On Bipolar, Ever-Evolving
I have, as is my habit, been fighting a depression that wins a little ground each day. My strategy, generally speaking, is to put a brave face on it in hopes that nobody will notice, and then, when I can no longer manage that, to beat a hasty retreat into the nearest isolated cave, emerging only to dance.
I’ve decided to pop the rest of this behind a cut, both because of strong language (“He said a-hole, Mom!*”) and because of subject matter that maybe could be a little on the triggery side for those of us currently wrestling mood disorders.
This is no longer surprising. Summer for me begins with mania or hypomania, and then, when my brain has burned all its kindling and every book of matches it can find, it careens into darkness. Sometimes there’s a second cycle, sometimes not, depending on whether I’m able to keep my insomnia and all the other precipitating variables in check.
I shore myself up with words, with action, with knowledge. Dancing helps as much as anything, but eventually the tide turns. That is the way of things.
I’m using a new metric these days. It occurred to me the other day that if someone came along who could take this thing (that is, bipolar disorder) away from me, no strings attached — if I could still be me, just without the staggering depressions and knife’s-edge glittering manias — I’d jump right on that train.
If I could be a me who remained creative, dynamic, active — if I could have all of the essential me, without the pain and disruption (especially the disruption) — my G-d, yes, I would.
But I am not yet at the point where I’d be willing to consider going back on meds; at least, not the ones conventionally used to treat bipolar. The pain and the disruption are not worse than the loss of my creative faculties and abilities; they are definitely not worse than the loss of my ability as a dancer. I would, at this moment in my life, rather skate along this precipice, knowing that chaos and even death are quite real risks, than ever, ever be unable to dance again.
In short, meds might temper my bipolar, but they do so at the cost of the essence of my being. I do not tolerate lithium well. I do not tolerate antipsychotics well. They may help pull my mood back towards the center, but they leave me stupefied, uncoordinated, and fogged (and, honestly, the center I experienced on them was not so much euthymic as simply a-thymic; on meds, I felt unreal, even dead). They leave me literally unable to dance, paint, or even really write.
Every year, at least once or twice, I revisit this question: has it come to that, yet? So far, the answer is still unequivocally no. (For the record, I would consider electroconvulsive therapy, if it was offered — that, too, has side-effects, but ones I’m willing to accept.)
I do think it’s time to see an endocrinologist, though. I think my lack of sex hormones, and the unsteady levels of those that bother to exist, aren’t helping. I have mixed feelings about this, too — I’m fairly content with my body, and anything we add will change it in one way or another. Some of the changes in question would be perfectly fine; others less than welcome.
But HRT will not render me unable to dance, and it might help take the edge off of my mood problems, as it has done in the past. It, too, bears side-effects I’m willing to accept in trade for a measure of function; for fewer days that I wrestle the voice in my head which tells me that I have no business living the life I’m trying to live and reminds me, as I lie in the bath attempting — lizard-like — to bring my body temperature high enough that I can move, that there’s a razor at hand; that I should use it.
I should stipulate, here, that this is not a cry for help or an attempt to wrangle sympathy: it’s actually not as bad as it sounds. I’ve been wrestling that inner voice for a long time, now, and I am pretty good at ignoring it. Sometimes it’s a constant undercurrent; a sort of soundtrack of suicidal ideation that is not sufficiently powerful to beget action. I have had therapy enough and I trust myself and Denis enough to speak up before it gets that bad.
It’s more like living with a conjoined twin who is basically an asshole, but who isn’t physically strong enough to overpower you. Sometimes he gets hold of a knife, even, but since his nervous system and yours are entwined, there’s no chance that he’ll stab you in your sleep or while you’re off your guard — he can’t be awake when you’re sleeping; he can’t act without you knowing what he’s going to do.
He’s still a pain in the ass, though, and he can make it hard to get things done sometimes, when he gets into a refractory kind of mood and won’t agree to go along with things that need to get done, so you have to drag him around like an overgrown toddler who desperately needs — and thusly refuses to take — a nap.
