JENNY HEARNS KENDALL COLLEGE OF ART AND DESIGN SECOND EDITION, 2016
This book is for those who want to know more about bipolar disorder, whether they have bipolar, have a loved one who has bipolar, know someone who is bipolar, or just want to be educated. Besides providing basic background information on the condition, this book acts as a collection of stories, from a family who has had personal experience with bipolar disorder. There will be advice on how to cope with the never ending roller coaster of emotions caused by this condition. This is the type of book I wish I had when my brother had been first diagnosed with bipolar and the book that I wish others who know him could have. Acting as a simple reference guidebook and memoir, I would want those going through experiences similar to my own to have access to the information this book provides. Bipolar is condition that affects communities, not just one individual. In the pages that follow, you will discover that there are more than two sides to bipolar. I hope this book will help you in your understanding of bipolar as it has helped me.
Bipolar disorder is a chronic mental illness that causes dramatic shifts in a person’s mood, energy and ability to think clearly. People with bipolar have high and low moods, known as mania and depression, which differ from the typical ups and downs most people experience. If left untreated, the symptoms usually get worse. However, with a strong lifestyle that includes self-management and a good treatment plan, many people live well with the condition. With mania, people may feel extremely irritable or euphoric. People living with bipolar may experience several extremes in the shape of agitation, sleeplessness and talkativeness or sadness and hopelessness. They may also have extreme pleasure-seeking or risk-taking behaviors.
The chances of developing bipolar disorder are increased if a child’s parents or siblings have the disorder. But the role of genetics is not absolute. A child from a family with a history of bipolar disorder may never develop the disorder. And studies of identical twins have found that even if one twin develops the disorder the other may not. A stressful event such as a death in the family, an illness, a difficult relationship or financial problems can trigger the first bipolar episode. Thus, an individual’s style of handling stress may also play a role in the development of the illness. In some cases, drug abuse can trigger bipolar disorder.
Brain scans cannot diagnose bipolar disorder in an individual. Yet, researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. While brain structure alone may not cause it, there are some conditions in which damaged brain tissue can predispose a person. In some cases, concussions and traumatic head injuries can increase the risk of developing bipolar disorder.
To diagnose bipolar disorder, a doctor may perform a physical examination, conduct an interview and order lab tests. While bipolar disorder cannot be identified through a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder, such as hyperthyroidism. If no other illnesses (or other medicines such as steroids) are causing the symptoms, the doctor may recommend the person see a psychiatrist. To be diagnosed with bipolar illness, a person has to have had at least one episode of mania or hypomania.
Bipolar I Disorder is an illness in which people have experienced one or more episodes of mania. Most people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I, a person’s manic or mixed episodes must last at least seven days or be so severe that they require hospitalization. Bipolar II Disorder is a subset of bipolar disorder in which people experience depressive episodes shifting back and forth with hypomanic episodes, but never a full manic episode.
Cyclothymic Disorder or Cyclothymia, is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks. Bipolar NOS (not otherwise specified) and bipolar NEC (not elsewhere classified) is diagnosed when a person does not meet the criteria for bipolar I, II or cyclothymia but has had periods of clinically significant abnormal mood elevation. The symptoms may either not last long enough or not meet the full criteria for episodes required to diagnose bipolar I or II.
Bipolar disorder deals with two extreme ends of the spectrum: depression and mania. Here’s how these opposing moods differ. Depression produces a combination of physical and emotional symptoms that inhibit a person’s ability to function nearly every day for a period of at least two weeks. The level of depression can range from severe to moderate to mild low mood, which is called dysthymia when it is chronic. The lows of bipolar depression are often so debilitating that people may be unable to get out of bed. Typically, depressed people have
difficulty falling and staying asleep, but some sleep far more than usual. When people are depressed, even minor decisions such as what to have for dinner can be overwhelming. They may become obsessed with feelings of loss, personal failure, guilt or helplessness. This negative thinking can lead to thoughts of suicide. In bipolar disorder, suicide is an ever-present danger, as some people become suicidal in manic or mixed states. Depression associated with bipolar disorder may be more difficult to treat.
To be diagnosed with bipolar disorder, a person must have experienced mania or hypomania. Hypomania is a milder form of mania that doesn’t include psychotic episodes. People with hypomania can often function normally in social situations or at work. Some people with bipolar disorder will have episodes of mania or hypomania many times; others may experience them only rarely. To determine what type of bipolar disorder people have, doctors test how impaired they are during their most severe episode of mania or hypomania. Although someone with bipolar may find an elevated mood appealing—especially if it occurs after depression—the “high” does not stop at a comfortable or controllable level. Moods can rapidly become more irritable, behavior more unpredictable and judgment more impaired. During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks. Most of the time, people in manic states are unaware of the negative consequences of their actions. It’s key to learn from prior episodes the kinds of behavior that signal “red flags” to help manage the illness.
