RealMental

My mother’s coming to visit.  I’m very mixed in my feelings about it.  On the one hand, I’m hoping to confirm what our phone calls are telling me– that she’s worlds better than she’s been for decades, since this spring’s bipolar diagnosis.  On the other hand, I’ve got years of pent-up resentment and anger waiting to be triggered by the slightest irritation, and my struggle to keep it in check.  I usually do keep it in check– prior to the bipolar diagnosis, she had no insight on how she affects me, and it’s like kicking a puppy.  Sure, the damned thing just pissed on your brand new virgin cashmere kilim (or whatever), but it just couldn’t help itself.

Now?  I wonder about telling her how angry I am, how mixed up I am, how mixed up I may always be.  Because she allowed herself to stay depressed for thirty years.  Because unlike my dad, she didn’t use any of her rock bottom points as the impetus to change things.  Because she seemed to enjoy playing the victim of cold and critical parents, and the ex-wife of an (undiagnosed bipolar) alcoholic.  Because she didn’t want to work, and I grew up with the stigma of a fat, lazy mother, section 8 housing, food stamps and free lunch.  Because her refusal to do anything about her weight made me bulimic as a teen (even worse?  she never noticed, despite my losing 30 lbs.), and in possession of a fine set of food and weight phobias for the rest of my life.  Because, because, because.  I’ve a world of reasons for anger, for shame, for grudges.

Now I wonder if she has the insight now?  ever? to understand these things.  Or whether she’s been so long in her self-centered groove that she’ll never have the perspective.   Or maybe that she is, under all the new meds, still self-centered?

And I wonder if it’s worth it, in any event.  Would I feel satisfied?  Relieved?  Healed? to tell her all these things?  There’s nothing she can do about it at this point.  And is my anger even justified, if she’s been bipolar all these years?  Can I hold it against her?  I want to.  Or do I have to forgive her?  I don’t want to.  I had enough insight, and enough concern for the effect of my behavior on others, to seek help and get the diagnosis that has been such a blessing to me.  My dad had enough strength after his first drunk driving arrest to kick the alcohol.  Is it fair for me to believe that someone who’s smart enough to write a Ph.D. at Harvard and become an ordained minister should be smart enough to get some clearly-needed help?  Or does it come back to emotional maturity, a lack of self-centeredness, an inherent personality flaw, instead?  If that’s the case, then I’d just be banging my head on a brick wall, which gives me a headache, and leaves blood on the wall.

Plus, if she didn’t get it, then again, there’s the kicking a puppy thing.  She would be sad, noncomprehending, and hurt because I’d shattered her self-image as a caring person.  But here’s the deal– she’s “caring” because she wants to be thought of as caring.  At least that’s what my therapist and I think.  But at the same time, there’s no doubt that she did want to listen to the things I had to say as a teen, and that she did want us to succeed.  And in a way, I have.

I don’t want to forget, and I am not ready or able to let go yet.  Forgetting would mean that none of this stuff was important, negative as it is.  And it’s who I am, this stuff.  I can’t, I won’t forget it.

Right now, I’m leaning towards just keeping my mouth shut, except for the bare minimum inquiries to make sure she’s taking her meds, starting talk therapy, and working well with her new shrink.  I’ll have a horrible stress migraine after she’s gone, probably get a cold, and fall exhausted into bed every night that she’s here by, like, 7:00 pm, but the self-inflicted harm at this degree is still better than staving in that poor puppy’s ribcage, so hard is my urge to kick right now.

Here’s to hoping I can let go at some future point.

I’ve been so anxious at work, so depressed at home, that I haven’t had time to think through what I’ve been going through beyond, “gotta get outta here” and “gotta try something different with the meds.” Both are right, but I’ve been feeling like I’ve been living in tunnel vision for weeks.

I had a brief talk with my immediate boss about the crazy and abusive behavior of the big boss, which has been the cause of my sleepless nights and anxious, teary days, and when posed the either/or of “should I take a leave, or just quit?” he was strongly in the leave camp, but added, “I have enough bad karma to be mad at you if you left. You have to decide what’s healthy, what you can put up with.” So that was a bit of a relief, because other things aside, I’d hate to never speak with him again if I left.

I also had some “progress” on the headache/dizziness/depression front, in that I had a head CT (negative) and a long talk with my lovely shrink about my past month & a half. She thinks it’s a metabolic reaction of the lamictal with the increased effexor. Since I’d had occasional migraines on the lamictal before this recent dose increase, she thinks I need to come off it. I’m not happy about that– because within four days of starting the lamictal last June, when I was in the depths of despair, it had kicked in, and literally was a lifesaver. I hate to let go of something to which I owe so much gratitude, sanity, creativity, and joy. But at the same time, it’s not working anymore. The headaches and dizziness are getting worse, not better, and I can’t tolerate them and try to work, or figure out what to do about work, at the same time. So we talked about other options, and she wants me to consider lithium or Depakote.

