Mental Health Awareness Month: An Unquiet Mind

An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison is a fearlessly, brutally honest 1995 memoir examining the exhilarating highs and soul-crushing lows of bipolar disorder (which was clinically called manic-depressive illness during the events of this book) from the perspective of a psychiatrist trapped in the disease. Her frank and intimately personal insights bring bipolar disorder’s cycles of terror, elation and crushing, abject despair into stark and sometimes heartbreaking clarity.

The book was recommended to me soon after I was diagnosed as bipolar in 2008, and it grabbed me on every level—from its smart writing to the recognizable, relatable, almost comforting details of its narrative—and I all but literally didn’t put the book down until I’d finished it.

I have an indelible memory of reading it on the Red Line EL train home from work one night in Chicago, and a man who’d clearly seen me reading it made sure we made eye contact as he stood up to leave and then he patted me reassuringly on the shoulder as he got off at the Sheridan stop. That encounter—a direct extension of this book—made me literally weep the rest of the way home as I was coming to grips with the label “mentally ill” and discovering the signs I’d never thought to notice until then that I wasn’t alone … and realizing that everywhere I go I’d never be alone.

If you are or love someone who is bipolar—or struggling with any mental illness—this book will make you weep, give you hope and quite possibly change your life.

Mental Health Awareness Month: Bipolar Disorder

I’m starting my series of essays with something I know on a cellular level: I was diagnosed bipolar II two decades ago, and I’ve spent a lot of time since then trying to learn everything about the illness, how the medical community’s understanding of it is evolving, and how we all can work to manage it both day-to-day and long-term.

Bipolar disorder in general involves one- to two-week swings between two opposite poles of mood, energy, focus and function. The top pole is mania, which manifests itself with elation, irritability, energized behavior and lack of impulse control. People in manic episodes experience racing thoughts; an inability to focus or stay physically still; and delusions and hallucinations that can inspire irrational or risky behaviors including gambling, sexual activity and drug use without regard for what can be catastrophic consequences. 

The bottom pole is depression, which manifests itself with hopelessness, indifference and despondency. People in depressive episodes experience extreme sadness; suicidal ideation and attempts; and difficulty functioning, thinking or experiencing pleasure (which is called anhedonia).

There are three types of bipolar disorder. Bipolar I Disorder involves swings between both poles—sometimes both at once—that are so severe they can require hospitalization. Bipolar II Disorder—sometimes called bipolar depression—involves mild manic episodes (called hypomania) and often more profound depressive episodes. Cyclothymic Disorder, which isn’t as common, involves hypomanic and depressive episodes that last at least two years.

As I’ve said, I’m bipolar II, where my hypomanic episodes involve restlessness, fast (well, faster than normal) talking and thinking, and buying shoes online that I don’t need. I usually post these purchases on here to broadcast that 1) I bought awesome new shoes and 2) I’m currently hypomanic off my ass. My depressive episodes are soul-crushing in their extremity. I can’t think, I struggle to breathe, my vision is blurred, I feel like I’m wrapped in a wet wool blanket that I can’t kick my way out of, I sometimes have visual or aural hallucinations (including seeing people in black clothing lunging at me and hearing stupid, irritating circus music coming from another room), and I often contemplate suicide but I have no energy or initiative to carry it out … I generally feel like everything is completely hopeless and I just want to have never existed. And when I emerge from these episodes I’m exhausted to my core.

Bipolar disorders can be managed with psychotherapy (talking with a therapist), psychiatry (drug therapies) or a combination of both. I’ve never found much benefit from my visits with various psychologists, but I’m a HUGE believer in better living through chemistry. Psych meds (which are awesomely called psychotropics) affect me strongly, for better or worse. They involve a lot of trial and error, but I’ve been highly functional for the last seven years after finally finding a magic cocktail of three psychotropics (there’s that cool word again).

I do want to stress, though, that what works for me is indicative only of what works for ME. If you’re living with a mental illness, don’t abandon a combination of therapies that might be working for you just because someone else is thriving on a different combination of therapies. And for God’s sake, ALWAYS TAKE YOUR MEDS.

