Friday, May 22, 2015

Bipolar Disorder in Focus - The Mother of All Manic-Depressive Cycles




The Mother of All
Manic Depressive Cycles


I'm not certain I've talked about this before explicitly but I'm sure I've referred to it often enough here and there. At any rate, I'm pretty sure I've never clearly outlined my last twenty-nine months (has it really been that long??). I would prefer not to talk about my own case too much but on the other hand, I do know it's a textbook case of advanced bipolar disorder and therefore there is much for readers here to learn from it.

I'm afraid most people still don't know what is meant by “bipolar disorder”. Most think one case is equal to another, something which could not be further from the truth. Aside from the basic guidelines I outlined in this post, how it manifests itself in any one person is going to depend a great deal on their age, gender, the amount of family and friend support they get, socioeconomic status and – most importantly – how often they've cycled through manic and depressive episodes, the length of those episodes, how intense and severe those episodes were, how long they've lived with it without being aware and receiving some sort of treatment, whether they have rapid cycled or not and whether or not they've had mixed episodes.

Like most terms tossed around about mental “illness” (one day I'll explain when that term can be used and when it should be in quotation marks), the term “bipolar” means almost nothing to me when people use it. I probably know more about the condition than most people alive and I don't know what the fuck is meant when people tell me they're “bipolar”. There are a number of reasons for this, mostly the fact that the diagnostic criteria for it have been expanded so much in the last several decades that practically any behaviour involving “mood swings” can be considered “bipolar”. What's considered “mania” has been greatly expanded and there's no shortage of people who get a “bipolar” diagnosis as a way of explaining away (and excusing away) what's really just asshole, cantankerous and irresponsible behaviour and inconsistent mental states (grumpy here, cheerful there). It's kind of become the sexy diagnosis de jour among the Hollywood/artist/musician set.

These – and diagnostic criteria in general – are something I hope to explore further in future posts.

I've wrestled with manic depressive cycles for many years. I won't recount all that here now and instead focus on the last seven years and especially the last twenty-nine months.

I mentioned that I was dying in a previous post. Which … well, we all die a little bit each day (and one day we don't wake up). But I'd like to explain that a little more.

I've often said I've got the worst form of bipolar and I'd like to clarify that a little more as well (and why my case is such a textbook example of an advanced and severe case).


On the night of December 28, 2012 I had a very bad psychotic episode, by far the worst of about a dozen that I'd had in the previous thirty months. Psychosis itself can mean a lot of things but for me they meant very powerful commands to harm myself (and sometimes others) along with very, very graphic and gory visions as to what it would all look like. They were always accompanied by a sort of “trial” first in which all my worst transgressions (and I'd accumulated more than a few) were “played” for me in movie like fashion and the voices telling me how terrible I was and how much I deserved what was coming.

If you have not experienced anything like this then there is no way for you to comprehend or imagine what it's like. This is the kind of psychosis you hear about in murder trials where the accused (usually schizophrenic) describes having been driven by inner voices and forces to commit the murder(s). Mine were just like that except generally the only victim was to be me. Horrific and terrifying stuff, I can assure you. That December night was by far the worst one as I was instructed to kill my then wife and my daughter and then myself and it became almost impossible to resist the forces that were taking over my mind and body.

But resist it I did (there was a tiny, sort of instinctive part of my mind that told me if I so much as put a foot to the floor, my body would just follow the commands so that tiny part of me just refused to move and I kept stock still on the bed for the whole four hours the episode lasted. I knew this because the one psychotic episode I had in which I was already up and moving my body just automatically went along with the commands).

It ended as suddenly and mysteriously as it began and when the forces left my mind I entered this state of incredible clarity. I began thinking through the previous thirty months under the care of the psychiatric profession and on psychiatric medications and my now sort of semi-famous favourite question “why?” popped into my head – why was this happening to me and why was I getting worse under the care of doctors and medications?

My mind began working very, very, very fast and with enormous clarity and insight. And it would not stop for the next five weeks. It was an enormous manic episode and it would be exactly thirty-five days to the day that it would finally end when I collapsed in utter exhaustion on a ski slope on a day of skiing with my daughter.

