisis situations (IE: on the brink suicidal ideation). 

I'll talk about, in short, everything you might need to know to get through that hell and into the best possible life you can still have. 

Because we can't control life, folks. We can only control our minds. 

And that's my ultimate goal - how to control, or better control, your mind. 

Yes, difficult, I know. I know. 

But we'll get there. If I can, you can too. Life is not perfect, never will be. But we'll build as close to something that will bring you more happiness, contentment and inner peace as we can. 

(1) Though I now have basic shelter under good conditions, it is a gift from strangers. I own nothing, have title to nothing, nothing on paper. I could be cast out at any moment and there'd be nothing I - nor anyone - could do about it. Home - a true and proper home - is something you have some sort of title or legal right to. 

Friday, March 13, 2015

The Zebra Storyteller

Once upon a time there was a Siamese cat who pretended to be a lion and who spoke excellent Zebraic. 

That language is whinnied by the race of striped horses in Africa. 

Here now: an innocent zebra is walking in a jungle and approaching in the other direction is the little cat; they meet.

"Hello there!" says the cat in perfect Zebraic. "It certainly is a pleasant day, isn't it? The sun is shining, the birds are singing, isn't the world a lovely place to be alive today!"

The zebra is so astonished at hearing a Siamese cat speaking like a zebra that he's fit to be tied. So the little cat ties him up, kills him, and drags the better part of the carcass back to his den.

The little cat successfully hunted zebras in this manner for many months, dining on filet mignon of zebra every night, and from the better hides he made bow ties and wide belts after the fashion of the decadent princes of the old Siamese court. 

He began boasting to his friends he was a lion, and he gave them as proof the fact that he hunted zebras.

The delicate noses of the zebras told them that there was really no lion in the area, however, the zebra deaths caused many to avoid the region. Superstitious, they decided the woods were haunted by the ghost of a lion.

One day the storyteller of the zebras was ambling along and through his mind ran plots for stories to amuse the other zebras, when suddenly his eyes brightened and he said, "that's it! I'll tell the story of a Siamese cat who speaks our language! What an idea! That'll make them laugh!"

At that very moment the Siamese cat appeared before him and said, "hello there! Pleasant day, isn't it!"

The zebra story teller wasn't fit to be tied at hearing a cat speaking his language because he was just thinking of about that very thing. 

He took a good look at the cat, and he didn't know why but there was something about the cat's looks he didn't like; so he kicked him with his hoof and killed the cat. 

And that is the function of the storyteller. 

- a short story by Spencer Holst

I use this story to try to illustrate part of the role that I see this blog playing. Like the storyteller, it is my belief that if one has more knowledge and narratives about the many possibly strange things we may meet in life, the less one will be "ambushed" by them (such as a talking cat!). And so it is with scary mental health disorders like schizophrenia, bipolar, severe depressive episodes, suicidal inclinations and so on; the more we know and understand, the less we fear and the less we get ambushed by the unexpected and the better we can deal with them.

A knowledgeable mind is a more prepared mind, a prepared mind is less prone to fear of the dark aspects of life that can be encountered. As a teller of knowledge and narratives, I hope to be a candle in the dark. Or perhaps even to light the whole room. 

Mental Health Disorder in Focus - Biplar Disorder: Part I

Before I get to the next post on how brains create reality and the implications thereof, I want to introduce bipolar disorder because I am going to use it to illustrate a great deal of how realities get formed and distorted in our minds. 

Bipolar is a multi-faceted, very confusing and difficult disorder to understand. I'll start off with a quote from Yale professor Jon Lieff. Jon is an email acquaintance of mine (although infrequent, our exchanges always have very high quality). Jon's science/neuroscience blog, Searching for the Mind is considered (and was named) one of the best sources for learning neuroscience on the Internet (and it is among some very heady and distinguished company, let me tell you). He is a fantastic source of bleeding edge and intricate knowledge of how brains work and why. He's been very kind in answering questions of mine and (occasionally) reading posts from this blog.

This is what Jon told me when I wrote asking him about bipolar disorder:

There are literally thousands of neuroscientists trying to understand the neuroscience of bipolar disease*. At this point in history it is too complex for our present tools (my emphasis). Everything is speculation.