There are many different types of episodes someone with bipolar disorder can experience. Mania is the flip side of depression; it’s the wired side of tired. However, you don’t officially experience a manic episode unless the mania lasts for at least one week or requires hospitalization. The episode must be characterized by an abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy and be present most of the day, nearly every day. Three of the following symptoms must also be present during the week (four, if your mood is irritable rather than elevated or expansive). The symptoms must be present to a significant degree and represent a change from usual behavior. Inflated self-esteem or grandiosity Decreased need for sleep Excessive talking or the need to talk continuously Racing thoughts with plenty of ideas or “flight of ideas” Inability to concentrate and being easily distracted by insignificant external stimuli Significant increase in goal-directed activity or significant physical movement or agitation Excessive involvement in risky, potentially self-destructive activities, including sexual indiscretions, unrestrained shopping sprees, and optimistic investments in pyramid schemes
A diagnosis of hypomania requires the same number of symptoms as a manic episode. For instance, the symptoms must represent a distinct change from a person’s usual behavior patterns,
and the changes must be observable by others. However, hypomania differs from mania in that hypomania has the following characteristics: May be shorter in duration (just four days is enough to qualify as a hypomanic episode) Doesn’t cause severe impairment in function Doesn’t require hospitalization Doesn’t include psychosis
Major depression makes you feel like you’re swimming in a sea of molasses. Everything is slow, dark, and heavy. You must have five or more of the following symptoms that last at least two weeks straight. These symptoms must be changes from usual behavior, and the episode needs to include depressed mood or loss of interest. Depressed mood most of the day nearly every day Markedly diminished interest nearly every day in activities previously considered pleasurable, which may include sex Notable change in appetite that lasts for two weeks or a marked change in weight (5 percent or more) in a span of one month or less that isn’t attributed to dieting Moving uncharacteristically slow or having physical agitation observable by others, not just internal sensations Feelings of worthlessness, excessive guilt, or inappropriate guilt nearly every day Uncharacteristic indecisiveness or diminished ability to think clearly or concentrate on a given task nearly every day, experienced internally and/or observed by others
Recurrent thoughts of death or suicide Sleeping too much or too little nearly every day Daily fatigue
A mixed episode is defined as meeting the full criteria for both a depressive and manic or hypomanic episode, except for duration. A person in a manic episode, for example, would have significant depressive symptoms—either at the same time or within a waxing and waning course of mania. The depressive symptoms don’t need to meet the full criteria of a major depressive episode, but they can. In other words, if someone has full symptoms in both states, then the episode may be described as a manic episode with mixed features of depression. Similarly, if someone with a major depressive episode experiences significant manic or hypomanic symptoms at the same time or within the same time frame, then the episode may be described as a major depressive episode with mixed features.
Perhaps the most frightening accompaniment to depression or mania is psychosis, which may include delusional thinking, paranoia, and hallucinations (typically auditory as opposed to visual). Although psychosis isn’t a necessary part of the bipolar diagnosis, it can accompany a mood episode. The extremes of depression and mania are sometimes associated with profound changes in the reality-testing system of the brain, which lead to severe distortions in perceptions and thinking. During a psychotic episode, any of the following symptoms may be experienced: Feel as though you have special powers Hear voices that other people can’t hear and that make you
believe they’re talking about you or instructing you to perform certain acts Believe that people can read your mind or put thoughts into your head Think that the television or radio is sending you special messages Think that people are following or trying to harm you when they’re not Believe that you can accomplish goals that are well beyond your abilities and means
Most people with bipolar disorder need to take medicine to help manage their moods, but there is no magic pill to alleviate all symptoms. Medications work differently for everyone; one medication can be a blessing for some and a disaster for others. This section introduces the most routinely prescribed medications that treat bipolar. Since the 1960s, lithium has been the gold standard, treating the range of bipolar symptoms more fully than any other medication in use today. It treats mania. It treats depression. It can reduce the cycling of mania and depression. And perhaps most importantly, it’s the only medication that’s proven to reduce the risk of suicide associated with bipolar. Lithium truly is in a league of its own. Interestingly, this wonderful med wasn’t cooked up in a multimillion-dollar lab. Lithium is a naturally occurring salt that just happens to reduce a number of mood symptoms safely when managed under a doctor’s care.
Your brain and central nervous system form an intricate power grid that carries very low-level electricity. With serious central nervous system malfunctions, as in epilepsy, neurons misfire to such an extent that they can cause seizures. Anticonvulsants—including valproate, commonly known as valproic acid (Depakote)—appear to reduce seizures, at least in part by regulating neuron firing. The mechanisms of bipolar aren’t the same as seizures, but a number of anticonvulsants are effective in treating some symptoms of bipolar disorder. Stabilization of neuron cell firing may play a role, but researchers are studying other potential mechanisms of action. Anticonvulsants include Depakote, Depakene, Tegretol, Carbatrol, Epitol, Equetro, and Lamictal. Trileptal, Topamax, and Nerotin are other anticonvulsants that are occasionally used for bipolar disorder, but are not considered effective treatments for bipolar symptoms.
Atypical antipsychotics (atypical neuroleptics or second-generation antipsychotics), were originally formulated to treat psychosis in schizophrenia, but this class of medications has also proven effective in reducing mania and augmenting antidepressant treatment. The atypical or second-generation moniker stems from the fact that this newer breed of antipsychotics works differently than the older standard or first-generation neuroleptics, such as chlorpromazine (Thorazine) and haloperidol (Haldol). Antipsychotics include Zyprexa, Relprevv, Risperdal, Seroquel, Geodon, and Abilify.
Researchers have started looking closely at protein kinase c (PKC) as a possible target in treating bipolar, particularly for mania. PKC is actually a group of enzymes (proteins that trigger chemical reactions in the body) that has many functions in the body. In the brain, PKC plays a vital role in coordinating and translating chemical reactions inside of cells. Many studies suggest that over-activation of PKC pathways may be related to manic symptoms, and inhibiting the pathways (with PKC inhibitors) reduces mania.
Although mania grabs all the bipolar headlines, recurrent and severe depressive episodes can be significantly more devastating than mania and just as dangerous. People with bipolar most often seek treatment during depressive periods, which means antidepressants are often the first medications prescribed. The effectiveness and safety of antidepressants for people with bipolar disorder are sources of considerable controversy. Some experts believe that antidepressants are effective and often necessary because medications used to treat mania typically don’t treat depression or fully control it. Others believe that antidepressants actually cause more mania or mood cycling. Evidence exists to support both sides of this argument. Serotonin is a brain chemical that helps regulate mood, anxiety, sleep/wake cycles, sexual behaviors, and many other brain functions. Selective Serotonin Reuptake Inhibitors (SSRIs) increase the level of serotonin in the synapses—the paces between brain cells (neurons)—in the brain. SSRIs may take several weeks to become fully effective. An SSRI may be combined
with an antipsychotic. SSRIs include Prozac, Zoloft, Paxil, Celexa, Lexapro, Luvox, and Symbyax. Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) increase the levels of two brain chemicals—serotonin and norepinephrine—in the synapses between brain cells. As in SSRIs, the full mechanism of action of SNRIs is poorly understood. But researchers know that, like serotonin, norepinephrine plays an important role in regulating mood and anxiety as well as alertness and concentration. SNRIs may take several weeks to become fully effective. SNRIs include Effexor, Cymbalta, and Pristiq. Marketed as Zyban and the antidepressant Wellbrutrin, Bupropion increases the levels of dopamine and norepinephrine in the brain synapses. It has an unknown mechanism of action but is clearly different from antidepressants in other classes, such as SSRIs, SNRIs, and tricyclics; therefore, bupropion belongs in its own category. Other uses include treating nicotine addictions and possibly ADHD. Tricyclics and monoamine oxidase inhibitors (MAO inhibitors or MAOIs) are older classes of medications that work differently from other antidepressants and even differently from one another. These meds are used much less often than many of the other treatments for bipolar because the side effects of tricyclics and MAOIs can be difficult to manage. Tricyclics affect norepinephrine and serotonin levels primarily, but they also touch a number of other brain chemicals, including histamine. These “extra” chemical events cause many side effects, which
may include sedation, dry mouth, constipation, and dizziness, as well as cardiac rhythm changes. MAOIs prevent the action of an enzyme that breaks down norepinephrine, serotonin, dopamine, and a number of related brain chemicals, which increases the levels of these chemicals in the brain. People taking MAOIs are restricted from eating certain foods, including but not limited to aged meats and cheeses and certain types of beans, to prevent a dangerous spike in blood pressure. MAOIs can also have severe interactions with many other meds. Glutamate is a neurotransmitter related to excitatory or energizing circuits in the brain. Research increasingly shows a strong correlation between glutamate systems and depression and bipolar. Researchers are looking closely at two meds that affect this system, Riluzole (Rilutek) and Ketamine, and preliminary studies show positive results.
