“Today I am off the medication and all of this is useless. I need help. My sleeping pattern is completely reversed: I am sleeping from 6am to 6pm, I never know when to take my medication anymore so I usually don’t bother… I have my rent money but cannot take a bus across town to pay the landlord… I have a cheque for the phonebill but cannot motivate to get to their office. I am a BiPolar Manic Depressive and I am off my medication, I need help.”
Gabriel [saltedlithium].
May 9, 1992, Age 22
“I am a Manic Depressive (bi-polar) and I still don’t know what that means. I know it’s supposed to be genetic, which only means I can blame somebody else for it. I know that Lithium helps, but the “Why Bother Syndrome” takes hold if I miss one dose. I really don’t like lying awake until 6am every night, sleeping until the afternoon everyday, the suicide fantasies I dream up when I’m alone, the writing I produce — yet it all lends itself to an air of mystery, an addiction to the depth of character. Do I feed off the disease or vice-versa? Why don’t I want to heal?”
Gabriel.
November, 1992.
“A depressive phase is a sign for [people with BiPolar Disease] and people around them to look at what is causing them to worry, boost emotional support and get help to get the emotional needs met. This is so obvious but is incredibly important and can’t be said enough times.”
The MindFields College Blog
“More than one in three Canadians treated in hospital for some form of mental illness are back in hospital within a year of their discharge, says a report that raises questions as to whether patients with psychiatric disorders are getting appropriate care.
“About 37 per cent of people with mental illness were readmitted within a year, and that compares to just over 25 per cent that were readmitted following admission for other types of disease or conditions,” [said Ian] Joiner [manager for rehabilitation and mental health at the Canadian Institute for Health Information].”
Canadian Institute for Health Information Press Release, Nov. 29, 2006.
“Don’t let me die while I’m
living in my mothers basement.”
One Star Cop, Grand Theft Auto: San Andreas
We can spend so many years trying to convince people of how sick we are then, when we’re finally diagnosed, we’re left by the health care system to fend for ourselves as if our family and friends network was fully formed and operational, as though we have a working understanding of what the disease is doing to our minds and bodies, as though we should know and understand what the medications will do to our minds and bodies.
It’s not just Manic Depression, it’s every mental illness. Obsessive Compulsives, Panic and Phobia Disorders, Attention Deficit Disease, Bulimia, Anorexia. We spend, on average, years trying to break into the Mental Health System. The only time we’re taken seriously and pushed into “hyper-care” is if we’re chronic: a teenage girl with Anorexia slips below 90lbs and the symptoms become too extreme to not notice anymore gets placed into a special home or is hospitalized. A young man is taken over by his Manic Depression and is found with slashed wrists is hospitalized and entered into an Out-Patient Program. A young woman gives into the schizophrenic voices and hurts her children and is immediately medicated into a coma which she’s unlikely to ever be allowed to come out of.
I keep hearing and reading about “Perfect World” responses. In a perfect world someone with manic depression would have understanding parents, a group of witty friends who look and act like Emma Thompson and Hugh Grant, a doctor who is available on a moments notice, medications which work the first time exactly the way the available literature says they’re supposed to work. Well, what the fuck? What other disease, or group of diseases has to rely on a Perfect World scenario to get the patient through their initial treatment phase? And when — just when — just one fucking time has it ever happened that a person with Manic Depression has ever had a “Perfect World” scenario? Why are we, the mentally ill, left to the vaguaries of the Perfect Scenario? Why are our doctors, once THEY’VE made the diagnosis, not making sure our families are in the room so the explanation can be made by THE DOCTOR as to why we’ve been such shitty fucking children over these many years? Why are our doctors not bringing dietitians into our appointment if diet is so important to our recovery? Why are we not being handed massive amounts of Vitamin D along with our Lithium? Why, if sleep is so all fucking important to our recovery, are we not being handed a sleep aid along with our Lithium and Vitamin D? Why does it take so fucking long for people to tell us that, “yes, in fact, your bizarre sleeping patterns are, in fact, quite abnormal and, yes, in fact, there are ways to manage your sleep with medications, in fact”? Why, with a disease that fucks with OUR MINDS, is it assumed that we have an understanding of the disease on par with that of the doctor? Why is it left to us to inform family, friends, co-workers, bosses about the effects of the disease as though we had written the DSM-IV?