I’m frightened of both. Lithium, because my father had a girlfriend who was manic-depressive, on lithium, and still not controlled. I know I’m a different case, and that it’s the gold standard for a reason, but that past experience continues to taint me. At the same time, though? The weight gain effects of Depakote terrify me. I’m a former bulimic, have a huge comfort-eating problem, and a massive oral fixation to boot. No pen cap is safe around me. I will always have issues with my weight, even though I’ve been pretty ok the last 10 years. At the same time, though, my mother and my aunt, who if you saw us all together in a photo, you would automatically know we’re related? Both over 250 lbs. And that’s without Depakote. I’m terrified of what would happen, even with trying my best.

Also, a really whiny, self-indulgent part of me does not want to give up my nightly glass of wine. Alchohol is a lot more contraindicated with these two drugs than with the lamictal, and I just don’t want to give my wine up. But if I have to, I have to. I actually defended a doctor years ago in a case where a bipolar on lithium ended up with tardive dyskinesia, a parkinson’s like neurological deterioration, because she was an alcoholic and continued drinking all the years she took the lithium. She was pretty much wheelchair-bound by the time the case made it to trial.

And the last part? I am terrified about what will happen to my mood during the taper down. I have a lot of work scheduled in the next month– I don’t want to hand it off, because these are my personal clients, not the firm’s, and at this point, I sort of feel like they’re all that I’ve got. But at the same time, it’s going to suck, to put it mildly, decreasing the lamictal to zero, then starting the lithium. (She doesn’t want to do a “close taper,” because there isn’t a lot of research on it since lamictal is still new in the bipolar formulary.) My husband asked me if I was going to take the end of the lamictal taper off, and it tells you how tunnel-visioned I am that it simply didn’t occur to me to reschedule stuff that week, rather than hand it off. It’s true that “I will be out that week for medical reasons, and need to reschedule.” No one else needs to know more.

It’s all too much, or almost too much, but it’s got to be done anyway, and I am scared shitless. I just hope that in response to all the resumes I am sending out, I don’t get a crucial interview on what might turn out to be a dream job, the week I’m off my mood stabilizer, and starting another. That would be a little too interesting.

I’ve suffered some occasional migraines, ne’er suffered before bipolar, since starting my Effexor XR.  Fortunately, they’re not so bad, pain-wise, compared to other folks I’ve known– they usually resolve with a nap and my meds.  But lately, they’ve been worse, not so much with the pain, but in frequency and in new manifestations– smell sensitivity, dizziness, nausea, hot flashes, generally unbearable wooziness.  I want them to stop, because if they don’t, I’ll have to stop taking the Effexor, and that means another round of trial and error on a new antidepressant, and feeling depressed and anxious in the meantime.  I’m too exhausted right now to start a new trial of meds, and to bring the necessary vigilance to bear.

If it’s a temporary side effect of titrating my new dose, and/or a withdrawal from going up one dose too high, hopefully it’ll go away.  But if this is the trade off for less craziness?  I need to try something else.  I can’t work when I feel like barfing whenever my secretary walks into my office, because her perfume is too smelly that day.  I can’t work when I get a hot flash and the whole room moves in front of me, so badly that it’s noticeable to colleagues (fortunately so far, only those already in the know and on my side).  I can’t work if the smell and taste of food makes me gag, so that I don’t eat anything, and then get low blood sugar.  And I can’t drive home if I am feeling like I am going to pass out, because what if I do?  I couldn’t bear hurting someone.  And I am not ready to give up on work.  Only if I can’t handle the stress of continuing private practice will I give up, and do something less stressful.  But that’s not a tradeoff I am willing to make.  Yet.

I’ve been having a hard time at work, and debating leaving, and some things that occurred recently confirmed that it just isn’t the place for me.  I’ve actually been debating leaving for a long time, just based on salary issues, but recently had the crazy waved over my head for no (to my mind) justifiable reason.  So I was describing this to my therapist last night, as being the final straw, and she said, “Oh good.  You needed a kick in the ass to get out the door.”  I so heart her.  After I told her not to hold back, tell me how she really feels, we got down to brass tacks.  But I love having someone who is frank, who challenges me, and who doesn’t just sit there nodding, or saying “that must have been hard for you.”

I’d upped my Effexor XR recently, and was achieving nice results at 112.5, but went up to 150 at the recommendation of my shrink. Two weeks in, I was feeling even bouncier. And then … anxiety in whole-body washes of hot, and cold, and tingles. Hyper-focused attention, impatience, inattention to idle conversation, and spaciness–verging on what I associate with my hypomania. Nausea and acid stomach if I ate more than 1/2 cup of food at a time. Nightmares. Ugh. No thank you. I called my shrink and left a voice mail with my symptoms and that I was going to knock it back down to 112.5 and see how I did. 12 hours in, I am feeling less verge-of-hypomanic, not so nauseous, and able to eat 3/4 cup of food at a time. Whoopee! I need a plateau, I really do.

Republished from BipolarLawyerCook.