Anxiety and sleeplessness often accompany bipolar disorder. If you don’t address them effectively in treatment, they can worsen mood episodes and other bipolar symptoms. To help someone with bipolar to calm down and get some sleep, his or her psychiatrist may prescribe one or more antianxiety medications or sleep aids. The most commonly used purely antianxiety meds are benzodiazepines (also known as anxiolytics or tranquilizers or benzos for short). These medications slow down the whole nervous
systems, thus reducing agitation and anxiety levels, both of which can be problems in bipolar disorder. Benzos appear to affect a brain chemical called GABA (gamma-aminobutyric acid), which has a calming effect on neurons. From many people, just knowing they can take a medication to stop a panic episode helps reduce the secondary fear of having an episode. Examples of benzos are Valium, Ativan, Xanax, and Klonopin. A couple less commonly prescribed antianxiety medications include buspirone and pregabalin, which aren’t considered tranquilizers. Buspirone (Buspar) is sort of a cross between an SSRI antidepressant and a benzo. Like an SSRI, buspirone affects serotonin systems and must be taken daily to become fully effective over time. But buspirone, unlike an SSRI, affects serotonin by increasing the activity or receptors for serotonin on the outside of brain cells. And like a benzodiazepine, buspirone reduces anxiety, but the effect isn’t immediate, as it is with benzos. Pregabalin (Lyrica) is approved for the treatment of fibromyalgia, a disorder of chronic pain and fatigue often associated with anxiety and/or depression. Some studies suggest its use as an antianxiety med, but this hasn’t been well studied. Side effects may include dizziness, sedation, tremors, and weight gain. Doctors commonly prescribe sleep aids for the short-term treatment of insomnia, which is often associated with depression and mania. The benzodiazepines listed in the previous section are often used to help with sleep, but a number of medications are designed to help specifically with sleep problems but not anxiety. Non-benzodiazepine
sleep aids aren’t usually combined with benzos because the two medications are actually closely related and the combined sedation effects can be dangerous. Non-benzo sleep aids include Ambien, Lunesta, and Sonata. Benzo sleep aids include Restoril and Dalmane.
Psychopharmacology is the use of psychotropic medications (any prescription drugs that affect mood, emotion, behavior, or perception) to treat mental illness. In the case of bipolar disorder, psychopharmacology has three primary goals: Alleviate acute manic and depressive symptoms, sometimes at the same time Maintain mood stability and reduce the likelihood or frequency of future mood episodes Treat any additional symptoms, such as anxiety or insomnia
Meeting all three of these goals is a tall order. There are several reasons why psychiatrists sometimes have such a tough time prescribing the right medicines. These include: Symptoms differ among people Symptoms change People can have multiple disorders Individual medications may not treat all symptoms Effectiveness and side effects differ for each individual Medications can worsen symptoms Medications can interact with each other
SOURCES: “Bipolar Disorder.” NAMI: National Alliance on Mental Illness. Web. 27 Nov. 2015. Fink, Candida, MD, and Joe Kraynak. Bipolar Disorder For Dummies. 2nd ed. John Wiley & Sons, 2013. Print.
The following stories are accounts of one family’s experience dealing with bipolar disorder. These stories were written without the influence of another’s retelling of the story. Poems written by this family’s loved one with bipolar will appear throughout these stories. These poems are based on his experiences with mania. Here is how one shared experience can be viewed by three generations: a sister, a mother, and a grandmother.
I was about to start a new chapter in my life when it all seemed to happen. I had finished community college and was transferring to another college in a different city. I had just been diagnosed with Crohn’s disease while my older brother was losing his mind. He had recently graduated from college and broken up with his girlfriend, who had not been a great influence on him. I went on trying to adjust to my new way of life away from the comforts of home, meanwhile my brother was embarking on what would be his first manic episode that lasted months. It was hard being in one part of the state, while my parents were in another, and my brother in yet another. I noticed he was being much more social and using social media more than usual. Then there was his “project,” the grandiose idea that eventually resulted in his being arrested for breaking and entering in order to accomplish his “goal.” There was also the time where he was found face down on the sidewalk at night, black out drunk, a hole between his upper lip and nose where his teeth cut through. Being away from all of this was very hard. I never knew what I would hear when my mom called. There were many times where I feared
the worst. He was losing control. His friends were noticing it too. The cops had to be called and he was hospitalized. Not soon after being released he was hospitalized again. He had become psychotic. He had been doing drugs. He had been drinking. He had become a different person. I wish I had known what was going on with him. It was as if someone had taken over his body and he was a completely new person. It’s hard seeing someone else inside a person you love. It’s even harder to separate the two. I saw the person I grew up with doing and saying hurtful things. It made me wonder if he truly meant everything he was saying or not. He lost a lot of friends as a result of his first manic episode. Friends who had been around since he was in middle school. It was hard seeing them just drop him without trying to understand everything that was going on and educating themselves. His real friends stuck around, although we often have to encourage them to remind him that he had friends who care for him. These friends continued to be loyal and forgiving during his next manic episode. My brother had returned home to live with my parents after being released from his second hospitalization during his first manic episode. Although he now had a diagnosis, he spent most of the next two years in a deep depression. It was during summer break in 2015 when I started noticing behaviors that made me nervous. I was told I was being paranoid by those I voiced my concern to.
