Sometimes it’s hard to tell a hospital from a jail

Caleb just spent a couple weeks in a county psych unit.  He had been getting more and more ill, out of balance, then manic, not sleeping…and finally suicidal.  We both lost sight of when the mania ended and he disappeared behind a wall of rage that wasn’t him at all.  We just knew he had to be in a safe place to protect him from harm.

During the first ten days of that hospitalization, every single thing that happened infuriated him. He felt nothing but contempt for the psych techs, the RN’s, the social workers and the doctors. And he said over and over, that this was a total waste of his time, and that jail was better. That at least in jail the people were sane.

But after several days, they found a medication that would help him sleep.  After a good night’s sleep, he was much more upbeat the next morning.  A couple days later he got another good night. Then another.  As one solid eight hour sleep stacked up on another, Caleb began to return to himself.  He felt more cooperative in group sessions, less persecuted by the staff, more compassionate about the ill people around him there, and his appetite returned.

Once again, a dramatic example of the importance of regular sleep for someone with bipolar disorder.  Sometimes, your brain just swings out of control and seems almost impervious to the sleep medications that have worked before.  Sometimes the symptoms of this illness get so out of proportion, that we have to just stop and let someone help.  Sometimes we just can’t do it all by ourselves.

This has turned out to be helpful.  Caleb is feeling better, looking forward to coming home and eager to keep his exercise, diet and rest schedule in place.  I’m glad we had somewhere to turn to help him get all that working again.

 

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Found on www.jamplay.com by Mark Lincoln

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When an ill boy goes to jail

We have a lot of work to do in this country, to manage mental illness constructively. When my son Caleb was 16, he was admitted to a psych hospital for treatment, which only lasted 10 days. Then he was transferred to a drug rehab farm that was intended to be dual diagnosis.  Though it was a fine facility with intensive counseling and psychiatric medication management, it was a nightmare. Caleb had tried to self medicate as a teenager with marijuana, which was devastating to me, as a parent who didn’t understand the desperation of mental illness, or really even what bipolar disorder was.  However, to conform to his environment, he pretended to have done every conceivable form of drug abuse when he was admitted, and was bunked with “other heavy users.”  It was in that confinement that he learned all the ways to abuse substances, where to get it and how to get it.  His substance abuse skyrocketed when he returned home. The experience was also terribly traumatic because the facility felt insecure with the medications that had been prescribed for him, and ended up experimenting with 22 medications over a 30 day period.  That was 16 years ago, but he still remembers it as one of the cruelest times of his life. His mind was put through more chaos by the medications than the disease had ever caused…and he was on suicide watch. After his release, his escalation of substance abuse led to the first of many arrests. For years he spent more and more time in jail, for Minor in possession, DUI, etc and finally at 17 was arrested for passing marijuana to an undercover officer and faced his first felony. He spent 9 months in jail one time, 14 months another time, 5 months another time…sometimes in county jails and sometimes in state jails.  His mind and emotions were in such chaos that I had difficulty knowing what was going on with him…all I saw was illicit and extreme behaviors.  I tried to reach out…he tried to respond…but before long he was bolting away and using again.

He learned to shave in jail.  He grew up there from a scared kid with high anxiety to a toughened man who knew the culture of inmates and how to survive.  As an adult,  he has his own form of post-traumatic stress syndrome from all the time he has spent with hardened criminals, many of whom are also ill.  As a young adult man living in the free world, he has had many struggles discerning the difference between the culture of normal upper middle class society and state jail inmates. His first response to an offense or perceived tension in another is to respond as he would in jail… not realizing that another person would not understand that violent ‘respect-driven’ reaction, in a  peaceful society.

All of this, because we aren’t equipped to treat mental illness, and because bipolar is so misunderstood.   We send an ill kids to a hospital to start their meds, then send them out to dangerous places. He’ll spend his life coping with his symptoms, but he’ll also spend it working his way through those knee-jerk reactions learned in a terrifying place for a sheltered kid.