I can't even begin to tell you how much I read in that time. Hundreds and hundreds of websites. Dozens and dozens of science articles. Books upon books. And the variety of material! Anything and everything to do with psychiatry, psychiatric medications, psychiatric disorders, their history, everything you could possibly imagine about suicide, substance abuse, homelessness, you name it. The vast, vast majority of what I learned that would go into this blog I learned in that five weeks.

And writing! I began with a series of emails on my findings. That turned into a book with my story and everything I'd learned about the mental health care system. I wrote close to 150,000 words.

All in five weeks.

And during that whole thirty-five days, I hardly slept at all. Maybe an hour a day and that would only be a quick cat nap. I knew I should sleep and I tried (I had become very good at meditating myself to sleep at that point) but after forty-five minutes to an hour, my mind would flash awake with more ideas about what to search for or what to write or what to do and I'd be utterly seized by a driving force to keep working. It was like an all night cram session that lasted thirty-five twenty-four hour periods. That is a staggering 864 straight hours with virtually no sleep. And virtually all of that time was filled with runaway manic energy.

Then on that day on the ski slope it just ended. I just collapsed. Somehow I got home and my mind settled down a little bit. Or at least I started sleeping more. But my mind kept going. I slowed down but only a little. I just couldn't stop. I really only just dropped from full blown mania into “hypomania” (“mania lite”).

By that time I'd already started studying neuroscience. Virtually everything I know about neuroscience I learned in a three month period spanning about late February of 2013 to early May of that same year. My mind just … I can't describe it, it's beyond description. My mind just did it. Within months I could debate neuroscientists on certain points – and win. I was consulted on certain academic papers by a neuroscientist acquaintance of mine (and mentor) because, as he told me, I “saw things that no one else saw”. I was hailed a genius by two different people in the neuroscience community. All within months.

After that I started reading all kinds of other materials and writing about that. I started other blogs. I started heavily writing in Taming the Polar Bears again (following a long hiatus after creating it in 2010).

In the May of that year I started to break down. I began getting hammered by horrifically dark suicidal episodes. However, I'd learned a great deal about mind control by this time and got over them quickly.

Meanwhile I could not find a job and I had no money. I finally had to tell my wife I had no more money to pay rent and for her and my daughter to go their own way.

It was shortly after that that I had a wildly terrible break-down. I managed to call 911 (because of intense suicide safety plan training I'd undergone it was almost automatic for me to dial the number and follow the directions given). Half a dozen cops and a SWAT team answered the call and I was hauled off to the psyche ward in the back of a cop car.

Yet my mind still wouldn't stop. I had several bags of books and some note pads brought to me in the hospital and I continued studying and writing. Some of my best blog posts for several of my blogs were conceived of and written while I was in the hospital or in the transition house following my release from the hospital.

In that time I was set up for social assistance. It was pitiably small but it was something. I found a room to rent in my hometown. I reconnected with old friends. I was determined to rebuild my life.

I continued to get hammered by the suicidally dark states, however. They'd just come out of the blue and just pummel me. Nothing mattered during these suicidal episodes except how to do it. It just completely took over my mind. But somehow I'd right the ship after a few days and the darkness would just pass. Then I'd carefully analyze the episode to understand why (and this led to some of my more brilliant posts of insight).

Then in September of that year the energy just stopped. I was trying to do some minor home repair and renovation work for a friend. Prior to getting sick, this would have been easy, easy work for me but I just couldn't do it. I could “work” for maybe an hour or so then my mind would just go blank and freeze and I had to just sit down for several hours before I could go on again. My cognitive functions began to fail. Days could go by where I couldn't think of a thing. Simple painting tasks were almost beyond me and I'd be struck mid brush stroke and feel I had no idea where to put the brush next.

Somewhere in there I wrote my very popular Positive Difference Making Fundamentals post (because I came to see that practicing these things were the only things that could make a difference to my states, symptoms and episodes).

Over the years I've played thousand and thousands of solitaire games on my computer and was very, very good at the few different kinds I played. All during my illness they became my go-to for a distraction when my mind was spinning out of control. But when I tried to play during this period there were often times I would stare at the cards and have no idea what to do. I spent hours and hours being able to do nothing more than just stare out the window.

