Living Bipolar (10 page)

I enjoy myself today and I enjoy the little things and things have become so much easier.

Anne is twenty-three years old and is diagnosed as Bipolar II and Borderline Personality. She had a happy childhood, she is very intelligent, she writes and she paints. As a teenager she was in abusive relationships, she attempted suicide, and became addicted to heroin.

Today she has been sober for a year and a half, and is an incredible example of how a young woman has overcome difficulties which most people would never recover from.

Bipolar-II
Disorder
(Recurrent Major Depressive Episodes with hypomanic episodes)

Diagnostic Features

The essential feature of Bipolar II Disorder is a clinical course that is characterized by the occurrence of one more Major Depressive Episodes accompanied by at least one Hypomanic Episode. Hypomanic Episodes should not be confused with the several days of euthymia that may follow remission of a Major Depressive Episode. The presence of a Manic or a Mixed Episode precludes the diagnosis of Bipolar II Disorder. Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a medication, other somatic treatments for depression, drugs of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar II Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. They symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. In some cases, the Hypomanic Episodes themselves do not cause impairment. Instead, the impairment may result from the Major Depressive Episodes or from a chronic pattern of unpredictable mood episodes and fluctuating unreliable interpersonal or occupation functioning.

Individual with Bipolar II Disorder may not view the Hypomanic Episodes as pathological, although others may be troubled by the individual’s erratic behavior. Often individuals, particularly when in the midst of a Major Depressive Episode, do not recall periods of hypomanic without reminders from close friends or relatives. Information from other informants is often critical in stabling the diagnosis of Bipolar II Disorder.

Associated mental disorders include Substance Abuse or Dependence, Anorexia Nervosa, Bulimia Nervosa, Attention-Deficit/Hyperactivity Disorder, Panic Disorder, Social Phobia, and Borderline Personality Disorder.

DSM-IV-TR pgs 392-394

is an “illness characterized by a pattern of depressive and hypomanic episodes. Indeed, it is the under diagnosis of hypomania that explains why the frequency of Bipolar illness has been so underestimated. This is scarcely just an academic issue, since the inappropriate treatment of Bipolar-II patients can lead to full-blown mania. Originally, the Bipolar-II pattern was described in patients who had been hospitalized for their depression. Now, appropriately, it encompasses patients whose hypomania alternates with depressive episodes of varying severity…specific symptoms of sufficient magnitude to be designated as abnormal by the patient or the family and to result in interference I normal role functioning but not severe enough to result in hospitalization

-Goodwin and Jamison 1990: 14-64

Anne’s Story

My grandmother is Bipolar and she used to torture my father. Aside from torturing my father, she would also pretend to kill herself so everyone would freak out. But I had a really good childhood. My family was middle-class, my mom attended college, and as a child I was really happy. I was bright for my age. In the fifth grade I was reading at an 11th grade level. They used to bring high school books for me, and I was placed in the gifted program. I always wanted to fit in and be popular, but the fact is I just didn't fit -- I was a nerd.

Starting in seventh grade, I got depressed, and in the seventh grade I wrote my first suicide note. My parents found the note and they sent me to a therapist. I think when I wrote the suicide letter it was more therapeutic for me at the time. At the time I wrote the letter I had just lost a friend and everyone close to her glamorized her in death and made her legend.

I was so miserable that I thought in death I could get the love that I couldn't get in life. I was sleeping a lot, I didn't want to go to school, and even as early as the second grade I would fake stomach aches because I didn't want to go to school. My parents brought me to physicians and doctors, but there was nothing wrong with me.

My family was stable until about the age of 12 when my parents got a divorce. Slowly my life got out of control. I would get very angry at first, and this was my mania expressing itself, but no one called it that yet. I would lose control, break dishes, I cursed a lot, and I would call my mom horrible names. I started experimenting with drugs just to get outside of myself drugs at the age of 12 and at this point my parents finally realized there was something wrong with me mentally. Initially the doctors diagnosed with depression at first and ADD. They put me on amphetamines, such as Adderall, and I think that upped the manic state a lot more. Also, I would cut myself as means to control my emotions.

In high school, my life got progressively worse. My impulsivity was the main thing. I believed everything that I was thinking was a great idea, and I could convince myself that when I had insane ideas that my thoughts were brilliant ideas and that my ideas were appropriate. I can also usually convince other people to go along with my brilliant ideas. High school was up and down and I would look for trouble and find it. I had numerous abuse issues with the people I was hanging out with.