In the minds of the people around us, as soon as we’re diagnosed our problems are over. Parents have something they can tell friends when they’re embarrassed “Oh, don’t mind little Bobby, he’s got the manic. Yes, it was going around his class last year and he hasn’t managed to shake it yet. Apparently you treat it with salt.” All you have to do now is take the fucking pills and everything will be Norman Rockwell. As if your brain was no longer working against you which, until this very fucking morning when you had that twenty minute suicide fantasy, it was. But, hey, the doctor says everything should be fine now, right? Because that’s how it works with cancer, or diabetes, or genital warts, or the Bird Flu. You get diagnosed, the doctor says here, and you do what he says because, obviously, any right thinking person would want to get better. When you get the Bird Flu your brain, obviously, says “hey, we should get that taken care of.” When you “get” Manic Depression your brain tells you “hey, you’re worthless, lets crawl into a corner and I can show you thirty different ways you can kill yourself.” Where’s the “Perfect World” scenerio there?
There’s a program on A&E, an American television station, it’s called “Intervention” and it is the most gut wrenching, tragic program you will ever see: “Each documentary follows the lives of these addicts, taking an unflinching look at the impact of their addictions on their everyday lives, all the while the addicts are unaware that an intervention is being planned. (A&E)” These things will tear your fucking heart out. The addicts are at their very bottom, they are young women selling themselves for a bottle of whiskey, they are young men bleeding crack from their eyes. The thing is, these addicts remind me of mentally ill people* who have been fighting to get into the health care system for so long that they’ve given up… like the non-addicted mentally ill they’ve had all of the hope sucked out of their bodies, there is nothing left but the body and the drug / disease.
When the intervention happens the addicts are led into hotel rooms where a counselor and their remaining friends and family are waiting. What happens next is the amazing part… the last loved ones in the addicts life tell them about all the crap the addict had caused through their addiction, and what the bottom-line consequences are to not getting better. About 60% of the addicts agree to go to a centre where they can receive help, but it’s the hope… their eyes just open right up as they realize there are people left who care for them. And the promises the family makes, the friends make, to learn about their addiction, to attend AA, NA, AL-Anon, to read the pamphlets, you can see the addict just melting, giving in “everything, from this day forward, gets better and finally they will understand me”. So off they go to get help. And the ones who come back reunite with their families and friends… who have done nothing. Not a fucking thing. Not a pamphlet, not a meeting, nothing. There is no understanding beyond “Well, Jimmy was a raging crack addict, but now he’s fine. Sure, he’s hanging out with some of the same people, but what are you gonnna do?”
I was Clinically Depressed before I was Manically Depressed. When I was finally diagnosed in 1988/89 as having Manic Depression there were no explanations, there were no pamphlets, I walked around for years thinking I could, after forgetting for a week, just start popping the Lithium again and everything would be fine. If I missed a dose, I’d just double, triple or quadruple it up. When I tried to take control over the disease, and get back into the health care system I’d run into doctors who insisted on psychoanalysis, insisting on delving into the minutiae of my childhood, as if my Clinical Depression had any relation to my Manic Depression. These people were looking at a 20-year old kid, who had already been diagnosed with Manic Depression, who was on welfare, eating from food banks, sharing rooming houses with alcoholics, drug dealers and prostitutes and they insisted that my salvation from Mental Illness lay in my understanding of family events and breathing techniques rather than in medication and diet.
The first time anyone explained to me that Manic Depression fucked with your sleep was when I read “An Unquiet Mind” in 2000. The only book anyone in my family ever bought for me which dealt with depression was a memoir of an aged former journalist who suffered from clinical depression because he grew up gay in a community that didn’t appreciate homosexuals — even though I’ve never been gay, at that point reporting was not my profession, I’ve never been sixty and I was not raised in rural America. My mother has been to three doctor appointments with me since 1988, after each one she insists that I blame her for everything and that all of my childhood memories are suspect. After being on the pills and 99% sober for three years my family still asks me why I’m not drinking alcohol with our meal. None of my family have read any literature on depression, and my mother insists to this day that she knows all about the disease simply from having to deal with me.