Bipolar disorders were classified as manic depression through most of the 1900s. In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders (called DSM-III), officially changed the classification to bipolar disorder to reflect a wider range of nuance and understanding of the disease. This paragraph is a broad generalization of the naming history, but I wanted to explain that manic depression and bipolar disorder are essentially the same thing.

There is a lot more I could discuss here, but I want to keep these essays short(er than this one) and digestible for anyone who cares to read them. Feel free to share this with anyone you think might be interested, and I hope to have another short(er than this one) essay posted soon. Stay healthy!

Why is the waiting-room music at my psychiatrist’s office playing “Send in the Clowns”?

I'm back from my three-month checkup with my psychiatrist

And she still wants to keep seeing me every three months instead of the every-4-6-week schedule I was on a year ago. This might sound good to you, but it's HUGE to me and my family. The bipolar med cocktail that she's methodically calibrated for me over the last three years seems to be keeping me stable (though the 12+ miles I've been running every week since March might also have something to do with it), and of course the tireless, diligent support of my family and friends has been an enormous part of that success.

I'm so thankful for all of this—and all of you—that I splurged on a massive bucket of Diet Coke and two super-sticky apple fritters on the way to work. Even though caffeine and sugar probably undermine the efficacy of my meds and exacerbate their weight-gain side effects. But I'm pretty sure I can manage these setbacks.

Yawn

When you accidentally took your night bipolar meds—which include the sedating Clozapine—instead of your morning ones plus you didn’t rehydrate nearly enough after your morning run so you’re profoundly sleepy and your entire body feels like an immolated corpse and you need all the stimulation and moisture you can get before work:

And on all days to screw up my meds, I had my three-month psychiatrist appointment this morning. I’m apparently still normal enough to be allowed to roam among the unsuspecting citizenry, but I’ve been having near-blackouts multiple times a day for months and my blood pressure is on the alarmingly low side of normal, so now I have another compelling reason—the other one being I’m 50 and need to be responsible and get a colonoscopy—to visit my GP.

I did NOT just talk about my colon on my blog. Did I?

Anyway, I’ll call to schedule an (yawn) appointment with my (yawn) GP just as (yawn) soon as I rehydrate my (yawn) cells and wake the hell (yawn) up.

Yawn. Colon.

Why is the hold music at my psychiatrist’s office playing “Send in the Clowns”?

 Making my entrance again with my usual flair ...

I just had my six-week checkup

(I'm still crazypants biploar but things continue to be stable and we're not altering my meds this time, thanks for asking) and when my psychiatrist met me in the waiting room she asked me if it was OK if a residency doctor observed my visit and of course I said yes because I'm clearly not a hide-my-crazypants-biploarness person and when we got to her office and she opened the door and he was politely standing there waiting to shake hands and introduce himself OH MY GOD HE WAS TALL AND HANDSOME AND LET'S NOT MINCE WORDS HERE HOT HOT HOT and we sat down for my visit but I kept looking over at his let's still not mince words here sexy forearms because that's all I could see besides his face because he rudely wasn't wearing a Speedo and WHY ARE YOU SO HOT STOP DISTRACTING ME and we talked about all the usual stuff like my moods and my appetite and my feelings of control and my ability to concen OH MY GOD I CAN'T CONCENTRATE BECAUSE JUST LOOK AT HIM HE'S TOO HOT TO WALK THIS EARTH trate and any side effects of my meds (still lingering exhaustion, but thankfully it's not 24 hours a day like it has been) and is there anything else I think would be relevant to tell her WHY ARE YOU TALKING TO ME HAVE YOU EVEN NOTICED THE LET'S AGAIN NOT MINCE WORDS HERE HOT HOT HOT MAN WHO'S ABOUT TO BE A DOCTOR AND I THINK WE CAN ALL AGREE IT WOULD BE A VERY GOOD THING FOR ME TO MARRY A DOCTOR AND HE'S SITTING IN THAT CHAIR RIGHT THERE SO CLOSE I COULD STARE AT HIM FOR HOURS WHOOPS I JUST DID and I said that I've actually ramped up the activities in my life like Follies rehearsals and editing a massive book pro bono and making my bedroom renovation finally really start to happen and cleaning out the storage room in our basement AND WHY WHY WHY DOES THIS INSANELY HANDSOME MAN HAVE TO KNOW I'M CRAZYPANTS BIPOLAR PLUS NOW HAVE A DOCTOR-PATIENT RELATIONSHIP WITH ME BECAUSE THAT PRETTY MUCH GUARANTEES THAT'S THE ONLY KIND OF RELATIONSHIP WE'LL EVER HAVE BUT HOLY SHIT WE'D LOOK HANDSOME IN OUR WEDDING PHOTOS and she gave me some more free samples of my really expensive medication and we scheduled my next six-week visit AND FOR THE LOVE OF ALL THINGS GOOD AND HOLY MAKE SURE HE'S STILL RESIDENTING WITH YOU WHEN I GET BACK IN SIX WEEKS and I think we had a really productive visit.