A lot seemed to be happening in a small period of time: he had recently lost a job in his field due to cut backs; he wasn’t invited to the wedding of a longtime friend; and he was working a new job that was labor intensive. There was more activity on his social media pages, he was going out drinking with friends, and he met a new girl. He came home one night, after my parents had gone to bed, and was being very talkative with me. I knew he had been drinking so I just thought his giddiness was because of that. He showed me his phone and the long conversations he had already had with a girl he had just met. My brother is usually a reserved person, which made me suspicious. Two years ago, he had met girls and said he was going to marry them. I could see the same thing happening with this girl too and it did. He became very obsessive about her. After awhile, others started noticing his bizarre behavior. We were thankfully able to get him help sooner this time due to being in such close proximity to him. The cops had to be called and he was hospitalized. This was the first time I had seen him while he was in a hospital and it was very heartbreaking. From my past experiences with him, I learned to not argue with him in order to keep him calm. He would get a bad temper when manic. The hard part was convincing my extended family members about his condition. He had been released from the hospital before he had leveled out and was kicked out of the house for his bad behavior towards my parents. He believed everything
was perfectly all right with him and apparently others believed him. He got a ride with my grandma to my mom’s nearby hometown where he spent three days causing problems for many people. My grandma finally understood how bad he could get after he stayed with her for a night. While other family members saw his behavior first hand, both in and out of the hospital, they still acted as though he was fine. They thought my mom and I were the crazy ones. Needless to say he ended up being hospitalized again, his fourth time overall. I left to go back to school, at the end of summer, before he was released. He has since fallen back into a depression. The solution seems to be a matter of finding the right cocktail of medicine for him. According to him, while he was manic, the trigger for his second episode was looking back at his journals from his first episode. He was obsessed with recreating his stories and drawings into a book, creating multiple versions of it and sharing it with everyone. Besides the behaviors already mentioned, my brother also has many other signs that point to mania: talking to people who he hasn’t talked to in years, including ex-girlfriends; talking in songs, finding meaning in them; drawing on himself and objects; taking more pictures of himself; having an increased interest in religion; writing his name on his belongings; buying movies, television shows, and video games; organizing things in a disorganized fashion; interest in himself as a child; little interest in anyone but him; multitasking; and staying up all night.
I can’t really remember the order of things. Some things are just a blur. I feel like we were living in a horror movie. My son turned into a stranger. For six months, our lives were turned upside down. After the six months, he was in a horrible depression and I joined him. Things got better and looked like maybe it was all a nightmare but it started happening again two years later but this time it didn’t go on as long. This time he was living at home and under our care. The first time he was manic, I don’t think any of us; his dad, his sister, or me, even knew what that word meant. We might have thought it meant really happy and going crazy shopping, but had no idea what severe mania was. He was away at college. He had been suffering from depression. He was seeing a therapist. She had him go to a psychiatrist who gave him Lexapro. The Lexapro made him manic. He had all the classic symptoms but since we knew pretty much nothing about bipolar disorder in its severe form we did not know what was going on and didn’t know what to do. He had grandiose ideas, racing thoughts, and wasn’t sleeping. He was self-medicating himself with drugs and alcohol. He was scaring his friends away. His apartment became a dark, scary place, which attracted people he did not normally hang out with.
It was very hard to get him into a hospital. It is like the law and the medical world are against getting an ill person help. If they aren’t an immediate threat to themself or others then they won’t do anything. My son was not himself. He could not take care of himself. He was slowly killing himself but we couldn’t get him help. When you do finally fight your way to get him into a hospital, fight with police, the hospital and your own son, they only keep him there until they say he is stable. He has never been stable when he has gotten out of the hospital. He has been in the hospital four times. Two times for each manic episode. He hasn’t been hospitalized for depression. I wish I had known signs to watch out for. If you can get them to a hospital before they get out of hand or get their meds corrected you have a chance of not having a manic episode. Once they go beyond a certain point they aren’t going to go to a hospital willingly. And no one is going to admit them unwillingly very easily. Take depression seriously. But if someone goes on an antidepressant watch them very closely. If their personality starts to change they need to see the psychiatrist. I wish I could go back in time. I would have done more for my son. I wouldn’t have believed him when he kept telling me everything was fine. I worry about the future. I wish he would accept that he was bipolar and learn everything he can about it. I wish he would keep a mood chart. Quit drinking, never do drugs. He should take this seriously. I want him to have a happy life. I know he
can have a happy, productive life if he takes good care of himself. I can’t make him do anything though. I encourage him too and I learn all that I can. I will listen to my daughter more closely, she seems to notice when his moods change better than I do. We are fortunate that he is willing to take medication. He doesn’t want to be manic or depressed. He has tried numerous medications. I don’t know if he has found the correct combination yet, or the right doctor. There is a severe shortage of psychiatrists in our area unfortunately. His therapist really cares about him. His family all love him very much. He has good friends. He is very talented, he finished college. He hears often of how talented and what a good person he is.