To a slightly lesser degree, when I was diagnosed, I was that addict walking into his Intervention. All of those same promises, explicit and implied, were laid out for me: “We know what’s causing the shit in your life now, Gabriel. It will take hard work, and we’ll all do our part, but things will get better from here.” After surviving eighteen years with the glories of manic depression it was coincidence that finally got me into treatment: my mother was home to take my suicide call. Things are only easier in my family now because I’m not insane anymore. No more 4am suicide phone calls, no more “230lb Dark Gabriel sitting on the couch using the TV to drown out his depressions”. Now it’s “easy to get along with 238lb Light Gabriel” so everything must be better. “See,” they say, “that wasn’t so hard. Obviously you were doing something wrong before because all you had to do was take your pills.”
We fight so hard to get into that room and when we leave we’re convinced that, finally, everyone who is important to us, everyone who loves us and who we love, is going to ‘get us’, but they don’t. And that’s a crime. We need more than we’re getting, especially those right at the beginning of the process, and especially from a “mental health” system that has been leaving too much responsibility for too long in the hands of people who — for most of our diseased lives — want nothing more than to slide a fucking razor across our collective wrists.
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[*without a doubt addicts are mentally ill…]
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...salted lithium. 
–Why, if sleep is so all fucking important to our recovery, are we not being handed a sleep aid along with our Lithium and Vitamin D? Why does it take so fucking long for people to tell us that, “yes, in fact, your bizarre sleeping patterns are, in fact, quite abnormal and, yes, in fact, there are ways to manage your sleep with medications, in fact”?–
‘New’ ideas, like the importance of sleep, unfortunately take time to permeate into society/services.
I am sorry to hear about the assumptions of your family. Nothing is ever perfect but fortunately you are intelligent enough to find out how to best deal with things in the way most appropriate for you.
The actual testing, putting numbers and figures beside the diagrams which reinforce theories regarding sleep patterns and their effects on natural and clinical depressions are new. The symptom of “sleep disturbances” caused by manic depression and mental illness has been known for quite sometime.
DSM-IV; Bipolar II [Disease]; A1 Symptom #5: “insomnia or hypersomnia nearly every day”.
I don’t doubt the research your organization is performing into sleep being a causal factor into natural depressions, but it should have been standard practice a long, long time ago for Manic Depressives, as part of our daily medication regimine, to be prescribed a sleep aid.
Intelligence has very little to do with finding treatment, it’s all about what the disease will allow and what you do with those moments. Three years of medicated and fulfilling sleep, and taking my pills everyday is what’s allowing me to look back with some clarity and lucidity, but it took eighteen years and a lot of coincidences and mistakes and not killing myself to get here.
yes – it should have. I meant the connection between worrying, REM sleep and why depressed people dream more. That has not been known for long.
I suppose you’re right about intelligence – I am hardly qualified to comment on that..
what was your experience with psychoanalysis like?
I think we’re saying the same thing… this: “The actual testing […blah blah…] sleep patterns and their effects on natural and clinical depressions are new” was my way of saying “I meant the connection between worrying, REM sleep and why depressed people dream more. That has not been known for long.”
And on we go…
My experience with psychoanalysis was, for the 90’s, mostly mindnumbing… no pun entirely intended. Because I had some experience with the mental health field before my MD symptoms really kicked in, and because I was always aware of the weird lunacy that was my childhood, I’ve always been able to separate the clinical depression I “suffered” under from about nine to seventeen from the MD which I kind of always knew was a separate animal. Although my understanding back then was very much at the “artists die from this disease” stage.
