RealMental

A story from my local paper about a teenaged girl suffering from bipolar and the push in Massachusetts for better funding for youth mental illness treatment.

I mean, not to draw deep meaning from the G.I. Joe cartoons, but really, it is.  Paying attention to my illness, as annoying as it is to have to be that self-aware, is the only way to ensure that I keep myself out of trouble.  And I’m pretty good at that part.  But.  But?

Did you know that taking a B-vitamin complex supplement has been clinically found to elevate mood in people suffering depression, as has exercise?  

Did you know that Omega-3 fatty acids have been shown to increase time between depressive episodes, among people suffering from unipolar and bipolar depression?  I did, but I’d never read the studies.

Did you know that clinical research is tending to show that antidepressants do not affect the recurrence or severity of depressive episodes in people with bipolar disorder ?  I didn’t, and when it came up during a medication discussion with my psychiatrist a few weeks ago, I was surprised.  I don’t know why– we already knew that antidepressants alone can actually trigger a manic episode, leading to an even worse depressive crash thereafter.

I’m not a doctor.  I am a lawyer who has worked with doctors, extensively.  I am also a civil litigation attorney, used to defending cases where people’s medical records are at issue.  I consider myself well-versed in the news, and I thought I’d done my reading about bipolar, by keeping up with the science and health sections of the Boston Globe (hooray for proximity to one of the top medical areas in the world) and the New York Times, my “paper of record.”  But I still missed things, and I’m embarrassed.  I’m not doing my work, doing the reading that I need to do to be aware of developments in the science.  Especially since brain chemistry is affected by hormones from all over the body, and is “hideously complex,” as my psychiatrist says.  I tend to think of it as playing darts, blindfolded, while balancing on one leg– there’s still so much to be learned.

I’m lucky to have a wonderful set of doctors caring for me.  But they can’t help me with symptoms and behaviors I don’t know are important, and so haven’t reported to them.  Too, doing my reading may give me a new perspective on something I’d never thought about, opening up a new avenue for treatment.  Doing you bipolar homework needn’t be a hypochondriac thing, nor need it be a distrust of your doctors’ advice or ability to keep up with the reading.  It’s simply this:  it takes two to tango, one to lead, and one to follow.  But the one who follows isn’t the patient– it’s the doctor.  My doctors can only treat what they’re aware of.  If I don’t stay abreast of the research, and combine that with my work to mood chart, med chart, symptom chart, then I am not leading, and we’re going to step on each other’s toes or crash into a wall eventually, having steered them in the wrong direction. 

So here’s what I’ve done in my battle to know better.  I’m using my gmail account more efficiently.  I set up a Google Calendar on which to record when I took my meds– since I check my email a lot, switching over to the calendar for a few minutes isn’t too time-consuming.  I take my meds three times a day– it’s hard to keep track of, even with my pill counter– but I’ve set up alarms in my calendar to go to my cell phone, to remind me.  I also enter symptoms– diahrrhea?  Worth tracking, in case I’m having a toxicity episode.  More clumsiness than usual?  A headache that’s different from my regular headaches?  Bad sleep, without the pleasantly weird dreams my medications usually give me?  Irritability?  Anything, and I do mean ANYTHING, that seems interesting or out of the ordinary goes in there.  I then did a brave thing– I emailed an invitation to share the calendars to my psychiatrist, my therapist, and my primary care doctor.  I’m a pretty reliable patient, luckily I’ve never gotten too manic… but knowing they can read the calendar whenever they want, and see how I’m doing, is comforting.  It also gives them a way to hold me accountable if I am NOT reporting things accurately, and if I’m not updating the calendar.  That all keeps them in the know.