The weekend started out fine. I was apprehensive because my grandson had just been released from the mental ward after a ten-day stay following a very manic episode. When his parents called the police, he was totally cooperative. But the day his mom, my daughter, had been ready to take him home, she was given a letter he wrote her—a scathing mean letter. It was a letter that was intended to hurt. After reading the letter, she didn’t take him home with her. Instead, his dad went to pick him up, but things were very strained when they got home. His dad had made firm plans with friends to go away for the weekend and he was the only authority figure my grandson might pay attention to. Leaving my grandson there would not have been
a good idea. He was obstinate and ornery with his mom right away, so his dad told him he’d have to leave. I drove over with Kellie, another of my daughters, to pick him up with his clothes, etc. to spend at least a few days with his friend, Brian, in the city where I live. Kellie and I first took him to his counseling session in his town. When he finished his appointment, he managed to slip out a back door and head across the street to a business where a girl he had become fixated on works. Luckily, he didn’t cause a scene or frighten her and he came back to meet us without incident. We made several stops in his town. One was a comic store to pick up something he’d ordered. He had a debit card and, since he had been saving his money while he’d been working, he felt as though he could buy whatever he wanted. He was agreeable and sweet, like his normal self, but with a somewhat smart alecky/know it all way of talking now and then. He convinced me he and his friend would get his medicine filled later. His mom was upset when I told her, so I had him come by with the prescriptions so I could make sure he did get his medicine. There was no way I could monitor if he took them
though. He went to his Brian’s (he lives in his sister’s basement). According to my grandson, Brian said he could stay at least four days. My phone rang about 7 a.m. Saturday morning. My grandson wanted me to come get him so he could eat. I took him to Big Boy and Salvation Army Thrift Store. At breakfast he talked a lot about how much he liked his friend’s little nephews. He bragged about their artistic talent, etc. He told me he needed to stay at my house because Brian said he “needs a rest from me.” He wasn’t here long before I’d have welcomed a rest from him too. His mouth went all the time and he went in and out to a couple of stores always buying something. He put two new quilts on the floor as rugs and ignored me when I asked him to put them up so they wouldn’t get dirty. He moved the bed around and brought up a second TV for the room. He just did as he pleased but I didn’t know how much worse it would get until the next day. Meanwhile, his mom had learned he’d taken a large amount of money out of his account on Thursday evening and Friday at various stores, using his debit card. He was buying DVDs, CDs, comics and what have you. I asked him if he’d take $200 cash from me and let me put his debit card up. Surprisingly, he agreed and actually only took $100. He wanted his card back eventually, but his mom had transferred his money and closed that account. He’d saved about $4,000 and at the rate he was going he’d have spent most of it. He hung posters, pictures and stickers all over the bedroom and was starting to write or draw on the walls when I happened to go in and was able to stop him. He managed to draw a black keyhole on the attic door. I heard later he wrote all over his friend’s walls
and possessions. He had a black permanent marker with a wide end and he wrote his name on EVERYTHING. At my house he rearranged cords from living room to bedroom. He was taking things that belonged to his great aunt who had the room before she passed away in March [2015]. It was getting harder to have him there, but this was just the tip of the iceberg so far. Kellie and Kim, two of my daughters who live in town, came out in the afternoon. I can’t remember why or what time—everything had a nightmare quality to it. I love him so very much and don’t want to let him down, but I felt like I wanted to run away. Every time I see him now, I want to hug him and hold him close—the other day when he was leaving, I grabbed him and said, “don’t leave me again” and he kind of smiled. Just trying to write this, I become confused on what day this or that happened. I realize he was only here from Saturday until he was taken to hospital on Sunday—it seemed longer. I can’t even remember some of the sequences of events. He’d walk to stores nearby and come back with things—his $100 didn’t last long. His mom called and talked to him and felt we needed to have him picked up and taken to the hospital—she recognized how bad he was from experience. By then, his other grandma and grandpa were here and none of us felt he was bad enough to be taken to mental ward. Two sheriff department personnel showed
up and talked to him and all of us. He was very convincing and they felt he was okay too. I told them he was driving me crazy because he never quit moving or talking, but when they asked if I felt threatened, I honestly had to say no. I never felt he’d hurt anyone. He was overly happy at that point. I asked him if he stayed with me, would he promise to go to bed by 11 and he said he would. His mom was hurt and disappointed in all of us—I realize in retrospect, but it is so terribly hard to call the police on your grandson who you love. He and I watched some TV and I went to bed at 10. I read awhile and came out to check on him and he was gone—he left the patio door unlocked knowing I don’t do that. I locked it and left a note taped to the glass telling him to call me when he got back. He finally got back at 3 a.m. I kept calling and texting him, but he ignored his phone. When he got there and I went to the door I saw the table on the deck was totally piled with boxes, bags and whatever. He brought all of that inside—the bedroom was wall to wall with “stuff.” He said, “I need a key to this house!” I basically told him no way. I was sleepy and angry and told him to go to bed so I could get some sleep finally. He kept moving furniture and was in and out of the bedroom the rest of the night. I finally came out to the living room at 5 a.m. and found he’d moved some hunting guns from the attic and put them in the living room doorway. They were kept behind a closed attic door that he would have had to stand on something to reach AFTER moving a heavy wardrobe I keep in front of it. After I got them moved to a better location, I asked him why he did that and he said, “I have to know everything in the room so I moved
the wardrobe to check that door.” I don’t know how my kids and my granddaughter have lived through several of these manic episodes. The next day, he left early with no sleep and no breakfast while I was in another room. He finally called me from his friend’s and asked if I’d come get him and get him some breakfast. I drove there immediately and he wasn’t there. I called his cell and he said, “I’m just going into church” and he hung up. This was so frustrating and so frightening. This boy had gotten his B.S. Degree from University of Michigan in 2012 with high scores. His mom had talked to Brian and learned how bad it had been there—his sister told him he would have to move out if he had my grandson back at all—even if he came there while Brian was at work. He had kept everyone awake Thursday night. He wrote on things with that permanent marker, etc. His mom came over to help find him. He was gone for hours—he apparently looked for a cousin’s home in a neighboring town— walking all the way there and back. His feet were apparently all blistered. He had come back briefly, but had left again and just disappeared for a couple of hours. His mom and Kim went to Brian’s house and found him there in the back yard. It was 90° out and he’d bought a heavy sweater and a leather jacket at a yard sale and had that on and he was surrounded by his “stuff” in the yard. They brought him back to my home and we convinced him to eat a sandwich and take a nap. He slept about 20 minutes. Kim said later that seeing him in that yard in the hot, hot sun in those heavy clothes, so disoriented, was such a sad sight.