[* - I quibble with and take issue with the the term "disease", but I'll leave that for another time]

So before anyone gets any idea that they have any kind of understanding what bipolar is or isn't, bear in mind that bleeding edge neuroscience can't even explain it. I have to mention this because I get advice all the time that runs along the lines of "Oh, I worked with someone with bipolar, I know all about it …" or “Oh, I've read about that, I know all about it...”. And they proceed to tell me what they "think" (and I use that term very loosely) what I should "do" (ahem).

But let me start out with the image at the top of the page. This is one of the most common images associated with bipolar and it's unfortunately very misleading. It's misleading because it gives rise to and perpetuates the most common myth about bipolar disorder - that it means something along the lines of "being happy one day and sad the next".

Bipolar is NOT about being happy one day and sad the next, or peppy one day and down the next day nor simply about emotions at all. If that were the case, nearly everyone would be "bipolar" or experience "bipolar" in their lives. Changing emotional states are certainly involved but they are just a very small aspect of the condition. So that's myth number one to disabuse yourself of.

Bipolar is also very widely mis-diagnosed or over diagnosed. It's sort of the "mental illness de jour" these days, especially among the celebrity/artist/performer/creative set and can be used as sort of a catch all excuse for bad behaviour. Or for anyone who's "moody". It's also grossly over-diagnosed, as are almost all mental health conditions, because the psychiatric and pharmaceutical industries make a lot of money off of "treating" people with life long supplies of drug cocktails. The mass over-diagnosis of bipolar is something I will address in a future chapter when we examine the “bipolar boom” (a term coined by Robert Whitaker in his book Anatomy of an Epidemic) of recent decades.

Bipolar disorder is, as mentioned, very, very complex and a great number of things are involved or possibly involved but for this first post dealing specifically with bipolar disorder, I'll start with some basics and - over time - flesh things out from there.

There are three basic states involved in bipolar - the manic state, the depressive state and "mixed states".

My view of bipolar is closer to the classic manic depressive definition. Manic depression used to be the term used until diagnostic criteria started getting carried away. Classic manic depression would look something like:  relatively brief periods of mania followed by long periods of depressive states. The former can last from about a week up to a year but the average is probably around ten days to two weeks. Depressive states can last for weeks, months or years.

Now one thing to clear up right away in understanding the severity of bipolar is the question of "depression". I have huge issues with the semantics of this term. It is so broadly used and applied to so many clinically different conditions that the term "depression" is virtually meaningless.

One - and here's a big dirty secret revealed - is that the kind of depression most people go through is not a "mental illness". It is, in fact, a perfectly normal reaction to some sort of life crisis or difficulty. In the vast majority of cases it's closer to bereavement or grieving (think the feelings you have following the break up of a serious relationship, the passing of a loved one or beloved pet and that sort of thing). Many other people will go through episodes of very difficult sadness and low moods because ... well, life is shitty at that time. This too is perfectly natural. Some people panic themselves into a mental health tizzy for a wide number of reasons (a kind of nocebo effect that I get into in great detail in a later chapter). No question it can feel very dark and difficult (mostly because it's misunderstood and mishandled by "professionals" or friends and family) but it is a temporary state that - generally - passes as naturally as it came. (all of this is grist that I grind in future posts).

But while the depressive state of bipolar disorder bears a lot of similarities to more common experiences of depressive episodes, I'll outline (again, as we go along and explore it later) how and why it is different and in many cases much worse. So let's look at the states of bipolar in a little more detail. 


Mania is really a tough state to understand. A great number and variety of things may go on. In a small percentage of cases great creativity can be (emphasis on can be) involved and experienced. Some people become violent. It is widely associated with all kinds of bad behaviour (hence many actively seeking a diagnosis of bipolar to explain away bad behaviour ... I am always skeptical of these cases). But let's look at some of the clinical criteria used to assess a diagnosis of bipolar. 