To keep me in the know?  Google Alerts.  I set up alerts to come to me once a week about “bipolar research,” “lithium research,” and “depression research.”  I may have to tweak the search descriptions after I start getting my reports, but at this point I figure over-inclusiveness is better– I can use the “Advanced Search” options to refine the queries after I see what I get.  I’m also in the process of setting up better bookmarks to mental health sites such as NAMI and DBSA, as well as NIMH, and a Google Calendar reminder to spend an hour, once a week, checking up on their science alerts.  After all, an hour’s not too much time, since I can’t know too much– especially when I think of the hours that might be lost if I know too little.

(You can ask Google for an invitation to a Gmail account from the Gmail front page.)

There comes a time when we all have to stop offering excuses, and pick up where we rather messily left off.  I’m at that point, and feeling rather proud of myself for doing something really incremental– taking the call of a creditor on some health insurance payment snafus.  It’s a drop in the bucket of all the stuff I’ve got left to wade through, swim through, not drown in, but until the last week or two, I just haven’t felt up to the task of being functional.  I still don’t really feel up to it, but I do feel more up to it than I have.  And I’ve got to start sometime.  But I still want to excuse myself from my behavior– I’m not normally like this, I’m usually more of your 45 day billing cycle procrastinator, every three week housecleaner and laundry doer, who still gets stuff done.

“My mother went rather spectacularly mad,” I could say.

“I have bipolar and have been having a difficult time adjusting to my new medication,” I might put it, mildly.

“The endless winter this year has made me even SAD-der than usual.”  That’s true.

If I was feeling really TMI?  “My thyroid is also falling apart and I am a rashy mess of brittle nails and hair, swollen hands and feet, and lumpy throat.  And I’m even colder all the time than I was before.  And I could lie down on the subway and sleep, I’m that tired.”

“I’m depressed and scared and elated and paralyzed and whirring with activity all at once at potentially leaving litigation forever, and starting a whole different career,” I could also say, at least as if I was in my therapist’s office.

All of these are true.  And they’re what come to mind when I wonder why my house is a mess, my bills are a mess, my life is a mess.  But at the same time?  I’m tired of making excuses.  I think I’m almost recovered enough that I just need to start plowing through, as painful as it is, and start taking those creditor calls, opening those bills, slaying those dust hippos, climbing those mountains of laundry.  In short, sucking it up.  No more excuses– even though I’m still tired, even though I can’t wear a turtleneck or scarf because my thyroid’s so tender, even though I don’t fit in my normal-sized clothes, even though I’m still not at a fully effective dose on my meds, and therefore prone to weepy-whiny-crankiness.

But life is what happens when you’re making other plans, or even just lying down in the middle of it, letting it wash over you.  I’m going to get more than a bit winded, trying to keep up, but I’m restless and productive enough now, I think, to pick myself up slowly, painfully, start catching up.

I saw this rain-ruined crocus the other day, and thought to myself, better a broken flower than an empty patch of ground.

I don’t ask that anyone succeed in all they do– but I do ask that they try. This is the key to my relationships with people—I can’t be around quitters, or people too cowardly to try in the first place. Better to try and fail, than to never know if you could have succeeded.

My obsession with trying stems directly from my observations of my parents’ behavior. My mother gave up on her Ph.D., gave up on working, gave up on being independent, gave up on her health and attractiveness, gave up on being forgiving. My dad tried and failed to stop drinking for a long time; he tried and failed to get his temper under control—but eventually, when he bottomed out after being arrested, losing his driver’s license, and losing his job, he tried some more. Eventually, he succeeded. First, he stopped smoking and drinking. Then, he started going to A.A. Then, he got two jobs below his abilities, so he could pay our child support. Then he began trying harder to present a more pleasant face to the world, and to overcome his misanthropic tendencies. Meanwhile, my mother, a pretty, smart, ordained minister with a promising career as a lecturer on women’s issues in the church, allowed herself to become obese, increasingly crippled by the obesity (no outdoor family activities with her), and welfare-dependent– yet she continuously harped upon my father for putting her in this position, while somehow missing that they’d been divorced for ten years, and she could try to do whatever she wanted.

