A Straight Shot of Politics

A blog from a gentleman of the Liberal political persuasion dedicated to right reason, clear thinking, cogent argument, and the public good.

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Location: Columbus, Ohio, United States

I have returned from darkness and quiet. I used to style myself as "Joe Claus", Santa Claus’ younger brother because that is what I still look like. I wrote my heart out about liberal politics until June of 2006, when all that could be said had been said. I wrote until I could write no more and I wrote what I best liked to read when I was young and hopeful: the short familiar essays in Engish and American periodicals of 50 to 100 years ago. The archetype of them were those of G.K. Chesterton, written in newspapers and gathered into numerous small books. I am ready to write them again. I am ready to write about life as seen by the impoverished, by the mentally ill, by the thirty years and more of American Buddhist converts, and by the sharp eyed people [so few now in number] with the watcher's disease, the people who watch and watch and watch. I am all of these.

Thursday, July 07, 2005

And Now For Something Completely Different

I haven't written in some time about my bipolar condition. The medications have calmed me down considerably and evened out the highs and lows. This has come at a cost. The brain fog that the medications induce is great. It is harder to get fully awake in the morning, and too much concentrated brain work in too short a space of time causes a serious function crash.

Since I last wrote seriously about my condition, I lost a temporary job because of this. I signed on to work eight hour shifts for 3 consecutive days without a break, instead of 6 hour shifts over the same schedule, because I really could have used the money. The money was really good, but the task was very mentally demanding. Trying to work 8 hours at a stretch was a mistake. With the drugs, I have, I discovered, no more than 20 hours of work at that concentrated level before my performance deteriorates precipitously. After that, I must have a minimum of a one day break to return to full function.

During the last four hours of the 24 that I was trying to do for this company, the function crash occurred, and my performance deteriorated so swiftly and so completely that by the end of the project I had failed to meet the minimum overall standards to be invited back. Such is the roller coaster that the morale of a mental health client is always riding. You feel better and you try to push beyond your limits, you fail, and then you must deal with the objectively induced depression (as opposed to the mere brain chemistry depression). It has taken me several weeks of dealing with this before I could even attempt to write about it.

How can you tell the difference between the two, you might ask? You can be pretty sure you have a brain chemistry problem of some sort if you are not depressed about anything particularly: if the depression is severe, extended, free-floating, and tied to no objective event. I knew for years that I was clinically depressed, but establishing the bi-polarity was much harder. The highs simply don't appear to be a problem and you and the GP end up medicating the depression only.

Bipolarity can be diagnosed fairly readily if your high is so great that you become delusional. Unfortunately, at this level of crisis, the transition to treatment, and then from treatment to functional recovery can be extremely, and unavoidably, destructive to the individual involved. In the treatment phase, it usually involves at least some physical restraint or confinement and forced medication.

The scars of this, and the lingering resentment that it leaves the patient with, often result in the patient's non-compliance with the need to medicate in the recovery phase, a relapse into delusion, and the need to put the individual under court order to take the medication when recovery is attempted once again, after a second confinement.

But even this, at least, can eventually have a good outcome, though the road to it can be rough. A bipolar such as myself, though, who never loses grip on reality can subsist for years being medicated incorrectly for depression alone. One indicator of this, which I learned after finally being diagnosed, is when several specific anti-depressives in succession simply cease to work to relieve the depression.

The non-delusional bipolar individual can, as I did, run through an entire spectrum of medications, one after the other, with the GP, only to have all of them fail in the end. Apparently, what occurs is that the manic and the depressive phases each act as a compensating feedback mechanism for one another. If you intervene chemically with only the depressive half of the problem, this feedback process slowly adjusts the brain chemistry to adapt to the intervention and resume the depression that compensates for the mania.

If you are depressed, under medication, and finding that several different medications consistently lose their potency to combat your feelings, ask your GP about a self-reporting set of oral questions which can indicate the possibility of a bipolar condition, and make every effort to get a referral to a medical professional specializing in psychiatric medicine if this questionnaire comes out positive.

