6. Questions Without Answers

6. Questions Without Answers. . .

Perhaps calling this disorder by its old name was more appropriate--but less explanatory. Referring to it as bipolar disorder, a set of symptoms easily identified by an individual's behavior, makes it less a thing to be feared. I feared it as a diagnosis.

Scary news stories about bipolars going off their meds and engaging in strange behavior are common news. In the spring of 2012, a flight attendant employed by American Airlines, who was bipolar and off her meds, excited a planeload of passengers who expected a regular boring flight. The female flight attendant spoke on the public address system to the passengers about “not being responsible for the plane”, which “would be going down if it took off.” She ranted loudly till everyone in ear shot decided she needed to be relieved of her job responsibilities.

The passengers and the other flight attendants subdued the flight attendant, as by this time she was shrieking wildly and loudly. (What would you do if a planeload of passengers subdued you?) One passenger described her cries as wild and “blood curdling”.

The flight attendant was removed from the plance, indeed verified as bipolar, and whisked off to a psychiatric hospital facility. Life can become quite intense for bipolars, who may find themselves begging for an escape from a world of their own creation, but not of their own choice.

This disorder is based on a person’s biochemical and neurological activity, it comes from an excess or a depletion of certain chemicals that travel nerve impulses down pathways from the brain. It has both a heredity and environmental aspect. Bipolar disorder is not like a light switch that you can turn off and on. The control is in our body’s chemistry, which doctors attempt to manage with medication.

Calling it "bipolar" brings the whole matter into better light, don't you think? Calling a thing makes it so. Language works that way. Then you have to figure in that each of us are unique in our perceptions of life, based on our own personal experiences. Language is based on our unique perceptions. It's amazing we manage to communicate at all.

Whether you call it bipolar disorder, or "Manic-Depression" like Jimi Hendrix did in his song, it doesn't matter. Call it what you will, but don't call it like you can actually have any idea what it's all about.

I have finally perceived that it's all about perception. For all the books, magazines, journals, and Internet articles I've read, I actually only know what I have experienced in my own life. I know tropical weather, but I lack the personal experience to understand life in the land of penguins and frozen tundra. I also lack the motivation to have the experience. Am I at fault for this? Is this what you call a guilty pleasure? I enjoy warm weather.

I like living where it's usually sunny and warm--my opinion based on personal perception. Everybody's got one, an opinion that is, but they don't always acknowledge it. Actually, you have to be aware of some facts and information to have an intelligent opinion. It's easier to not get involved, to not have to think, to not have to deal with new challenges. I suppose that could be somebody else's guilty pleasure. Who am I to judge? But we do judge, don't we?

Nobody walks in another person's Uggs any more, though at present prices I understand why one would aspire to. That company gets an amazing price for a functional product, in my opinion. In addition, children wear these extravagant foot coverings! It’s adolescent chic.

How often do we wonder what kind of day the person is having that's giving us so much trouble. There's lots of trouble running around out there in the world, and it runs deep.

Current statistics have bipolar disorder diagnosed in the general population as affecting between 2% - 20% of the US in 2012, according to data from NIMH (National Institute for Mental Health). In my studied opinion, I would estimate that the incidence of undiagnosed bipolar disorder is just as high. Lots of people are walking around with problems for which they have no answers

Okay, I was never great at math, and I realize this is kind of pushing mathematical statistics, but--that is almost as high as one person in five. Think about that the next time you are in a crowd waiting to fill your vehicle with gasoline, or as you are waiting for your turn at a busy convenience store. Thank goodness, we aren’t all primed to go off at the same time!

How many people do you deal with on a daily basis? If you knew who the bipolars were, would you act differently around them, or treat them differently than you would other "regular" people? Moreover, would it matter?

For all the positive neurochemical adjustments those psychopharmacologically educated psychiatrists attempt to precipitate with their 'antipsychotic cocktail mix", they don't really know what it is to be bipolar either. You can't really know it unless you're inside it, and it's inside you. When it's in you, “they” tell you that you aren’t yourself--or you're too much yourself.

