Monday, July 8, 2013

Bipolar and Suicide

Some of my embryonic thoughts on the connection between bipolar disorder and suicide which, while embryonic, are, quite frankly, probably better than you'll find in most sources. Again, you'll have to trust me on this as I build my credibility and case. Part of my case is based on the fact that I get to study my own mind. I have vast amounts of personal experience with manic depressive cycles and episodes as well as probably being as deeply researched and widely read on both bipolar and suicide as anyone you're likely to meet. At any rate, here we go:

The numbers are stark. From the book Taming Bipolar,

The statistics on bipolar disorder and suicide are unrelentingly grim: the risk that you will attempt or commit suicide if you're bipolar are between 8 and 20 percent with the "smart money" going for the high end of that range. Put another way, if you're bipolar, then you're between ten and twenty times more likely to commit suicide than your non-bipolar friends and neighbors. You're also more likely to do it "successfully". 
To be frank, I'm not sure I really wanted to know that but there it is. The list of famous people with bipolar disorder that have committed suicide is a long one. I waver back and forth on whether bipolar is an "illness" or not (and there are strong arguments for "not") but the connection between bipolar and suicide may, I think, heavily tilt in favour of it being an illness.

The name of my book is Dancing in the Dark - Why? (1) and that's what I just keep asking and deeply digging into - why?. And the whys of bipolar and suicide are, for obvious reasons, a big one for me. These are, as I've said, my embryonic thoughts. I started researching bipolar and suicide three years ago, just after my first psychotic episode and attempt. I quickly came across studies that showed that bipolar brains are physically different. Again from Taming bipolar,

What differences are seen in the brain in bipolar disorder? For one thing, there may be enlargement of the ventricles, those spinal fluid filled cavities at the center of your brain. It also wreaks havoc with your amygdala, your brain's almond shaped "seat of emotion" - the place from which your feelings and impulses arise. 

There are, as I pointed out in another post, observable changes in the hippocampus (found through studying cadavers of those with bipolar who committed suicide). Also there are changes in the function of the frontal cortex - the "driver's seat" of the human brain where our cognitive functions take place. But, as I've also pointed out, psychiatric drugs have been proven to cause brain tissue damage so it all becomes a chicken or the egg question - did the brain start out that way and that's why one is bipolar? Or did the presence and long term outcome of the disorder cause the physical changes? Or, as has been demonstrated as possible, did the very drugs prescribed and taken for the disorder cause the changes?

Again, and this is very frustrating, let me tell you, no one knows for sure. And as I described in the post on the human brain, things are awfully complicated up there.

But this is what I think. And this comes from someone with a) thirty years of experience with living with bipolar, b) someone who's experienced a LOT of suicidal behaviour and, most importantly <puts on science hat> c) one who is very well studied on it and able to think on a very high level about it.

These are the areas that I think that contribute.

Cycles and swings between mania and depression:

I cannot emphasize this enough. And it is so hard for anyone - even doctors - to understand just what goes on during these swings and cycles. Trying to describe this and explain it is, as I described to one person, like trying to describe colour to one who's been blind all their life; they simply cannot imagine what colour "is" because they have no "data input" in their mind for it. I could describe and explain this at great length but I'll sum it up thusly; the swings between mania and depression are so great and so opposite of each other that just these swings - never mind the states themselves, just the swings between the two - are literally maddening. There have been times - and I am by no means exaggerating here - I'd have put a gun to my head and pulled the trigger just to make them stop. It's like being on the most sickening roller coaster in the world and you will do anything to just to get the fuck off of it. So yeah, right there would be one possible reason. 

The stark difference between the manic mind and the depressed mind:

The manic mind can be many things, many of them not good, but what I need you to understand now is the "good" and "up" side to mania. When you are manic, you are fucking brilliant. I mean flat out fucking brilliant. This is well documented. You operate at levels you never in your wildest dreams thought possible for your brain. And you are optimistic. And driven. And motivated. And full of dreams. Life has endless possibilities when you are manic. You have ridiculous amounts of energy. You have mental clarity that Einstein would kill for. Mania "lifts you up where you belong". It is, without a word of a lie, a thousand times better than the best euphoric drug on earth. People would kill to have a drug that makes you feel like you do when you're manic. It is way beyond and above cloud nine. And it's all right there, right there in your own little noggin for free. 