His mom and I were on the deck while he napped. Kim and Kellie had gone home. He came out and was immediately no longer that “happy” personality. He was belligerent. She told him they’d be heading home soon and he said, “No, I’m staying here. I have everything set up here.” She said he couldn’t stay and he said, “Do you want me to go to nine on the manic scale right now?” He jumped up and went into house and came out in that heavy leather jacket and a backpack and he took off walking. I followed him because he had walked all the way out to another city, earlier when he was gone, and we didn’t know where he’d end up since he doesn’t really know my town. He looked back at me and smirked a couple of times and then sped up, but didn’t try to get away. I let his mom know where he went and she called 9-1-1. He was in a flea market buying more little things. He came out and was very pleasant and calm talking to the officers (sheriff and state police). They said he didn’t seem to need to be taken in and paid no attention to how worried we were—he was going to be on the streets all night and could be in jeopardy. They didn’t care. We finally left and walked back to my house. They drove into the driveway with him in the car so he could get some things. One older sheriff officer talked to me and he seemed more compassionate than the others. His mom gave them a jar of my coins he’d taken to shop at flea market. My grandson finally saw we weren’t going to change our minds about where he would stay and he decided to go to hospital
and get checked out. We followed and he did get committed. The psychiatrist talked to us and could see beyond his calm demeanor. The coordinator said it would take a while and we could leave and get his clothes he’d need. So we went back to do that and left for the hospital in separate cars. On the way back to the hospital, Kim called his mom and said her son had seen my grandson walking on one of the side streets behind the hospital. Kim went and got him and took him to her house, so he wouldn’t be on the streets. When his mom called the hospital they told her they weren’t sure they’d even try to get him back even though he’d been committed. I was upset and called 9-1-1. I told them the story and gave them the address where they’d find him. They agreed to go and his mom and I decided to go to Kim’s, rather than wait in hospital parking lot. That way we could see if they came. Just as I got there, the officers had decided he didn’t need to go back and they were ready to leave. I lost my temper and I told them the psychiatrist had committed him and they better wait. About that time the hospital called and said they needed to bring him back. The whole thing was so inexcusable. Emergency just left him in the examining room and he got bored, took some bandages for his poor swollen feet (from walking so far all day) and left. He had no idea where he was going. He picked up some things as he walked, like a sock. He’d picked up pop cans
and a beer can earlier, a cigarette box, etc. Buying or picking things up—it was compulsive I guess. We took his things back to the hospital and when they opened the door we had to, unfortunately, see him being brought to the ward. His mom lost her composure and gave in to the tears she’d been holding back all day. She took off for home and I worried about her since she has terrible night vision and it was very dark by then. I called an hour or so later and my granddaughter said she hadn’t gotten home. When I told her what time she left the hospital, she got worried and went outside and found her mom watering her plants—not knowing I’d worry her looking for her mom. Here is just a summary of what he’d bought or brought or taken from Brian’s or my house—I counted some of it and took pictures. I counted 78 plus DVDs, two dozen games, 10 CDs, 3 cassettes, Yamaha Digital Drums, magazines, books, posters plus lots of VHSs—63 he put in wardrobe and another 47 at least in a box his friend brought. Some of these he took from my house and some his friend’s sister had given him. He had empty pop bottles and one with water and wild flowers. The things on the walls got worse and worse. A big map with notes all over it, which is hard to explain. He also took my sister’s flowered fabric wallet to use.
The following stories share what it’s like to live with, know someone with, and be in a relationship with bipolar disorder.
Amanda is a 27 year-old with Bipolar Disorder I. She had her first manic episode in March 2014, but was never officially diagnosed until her second manic episode at the end of January 2015. She’s had three hospitalizations, one during her first episode and two during her second. Here is her experience with living with bipolar disorder. It’s really difficult as the person to really be able to help yourself. Even though beforehand and afterwards you realize and you know what the symptoms are, during it you don’t have the ability to recognize it. It’s just happening. When it’s in full flame and full motion, it’s like you’re watching a movie. Not sleeping It’s not even like you have any control over Eating little anything, it’s like your just watching yourRapid speech self, it’s like an out of body experience.
HOW LONG DID IT TAKE FOR OTHERS TO REALIZE YOU WERE MANIC? I had two episodes. The first one was never officially diagnosed bipolar disorder, so I was referring to the first one when I was explaining the symptoms that they recognized. I was living in Florida when this happened. I was probably manic no more than a week. And then the second time around, I was manic for maybe two weeks
because I had the beginning of the episode—not a full two weeks, maybe a week and a half. I had like three days and then I went missing and then I came back and it was confusing to people. Then, my friend took me in for a week to make sure to see if I needed to go the hospital; just to monitor me and see if it was the same thing happening as the last time. And then my friend decided to take me to hospital. We had a conversation about it and I went to the hospital. So the second time around, it was easier for people to recognize the symptoms, being that I got less sleep, had more vivid dreams, and I also became overly spiritual, like I would talk a lot more about Jesus than I usually do. So those were the signs. But they didn’t catch me fast enough before I disappeared. I was missing in Miami for almost 24 hours and I ended up in a really bad situation with a stranger. It could have been a lot worse, but luckily I was okay.
WHAT WAS YOUR EXPERIENCE IN THE HOSPITAL LIKE? My first experience was awful. I was going through the process of being evaluated and the last step of waiting and in the waiting room to go into the hospital they tranquilized me and took me in. So they took me in on a stretcher, knocked out. I had a full day of not remembering what happened because of the tranquilizer. Apparently I talked to people and I don’t remember. The food was awful and really unhealthy. They never tried to diagnose me with anything, they just gave me medicine. So instead of allowing my symptoms to kind of manifest, they just tranquilized me and then started medicating me for bipolar disorder without being certain of anything. I never had a diagnosis. It was also a minor episode, it wasn’t anything really large. Then the second time around I really emphasized going to a different hospital and it was much better. The food was a lot healthier and they allowed my symp-
Risperdal Depakote Wellbutrin
toms to manifest more. I was on lithium, a pretty strong drug for bipolar disorder that kind of makes you loopy. I was on that while I was in the hospital, so I was definitely loopy from that. That was a much better experience. And then I came back from Florida to Michigan and I was still manic with the lithium, so I was committed to another hospital here in Michigan. It was an interesting experience with the women there. I felt threatened by various women. It was interesting. The dynamics were interesting because everyone else had their own things that they were there for. It’s difficult to be in a place with a ton of women, having their own problems and insecurities. And then they like to take things out on others. That was an interesting dynamic, but I got better while I was there.