Obviously, my perspective is my own, flawed, and I am not as sympathetic to my mother as I would like to be. But the fact remains that older I get, the less sorry I felt for my mother, and the more I appreciate my father’s attempts to be a better person. That I got my bipolar in a double shot from both parents makes the contrast in possibilities, in attempts at success, even starker. But Dad finally pulled past his own pathologies, and worked long and hard to improve. I never really saw my mother trying, although she’d talk a good game, and did manage to do the minimum, working as a substitute teacher just enough (never full time, never every day) to earn what child support didn’t supply each month, when it became clear she wasn’t going to win the lottery (or an increase in child support) anytime soon. However, as soon as my grandparents died and her brief teaching pension vested, she stopped even that– and now lives a life of complete leisure in Southern California. I say that sarcastically, but still– she’s clearly got more disposable spending money than we do on a month to month basis.

I am always going to resent her—for not even trying. She did not try to shelter us from poverty. She did not try to get help for her own mental state in order to do best by us. She did not even try to think about her own mental state in order to recognize she needed help. She was too focused on being the victim. (I suppose that’s what makes her a narcissist.) She did have unloving and harsh parents, and she had to work at the family business—but she also had loving sisters and many friends in high school, and that family job paid for college. Yet the focus is always on the negative, unless she’s feeling ignored in a social situation, when she gets grandiose and bragging. My father’s mother was not the most loving or uncritical of women, either, and he had to become the “man of the house” at age 13 when his father died. So I don’t know where she got off whining about the tough childhood—certainly, she never had to endure the humiliation my brother and I did of being called to the front of the classroom to get our free lunch tickets as my brother and I did, or being mocked by other kids for wearing the same five outfits, week in and out, all school year long.

My dad doesn’t try to be a parent now. He just wants to spend time with me. He is constantly trying to make amends, even though I’ve long since forgiven him. I worry about his getting older, and his untreated depression, but he knows enough now that if he got really bad, I think he would do something about it.

My mom, however, still tries to parent me. She urges me to finish all the food on the plate, despite the fact that her obesity as a model of my biological fate makes me sick to my stomach. She tells me what to do. She interrupts constantly to relate her opinion. She never listens to any professional legal advice I have to give her, only when she asks. In short, she has no respect for me as an adult. No conception, I suppose, because her narcisissm dictates how she re-writes the stories I burst in upon.

I tried to forgive and to understand her perspective, but I can’t understand how she could be so smart and yet so damaged that she is unable to make up her mind to get better. So what do I do? I tried to keep my mouth shut and my temper in check. For a while, I was getting better at it. I didn’t erupt, insult or ignore as much as I once did. And I tried not to take it so personally; realizing that her failure to try has nothing to do with my worthiness, or lack thereof. I failed, and we’re not speaking anymore, but I think I tried.

Sometimes, it’s possible to overthink things. I had a mild toxicity episode after starting what was hoped would be my effective dose of lithium, characterized by nausea, dizziness, a head that felt like a heavy water balloon, bad GI effects, and tremendous sleepiness. The nausea was not the mouth-watering, bile-in-your-mouth type, but pretty close. And throughout that time, it felt like there was 2 pounds of puke pushing up on my epiglottis, just waiting to hurl. (Is there a medical term for that? Imminent pukerizing? Yak-readiness?) After four days on the new dose, and two days thereafter when the nausea and dizziness got more severe and more constant, the little dim bulb popped on over my head– toxicity! I called, I got the blood draw, the doctor said yes, I decreased the dose, and three days later, I was feeling better, physically. I was, however, cranky, because right after (no, really, right after, because never say the universe does not have a sense of humor) I called my doctor to say, “um, toxic, I think I am, and talking like Yoda, too?” (ok, not that last part), my mood snapped into place, like a dislocated joint. It was such a relief that it almost hurt. But the mood dissipated back into okay-not-too-bad- occasionally- laughing-but-usually-just- meh-ness. Fortunately, so did the physical symptoms. Mostly.

