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Taking down the monster.

Posted 18th February 2009 at 15:19 by acidcasual

I've decided to start a blog. For this first entry I'm going to talk about manic depression or bi-polar disorder as it has been renamed. Apparently about 1 in every 100 people suffer from it. The risk of suicide is also 10 to 20 times greater than that of the rest of the general population. On the plus side it's become easier to diagnose and manage.

The jury's still out on what causes it. But there is a general consensus in the medical community that it is genetic in origin. Studies have shown that it tends to run in families. Recent fMRI studies of the brains of schizophrenia sufferers (schizophrenia and bi-polar disorders are now thought to be related rather than being thought of as two separate conditions) have also shown that their brains are wired differently to those of people considered normal. The medical establishment believes that bi-polar disorder cannot be cured but it can be managed. Mood stabilising drugs such as lithium and sodium valproate along with anti-psychotics such as Olazapine help manage the condition. Cognitive Behavourial therapy can also help a person to recognise the onset of mania and to deal with the underlying thought processes when depressed.

So what's it like? Well it's exhilarating, devastating, life affirming, terrifying, and can ultimately be life destroying.

How can it be so many opposites? Well there's incredible highs followed by devastating lows. Without treatment Manic episodes can typically last from 2 to 6 months. While Depressive episodes can last from 6 to 12 months.

We all suffer from mood swings. We can feel low one day and up the next. So what's different for the manic depressive? Well the lows feel like they're going to last a lifetime and so do the highs. There's such a rush from the highs that you feel got the energy to go on forever. The intense feeling of well being and invincibility is similar to the incredible high you get from taking a cocktail of ecstasy and cocaine.

The depressive phase is just the same as clinical depression. Here's a description of clinical depression taken from Malignant Sadness by Lewis Wolpert.

"It was the worst experience of my life. More terrible even than watching my wife die of cancer. I am ashamed to admit that my depression felt worse than her death but it is true. I was in a state that bears no resemblance to anything I had experienced before. It was not just feeling very low, depressed in the commonly used sense of the word. I was seriously ill. I was totally self-involved, negative and thought about suicide most of the time. I could not think properly, let alone work, and wanted to remain curled up in bed all day. I could not ride my bicycle or go out on my own. I had panic attacks if left alone. And there were numerous physical symptoms - my whole skin would seem to be on fire and I developed uncontrollable twitches. Every new physical sign caused extreme anxiety. I was terrified, for example, that I would be unable to urinate. Sleep was impossible without sleeping pills: these only worked for a few hours, and when I woke up I felt worse. The future was hopeless. I was convinced that I would never work again or recover. There was the strong fear that I might go mad."

Counter that with this description of the manic phase by a fellow sufferer.

"With hindsight, my thoughts started to spin out of control. I was young again, fearless and capable of great things. I was making unrealistic plans for alternative careers which would make me super-rich. Before long, I had abandoned my family, citing temporary marital differences, and was charging around the city meeting all sorts of people and having all sorts of adventures. A few times I was in danger of being attacked by people who found my behaviour and conversation odd. My mind was constantly skipping from one scheme to another, until everything seemed connected. One of my many notions was to capture all my thoughts and experiences in a great, earth-shattering novel that would revolutionise the world! There were also times where I would simply wander around, smiling or muttering to myself, and spending money on whatever seemed fascinating at the time."

My own experiences have been fairly similar.

The highs can convince the sufferer that they have solved all the riddles of the universe and they can't understand why everyone else doesn't share their vision. When manic we can become convinced we have all the answers and we want to save the world. We're almost like those evangelical preachers you see on the tv from the states.

We're creative, full of ideas, have boundless energy and grandiose delusions. Uninhibited and spending money with reckless abandon. Some people will believe they're on an important mission or see themselves as an emissary of God. Think Joan of Arc. Like her sufferers in ages past might have been burnt at the stake, had an exorcism performed on them or been lauded as visionarys.

The more extreme forms of mania mimic those of schizophrenia making manic depression harder to diagnose. In fact it is commonly misdiagnosed. For instance in my case I was initially diagnosed as paranoid schizophrenic.

During my manic episodes I heard voices, had visual and auditory hallucinations I even had olfactory hallucinations (experiencing strange smells).Classic schizophrenic symptoms.

As the mania progressed I experienced full blown psychosis. I started drinking heavily and doing more drugs than the average touring funk band*. I saw my psychiatrist and others as part of the conspiracy against me and the message I was trying to get out.

When you tell somebody that they are delusional they will not accept it because to them its real. I would be come hostile and suspicious towards anyone insisting that I was ill. I became convinced the paranormal and some conspiracy theories were real. I got everything I could get my hands on about the paranormal trying to understand what was happening to me. I started to hang around conspiracy nuts uncritically taking on board everything they told me. I refused to believe I was ill. Everything seemed so real.

My mania was very public but they're used to nutters in Harborne so I was tolerated until things got out of hand. This sometimes meant a night in a police cell and a psychological evaluation before being carted off to the funny farm.

I was running round visiting psychics, healers, going to spiritualist churches. Thinking I would find the answers there. Slowly over time I came to realise they were all charlatans or in a few cases seriously deluded, which eventually caused me to examine what I was experiencing and become open to the possibility that I was in fact ill. It took quite a long time though.

As with my investigations into the paranormal and other pseudoscientific bunkum I got hold of as much information as I could on manic depression and gradually came to the conclusion that this was what I had. Also discovering skepticism has had a great deal to do with my recovery. Learning about critical thinking and the scientific method helped not just to examine the world around me more objectively but also my own thought processes. I have learnt that my senses cannot always be relied on to be accurate.

Now that I've accepted that I'm Bipolar its a lot easier to manage. Acceptance of the condition is important to maintain wellness. I also made sure that I took my medication. Many people don't which causes a revolving door at many psychiatric units. I'm now medication free and have been since last October. My psychiatrist won't be happy when I tell her, but she knew I was going to try at some point and will support my decision. I've got an appointment with in a couple of weeks and will break the news to her then. I'm mentally tougher now and knowing that my senses and cognitive processes can't necessarily be trusted gives me the confidence to dispute any automatic harmful thoughts, especially the voices.

Bipolar has a high rate of recurrence even on meds. I've had three depressive episodes since my last hospital admission three years ago. But the meds prevented any further manic episodes and after all the hard work I've put in I feel confident that I can keep the mania at bay. Lifestyle changes have also been an important aspect of recovery. You need to achieve a certain balance in life and avoid too much stress. Know your limitations , get plenty of rest, eat a balanced diet and exercise. My challenge now is to work on my SA and depression. The wonderful thing about the depression now though is, that I know, all I have to do is ride it out. It might take a week, it might take six months but it will lift. Cold comfort I know but personal experience and all the medical studies I've read reinforce that notion. As for the SA I'm ready to tackle it now and have made already made a lot of in-roads over the last three years.

I've probably beaten the mania and now having decided to attack my anxiety and depression I'm looking forward to this next challenge. It's been proven to me that SA can be beaten with dedication and hard work. As with the Bi-polar I've read as much about it as I can and now that I know my enemy I can pinpoint it's weaknesses and develop a strategy for defeating it. I know I'm in for the long haul but having got to know the beast I'm ready to commence battle. I'm no longer tilting at windmills. One of the positive elements of my new found determination is that it has stopped me being a drifter and on my better days has given me a new zest for life. I've learned how to set goals, realistically self evaluate and to know when to say no. I'm also lucky to have had a great group of friends with me on my journey. They just refer to me as Mad Karl.

*Would love to take credit for that line but it belongs to Bill Hicks.
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