Anyway, this is getting long.
So that’s my new metric: okay, so I own that, if there weren’t side-effects, I’d happily take a magic bean that would just make my bipolar disorder go away, and I’m okay with the specific side-effects of ECT or HRT, but not those of lithium, antipsychotics, or anticonvulsants.
And this is all part of how I’m hanging in there, I guess.
*For some reason I’m reminded of this episode from my childhood in which a friend and I created this elaborate story about “The Swear Stone**,” which allowed its holder to use strong language undetected in the presence of adults.
Neither of us really believed in it (we were cynical pre-teens, something like 9 or 10 going on 40; I was so much older as a kid sometimes than I am now), but jokingly tested it with a fake sneeze and a fake swear — an, “Ah — ah — ah — SHIIIHHH!”…which emphatically did not end with a T, because A) the whole thing was a cynical joke and B) I had never gotten away with anything in my life, ever, so I had no delusions that I would start getting away with things now.
Only, my Mom either didn’t realize it or felt that the spirit of the thing was just as bad as the actual thing (I suppose she was probably right) and I was roundly shouted at.
Oh, and later my friend totally threw me under the bus about the whole thing, because we were basically both horrible little narcissists with bad cases of (sing it with me!) “…SCHAAA-DEN-FREU-DAAAAAAAAH, SCHAAAAAAAAA-DEN-FREU-DAAAAAAAAAH (fuck you, lady, that’s what stairs are for!)”
…But I’m not bitter.
**Yes, I did immediately think of this the first time I saw Harry Potter and the Sorcerer’s/Philosopher’s Stone***
***Autocorrupt seems to think the phrase Harry Potter and the should be end with …Charger to Which the Phone is Currently Attached. Which, yeah, that totally sounds like a super-exciting novel, there, I guess…? Fanfic challenge, anyone? I’m old enough to be a long-time fan of the Potter/Malfoy ship, after all.
****PS: Devolving into this strain of darkish humor, by the way, actually did make me feel a touch better. That or else my blood sugar is now so low that I’m starting to feel a touch euphoric. I don’t know. Kinda makes ya feel like riverdancin’, as it were.
Posted on 2016/06/27, in balllet, bipolar, healing, health, life and tagged bipolar, decisions, weights and measures, why I'm still not taking lithium, yeah verily it sucketh like unto a mighty vortex. Bookmark the permalink. 9 Comments.
I been through this. I hope you find your own way. And dance, dance dance…
Jeez asher. A student of Buddhism banging on about “the essential me”?
You get to wear this cool Tibetan dunce’s cap.
And the idea of some kind of ‘you’ sans bipolar?
Yeah. Right. And I’ll have a bruschetta. Hold the tomato.
You’d still be creative without bipolar. We’re all creative. We create an entire universe every instant of our conscious lives. It’s just that not all of us get applause from art school wankers or big bucks from tax avoiding corporations for our creativity. That’s not creativity. It’s acclaim.
If you want to be recognised for your creativity you’ve gotta try to be ostentatiously original (or a cunning plagiarist). If you want to get by easily in the world you’ve gotta try to be like everyone else. Notice the problem?
And I wouldn’t recommend ECT as a means of finding “the essential you”. The odd notion you have there’s an individual called ‘asher’ is largely a function of your narrative memory. ECT does funny things to memory.
I’m not usually one to recommend the writings of Robert Pirsig, but as an ECT survivor (or not) he has some interesting things to say in Zen and the Art of Motorcycle Maintenance about what it does to any coherent concept of ‘me’.
Excellent points, here. You’re right in many ways: this is very bad Zen, not to mention myopic (I suppose depression does that, at least as I experience it, anyway; likewise, I would say that I’m rather myopic even at my best). I definitely appreciate the wake-up call.
For what it’s worth, where things like dancing and painting are concerned, I’m not talking about the difference between being able to just do them at all or being able to achieve acclaim/commercial success with them, but rather the one between being able to do them or literally being unable to do them (or basically anything else) at all. If the goal of medicating is to improve one’s ability to function and to cope with daily life activities, lithium utterly failed me in that regard.