It’s no secret that Bipolar Disorder is genetic. It was a “surprise” that I was the first person in our family to be diagnosed as bipolar, though. I’ve long felt inadequate, intellectually, compared with my parents the Ph.D.s, but I was the one who was proactive enough about her dysfunction to make thrashing overtures toward diagnosis and treatment. Since my diagnosis and miraculous recovery of the person I’ve suspected I could be all along, I’ve been trying to nudge both my parents along toward getting themselves checked out, with little success. But I’m convinced they’re both bipolar, given what I now know, and I’ve been trying to get them to see the light.

My mom’s resistance ended dramatically, with her psychotic (but happy! oh, so happy!) episode this spring, after which she was hospitalized and diagnosed as Bipolar, and her crippling depression (lasting my whole life) at last yielded to a combination of antipsychotic and mood stabilizers. Amazing– but not really. When your depression’s affected you for so long, no anti-depressant makes a dent, and you used to have pretenatural spurts of productivity when you were in grad school (did I mention bipolar often most obviously manifests itself in the late teens and early twenties?), why wouldn’t you believe your daughter when she tells you that maybe you should see a shrink to reevaluate your depression, given your daughter’s diagnosis and resounding response? But all’s well that ends well, and now her meds seem to put her in to a receptive frame of mind, and she seems to be doing her homework, reading up and meeting with her care team regularly.

My dad’s been more stubborn. Granted, he was functional in his dysfunction for much longer than my mom was– it took him until I was 12 before his alcoholism cost him not just his job for a few weeks but also his driver’s license. At that point, he took sobriety seriously, and made up his mind to stop the self-medication he’d been indulging in since he was in graduate school (that whole teens & twenties thing again). After he became sober, his moods didn’t change minute to minute, but he was still bouncing between talkative, charming, funny, and reticent, snappy, shy, disinterested, apathetic, inactive. He wasn’t able to find a shrink he liked in the immediate aftermath of the arrest, and made do with the talk therapy at AA. And then the blood pressure meds came along. (Blood pressure meds are sometimes used in combination with antipsychotics to assist/speed the effect of an antipsychotic when someone’s in an acute episode.) He’s on a serious dose of the bp meds, and they dial down what he calls “the jiggies,” but they also make him very slow in the morning. And in the meantime, he’s still sad. And lonely. He seems resolved to believe he’s just a naturally melancholy person with too much distemper to successfully live with someone else, but I see someone whose long and deep depressive episodes aren’t being appropriately managed, and who could be a lot happier.

After having such amazing relief of my own misery, I want the same for them. I know I inherited it from them, but nobody wants to acknowledge they’re “mentally ill,” even though the failure to acknowledge it can be so disastrous. Even with the proof in front of them of the success of appropriate medication and talk therapy, though, they continued to be stubborn. My mom would always say, when I was being hyper, or in a raging, nasty, irritable mood on the downturn, “you’re just like your father.” And my dad would always say, when I’d burst into tears at the littlest thing, “you’re just like your mother.” Um, yeah. But I’m like you, too– that’s the point. Too bad you’re too blind to see it.

Republished from BipolarLawyerCook.

Republished from January 2007.

Please allow me to introduce myself…

Leah was generous enough to let me come and play. Here’s a slightly revised version of one of my first posts as the blogger BipolarLawyerCook. Without revealing any names (to protect the innocent and not-so-innocent), here’s a hopefully somewhat concise description of my learning that I had Bipolar II, and the beginning of a new chapter in my short life.

I’d been depressed since November of 2005, with no particularly good reason. Work was going well– I enjoyed working with my clients and colleagues, even if my cases weren’t always what I would want, either for facts or for sheer excitement. My marriage was going well, as my Better Half was finally employed again after a long period of unemployment, and the money situation was starting to be stable again. And there were no particular Larger Family Issues, since my family and the BH’s family were doing well. My depression and energy levels continued to sag– I gave up yoga, stopped cooking, was exhausted when I came home from work, and I became more anxious about tasks at work that normally wouldn’t have bothered me. I began wasting more time at work, taking longer than I’d like to do routine work, and avoiding doing tasks I did not want to do but which were necessary steps to moving my cases along. One case in particular began to gnaw at me; the facts were stupid, and my client simply wasn’t liable, in my opinion. But opposing counsel was the most stubborn, obstinate, WRONG lawyer I’d ever come up against. I began to doubt that I was seeing the case aright, at which time I started to fall apart, and let the entire case go straight to hell.

At the same time, I was having other health problems, none in and of themselves ultimately life-threatening. Each one contributed to my distress, distraction, and physical and mental discomfort. I couldn’t sleep at night for waking up in a cold sweat thinking about The Problem Case, and yet I was utterly paralyzed from doing anything about it when I got to work.

On the outside, I still put up a pretty good show to my colleagues, who were occupied with their own worries and some pretty large cases our office was handling. This all continued through April 2006, when the prozac my PCP had prescribed stopped working after 6 weeks and I was feeling Worse Than Ever. I made an appointment with Massachusetts’ Lawyers Concerned for Lawyers (www.lclma.org), and after an intake session with a sympathetic but unsentimental social worker, I got a referral to a therapist, who ended our first session with these life-saving words– “You know, I think you might be Bipolar.” Read more »