See, I continued to have this mild what-I’ll-call-epiglottal pressure. I figured it was some weird malingering effect of the nausea. Or an emotional lump in the throat– something psychosomatic having to do with my telling my mother never to call me again the day before Easter, after she told me that I had no idea what it meant to be depressed and unhappy.   (Insert confused Scooby-Doo noise here.)  But I didn’t really think it was the Mom thing– even though I have sometimes been “all choked up” physically about things I’ve been mad about in the past– because when I hung up on her, I felt five hundred pounds lighter, so I didn’t think I was suppressing anything.

Friday I saw my psychiatrist to check in and discuss alternate dosing options, to see what we could do between 1200 and 1500 mg. to make my baseline mood a bit better. And I mentioned this lingering lump in my throat, along with the relevant bits of the story above. She scooted over, had me lower my turtleneck, and palpated my neck. “Your thyroid is inflamed.” Oh. And hadn’t I complained about gaining weight recently? Double oh.

Why yes, I do have the prescription information on my fridge, along with the warnings about people with thyroid conditions in the side effects section! Why do you ask? Oh, because I’m feeling stupid that it was something that obvious, weird inventions about nausea notwithstanding? (That BLC, she always wants to be unique…) And, why, yes, I am a lawyer who is familiar with medical research, having defended medical professionals on more than one occasion. Why do you ask? Oh, because I could have consulted Dr. Google earlier on? (Hey, just because I’m “smart” doesn’t mean I’m sensible all the time.)

I’ve got my lab slip to get my TSH level done when I get the lithium drawn next Friday, since I’m starting a new preparation and intermediate dosing schedule this week. Probably means more pills. F*ing thyroid.

Sometimes I think that the side effects to treating the crazy are worse than the crazy itself. But then I remember that my thyroid never nearly lost me my job. So, yeah, my latest adventures in psychopharmacology suck, but it could be worse. I could still be speaking with BipolarNarcissistMom.  Bring on the synthroid!

When I was in high school, I played the organized (thuggery) sport of field hockey.  It’s not a genteel sport for ladies, or at least it wasn’t in the Greater Boston Division One league.  Pushing, shoving, high sticking, tripping and fouling when we hoped the refs weren’t looking—if it only pushed the bounds of dirty, we pushed it.  (And had more than a few fistfights after games to prove it.)  But it was all a part of our love of the game. 

I wasn’t an all-around athlete, but I was a good defenseman—halfback, fullback, and occasional goalie as the changes in the line up dictated.  But I could drive and tackle, defend corners, pass, flick, scoop, and make penalty shots with the best.  I was blessed with a team that functioned as a team.  My offense was there, up ahead, making themselves open so I could dribble and dodge the other teams offense, and push them the ball or drive it up the sidelines to a waiting wing or center.  I had a long drive, so I also had league record number of assists for a defenseman.  I drove a ball so hard one time from just the other side of the 50 yard line that some of the opposing players jumped out of the way.  And the joy of the game well played more than made up for the laps I hated to run, the sprints I had to do.  Stickwork drills?  All over that.  Running?  Not so much.  But tackling an opposing player, stealing the ball, passing it to my wing, and having her flick it into the upper corner of the net?  All the sprints were worth it. 

Life is like field hockey in that it’s played with very little external padding.  When I played, we wore mouthpieces and shin guards.  That’s it.  No helmets, no padded glovers, no chest pads—despite the fact that concussions from balls to the head, and ruptured spleens from balls and stick-ends to the gut were a frequent occurrence.  And even with the padding, we were still open to injury.  Broken fingers, noses?  I’ve had several, some twice.  And that ball?  A larger-than-baseball-sized solid plastic ball, driven at as much as 75 mph (my hardest driving speed) by a fiberglass-reinforced oak stick of no small dimensions.  It hurts. 