For whatever reason, I’m one of the people who develops very disruptive and persistent side-effects even at quite low doses (tremors, disrupted balance and equilibrium, micrographia, the inability to string two thoughts together, etc).
The worst side-effects are much harder to describe, so I didn’t really try in this post. All I can say is that I felt as if I was dead — hollow, empty, depersonalized (in the technical sense). It was the constellation of some of the worst parts of depression, writ large. I felt as if I’d been pithed, or something.
Perhaps all experience is delusion, but given the choice between that delusion and this one, I’ll take this one. All life is suffering, but I would rather stick with this flavor of suffering. For now. Until I can no longer manage this one, I guess.
For what it’s worth, regarding ECT, I felt much the same about it (in part due to reading Pirsig’s account in -Zen &…-) until a few years back when I wound up doing some research about it. There have been significant changes to how ECT is administered since then, though memory-related side-effects are still pretty common.
That said, I’m not rushing out to find someone to zap me: it’s just something I’m much more willing to try than I am to try lithium again.
I suppose returning to the basic practice of mindfulness might actually be a better place to start.
If I’d ever got desperate enough I probably would have tried lithium first. Last I heard they still had no coherent theories about how it works beyond somehow messing with the neuronal sodium-potassium pump. Like a lot of neurology they basically equated one thing they don’t understand with another thing they don’t understand and pretended it was an explanation. Like quantum mysticism. 0/0 = 1?
Besides, lithium carbonate has been off patent for decades and is about the cheapest psychiatric medication out. So not only can you expect more medicos to know something about side-effects, etc, you can also be pretty sure the Rx is for you and not for Big Pharma.
Too bad it didn’t work for you. It’s about the only p-medication they tried on my bipolar grandmother that didn’t fuck her up big time, though it’s debatable whether it actually helped her.
But anyone who expects to function on antipsychotics just hasn’t been paying attention. Not to the list of documented side-effects – which tend to accumulate the longer you’re on them. Not to the majority of people who’ve taken them (they’ve got a minuscule compliance rate because most people find the cure worse than the disease). And not to the neurologists who tell the stories about how they’re supposed to work.
What they’re supposed to do is cripple the mesolimbic and mesocortical D2 dopamine pathways that link the limbic system (especially the amygdala) to the pre-frontal cortex via the ventral tegmental area (i.e. they’re a form of titrated pre-frontal lobotomy). I’m not sure how you’re supposed to be creative when the brain areas most concerned with emotion, cognition/motivation and executive functioning have been isolated from each other.
But of course dopamine is used in lots of other parts of the brain and body too, so antipsychotics have far more effects than just as a lobotomy in a pill. They also mess with the nigrostriatal pathway – so they fuck up your motor functions – and the tuberoinfundibular pathway (what I like most about neurology is the jargon), which regulates the pituitary glands – especially the ones that release prolactin.
So if I was a dancer with hormonal imbalances I’d sure avoid them. If I was trying to get a job as an extra in a George Romero movie on the other hand …
My understanding is the main innovation in ECT since Hemingway blew his brains out has been the use of anesthetics and muscle relaxants so that people don’t keep breaking bones and teeth with ECT induced spasms. The memory loss is as bad as it’s ever been and according to some theories that’s how it works (when it does). By cooking out traumatic memories.
Ha — “extra in a George Romero movie” is a precise description of the role I was playing in life when I was on meds. Complete with drooling (Do Romero’s zombies drool? I can’t remember.). I didn’t actually eat anyone’s brains; perhaps I should have tried that as a means of offsetting the side-effects? 🙂
I find the fact that we still don’t really get what’s going on with Lithium really fascinating. It’s one of those things, like, I wish it worked for me, because it works so well for so many people, and frankly a lot of p-docs are like, “Lithium doesn’t work for you? Oh, so, we’ll try … um. Have you thought about prayer? Good luck, then.”