I attempted suicide at the age of 16 after I stayed up for five days straight and I became psychotic as a result. Leading up to the suicide attempt I had been raped by a close friend, and I was manic and had been out for three days. The mania didn't hit me until about week later, after I had been doing cocaine. It wasn't that the drugs were gone from my system, they just weren’t working anymore and I crashed really hard. I took a lot of pills and I washed them down with alcohol. I guess I passed out because I woke up in the hospital the next day.

The suicide attempt was completely impulsive. It was a consequence of the crash that comes at the end of mania. It was awful. A lot of things happen during mania and everything builds up. Then the crash comes and I realized, “Oh, my and out of control!” I'm embarrassed and I'm ashamed, and the guilt and shame comes from the crash. The crash after mania is what happened to me before the suicide attempt.

SHAME

Manic-depressive individuals experience acute shame and humiliation for many reasons: because of psychosis (particularly manic) and shame for bizarre and inappropriate behavior, violence, financial irregularities, and sexual indiscretions, to name a few of the common problems. One patient state, “No one who has not had the experience can realize the mortification of having been insane” (Reiss, 1919). Robert Lowell, in “Home,” described the indignities of psychiatric hospitalization: “we might envy museum pieces/that can be pasted together of disfigured/and feel no indignity” (1977). And Graves (1942) wrote:

While the intoxication of mania lasts, I for one have no disposition to embrace death. After the intoxication is over, my chief emotional reaction is shame and disgust with myself, and a wonder that my fear of death could be so wonderfully and idiotically twisted. That the facing humiliation, of despair, or deprivation should produce a desire for death is quite natural.

Goodwin and Jamison 1990:19

All of a sudden before the suicide there was a huge drop with me mentally and I just couldn't handle life anymore. I was institutionalized for the first time after the suicide attempt, and it was terrible because I was adolescence. I was the only adolescent in the ward, and it was all adults and me. They took me off all my medications and I was also detoxing off illicit drugs. But I was still very depressed because I had a failed suicide attempt. They would not let me smoke at the institution and I remembered that was a huge deal, because I was underage and was not supposed to smoke, but of course, I wanted to smoke.

I was freaking out and I called my insurance company. I refused to go to groups at the institution. And for some reason they just released me from the institution. They simply did not know what to do with me. After that I was in and out of therapy. I was medicated, and sometimes I would want certain medications from the doctors, because I thought I knew best. A lot of psychiatrists even refused to see me, because I was so manipulative. I'm diagnosed as borderline personality in addition to being Bipolar. They diagnosed me as Bipolar right after the suicide attempt, but the second time I was institutionalized at Silver Hill in Connecticut they diagnosed me as borderline personality at the age of 18.

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or Bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women.
¹
There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. `` Yet, with help, many improve over time and are eventually able to lead productive lives.

While a person with depression or Bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly Bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

The National Institute of Mental Health (NIMH)

I maintained a pretty manic state for around three years, and during this time I had been taking large amounts of amphetamines. During this three year stretch I was painting a lot, and I was also writing a novel. I would write every single day. Even if I was at a party I would have my notebook with me. I was obsessed with the idea of writing the great American novel. On my notebook it even said: “The Great American Novel.” I was going to write this book and I have boxes and boxes of notebooks that I still haven’t looked at to this day.

I would stay up for days and days writing this book, sometimes for five days in a row and then I would sleep. I was in an abusive codependent relationship, and since I'm borderline, I attach myself to men who were very disturbed individuals. That's who I'm attracted to. I have a savior complex with men or something. In this particular relationship, I liked the fact he would push me, and he would encourage my insanity. He would encourage me to believe that these insane and grandiose thoughts in my head were right.

My mom used to know when I was manic and she wouldn't let me leave the house because she knew that I was manic. When I was manic I would dress differently, and I would wear more makeup and dress sexier and I would always come home completely blitzed. I simply did not have a stop button. It was like when I was manic I was invincible and this personality would scare my mom. She didn’t know how to handle my mood changes.

I use to take myself off the mood stabilizers, although I always stayed on the antidepressants. They put me on a mood stabilizer when I was 16 when I was diagnosed as Bipolar. Because the mood stabilizer would curve my creativity I would take myself off of it because I enjoy my creativity. By only taking the antidepressants it caused me to be more manic.

What led up to me going into an institution for the second time is I had the realization that I had a drug problem. During this time I was living with my father, and he's an alcoholic, so he would let me do whatever I wanted and that's why I lived with him. He would just let me do whatever I wanted, and living with him I had a lot of freedom and I would through parities almost every night.