WHAT WAS IT LIKE HAVING A BROTHER WHO HAS BIPOLAR DISORDER? I was living away from home. I was in college, so initially it was scary. I was afraid for him. I visited him in the hospital and he was saying a lot of things that didn’t make sense. Then he started to get better with medicine, but he never was the same. He was never the same person again. I lived away from home for college for four years and then I moved away to Florida. His medicine has only gotten better and he’s more of himself today than when he was Bipolar Disoder - Younger Brother first diagnosed. So it’s taken Schizophrenia - Dad & Uncle a while, but I would say he’s almost there. They’re still working on it, even today. He’s changing and re-balancing his medicine. The goal is to be more like himself. He’s much better today than when he was first diagnosed.
DO YOU HAVE A HISTORY OF DEPRESSION? No. I’m on depression medication. My doctor, when he prescribed it to me, said, “You need to be more chipper. I’m going to give you this medicine.” So that’s why he gave me it to me. Just for my general mood, I guess. In general, I’m a pretty bubbly person. I have a bubbly personality and that wasn’t exactly shining through with the medications. I think that’s why he gave it to me.
HOW DO YOU AVOID TRIGGERS? Lack of sleep
With the lack of sleep, I was sleeping the second time around. It’s just that my Malnutrition dreams kept waking me up. Exposure to certain aspects of worship and churches They were really intense and it was really hard to sleep at night. My dreams would just wake me up and then I would go back to sleep and my dreams would wake me up again. Stress
Stress is a hard thing to avoid, but I was eating well and I was exercising, so I consider that to be something that combats stress. I was trying to avoid stress, but the stress was still there. My boss was giving me a lot of things to do and she also made me feel uncomfortable by telling that she thought my church was a cult. I was trying to avoid stress and trying to avoid those things. I was definitely stressed and not eating was a bad thing. I was really trying to prove to everyone like, “No, I’m okay. I’m eating really well.” I was eating more than usual. I was eating really healthy and thought I was doing well.
HAVE YOU LOST A JOB AS A RESULT OF BEING BIPOLAR? I lost my job in Florida due to my bipolar disorder. It was more or
less a decision made for me, not with me being involved. I believe people wanted to make the best decision for me based on my health. My workplace and my family decided that I was moving back to Michigan, no question. They didn’t ask me if I wanted to work with the health system in Florida for mental illnesses. I came to Michigan and started receiving treatment. Then I found out that I wasn’t going back to Florida and that my coworkers and friends were going to pack up all of my things ship it to me. I learned that I was no longer going to be working at where I had been working, so I lost my job. Since, I have only been volunteering. I have not sought a job because I know I will not receive as much pay as I used to and I also know I will not receive insurance that I need to pay for my medicine. The insurance is really the big thing. Right now, I have Medicaid through the state based upon my disability and my income level. The fact that I’m not working allows me to. If I were working, it would have to be under a certain amount, but I need insurance, unless I’m going to get a job that provides insurance and that’s very stable. I’m currently going back to school to get my teacher’s certificate, so that I can be a teacher and will be provided insurance.
DO YOU THINK YOUR PSYCHIATRIST HELPS YOU? Psychiatrist I only ever see him for less than 15 No current therapist minutes, once a month. It’s always a really short visit. I always think it’s funny that I pay $70 to see someone for less than 10 minutes. It’s kind of annoying once in a while, but for the most part I think he’s a good doctor. Even though he doesn’t really know me that well or talk to me that well, he knows me well enough and I think he knows what he’s doing with my medicine so that’s good.
I was seeing a therapist when I first got back, in the same facility as my psychiatrist. I just didn’t like her, so I stopped seeing her. I think with bipolar disorder you need to see a therapist, but I haven’t been stressed. I’m not working right now, but if I were working, I think that I would make more of an effort to find a therapist because I wouldn’t want to put myself in a situation where I’m stressed or where I might relapse due to stress at work This therapist I was seeing wanted me to record my mood everyday and say whether I was positive or negative and I just thought it was really silly. I’m not experiencing ups and downs, and highs and lows. I’m balanced. If you’re a therapist, you’re not going to ask a normal person, who doesn’t have bipolar disorder, to record whether they’re up or down and things like that. If I’m seeing a therapist, I want them to treat me as if I’m any other person. That exercise just really didn’t work for me. I really didn’t enjoy it, but if I wasn’t doing it, it was a problem.
DO YOU PRACTICE ANY ALTERNATIVE THERAPIES? I used to be in a mindfulness group. It’s specifically for mental disorders. I was in a group after my first episode. I think, in general, I live my life in a pretty mindful way. I’m a yogi. I’m really mindful of others and myself and that sort of thing. I do practice mindfulness, for sure. I don’t like to do multiple things at once, I try to be intentional about what I’m doing, and I monitor my thoughts. I could definitely meditate and practice yoga more.
WHAT DOES STIGMA MEAN TO YOU? I think I want to show people that they shouldn’t believe in stigmas. Often times when I share with people that I have bipolar disorder, they’re shocked. They don’t really believe that I have bipolar disorder, so I try to explain to them that you can live a normal life, despite having a mental illness. Just because I have bipolar
disorder doesn’t mean I have to be this angry person or whatever people would expect people with bipolar disorder to be like. It doesn’t mean that people with bipolar disorder are actually like that. Often times, people have mental illnesses and you would never know unless they told you. I think it’s important not to allow stigmas to dictate how you view others.
DO YOU FEEL YOU HAVE THE SUPPORT OF FRIENDS? WERE THEY ACCEPTING OF YOUR DIAGNOSIS? Definitely. I will say that when I was in Florida, my episode and then my leaving to go back to Michigan really strained a lot of my relationships. They didn’t talk to me for months until I was getting ready to go back to get my car and I had questions about my things that they packed and stuff like that. So they had to talk to me, but it was really difficult because they were my good friends and coworkers that I had really great relationships with. It was difficult because I was upset with them because they weren’t talking to me. I just thought they were upset with me for what I had done during my manic episode, for scaring them and for thinking I was lost. They thought a lot of things. They thought I was dead. Basically they thought I could have died. I had a lot of guilt in terms of what I put them through during my manic episode, even though I didn’t have any control over it, and they knew that. I still had a lot of guilt and figured that’s why they weren’t talking to me. I’ve since forgiven them. I went and visited them and it was okay. We were still friends, but there was this time period where there was no communication and very much strained. It was difficult. I’ve made new friends here in Michigan. I’ve shared with them and they’ve been really supportive. They just consider me to be someone who has overcome a lot. They respect me for that.