In no particular order, we have:

  • extreme euphoria (get used to the word "extreme")
  • very impaired judgement and/or insight into one's own behaviour
  • extreme sexuality and high/obsessive sex drive
  • extreme and seemingly inexhaustible levels of energy
  • extremely high and unrealistic levels of positiveness, hopes and optimism
  • inability to sleep (Note: this is not at all the same as the kind of restless/anxious insomnia many people experience. When I say can't sleep, I mean being in the grips of bouncing off the walls energy and extreme levels of mental alertness and having no need or desire to sleep whatsoever)
  • obsessive drives and high motivation to act on one's thoughts and "visions"
  • behaviour like runaway spending and/or extremely poor financial judgement, discretion and management
  • extreme levels of "I can do anything" confidence and beliefs
  • extreme, perhaps delusional levels of optimism
  • a feeling of being on top of the world, the world is my oyster and can conquer anything
  • nothing but the most positive thoughts and self-dialogue
  • "Superman" like feelings. Like literally the belief that one can fly or cover great distances through the air. (hard to believe but this actually happens in some cases and there are cases of people in the grips of mania who jumped to their deaths because they literally believed they could fly)
  • severe delusions and/or delusional thinking
  • great clarity of thought (which may or may not be delusional ... a thorny aspect to pick through)

All of these are extremely (that word again but seriously, it cannot be used enough in describing various states of bipolar) powerful and gripping. The power of these is well, well beyond the ability of most people to imagine and are well beyond what almost anyone has experienced.

For a proper diagnosis of mania, one does not have to have experienced all these criteria in one episode. I believe (if memory serves) it requires (or used to when strict diagnostic criteria was closely adhered to) seven to ten of these conditions to be present for a minimum of four days running. How all that "plays out" in any one individual is going to vary about as much as there are personalities and personal differences (if you start to add all that up you can begin to grasp the complexity of the disorder).

A key thing I personally believe should be factored in is how much a manic episode disrupts a person's normal life. As well, how much all these behaviours/states depart from a person's normal personality. There are people who experience many of these things but aren't so put in the grip of them that they stop going to work or otherwise greatly alter their normal lifestyle. In true mania, one will completely be in the grips of and be obsessively driven by these things and their life will be greatly disrupted.

Some personal thoughts:

A young psychologist who was working with me, genuinely curious to better understand what mania feels like, once asked me what it was like. What I told her, and I'm paraphrasing from memory here, was this:

Mania is like the best drug anyone could ever make. It is beyond the best feeling in the world. You feel like you can do anything, be anything, think anything, solve anything. You have sexual energy a porn star would die for. Doubts, fears, any negative feelings whatsoever evaporate. You become God's gift to humanity. If such a drug could be made you could charge $1,000 a pop for it and people would gladly pay and line up for blocks for it. There is nothing like it on earth. Nothing.”

Until, of course, it stops.

Depressive States:

Boy, where to begin. Well, the easiest thing is to simply look at the mania list of symptoms and then try to imagine (and this is very, very hard to imagine indeed for the average person who's never experienced anything like that) the polar and extreme opposite of all those states.

Again, in no particular order, we have:

  • extremely low energy levels (to the point of literally being incapable of getting out of bed, taking a shower, preparing meals and so on)
  • extremely (again, get used to the word "extreme") low desire, drives and motivation
  • complete loss of interest in sex
  • extremely negative views of oneself
  • extremely negative and destructive "self-talk"
  • extremely persistent and intrusive thoughts and visions of self-harm and/or suicide
  • literally crushing levels of guilt and self hatred
  • extreme hopelessness
  • an obsession with the "dark side" of life and humanity
  • extremely negative views of the world and future
  • extremely impaired insight
  • and just an indescribable level of literal inner darkness

All these too are extremely powerful and quite beyond the ability of anyone to "control" without massive amounts of intervention, help, training, awareness (and yes, perhaps short term drug therapy).

And if that sounds horrible, let me introduce you to -

Mixed States:

Mixed states are completely beyond almost anyone's ability to comprehend and imagine. Even most highly experienced clinicians cannot fully grasp it. As the name suggests, it is a combination of aspects of manic and depressed states. Except it's none of the "fun" part of mania and all of the worst aspects of depressive states. It's all the dark and negative elements of depressive states except unlike the lack of energy and drive and motivation in depressive states, the person will have nuclear levels of energy and motivation to act on all those horrible, negative and distorted thoughts.