I have a preexisting condition. Rick Santorum doesn't care.

Scamming?

I'm bipolar depressive, and I've been bipolar depressive since long before I was finally diagnosed as such seven years ago. So I definitely, unquestionably have a preexisting condition. And when I learned years ago that because of this I was de facto uninsurable if I lost my job, it terrified me.

And then I lost my job.

Scamming? Thanks to the Affordable Care Act, I can get insurance despite my preexisting condition. My insurance is not subsidized through the ACA marketplace; I pay the hundreds and hundreds of dollars in monthly premiums, the thousand-plus-dollar deductible and the chokingly high co-pays entirely with my own money. I'm on four medications that cost over $1,000 a month. I see a psychiatrist once a month to regulate my meds. I see a kidney specialist every few months to monitor the potentially fatal side effects of my meds.

Scamming? Despite your 9-months-of-payments accusations, Rick, I am faithfully making a full 12 months of payments for a full 12 months of coverage. I SPEND ALMOST HALF MY SALARY FOR COVERAGE ON THE COMBINED ELEMENTS OF MY MEDICAL CARE, WHICH WOULD PROMPTLY BANKRUPT ME AND THEN FORCE TAXPAYERS TO PAY FOR MY EXORBITANT MEDICAL EXPENSES IF YOUR CONGRESSIONAL ILK REPEALED THE AFFORDABLE CARE ACT FOR NO QUANTIFIABLE-AS-OF-YET REASON BEYOND YOUR PARTISAN GRANDSTANDING.

And YOU accuse ME of scamming the system—without a shred of evidence to support your lies, no less. You have a staggering amount of nerve, Rick. A staggering amount of repulsive, hypocritical, selfish, hateful, lying nerve.

YOU are the one who is scamming. You're scamming the religious community with your "faith-based" campaigns to destroy the families of gay people, immigrants and now sick people with preexisting conditions. You're scamming your vast low-information base that looks to you for moral and political guidance on matters regarding public policy, the common good, witnessing for Christ and basic human decency. You're scamming Trump's all-caps FAKE NEWS with your insistence that you bring value to the public dialogue on anything beyond your self-righteous narcissism.

You are a catastrophic moral and intellectual failure as a human being. And that fact is compounded by your desperate attempt to distract the country from your ethical bankruptcy by condemning me and every other taxpaying citizen who is dutifully and faithfully and responsibly managing preexisting conditions through the financially essential and morally right Affordable Care Act, which you—again, without even hinting that you have or are willing to supply a shred of supporting evidence—dismiss in blanket-statement Trump style as "a failure."

There is a reason you have been publicly vilified for well over a decade, Rick. And no feigned persecution complex can exonerate you. You are beyond contempt. You are beyond pillory. You are beyond malice.

And you'd better pray you're never beyond uninsurable.