We must find alternatives to spare teens in the future of what Caleb has endured. And the first step, is learning to understand the illness. Learning what is causing it…where in the brain is it taking place?  Is it a generalized brain chemistry issue?  Or is there a place in the brain to pinpoint it?

There was a time when I believed from what I read that somehow there was a chemistry in the fluid that washed over the brain somehow and that we were improving the balance of that chemistry with medication. I guess it was my lack of understanding about serotonin re-uptake that started that idea. But lately, I’ve been learning more and more about the amygdala and the work it does in conjunction with the hippocampus, the hypothalamus and some other brain things… and have learned that the anxiety, fear, rage and even sexual inappropriateness is actually originated there.  Who knew?   And if I just learned about that, imagine what we’ll learn in five more years?  They’re talking in the neuroscience journals about laser surgery to the deep brain without an incision…deep brain stimulation (there is an article about that in our scientific section), and all kinds of possibilities.  Let’s watch for them together.

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Maintaining a flexible attitude about life

I have had to change plans this weekend. My son has been doing well, and I had made plans to go to reunion of 30 year friendships in another city, where we gather and talk and cry together, pray and eat, and talk some more. We have all been eager to see each other… we had our first meet-up last summer at my mother’s 80th birthday party, and determined to not let time separate us again.  We met up again in January, and were trying for this Easter weekend. However, my son has taken a dip and it seems unsafe for me to leave him. So, I have had to cancel the get- together, since the few of us planning to meet don’t want to leave anyone out. We will try again when my son seems stable again, and then we’ll begin juggling everyone’s schedule…and do our best to make it happen when we can.

It’s disappointing. It’s something that is in my life just for me. There aren’t many of those. But, when a mentally-ill person is in your life whose well-being relies on you, you don’t have the freedoms you might otherwise have. When you see symptoms the symptoms aren’t a sore throat you can see with a flashlight, or a runny nose or a rash. The symptoms are behaviors. And like it or not, you find yourself doing a quick assessment of behaviors every day and throughout the day.  Loved ones and those who care will check in and ask regularly, “How’s Caleb?”….and they aren’t really asking if his fifty yard dash time has improved, or whether he got sore working out yesterday.   They’re asking how his behavior appears, or more to the point, how is his frame of mind?

It’s part of life. For him, for me and for everyone who lives close to us.

And if I was rigid in my expectations, I would not handle these disappointing turns in the road easily.  I’ve known people who are thrown for a loop because their plans to go to the mall were upset by rain. But there’s no place for high expectation and hard falls over changed plans in the lives of families with mental illness among them.  Flexibility is key.  Peace is key. Being able to ‘go with the flow’ whatever the flow may be…..is key. There are far more upsetting things out there than giving up a fun get-together. And I believe I’ll look at the silver lining and be glad for the peace that is here, now.  I’ll use the time to get more work done and to spend some time with my son. And be glad for all the times he survived his attempts on his life, and that he is actually here to enjoy.

Life is to be lived, however we go about it…one day at a time.

And don’t forget the Serenity Prayer:  God grant me the serenity to accept the things I cannot change.  (I cannot change this.)  The courage to change the things I can.  (I can change my attitude for the better.)  And the wisdom to know the difference.

Peace.

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Bipolar Love: A Match Made in Heaven?

Bipolar Love…A Match Made in Heaven?

It Takes More than Good Intentions to Navigate the Challenges of Romantic Relationships in the Face of Mental Illness

How’s your love life?  Going as smoothly as you’d like?

These days, romance is more complicated than it ever has been before.

The global economy has brought pressures and life changes. Couples bearing the burden of multiple jobs while being stretched to the max, and people with more need for support in a world where there are fewer able to give it.

The pressure is on!

Couples are expected to produce sexually-exciting activity for each other, plus thoroughly honest, loyal and trusting communication.

There’s a need for realistic expectations

We are expected to have high Emotional IQs and to look great on the beach.  And, don’t forget the demand to do well professionally, live in impressive houses and drive expensive cars like the make-believe world promoted by Hollywood.

All this has imposed unrealistic expectations on relationships ..and lasting love is subjected to an awfully big threat.