One in five cases of severe life long bipolar will end in suicide. It is widely believed and accepted that the vast majority of these will take place during mixed states. Bipolar has a reputation for violent behaviour. That violent behaviour will take place during mixed states. Mixed states are very, very, very bad news.

As much as I've experienced these states, they are beyond my ability to describe them. Very, very difficult to survive them.

Various other "fun" stuff:

  • various forms of psychosis or psychotic states - I'll have to cover this in more detail another time. This is virtually impossible to describe. Think hallucinations, voices, commands to perform harmful acts and all kinds of fun stuff like that. Extremely powerful and horrifying stuff, let me assure you. And quite beyond the experience of all but a small handful of people.
  • People with bipolar will often suffer from or experience other mental health conditions such as ADHD, Borderline Personality Disorder, Major Anxiety Disorder and a host of other fun things to try and deal with aside from all of the above.
  • there is no known cure for bipolar
  • drugs, despite what is commonly believed, do not "cure" bipolar but instead may lead to a worsening of conditions and other severe side effects (long, long topic that I will cover elsewhere) though they do “knock down” many of the drives and can give an impression of stability
  • the "illness aspect" of bipolar will worsen with each cycle through manic and depressive states and/or mixed states

So that's kind of a clinical overview. Let me leave off with a few final thoughts. 

None of these are simple "moods". We are talking massive, massive and long term changes in literally how the brain operates and takes in and processes sensory information. Huge changes in brain regions, neurochemistry and other neurobiology are involved. Over the long term, there will be actual structural changes to the brain and brain damage. There will be changes down to the cellular level and - believe it or not - the DNA level. The differences in these states are so vast that they each literally change how one views the world and acts according. One becomes, almost literally, a different person in each of these states.

These states can change in long, slow waves (the classic is one manic state and one depressive state a year). Or they can switch back and forth like a light switch (so called "rapid cycling", a truly, truly horrible and horrifying experience to go through, something I would not wish on my worst enemy).

Advanced state bipolar is considered one of the two most severe, destructive and difficult to deal with neuropsychiatric disorders on earth along with schizophrenia. I'd argue that it's worse than schizophrenia because of the wildly varying mental states (schizophrenia is certainly no fun but at least it's a consistent state).

I have, and have had for some time, the most advanced and severe form of bipolar. There is very little in the upper echelons of psychiatric experiences that I haven't lived with or experienced.

There are other aspects and behavioural changes quite different from what I've outlined here that can lead to a diagnosis of bipolar that I'll also try to explore as we go along. 

 A few further thoughts:

Bipolar disorder can decimate a person's ability to live a normal life, hold steady jobs, have steady relationships or even fit in with society at all. Personally I have never been able to keep a job long term or stay in a relationship. It can destroy you financially. It can destroy any concept you have of yourself as a human being.

Emphasis for each on "can", however. For most of my life I had no idea what was happening and thought it was just my "colourful personality". It is my view that it can be managed but the sooner in life the better. Once you're at an advanced stage and age such as myself, it gets increasingly difficult (I'll also outline the reasons for this in later chapters).

But my personal state is not what I want to focus on. I have learned - through personal experience and enormous amounts of research - that there are ways to "Tame the Polar Bears". That is what motivates me to keep going, what motivates me to write this blog. There will be numerous chapters teaching how to tame the poplar bears (1) but I always point to my Positive Difference Making Fundamentals as a place to start.  

It is also my belief that bipolar needn't become a permanent life long condition if one learns early enough to recognize and manage triggers and stress (two things that will be a huge focus of this blog in managing any mental health condition). 

There will be lots, lots more on bipolar and exploring all aspects of it so please stay tuned! (2)

(1) The "polar bears" are my term for the polar opposite states of bipolar disorder.

(2) I have a lot on the go writing and research wise so please be patient in waiting for future posts specifically dealing with bipolar. It may take some months before I get to them all.