Meanwhile during this time, I had an ugly altercation with a woman at the place I was doing the light renovation work. My mind just snapped. I fell into kind of a catatonic stupor and felt that I just had to go somewhere so I started walking home (about a four kilometer walk). My route took me by some train tracks and without even knowing how I got there I just ended up there waiting for train to come along. Just as calm as could be I was going to step in front of the next train (they passed by every ten minutes on average).

But I waited and waited and after about forty minutes no train had come (by some miracle). During that time my mind began to wander, I thought of some of my old hometown friends, I began to think how much they'd be upset by having to come by and ID my body (during my research into suicide I saw no shortage of police photos of what trains did to a human body) and slowly my mind began to reconsider. Finally I got up, walked back up to the road and continued walking home. Minutes later a train went by.

This period of on and off mental fog lasted all of that fall. But the fog was interspersed by flashes of brilliance still. I started my neuroscience blog then. I was still writing to scientists around the world looking for answers and, miracle of miracles, some of them wrote back and engaged me in great discussions (Steven Pinker, Jon Lieff among them, both of whom answered me with very useful information). I watched online lectures on neuroscience, gained more great insight and wrote great pieces on that.

Then it'd all go blank again and I'd spend days just staring out the window.

I literally had no idea what my mind was going to be capable of on a given day during that fall. Brilliant? Catatonic? Suicidally obsessed? In rollicking good humour?

I described that period to friends as my mind being like the apartment of a blind person and every day you move the furniture on them and so each day the blind person has to find their way around the new lay out and get used to it. That's exactly how my mind was then – every morning I'd have to feel my way around my mind and learn what it was going to be like that day.

At some point in early December of that year I entered the dreaded “mixed episode”. This is when the bipolar mind is in the grips of dark, dark thoughts and thinking and suicidal obsession, all the sort of things associated with depression, ALONG WITH the high powered energy of mania. It is lethal combination. My mind got more wildly and wildly dark and obsessed. I went two weeks without sleeping. All my mind did was plan my final days, method of death and final preparations. At some point I wrote my Visions for the Future of Mental Health Care post, the basis for which I wanted to leave behind as my legacy.

Somehow friends and family were made aware and notified and again I went into the psyche ward. And that's where I closed out a very wild 2013.

Altogether in 2013 I wrote somewhere around 400,000 words in various blogs, book manuscripts and hundreds pages of notes of all kinds, not to mention dozens and dozens of long emails sent to god knows how many recipients. Meanwhile, I read – I estimated once – somewhere close to two million words of highly advanced neuroscience, papers on psychiatric disorders and drugs, dozens of books on science, essays of all kinds – all of it on subjects I'd never thought about or read about in my life.

January through March of 2014 were the worst in many ways. My mind was really shot by this time, now fully being hammered by the effects of an entire year of mania, hypomania, rapid cycling and a horrendous mixed episode. I couldn't read, I couldn't think, I couldn't write, I couldn't move, I couldn't do anything. Day after day after day I just stared out the window or laid in bed. Sometimes I went for walks. Sometimes friends would come to visit.


I have virtually no memory of anything during those three months. It's almost as if it didn't exist, as if I was in a coma. I remember a few certain things. Some friends gave me a very sweet and moving birthday party. Actually, that's the only event I can remember. I tried, as well as I could, to practice something from my Positive Difference Making Fundamentals each day. I listened to a LOT of music. That I can remember. I'm pretty sure I'd be dead if it weren't for Vivaldi, Mozart, Glenn Gould, Miles Davis, Dave Brubeck, John Coltrane and Bill Evans. I can recall starting work on mindfulness cognitive behaviour therapy.

Somewhere in that three month stretch to start 2014 I ended up planning suicide again. It was just unbearable to me. During the previous six years I'd lost everything I'd ever created in my life (all life savings, ownership of my condo, family, friends, the ability to work and earn money). But I felt I still had my mind. I had the ability to write. But then I lost my mind as well. It simply didn't function anymore. And with it my ability to write or do the reading necessary for my studies. I was down to nothing. Somehow, however, I ended up in an email exchange about what I was going through with a bipolar researcher in Australia (I was investigating an online program he'd developed for bipolar patients). He contacted an associate of his at UBC in Vancouver and she contacted me and she talked me through it (we've remained in contact to this day).