Manic depression is a terminology that is too austere, too grave, and serious for me. It feels cold and clinical. It smells of a hospital. For me, the term paints images of white straight jackets and white walls in a ward where attendant men in white suits do their best to restrain some overwrought individual, flailing and scratching and screaming, doing harm to themselves and anyone within reach. It is such a vivid image--I cannot remember if it was from an old black-and-white film noir I had seen, or if it were a hazy recollection of my own past. I grew up on Hitchcock, so it's hard for me to say.

I agree with George Carlin's analysis that we as a people tend to ease away the harshness of words associated with harsh things. He explains how the "shell shock" of World War I went through various changes until we came to know it as "Post Traumatic Stress Disorder or Syndrome." Now it has a tidy and politically acceptable term to cover it. It sounds less messy than the graphic previous version called shell shock. You can even call it PSTS, or PSTD, and obliterate any notion of the meaning. However, to paraphrase Carlin, it's still fucking shell shock.

Bipolar disorder is Manic Depression.

It’s not two different diagnoses.

Bipolar Disorder is Manic Depression

I stress this because I knew a teenager who had been given the same bipolar disorder diagnosis with which I deal. His mother told him that they were two different diagnoses, and he only had bipolar disorder. It’s a real shame when a family member is uninformed or misinformed.

Most who learn that a friend or family member has this diagnosis, want to know more about it. When you read articles about bipolar disorder on the Internet, note if you are reading what a patient wrote, or if some PhD wrote the work. There are many differences of opinion, but the fact is the fact. Can you read a section of text without making the distinction as to whether you are reading fact or fiction?

Besides the mania and depression, is the entire awareness of the unique perception of life in-between the two extremes. That is what is afflicting me now. I would not call what I have depression, because depression is much worse than what I’m feeling now. I am not able to maintain a daily productive routine like I can usually. Nevertheless, it feels a lot like depression, and I can't shake it. You cannot shake bipolar disorder either. You cannot think it away. It is in your blood if you have the diagnosis.

Due to my insurance company inserting their primal veto in my psych doc’s prescription for my ills last fall, I cannot seem to get the right meds to shake my bipolar funk now. Most meds will not produce a noticeable change in an individual’s prognosis for ten days to two weeks, or even longer. Time is of the essence when it comes to prescribing to alleviate bipolar symptoms. It’s not easy to wait for medicines to take effect. Often finding the right mixture of meds for an individual is a process of trial and error on the doctor’s behalf. From the patient’s perspective, it is a very slow process.

My psychiatrist suggested a medication that the insurance would not approve initially. My doctor was open enough to discuss other treatment options and the pros and cons of each. It’s difficult to select when both options include side effects that one doesn’t want. In addition, one doesn’t know what side effects a med will actually produce until one takes it. Package inserts, as well as Internet pharmaceutical sites, state the side effects experienced by individuals in formal studies of all FDA-approved medications and the various percentages of reported side effects. Side effects and percentages shown are available for all medications, but finding the information may take some hunting. There are times I gave up before I found anything. Perhaps there's something to be said about expecting side effects to show up if you know what may happen.

Some side effects are tolerable; one can learn to live with them. Some are not, because, in my opinion, they affect the quality of my life. I didn’t mind being thirsty when I took lithium, but it increased my appetite and slowed my metabolism so I gained 75 pounds over a winter, about four and a half months. I developed back and knee problems from my weight, and I was tested for thyroid irregularities since the thyroid can produce bipolar-type symptoms. I concluded that my doctor needed to consider other options to keep me emotionally stable. I am one who can’t take lithium for mood stabilization. Eventually, a doctor removed lithium from my prescription diet, and I take a different mood stabilizer.

One anti-psychotic cocktail consisting of numerous meds that helps one bipolar may not help another. Nevertheless, the Internet has lots of chat rooms where patients do discuss specific medications and their side effects. I am currently taking two medications as mood stabilizers, in addition to an anti-depressant. I take another pill for anti-anxiety a couple of times every day. Four types of pills a day is manageable, but it does take me most of the day to get all my pills down my throat because there are 13 pills total. I prefer not to experience the side effects that go along with swallowing all my daily medication at once.