Add to that the hugely complex symptoms of a mental illness in either of the partners, and it can all be to much to manage.

As tough as all that is…satisfying, loving and fulfilling relationships involving a bipolar partner are not only possible, but probable.  However, success does require training, mutual growth and a deep, shared commitment to the process that’s involved.  Then, obstacles transform– and can become opportunities to grow more intimately together.

Zeal just can’t compensate for good old-fashioned know-how.

For example, the junior high school student with a great love for the Navy can’t step into a nuclear submarine and maneuver it into battle.

The kid’s zeal just has to give way to education and training, or he will never maneuver a submarine at all.

So it is in any relationship.

Zeal, passion and affection alone can’t prepare a well-meaning lover to navigate the deep waters of a romance.   And that is even more true if it is with someone who suffers from a mental illness like bipolar disorder.

Education and training are paramount.

Actually, you might say that in most cases, training makes a big difference for even the healthiest people to make a loving relationship work and endure the test of time.

As recently as twenty years ago, bipolar disorder was still enough of a mystery, that there was’t much help offered to effectively live with it.

However, with the growth of the internet as well as the advancement of science, more understanding of this illness is emerging.

We’re learning what causes its symptoms and how people affected by it can work together to manage their relationship when the going is the roughest.

Knowledge is Power

In the uncertainty of daily living, knowing what causes relationship conflicts is empowering.

The ability to anticipate ‘land mines’ between two people and having some idea how to respond to them productively, can give you an arsenal for conquering the obstacles on the road to building a loving and secure bond with your mate.

When mental illness is woven into the bond between two people, then becoming ‘experts’ on the illness can’t be promoted too much.

Assimilating information about both of these areas provides both armor and arsenal for what is possibly the most important crusade of your lives.

Shame has to go

Fundamental to the core of suffering from bipolar disorder is shame.  (Link to article on Shame)

Brene Brown, PhD,  is author of The Hustle for Worthiness, and says that there’s a huge difference between shame and guilt.  Shame implies worthlessness.

That the one who is shamed is not worthy of love.

Guilt simply says, “I did something I shouldn’t have done.”

Guilt says: “I did something bad.”

Shame says: “I am bad.”

There’s just no place for shame in a loving relationship….and the person who loves someone with bipolar disorder must understand how sensitive this loved one is to debilitating feelings of shame.

Shame doesn’t motivate, but rather demotivates.   In truth, we would all do well to utterly remove implications of shame from our vocabulary.  By doing that, we may begin to build that ‘safe place’ that is needed for trust to grow.

If you would like to learn more about shame and the role it plays with bipolars, click on the section, Shame.

Among other issues to consider, when you try to understand the upheavals that take place in a relationship with a bipolar sufferer…and one that is enormously significant, is triggers.

Triggers

Ok, now…for people with bipolar disorder, understanding and recognizing the triggers (link to article on Triggers) that can set off emotional upheaval and pain, is paramount to developing the skills to pre-empt the upsetting episode.

Just as important, is having that understanding in common with the one they love and trust.

In many cases, these triggers are related to an old painful memory.

The partner cannot be expected to understand and respect such sensitive areas if she is not informed about them.

So, a brick to be laid in the foundation, one that is a cornerstone for its stability, is communication, and especially communication about triggers the sufferer may find particularly threatening and painful.

Most people with this illness have had specific painful experiences in life that became like an electrical hot button for them.   When another person makes a comment that touches that button, the sufferer has sometimes reacted with great impact before he even realizes it.   And once he reacts like that…a chain reaction happens in his brain that has been compared to a seizure.   Bystanders may be watching behaviors that appear to be ‘rude’ or ‘irrational’…but the sufferer is experiencing an anguish few other people can comprehend…and the effect on his brain has commonalities with convulsions.   These reactions…or ‘episodes’…need to be taken seriously.    And avoided when possible.

When loving a person with these triggers, communicating what those triggers are…perhaps how they came to be…and how to avoid stepping on them…are all parts of the vital communication that will mortar the foundation in place between these two people.