It was a time where taking care of myself became virtually impossible, making any decisions about myself became beyond my scope and ability. It was only through the “team” that I'd managed to assemble (consisting of my twin brother, his partner and a married couple who'd been life long friends, all of whom agreed to be my special support team) that I was able to get anything done at all as they took responsibility for my life. I deferred all decisions to them. At one point I felt it would be necessary to sign over legal guardianship of myself to someone else. I was that incapable of thinking through anything. I needed help with everything.

Sometime in April my mind started coming back. In May I started researching mitochondria (after a tip on its implications in bipolar from Jon Lieff of Searching for the Mind) and I wrote my widely and highly acclaimed series on bipolar, the brain, energy and mitochondrial dysfunction.

That effort burned me out again, however, and back into the pits of darkness I fell again.

Now knowing why this was happening to my brain – the mitochondrial dysfunction – I then created and did my Mental Health Boot camp. I spent four weeks in a strict very simple daily routine that I carefully designed for myself. It was based on something similar to what I knew the routines would be in Buddhist monasteries in Asia (to where people there in severe mental and life distress often turn). I gave myself simple domestic chores to do daily, meditation, yoga/tai chi like exercises, gentle walks, I adhered to a strict all natural diet. Every task I did very mindfully. I allowed no other thoughts.

And once more my mind began to come back. I was able to write again and my reading levels began to return.

Then I received a hammer blow. I was told I had to move out of the apartment I'd been renting, the place where I'd worked so hard to build and achieve stability in my mind and life. My therapy cat Mrs Bean had come into my life by then and she meant everything in the world to me. I'd been given a deep discount on the monthly rent and had still struggled with the confines of my small pension. I knew it'd be virtually impossible to find a living arrangement that would suit me and my mind and that would take Mrs Bean and which would fit into my budget.

By the end of July I was homeless.

From August of 2014 to early March 2015 I couch surfed, lived out of a barn (eating in and using the bathroom of the attached apartment suite my friend lived in) and then out of a camper van provided to me by family members. I spent the Canadian winter living out of doors. The story of that will have to wait for another day but the upshot was that while I put great effort into making the best of it and I did a lot of spiritual healing during that time, the efforts of surviving a Canadian winter outdoors burned me right out again (this too I'll address in future posts on natural stressors and how our bodies respond to them).

In early March of 2015 a chance encounter led to a new living arrangement and I again found a home for me and Mrs Bean. I was given a small mobile home that I could call home. I could move my things in and be comfortable again (though still without heat).

But the previous eight months of homelessness and the stress of that caught up to me all in a rush and the all encompassing fatigue and brain fog returned.

This time, however, I was ready. I knew what was happening. I knew what to expect. I knew why it was happening. I could avoid the terrifying panic of losing one's mind. It still remains a tremendous struggle, however. There is little I can do in any given day. I get perhaps an hour or two of truly productive physical and/or mental energy a day. The rest of the time I have to take it easy.

I have no idea how much longer this will last. I have no idea how much longer I can take living like this. Scarcely a day goes by where at some point The Inevitable  doesn't enter my mind. I struggle every day to find reasons to keep going.

But I also try to remind myself what I've been through in the last six and a half years. 2007 is the last year where I had any kind of good mental health at all though even then, I can now see, the seeds for what was to come were being sown. 2006 is the last year I had full working capacity, a good stable life, a loving family and was completely depression or mania free.

From the end of 2007 I have either been in manic, hypomanic or depressive phases. From 2008 on I've battled episodes or instances of severe anxiety disorders, major depressive disorders, nearly a dozen psychotic episodes, numerous total mental breakdowns requiring hospitalizations, severe top of the chart suicidal danger (there are rating scales for that), the effects of Borderline Personality Disorder, at times being penny-less and homeless and all of the cognitive and mood disorders that come with all of that.

That's over six years – with the only exception being a few month stretch during the fall and winter of 2008-2009 – without what would be considered remission from psychiatric symptoms.

Most people with severe psychiatric disorder don't survive that. Most mentally healthy people don't survive that. 