…Which, btw, I totally don’t hold against them. When you have a given set of tools that normally work for a thing, and you run into a patient for whom those tools don’t work, it can be really ridiculously hard to figure out what to do.
FWIW, the prolactin-inducing effect of atypical antipsychotics is how I wound up occasionally referring to myself as “Dances with Moobs,” heh. I manage to be fairly philosophical about it – could be worse, at least it doesn’t bother my spouse, etc. – but at the end of the day it’s really freaking annoying.
I think there have been changes both in dosage and in treatment schedules in ECT (which is to say, the treatment path is no longer “Full Steam Ahead, As Often As Possible,” heh) – and, also, as you mentioned, anesthesia and muscle relaxants. But, yeah, we have no idea what’s going on there, either, basically, last I checked.
Not everyone would agree.
I find it unsurprising that we don’t know how most psychiatric treatments work (or don’t). Trying to use reductionist linear cause and effect to explain the sort of complex, non-linear processes that go into creating emergent phenomena like minds or ecosystems is a mug’s game if you ask me. Besides, I think the diagnostic basis of mental illness categories is completely wrongheaded so the theories of their causes and treatments are built on sand.
Most of the ‘explanations’ that exist for psychiatric treatments are reverse engineered onto pre-existing therapies to justify them. ‘Antipsychotics’ were originally ‘major tranquilisers’ and no-one pretended they were used for anything other than controlling patients in overcrowded, understaffed asylums. It was only in the 50s when people started to wonder if human rights should also apply to crazies and – more importantly – when the ever-growing asylums became major drains on health budgets and people started talking about deinstitutionalisation that they were rebranded as ‘therapeutic’ and researchers started coming up with theories of their mechanisms (which in turn were used to produce biopsychiatric theories about the mechanisms of the problems they supposedly addressed – e.g. antipsychotics and lobotomies reduce activity in the pre-frontal cortex, therefore psychosis is due to an overactive pre-frontal cortex).
The whole thing got supercharged from the 1980s when drug companies realised they could use simplistic but persuasive neurochemical models to flog their wares direct to consumers. I wonder how many SSRI poppers today know the serotonin deficiency theory of depression was thoroughly debunked by researchers a generation ago.
BTW, please accept my sympathy for your depression. Sucks, don’t it?
I don’t reckon Buddhism is about ending pain at all – whether physical or emotional. After all the Buddha’s death wasn’t much nicer than Jesus’ (though I love the way he kept on poor Ananda’s case right up to the very end).
Suffering ain’t something that happens in your brain, body or mind. It’s what happens at the interface of what you think is you and what you think isn’t. That suggests two possible strategies. You can either expand yourself to make the suffering part of you (which ultimately means making everything you – i.e. Advaitism) or contract yourself away from the suffering until you’re ultimately nothing at all – i.e. Buddhism. In the end I don’t think there’s any difference between the two. Subject and object only exist in the presence of each other.
That doesn’t mean you have to walk around in a permanent state of non-dual samadhi. That’s pretty impractical and, all-encompassing bliss notwithstanding, it’s kinda dull. But when existence hurts too much it’s nice to have a refuge that doesn’t have so many nasty side-effects (or make big money for bad companies).
“I don’t reckon Buddhism is about ending pain at all – whether physical or emotional.” I think this is very true – I wish I could actually articulate why, but my ability to do language about abstracts seems to be limited right now.
I think the point about how it’s nice to have a refuge when you need it is probably something even the Buddha would’ve gotten behind. It seems like an appropriate point on a Middle Path, after all — neither rejecting nor clinging to various phenomena.
Thank you, by the way, for all your thoughts on this. They have helped me take a step back from the immediate pain and remember some of the skills that I’ve gained through my mediocre efforts at Zen — being here, now, basically, instead of projecting into the future where OMG WHAT IF I FEEL LIKE THIS FOREEEEVVAAAARRR?!?!?!?!!!11onone
I am still in a difficult place, but I’m coping with it better in part because of this exchange. So thank you again for that.