Communicating through Triggers

Bipolar person

If you’re the one with the disorder, give your partner the advantage of hearing about your triggers….and why they cut through you like they do…

Because of the disorder, you may feel terrible hurt, and may express it with outrage.   (Link to triggers)

Your partner may only see the rage and feel attacked for no reason.

It will help her to remember to avoid those proverbial pitfalls if you will give her information.

It isn’t necessary for you to tell every painful detail, as just reliving it can trigger the pain again and lead to a devastating episode of anguish.

Do set the ground rules for communicating about this ultra-sensitive topic.

Just explain enough so that she is equipped to avoid that pothole in the future. Tell her how you want her to listen.   Walk through it with her–then let her know how you want her to listen — Either quietly, or actively sympathetic.

She may want to tell you a story that this brings to her mind, to show you she understands; If you don’t want to be interrupted with another story, tell her that before you start.

For the partner: Show that you hear what he is describing and can empathize, but can’t possibly know how painful it must have been.

To dismiss his efforts to expose this deepest vulnerability to you may convey the message that you don’t respect his pain.  This communicates worthlessness to him…hence shame.  And shame, in turn, is crippling, even deadly.

So safeguard the setting to ensure he is not interrupted. Turn off phones and the television.  And listen.   Don’t explain or give him solutions.   Just listen.

There are psychological and physiological reasons your loved one shields these memories and the resulting feelings he bears.

For more information about these reasons, refer to The Science of Bipolar Disorder. (link to The Science of Bipolar Disorder.)

The Bipolar Individual has Responsibility, too

Attached to that terrible feeling of shame is the determination to hide his true self.  In many cases, the reactions of people around him have been conveying rejection throughout his life.   He has learned through pain and loss that his true self is unacceptable.

Therefore, authentic vulnerability  (Link to Bipolar’s Responsibility article) without pretense, is extremely difficult…but without it, there can be no authentic connection.

Authentic vulnerability is exposing our most genuine and unguarded self to another in trust.  That exposure is very difficult for many people…but especially difficult for the wounded.  But, when we do, we are allowing that person to help us in our weakness…protect us when we need it.   Among human relationships, most of the time…both partners get their turn at being the vulnerable one…and at being the protector and helper.

This is a difficult process. It requires lowering a guard that has been erected for good reason and has provided much needed protection in difficult times.  But, the guard that served as armor in time of battle, serves as a wall between two people who yearn to know and trust each other.

Dismantling that wall is vital to the intimacy and trust of the relationship. It requires that both partners be patient with the other–and with themselves–as they explore the secrets to removing the barrier that separates them.

Any event where the partner communicates that the bipolar individual has been selfish, unreasonable, insensitive, etc will most likely lead to withdrawal of trust by that person.

In relationships where there is no illness, this type of accusation is often hurtful also. But  since people who are not ill have more resilience, they might not let the partner know that the accusation was hurtful.  They erect a guard, as we spoke about earlier.  The good news about the special sensitivities of our beloved bipolars, is that accusations have to go the way of the albatross.   There is no place for them…they cause needless and often un-healable wounds.   So, loving these special people makes the lover a kinder and less self-absorbed person.  The entire world could benefit from the same lessons!

Patience, understanding and tolerance of outbursts are paramount to the survival of this relationship.

A common complaint expressed by bipolars is the baffled sense of feeling ‘misunderstood.’   In spite of their outbursts of behavior, they usually know that it isn’t in their hearts to behave hurtfully.  That the outburst comes from an event triggered in their brain…and they think, say and do things that are not in their loving nature. They count on those they trust to remember that.

With support and loving acceptance, little by little, the bipolar individual should hopefully come to reveal his true feelings: his fears….his self-loathing…. and his appreciation for the love and support of his mate.

This vulnerable authenticity equips his partner to know the triggers, to offer support at threatening times and to be otherwise cognizant of his needs.  At the same time, she enjoys the gift of knowing his deep and creative sensitivities, his capacity to love and care for her on a level she may not have found in others before.

A Match Made in Heaven?

No relationship among humans carries a guarantee.

Loving relationships between two people, when one bears this mental illness, is no exception.