DID YOU FEEL LIKE YOUR FRIENDS IN FLORIDA BETRAYED YOU FOR TELLING YOUR FAMILY YOU WERE MISSING? No. That’s common with bipolar disorder. When I was going through my episode—my second one—I didn’t want to communicate with my coworkers. I didn’t trust them, so that’s one thing. While I was missing, everyone was trying to contact me. I don’t know why, but I just didn’t trust them during that time, so I ignored them.
DID YOU DO KEEP A JOURNAL OR SKETCHBOOK WHILE YOU WERE MANIC? I’m so upset. When I was in the hospital in Miami, I had so many cool drawings that I did. There was one that was really beautiful. I brought that all home and my friends threw it away. I think they just figured I wouldn’t want it, they were like kind of—not afraid of it, but maybe it has to do with the stigma—they were like, “this stuff is weird,” and maybe they just didn’t know how to relate to it. In terms of the creative process, I could have used stuff now today to create children’s books. There were neat little things that I had done during that burst of creativity. During a manic episode, you are extremely creative and if you can use it afterwards—use whatever you created for the good, for the positive—that’s awesome. Van Gogh may have been bipolar, but we don’t know because they didn’t have knowledge of bipolar disorder when he was around. So, I just think the creative aspect can be used for good and it shouldn’t just be disregarded. Obviously if it affects someone in terms of bringing on another episode, that’s not a good thing. I’m still disappointed that they threw away my art. I feel like they didn’t have the right to do that. They should have asked me.
DO YOU HAVE ANY ADVICE FOR OTHERS GOING THROUGH SIMILAR SITUATIONS? It definitely gets better. It sucks to find out you have a mental illness. It really sucks. I was in utter disbelief the first time when I had my first episode and I wasn’t actually diagnosed, but I was labeled with bipolar disorder. I was in complete disbelief and completely upset about it. That didn’t help my health. That wasn’t good and that’s why I ended up having an even worse second episode because of my disbelief. I was just working to get better. After my second episode, I had a period of time of depression, which I had never experienced before. My advice to others is: you may experience depression after your first manic episode, and maybe you’ve never experience depression before, but it gets better. The doctors are going to work with you and the medicine does help, it doesn’t help right away. It sucks really bad in the beginning because you won’t feel like yourself. I felt like I was in someone else’s body for the longest time, like I was in a cage, like I couldn’t be myself at all. The medicine makes you really drowsy and it makes your reactions slower. You just seem like you’re in slow motion and my friends would noticed that. They would notice that I wouldn’t converse as much and react a lot slower than usual. Just know that it gets better and definitely seek the support of friends or family. Be open about it, but don’t feel like you have to be open to everyone. It really feels awful that you’re living your life normal and then all of a sudden this new thing happens in life and your whole perspective on life It gets better changes because you have Finding the right meds takes time an illness. Even though it’s out of your control and you Acceptance helps have no say in it, you can Life can still be normal still live a normal life. You
can do all the things that you used to do. You shouldn’t have to worry about it. You can work with your doctors and it might not be the easiest, quickest thing, you have to work with them and be patient with them because they want what’s best for you too. They’ll listen to you. They’re not just going to give you whatever and not care whether you feel like yourself or not. You can do all the things that you used to do and still succeed in life.
WHAT WOULD YOU TELL THE FAMILY AND FRIENDS OF SOMEONE WHO HAS BIPOLAR DISORDER? I would tell them to be supportive, obviously. Allow them to speak and have the space that they need. Don’t judge how they feel or tell them how they should feel.
Haley has been friends with Amanda for many years. Although she was not around Amanda during her first manic episode, she witnessed Amanda’s second manic episode. Here is Haley’s perspective of the situation. When my friend came home to Michigan after disappearing for 48 hours, she was placed in a psychiatric hospital for a while, and diagnosed as having bipolar disorder. I visited her a couple days after she arrived and was shocked by the changes in her. I would not have been able to sit through the entire visit if not for the support of my husband, who came with me, but I knew I wanted to be there for her. I cried on the drive home. I thought my friend was gone, though I know now that it was actually the drugs they had her on that were causing her huge disconnect with reality.
I saw her again the day after she was discharged and we went out to breakfast. Her mom warned me that the drugs were still affecting her, so she might seem very tired. She seemed much more herself and I was so relieved, and I began to hope that she might be able to return to her normal self. I know it hasn’t been easy for her, but she seems to be doing really well lately. She’s been going back to school, and volunteering, and I get to see her regularly again. Friends and family who have mental disorders need our patience and understanding. You wouldn’t get upset with and abandon someone who wasn’t responding to their cancer treatment, and you also wouldn’t try to act like it wasn’t a real disease, so we all need to remember to treat mental illness the same way.
Kellie, 54, was married to Troy for 17 years. Here is her story about how bipolar disorder can affect relationships. Troy was diagnosed bipolar after a suicide attempt. I did always feel he at least suffered from depression. He would sit and look like he lost his best friend. You could almost see the black cloud hanging over him. Unfortunately, I am an enabler. So, between his illness and me, it eventually tore apart the marriage. I turned him into a selfish lazy man. He drank a lot too because of his depression. He didn’t have the obvious manic stages, but I believe that’s what was happening when he thought of going into business on his own. Looking back, it wasn’t a good choice to do what we undertook. It put us into bankruptcy, eventually. I let this happen because I
didn’t want him to be sad. He was so hard to be around when he got like that. I think the stress of the new business and all those pressures starting him going into a decline. That lead to him attempting suicide. Then, he was put on medication and he quit drinking. We both got real jobs and it kind of leveled out a bit. But, by this time, he was spoiled. I took care of everything and I cracked in the end.