Then, like Icarus, the wax melts off your wings and whoooooooooooooooooooooooooooooooooosh, you crash back to earth. Let me introduce you to manic depression. Manic depression is, I'll always say, much worse than "normal" depression. You'll have to trust me on this one; I've had lots of experience with both. Basic depression doesn't even come close. As high functioning as the brain was when manic the brain is as low functioning when depressed. Brain scans bear this out. A brain when in the throws of manic depression is largely shut down. It doesn't just feel like it's not functioning, it's NOT functioning. It is the blackest black possible in the human mind. The brain can barely handle even the most basic of daily tasks. Whereas when manic you barely needed any sleep, now twelve (or more) hours a day barely feels adequate. It is, I swear, as close to brain dead as you can get and still be functioning. And it's not just this state that is bad, it's the fact that just before your brain was operating at such a high level. It's the contrast that's part of what makes it feel so bad. (2)

And here's the thing - your manic mind created all these ideas, all these plans; books, music, business plans, you name it. Things which probably had great meaning to you and which you wanted so, so badly. Then - POOF! - all gone. Again, this is literally maddening. When you go through several cycles of this and you no longer have any idea of who you are and what, it's ... well, so maddening that you want to kill yourself. And here's the other thing about manic depression; it can treat you, non-stop, to the very worst memories of who you are.

And here's the other, other thing. You have no control over these states. None. You can't turn them on or off or make them stop once they take control. Your brain, your you, your personality, your actions, your thoughts, your everything is in the complete control of whatever "it" is. 

Welcome to my nightmare. But wait! It gets MORE fun!

Manic Psychosis:

Again, all but impossible to describe. I may as well try to describe the Internet to a Borneo tribesman who's never done anything more than bang two coconuts together to communicate. One of the things that "good mania" can give you is visions. When these visions are good things - like an entire story line for a book played out in my mind like a movie (literally; I did nothing, I thought of nothing, I created nothing. I just "sat back" and "watched" it unfold in my mind just like watching a movie) - it's a great thing. 

But this can go the other way. It can create horrific nightmare visions. Another thing to understand here is the power of mania. Think atomic energy. Think enough power and energy to light up a city. Or think an atom bomb strapped into the belly of the Enola Gay. It truly is that powerful. And when it goes wrong, it goes really wrong. It will fuck with your mind in ways that will make a combination of the worst nightmare you can imagine and a phobic reaction look like a trip to Disneyland. Again, I invite you to read my description of one here. While I wrote in metaphor and in allegorical form, the events and details of that were absolutely real. It is graphic, graphic visions, voices (inner or projected) and demands of self harm or death. Like slashing the shit out of your throat with a knife. Or jumping in front of a train. Or putting a gun to your head. And all your worst nightmare memories. All played out like a movie in your head. And demands to carry out what you're "watching". And I went through a dozen such events (though that one was the worst). It is the worst terror possible that you can imagine. And it's inside your head.  There's no stopping them, no turning them off, no "waking up" and them going away (like a sleeping nightmare). Nothing. You have ZERO control over them. NONE. It's just hang on for the ride and hope you survive. Or have enough to make you want to survive. 

(1) the book I refer to here (and elsewhere throughout my posts from 2013) is a book manuscript I wrote but do not intend to publish. There is a lot of good material in it that I continue to mine, however.

(2) I would later discover the neuroscience behind what happens when the brain plunges from the high, manic energy into depressive phases and summarized what I found in a three part series. The second part of that series perhaps best describes why what I describe in that paragraph (the one after which "(2)" appears in this piece) occurs. The series I link to takes a good deal of the mystery out of why mania almost always ends in "burnout" and a depressive phase. - BGE, Oct, 2014

1 comment:

  1. I have been starting to wonder if a component in the suicides of those diagnosed mentally ill might to some extent be because of the diagnosis, the label, convincing the individual that rather than suicide being a permanent solution to a temporary problem is a permanent solution to a life that will never be right.

    Then, there's the vicious treatment.