It is hard work to make any relationship endure and thrive in the atmosphere of today’s society.

While many people from every walk of life are more informed about the dynamics of relationship growth than ever before in history, nevertheless, there is a strong influence in the world around us to want to be indulged our every whim.

Loving a person with this type of mental illness is not for the self-indulgent, but is a rewarding, deeply satisfying and fulfilling life for those willing to weather the storms to get there.

People with bipolar disorder tend to be highly intelligent, talented, tender-hearted, warm, expressively creative, and emotionally deep.

The waters around the experience of that depth can be rough, but the rewards are beyond what scores of other people find as long as they live.

Loving a mate with this illness is both challenging and fulfilling.

While days of upheaval can be extremely difficult, even so, through information and understanding, the empowered partner can detach from taking upheavals personally, and enjoy the depth of loving and sharing that is so much a part of this person’s heart.

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When One Bipolar Marries Another: An Interview with Shannon Flynn

This article, by Therese Bouchard, was posted on http://www.psychcentral.com:

When One Bipolar Marries Another: An Interview with Shannon Flynn
By THERESE BORCHARD

Today I have the honor of interviewing Shannon Flynn, who works at the National Institute of Mental Health with adults with schizophrenia.

She has degrees in psychology, art therapy, and counseling, and has just released her memoir, called Spin Between Never and Ever, a story about her journey as someone who has suffered from bipolar disorder (also known as manic depression).

1. What advice do you have for other couples in which both have a mood disorder?

Shannon: My husband, who also has bipolar disorder, and I discussed this question together and we agree that mutual love and tolerance plus open communication is very important. I tend to get a little paranoid when I get depressed, and want to spend money when I’m a little manic; whereas he tends more toward long spells of depression, including seasonal depression, during which he sleeps a lot and withdraws to some degree. Both of us have had to adjust to these tendencies in each other, and I think (and he agrees) that we’ve learned to do a fairly good job with this. He’s invested in a sunlamp to treat the seasonal depression, which has done wonders; I try my darndest to combat my paranoid tendencies through discussing what I can do differently in psychotherapy.

2. How do you make your dual role as mental health consumer and mental health professional work in daily life?

Shannon: Because I truly know the emotional territory my clients are coming from, I find that empathy and understanding and the capacity to carefully listen come naturally to me when I’m working with people with mood disorders, and with other psychiatric issues as well. In fact, sometimes it’s all too easy to identify with others I am working with and I run the risk of tearing up (though never to the extent of “losing it.”) I’m learning, with the assistance of a remarkable supervisor, how to keep that tendency to let my own past wounds well up to the surface, under control so that I can keep my focus on the client’s pain and how I can best help them instead. Still, I give thanks that I’ve been blessed with the ability to empathize with others because it keeps me genuine in this work of helping people heal through art therapy and counseling, which I see as my calling.

3. How does art and art therapy work to treat depression and bipolar disorder?

Shannon: Art, as well as its instrumental workings through art therapy, is a wonderful means of activating the parts of the brain, heart, and soul involved in healing, from mood disorders and from many other vagaries of the human condition. In the memoir I’ve recently published, “Spin Between Never and Ever,” I describe my earliest dealings with creating and reflecting on art, up to my formal training in art therapy at George Washington University and through my practicing art therapy with clients with mental illness at various hospitals and consumer-run wellness centers in the Washington, D.C. area.

Art gives us a way to express, modulate, and even transform our emotions when no words are possible to make sense of our lives. This is true not only for those of us dealing with mood disorders or psychiatric conditions, but simply for all of us at one time or another.

4. Finally, can you tell us a little more about your book, “Spin Between Never and Ever?”

Shannon: My memoir had been brewing in my heart and mind for a long time before I sat down to write a couple of years ago. “Spin” invites the reader along on a journey that begins in a troubled childhood marked by depression – not due to family conditions, because I grew up in a loving family where my intelligence and creativity were treasured, but probably due to my oversensitive personality and genetics. As an adolescent, I excelled in school and had friends, but grew ever more deeply depressed. I put on my usual pressure to achieve straight A’s, apply to top colleges, and hold up under the strain, but simply was unable to withstand the suffocating depression that stifled me. I was hospitalized, diagnosed with bipolar disorder, and put on medications. I took the rest of my senior year off, then restarted it with much greater success.