Most of the problems I’ve experienced as a bipolar patient have to do with medication keeping me too sleepy to function productively. With my disorder presently, I can’t shake the sleepy side effect of one. I feel like I’m going through my day in a haze, and I don’t feel like myself. This is a topic to take up with my psychiatrist at my next appointment. Doctors usually begin by telling you that you’ll become accustomed to the dose, and the side effects won’t be debilitating. If I take a medication for a month, and my productivity, in terms of keeping a basic daily routine falls off, I have a reason to ask the doctor to adjust the dosage or discontinue the medication.

Patients, myself included, perceive a psychiatrist as a personally unapproachable professional. A good psychiatrist feels like a friend because one ends up spilling his most embarrassing and emotional experiences. If you aren’t honest with your psychiatrist, you’re not looking out for your own best interests.

Far too many patients take the doctor at his word and avoid giving input. When meds don’t work as predicted, the patient may stop taking the medication before consulting the doctor. These patients sometimes end up going off their medications, having symptoms that erupt into severe psychosis, and often end up requiring days to weeks of hospital treatment.

Having a doctor who is knowledgeable about chemicals in the bipolar brain, and who is willing to listen to his patient’s concerns is the key to successful treatment. A good psychiatrist knows his pharmacopeia for bipolar disorder, why the meds are used, and how to expect the patient to react at any given dose of a specific medication.

New medications for bipolar symptoms are being marketed to doctors by pharmaceutical sales reps all the time. My doctor has prescribed some medications marked as “off-label use”. I trust that my doctor knows what he is doing, but I try to understand the biochemical side myself also.

The basic biochemistry of bipolar disorder introduces words like neurons, which are part of the nervous system. Neurons have fingerlike dendrites extending between cells, and they and axons carry messages all over the human body. The bipolar brain experiences an abundance (mania) or a deficit (depression) of the chemicals which lubricate the message pathways. Bipolars have a different brain structure or a difference in the pathways that messages travel. Not every bipolar will react the same way to the same medications. A bipolar may not respond to the same medication the same way at different times. Medication is always a challenge for the psychiatrist and the patient.

Insurance authorization is often a requirement in addition to a written prescription from your psychiatrist. If the insurance company should deny you a medication that your doctor feels is appropriate, you have the option as a patient to ask your doctor to formally appeal the insurance company’s decision.

At this point, my prescriptions have eventually been approved, but the authorization process can postpone starting a medication for two or three weeks. When bipolars need a medication change, they need it now. The additional passage of time before a medication is begun is another irritant in the system because symptoms often become more severe or intense if not treated immediately.

Although individual medications may be inexpensive, like lithium, other a-typical antipsychotics are quite expensive. In addition to the cost of the doctor’s office visits, and the cost of medication, bipolars at times, must enter in-patient treatment at a psychiatric facility.

The role of the insurance company in my mental health care is a matter of contention for me because I prefer to be treated by my psychiatrist and not my medical insurance company’s bottom line. I finally got a prescription for what was helping me before my meds got changed last fall, and they aren't working like they did the last time I took them. I feel blah--well, worse than that because I've just risen from spending three days in bed. I've been awake for six hours, and I'm fighting myself to keep from climbing back into my sleep space. I've got so much I need to deal with, and I can't seem to deal with anything except sleeping in my bed. I can’t concentrate.

This hasn't turned out to be the brilliant editorial I had envisioned. I'm just in that zone where I aspire to brilliant editorial and a couple of half-thoughts and general linguistic complaints surface. If there were a magic button to push to fix my innards, I'd push it. I guess my personal challenge right now is not pushing the wrong buttons.

Even when you're not manic, and even when you're not depressed, the bipolar middle ground isn't like most other people experience. A mixed state can have a person feeling both the grim seed of depression, as well as the sleeplessness of a manic episode.

I tend more toward mania in the summer--when I get more sunshine and vitamin D. It's May now. When depressed, I look forward to mania. However, mania can be just as dangerous and debilitating as depression, but I personally prefer it. I can take a positive step toward shaking my blah feelings by taking a walk in the sunshine, as soon as the sun comes out from behind the clouds. The weatherman says it's going to rain. However, it can’t rain forever and I won’t stay depressed forever—though it feels like it sometimes.

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