Whatever the drawbacks of medication, I can testify that the unmedicated alternative is far worse, particularly when, as in my case, it goes on for years with repeated failures to treat the depressive condition reliably. I made it through, but only because I started out with a will of iron and an active religious life. I very greatly fear that many others don't make it and are eventually pushed into either overt or covert suicide. I came close.

I will say no more about it, but I came close.

7 Comments:

Anonymous Anonymous said...

I have a question. Our daughter married into a family with bipolar children. The parents both say it is not in their family. It seems like several of the children are troubled although only one has officially been diagnosed. The one diagnosed has had a history of problems including having children by different men and illegal drug use. When she is medicated, legally, she seems far from normal, but not dangerous. Recently she went on a drug binge and held a gun to her child's head. It proved to be unloaded and she went to court where he one child still under age was taken away and her mother is caring for the child.
Here is the issue. That mother is our grandchildrens grandma and a couple days a week she watches the children. The son of the bipolar child lives there and this attracts the visits of the bipolar mom. With this history, we worry about the safety of our grandchildren for fear she might decide they have a lot going for them and she has nothing. We have discussed this with our daughter, but she is not willing to raise any problems with her husband who will not hurt his mom by doing anything to keep his children away. Are we foolish for pushing this issue? We have no history or knowledge of this bipolar situation.

1:00 AM  
Blogger Joseph Marshall said...

From my experience both as a mental health client and in contact with other clients, it is very important to take a client's threatening and inappropriate behavior seriously.

But matters of this kind have to be approached calmly, clearly, and with discretion. The problem is probably not with the natural mother's bipolarity, but with her history of substance abuse and threatening behavior.

You may find her manners under the psychotropics to be unusual, but they are not "abnormal" and you should be very discreet about your uneasy feelings here, as you would be, say, about a cancer patient whose hair fell out from chemotherapy.

I would say that your saftey concerns are quite legitmate and you should address them with all parties, including the mother herself, if possible. There are a series of questions that need to be asked.

1. Is her substance abuse problem being explicitly treated? If it isn't, it should be. This appears to be the source of any real danger she may be.

2. Is she still legally responsible for her own affairs, or is she under court order to continue treatment? If the court did no more than separate the mother from her child and exercised no other legal control in the matter, this is a serious problem.

Without court supervision, if she chooses to abandon treatment and seek bad company once again, she cannot be prevented from doing so. With court supervison, she can be restrained and treated before she can become a danger again.

All the interested parties have a stake in knowing what everyone is prepared to do should the mother relapse. This sort of thing requires talking out and an advanced consensus and plan for dealing with it.

3. Have the issues of how the mother is supervised when she is visiting the children been addressed? You definitely have a duty, I would say, to be forthright about this. There are some options.

For example, if the mother has a "case manager" helping her with the affairs of ordinary life, the case manager can be asked to arrange the visits and be present.

4. More broadly, the mother should be with a mental health agency, and a separate substance abuse program if her agency does not do this. This agency should have arranged a "treatment team", involving the therapist(s), the doctor prescribing the psychotropics, and the case manager.

This treatment team should have a written plan of treatment for the mother to be able to measure her progress and communicate their expectations of her clearly to her. You should ask if this is happening.

5. Finally, due to the federal health privacy laws (HIPPA), everyone else involved is barred from knowing about the treatment of her condition (unless she, herself, talks about it, of course).

This can be waived with a release from the mother. Someone should have obtained a written release from her to be able to discuss matters with her treatment team. You need to find out if this has happened, and you need to discuss these problems frankly with whoever has such a release.

And it might be a very good idea to ask for all the adult parties involved to have such releases from her, so frank communication about the real state of her condition can take place with the professionals involved.

I hope this is helpful.

8:53 AM  
Anonymous tracey said...

Thank you for sharing your story. It took no small amount of courage and forthrightness.

I admire you for it.

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