Eventually I earned several degrees, all the while working full-time in schizophrenia research/recruitment, and part-time as an art therapist and counselor — which I continue to do today. But those are just the bare bones of the story; to flesh out this narrative I include chapters on the insidious side effects of the medications I’ve taken; my wishes to get married and have children and the way I’ve reconciled myself to not realizing the entire dream; and my advice to other people like myself trying to make the best of living with mood disorders. It is ultimately a book about hope.

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Therese J. Borchard is Associate Editor of Psych Central, where she regularly contributes to the award-winning blog, World of Psychology. She also writes the daily blog, Beyond Blue, on Beliefnet and blogs for Blisstree.com. Therese is the author of Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes and The Pocket Therapist: An Emotional Survival Kit. Subscribe to her Psych Central RSS feed, Beliefnet feed, or Blisstree feed. Visit her website or follow her on Twitter @thereseborchard..

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Bipolar Disorder and the Americans with Disabilities Act

The following article, by Linda McCullough, is posted from http://www.psychcentral.com:

The Americans with Disabilities Act (ADA) was amended in 2008 to include bipolar disorder as a covered condition.

The original 1988 law was designed to protect people with disabilities from discrimination in hiring, job assignments, promotions, firing, pay, layoffs, benefits and other employment-related activities. It states that if a disability causes impairment that “substantially limits” a person’s ability to handle “major life activities,” whether on or off the job, the employer must follow ADA rules in treating the disabled person.

Reasonable accommodations that employers must provide under the ADA may involve job restructuring, part-time or modified work schedules, reassignment to a vacant position, or adjusting examinations or policies. It may mean a change or adjustment to a job or work environment that permits an applicant or employee to participate in the application process, to perform the essential functions of a job or to obtain the benefits of employment that those without disabilities have.

To gain accommodations, an employee must disclose the fact that they have been diagnosed with bipolar disorder (or another mental or physical disability) and make request for accommodations. Those who believe they have been discriminated against can report discrimination and file a claim with the Equal Employment Opportunity Commission (EEOC). The claim must be filed within 180 days from the date of the alleged violation or 300 days if the charge is also covered by state or local laws. The EEOC has an intake questionnaire to help you determine if you are eligible to file a charge. It can be filled out online or at the nearest EEOC office. Charges themselves cannot be filed online.

For ADA purposes, major life activities that may be limited by a mental health disorder could include learning, thinking, concentrating, interacting with others, caring for oneself, speaking, or performing manual tasks. Sleep also may be limited in such a way that daily activities are impaired.

Someone with bipolar disorder may temporarily experience “limits” to handling life activities. A deep bout of depression or insomnia may create a need for time off or for flexible hours. An individual may need time off for doctor appointments. In the daily work environment he or she may need a quieter work area to decrease stress and enhance concentration or more frequent breaks to take a walk or do a relaxation exercise. He or she may need office supplies to help them organize and focus more effectively.

To improve their work experience and productivity, individuals with bipolar disorder may need to create good structure to their day and to their eating and sleeping habits. They may need to develop special organizing behaviors and divide large assignments into smaller tasks. They will benefit from a firm schedule for work activities and rest, as well as strategies to manage stress and reduce distractions.

Disability by itself is not enough to be protected from job discrimination by the ADA. An individual must satisfy the employer’s requirements for the job, such as education, experience, skills or licenses. He or she must also be able to perform the essential functions of the job with or without reasonable accommodations.

Employers may be exempted from ADA rules under several conditions including cost, disruption to business, or health and safety, but regardless of whether these conditions exist, employees still can file a claim with the EEOC. The company will have to prove its assertions of inability to provide reasonable accommodations to deny them legally.

Sources

Psych Central bipolar disorder library
About.com bipolar resources
Equal Employment Opportunity Commission
Disclosing Your Disability To An Employer

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