The psychoanalysts I encountered after my MD diagnosis only wanted to talk about the things which made me clinically depressed, which always pissed me off because I thought I could deal with that stuff on my own. Or, at least deal with it better with the MD under control. There was always a sense of disbelief when I started talking about my past as well, which annoyed me. The therapist I’m seeing now is an MD specialist, and now that the MD is under some form of control, we’re working on the clinical depression stuff. Which, in my humble opinion, is how it should be from the start: Treat The Disease so you can treat the disease.
“I suppose you’re right about intelligence – I am hardly qualified to comment on that”
Don’t do that. You’re a researcher (correct?) at a major (albeit new) health institution? Somewhere along the line you had to pass more tests than you failed.
Great article Gabriel. Lots to think about.
Absolutely wonderful indepth article.
However as an outsider looking in I have this to say. Going back into one’s childhood may help. I do know a little about genetic diseases and it’s this: We all have genes that give us things but they are activated early or late (or never?)depending on one’s environment. I do not know if this refers to manic depressives but I do know it refers to some many diseases.
No, you’re absolutely right Nita. The genetics are there, but there needs to be a trigger. Usually, but not always, it’s something traumatic like a death or a major event. For women childbirth is a common trigger. The chemicals get sent to a level where they don’t come back from. There is also an idea that menopause in men and women has a tendancy to re-balance the chemicals (but that might be an urban myth I picked up somewhere). Then there is the theory that “manics” are really hyper-depressions, that there really are no “ups” just completely new levels of downs… but maybe that’s a different topic.
The theory about menopause ‘rebalancing’ neurochemicals/hormones is, in my personal experience, very true.
I am the child of a MDsuicide mom. I suffered from dysthymia/unipolar depression/postpartum depression my entire life-UNTIL menopause.
Nine years post menopause have been the best years of my life. Mood is calm,sadness is mitigated most of the time,I now have a Zen response toward life’s vicissitudes.
Life did not get easier, my husband died young and various other crises have been happening. What changed was that I no longer swim in a stew of estrogen and progesterone. That has made all the difference.
Thanks much for your excellent blog. I am researching ways to support one of my sons who is bipolar.
Thanks very much Debra… and thanks for reminding me about the menopause factor, three years later and I’ve completely forgotten to write more about it. There are several links in my sidebar you might find interesting regarding your son…
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“We can spend so many years trying to convince people of how sick we are then, when we’re finally diagnosed, we’re left by the health care system to fend for ourselves as if our family and friends network was fully formed and operational, as though we have a working understanding of what the disease is doing to our minds and bodies, as though we should know and understand what the medications will do to our minds and bodies.”
See, you say so succinctly what I was trying to say today.
Thanks, but I think you said it very well over at your place. I’ll send the questions a little later on…
I got my Dx for Manic Depression in 1989 too!
Sure wish I had had some of that psychoanalysis and breathing stuff back then. I had to figure all that out years later on my own.
Instead I just got the meds, more meds and meds to treat the side effects of those meds. *shudder*
Seems some folks do indeed achieve lasting results from those breathing exercises.
You might be surprised to know what recent imaging studies have demonstrated about the long term results of proper meditation training.
There is substantial development of the prefrontal cortex in practitioners that stick with it. That is the area of the brain responsible for emotional and cognitive processing.
When the meditation elders said meditation would free you from mental and emotional suffering they did not know the science of how or why they just knew it worked.
The PET and MRI scans results show that what’s actually happening is that their brains are growing.
ymmv
good luck with recovery
Hello Jane, welcome and thanks for commenting.
I did not know specifically about meditation increasing brain matter, but I’m not surprised. I know there was an MRI study involving juggling where the brains of participants who learned a new juggling skill grew both in volume and density within the areas responsible for spatial and numerical processing.
I’ve also read about researchers who have recently used PET scans to watch the brains of master Tibetan Buddhist monks as they meditate. The findings were very interesting, showing the incredible control these masters have in controlling their brains “happiness centres”. So the next logical step would have to be some growth as a new skill was learned, or control attained through more years of enlightened meditation.