In my sophomore year, I got whacked on my left shin one day intercepting a straight-for-the-goal drive from a player on the Bishop Fenwick team, and even through the shin pad, I could feel it start to sting.  The hit was so hard it didn’t even really bruise—it just became a hard, sore mass right in the center of the shin.  For weeks, it sent stinging, shooting pain up my leg, every time I ran on it.  Since the xray was negative, I learned to ignore it.  For months afterward, the lightest brush was excruciating.  So I taped a small gel pad on between my shinguard and my leg, and kept playing.  For three years, it was tender to the touch.  I learned not to touch it.  I never thought it would heal—but it did, while my attention was elsewhere.  (Only to promptly get whacked again in the same place during college field hockey tryouts—but that’s another life metaphor, for another time.)

I was reminded of this after a recent fight with my mom, who, less than three weeks after her release from the hospital for another psychotic/manic episode, accused my brother and I of trying to take control of her money and leave her in the poorhouse.  Currently, we’re not speaking, since she had the gall to tell me that I had no idea what being depressed was like. (I believe I said “I find that hard to believe, since you gave me the f-cking bipolar…nice f-cking present.  Thanks.”).  Afterward, I was angry for letting her goad me, and then angry at her for being Queen MeMeMe– but then I accepted that I’ve just got sore spots that she pokes, hard, intentionally or not.  But I was still despairing of the whole situation, until I remembered what I’d learned from my field hockey bruise– some things just take longer to heal.  Even if you think they never will, they very well might, long after you’ve learned to function, walking wounded, and have gotten on with things.  One day, the sore spot will be gone.  So for now, I am going to ignore my most recent sore spot, pad it as best I can, and trust that it’ll heal when it’s good and ready.  It’s the only thing I can do– I’ve got a life to live in the meantime.

Hi Doctor, it’s (BipolarLawyerCook). Wanted to follow up with you about last week’s toxicity episode and the step back to a lower dose of lithium. I am feeling much physically better now– the headaches are essentially gone, as is the sensation of a waterlogged, heavy head. I am less dizzy, less sleepy, and less nauseous. That permanent lump in my throat is almost gone now.

But I’m really bummed out, because while we were waiting for my blood work to come back, my mood snapped into place, like a dislocated joint, or like that pop that your back makes when the massage therapist finally gets that one knot out. It’s since dislocated again, and I’m back to feeling a little too close to the surface. Before I slipped out of place again, the husband and I had a fabulous night, and he said “you haven’t laughed like that in a long time.” No, I haven’t.

I say “close to the surface” not in the sense of boiling over in irritation, of exploding with rage, of imploding at any minute into a sucking vortex of need. More like seeping through whatever dry, calm, surface I am trying to maintain. Cute puppies, a touching email from a friend, a favorite hymn? Teary-eyed. A sarcastic remark from the husband, a thoughtless interruption from some in-law? The eyes well, the hands and voice shake in anger and hurt. A question in an interview about some unresolved stuff from my last job? My face flushes, my voice and hands shake, I have to apologize for my “clearly still feeling angry.”

It never lasts too long, and I am learning to just be quiet through it, but I’m feeling I still need a tune-up, a popping back into place. Certainly, I could live close to the surface like this– because it’s still not the prickly cranky ouchy huffy angry enraged hurt self-conscious depressed worthless I don’t want to wake up, I’ve been holding this bottle of pills in my hand for too long spectrum. I could live like this– perhaps the inability to maintain a poker face is better for me, given my not-so-successful history of repressing my feelings. But I am getting tired of constantly blotting my now-slightly damp to outright-soggy surface– I really don’t own that many towels.

So, once we get me back down to my non-toxic dose, get my new level, and confirm the passage of the poison, I hope we can talk about some fine-tuning. I don’t know– half doses? Mega doses of B vitamins or Omega 3s? A gym membership? I feel the need to tinker, to tune, so I feel truly fine.

(Only slightly more detailed than the voice mail I left my poor psychiatrist.)