For those reading along trying to understand psychiatric disorders, the prior twenty-nine months would be an absolute textbook case of classic manic-depressive cycle – weeks of full on mania with no sleep, months more of hypomania, several months of cycling between hypomanic periods of energy and mental clarity and brain fog depression and then finally a months and months long episode of classic depression. There is a rule of thumb about bipolar that says for every week of mania there will be about two months of depressive states. I can see now why that is (and some of the main reasons for this is what I outline in brain energy and mitochondrial dysfunction).

So sometimes I have to remind myself of all that, to remind myself that no wonder every cell in my body is burned out and to give myself permission to recover. I have to remind myself that I am still technically in the depressive cycle. Though I am able to control most of the mental symptoms that would normally accompany the depressive phase of a manic depressive cycle, the biological basis of the fatigue I cannot. I can only do my best to not make it worse and to allow it to recover naturally. 

I do this without medications or psychiatric care of any kind (the reasons for which I really must get to soon). I also need to get to in more detail what I do do (in addition to my positive difference making fundamentals, that is).

I also must daily deeply feel gratitude for what I do have. I have – despite everything – been incredibly blessed. There are countless people who in psychiatric terms have been put through something similar to me (the more difficult cases of schizophrenia, bipolar and major depressive or anxiety disorder) who are not so blessed. They end up on the streets, viewed as little more than human garbage. Many descend into substance abuse to numb their pain. Thousands take their lives.

Yet others – with little or no family support or understanding – slip into eternal hopelessness, living out their lives not living, not reaching, not dreaming, not understanding that they have greater potential, that there's more. They don't know that there could be hope, there could be ways to improve their mental states and lives.

I have seen them, talked to them and have heard from them when they come across this blog.

And it is for them that I continue, to fight to find a way.

Meanwhile, I do all that I can to ride out this depressive phase of this mother of all manic-depressive cycles. Twenty-nine months. That's a long time. On top of thirty months immediately prior to that of mental madness. And prior to that two and a half years of instability between mania, hypomania and depression. Mild episodes of psychosis had started in the summer of 2008. That's a staggering ninety months or so without remission. The worst of those ninety months, by the way, were the thirty months I spent on medications. About the only thing the mental health care system did was help make me aware that I had serious problems. They did virtually nothing to solve them (the only exception being a few days of group therapy that I found very useful, something I'll address when I explore the benefits of psychological therapies).

During the time since I had what would by my last psychotic episode (at the end of 2012) when I took full control of and responsibility for my own mental health and well being (and doing all the research that would lead to the creation of this blog), however, I did learn how to keep under control the worst of the symptoms. What I am left with is the inevitable burnout of the previous six and and a half years. The horrible fatigue, I can see now looking back, started in the spring of 2010 and has been worsening ever since.

It is very hard most days to believe that there is an end in sight, that I can look forward to a life with normal energy again. Five years of “data” - all indicators pointing to worsening and perhaps now incurable fatigue - makes it very hard to believe anything else is possible. It becomes very hard to believe that one can be something approaching normal again, that I can be productive again. 

Back to stating that I am dying. 

Many times it feels exactly like that for it feels like the very essence of my life has been sucked out of me. There is nothing there. It feels like I can barely even draw a breath. Days upon days of a blank mind with only dark thoughts fighting to get in. It feels for all the world impossible to survive another hour, yet alone another day, let alone another month, let alone life itself.

So daily I must manufacture hope out of nothing.

And it is so often my dear readers and followers who give me the will to do so.








4 comments:

  1. b, wow, what a trajectory, fascinating and inspiring, if really scary at times.

    i hope i can be part of the pack who can breathe that will into you, that hope.
    can you feel it?

    ReplyDelete
    Replies
    1. I appreciate that, a. I have a lot of supporters, an embarrassing number of supporters. All online. The struggle takes place in the real world, though. That's where I need more. Where anyone with a disorder like mine needs more.

      Delete
  2. *jaw drop*
    This is the most relatable thing I have seen written. I was just diagnosed Bipolar I during a mixed state; previously I had been working on my Master's in Counseling plus having other diagnosises. Anyways, the cycle of brain fog, depression, suicidal automatic behaviors, mania, insomnia - nailed it.

    ReplyDelete
  3. This comment has been removed by the author.

    ReplyDelete