Personally I’m a huge fan of PET and fMRI technology and firmly believe, as it becomes more refined, imaging technology will become a vital part in the diagnosis and treatment of mental diseases.
fMRI scans have already shown, for example, that when ‘bipolar brains with Lithium’ were compared to ‘bipolar brains without Lithium’ “the volume of grey matter in the brains of those on lithium was as much as 15 percent higher in areas that are critical for attention and controlling emotions.”
Thanks for commenting Jane, and good luck with your own recovery. I hope to see you around again.
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The sleep medication I have been given sucks shit… sure I’ll use it after 14 days of bad insomnia, but I know I will feel like utter crap after it… it’s a trade off between being mad as a bag of cats with no sleep and feeling like I have drunk 2 liters of vodka.
Most of the time I use camomile tea to relax before bed.
Why do doctors have such a hard on for pharmaceuticals???
There’s a wide variety of sleep aids you could be trying, clintontryee… both prescription and over the counter. Most of the prescription sleep aids get more tolerable with use… I hope you’re not drinking alcohol while you’re taking them.
From what I understand doctors generally like prescribing drugs because in the vast majority of cases the drugs help.
I fixed your username so it links to your blog, if you really don’t want it there just let me know.
Thanks for coming over, stop by anytime.
I don’t drink.
Hmm, depends who defines the concept of “help”.
Well if it’s a third party, like someone who has no vested interest in the outcome except whether or not it could help with their quasi-religious agenda, I suppose that person could define “concept of help” anyway they wanted. If the vast majority of patients were to be asked, however, the “concept of help” would probably start with “improving the quality of life for the patient”.
Not drinking is good, alcohol and recreational drugs can really screw around with the medications you’re on.
quasi-religious??? Lost me there… Obviously can’t be referring to me as I’m an atheist.
I don’t do anything… I’m practically unmedicated (for the time being) and tea is the strongest thing I ingest excepting the occasional sleeping tablet.
My point is that most of the time herb camomile does the job, yet the fist thing a GP will do is try to foist a pharmaceutical on me which will kick the crap out of me.
Hey, if you do 2 grammes of amphetamine a day, you soon become normalised to it… doesn’t make it good for you though.
Even a few months of deralisation as a side effect will become normal.
And neither are SSRIs that make your mouth bleed and your legs twitch, or trigger mania…
And latest INDEPENDENT finding is the UK seem to indicate that SSRIs aren’t really that beneficial to most people anyway, but doctors were ramming them down our throats on the say so of research with most vested of interests.
So, sorry, I don’t share your appraisal of either suitability or efficacy.
If you can get to sleep using just tea, good on you. But if all you’re having is a difficult time falling to sleep, why are you here? Are you suggesting tea would be a good substitute for medications when a sleeping disorder, as a symptom of something larger, has been diagnosed? Surely (gasp) you’re not here to preach the gospel of anti-medication and anti-psychiatry?
If you’re having fourteen-day long bouts of insomnia maybe you should switch brands of tea.
Insomnia was never an issue with this post, and sleeping disorders brought on by untreated manics need to be medicated.
I’m also not “obsessively” against anything… I do, however, dislike people with an agenda pretending they don’t have one. You’re comparing “pharmaceuticals” to a “2 grammes of amphetamine a day” habit, and claim you’re dealing with fourteen-day jags of insomnia by drinking tea and occasionally taking a pill you say makes you feel like you’ve “drunk 2 litres of vodka” when there are dozens of alternatives out there…
When you’ve got something coherent to say, feel free to come back anytime. Good luck with your recovery.
You make an awful lot of leaps (of faith?) for someone who so obsessively against preaching.
Your comments about insomnia reveal you haven’t much of a clue about much of what you rant on about, so I shan’t be back- you say nothing that is of use to me; and I’ll be so bold to say not much use to anyone.
Bye!
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Often, even when an intervention is achieved, the person struggling with a dependency does not want to go in a rehab. A lot of the time, some time will pass before the individual can realize the extent of his addiction
Cynthia Kurtz
Drug Intervention Michigan
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“they insisted that my salvation from Mental Illness lay in my understanding of family events and breathing techniques rather than in medication and diet.”
You know what’s scary to me…Even 30 years later this is still a truth.