Bipolar Disorder

Bipolar Disorder, formerly known as manic-depression, is a category of mood disorders. There are several reasons a psychiatrist may diagnose a patient as bipolar, or rather, several sets of criteria. There are also, technically, two classifications of Bipolar Disorder - Bipolar I and Bipolar II.

The primary symptoms presented by a bipolar brain are a combination of episodes of major depression, mania, or hypomania. A person living with untreated Bipolar Disorder may experience any combination of those episodes, and the presence, frequency, and pattern of those episodes will define their particular diagnosis and treatment plan.

A physician will take into account many factors when evaluating mood disorders. It is not unheard of for a round of antidepressant to stimulate a pendulum reaction of manic behavior. Neither is it unheard of that normal life circumstances may cause unusual mood swings that cause concern but do not meet the criteria for Bipolar Disorder. It is necessary to visit a psychiatrist for trained evaluation and proper diagnosis.

Major Depressive Episode is characterized by symptoms of depression (impairment of daily function and interruption of activities) - including sadness, tearfulness, suicidality, insomnia/hypersomnia, weight change, delusions of guilt, decreased motor and cognitive function, severe loss of interest in daily activities - for a consecutive two-week period. A person struggling through a Major Depressive Episode may not venture out of their home for days or weeks, and therefore may not be noticed in the midst of their struggle. It is extremely difficult for that person to invite someone else over to help or to talk, when they can hardly muster the ambition to leave their bed. Outside of an episode, a person suffering depression may have a hard time describing their struggle, and the perception of helpless slavery to unseen forces.

Mania is loosely defined as "a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)". Many people become very productive during a manic episode, if there are no psychotic (break from reality) features. Books and theses have been written, business proposals designed, a week's worth of work or chores completed. Some people struggle to treat their Bipolar Disorder because they lament the loss of their hyperproductive energy. Some, however, do not associate any positivity with their mania. Instead, they find themselves struggling to think clearly, control their impulses, and live within the necessary bounds of social inhibitions.

Hypomania is loosely defined as "a distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed mood." The hypomaniac does not fit the bill for having a manic episode, but there is certainly something amiss. The people in their lives notice that they are not themselves, and not predictable during an episode of hypomania.This event may or may not incapacitate a person, but when combined with episodes of depression, make it difficult for one to have a healthy, reliable, or stable relationship.

Following a diagnosis, one or a combination of medications may be prescribed to stabilize the painful and unstable combination neurochemicals and hormones. The inclusion of conversation therapy with a counselor or psychologist often proves more effective than medication therapy alone. The benefits of combination therapy involving a counselor include the outlet for stressful emotions, tools for learning how to live with someone struggling with Bipolar Disorder, and support for anyone crippled by isolation or alienation. 

If you or someone you know has thoughts of death or suicide,call (800) 273-TALK (800-273-8255) or 9-1-1 immediately. Or contact a medical professional, clergy member, loved one, friend, or hospital emergency room.


Facts taken from the DSM-IV-TR, American Psychiatric Association.

Do your own research...
http://www.dbsalliance.org/site/PageServer?pagename=education_bipolar
http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Grief

No one ever told me that grief felt so like fear.

- C.S. Lewis

An often misunderstood state of emotion is that of grief. Its complex layers push and pull like the tides of the sea, and leave you imagining that the work will never be done. In fact, it will not. While we are often told that grief is a process, or a place, a doorway to a healed life, it is more like a new layer of skin put on. It becomes a part of you, and the discomfort you feel is the process of adaptation. Some grief is featherweight. Other grief is like a suit of armor. The heavier the grief, the more support you long for - strong hands and steady hearts to hold you up while you learn.

Grief results from traumatic circumstances that usually involve loss. Loss of safety. Loss of relationship. Loss of one you depend on, or one who depended on you. Watching a loved one die. Facing your own death. As good things are given to us and then taken away, our hearts and minds are forced to reconcile the dichotomy of this life. Something in our love bonds us to one another, and that bond can be as reflexive as our breath. It takes magnificent strength to tenderly love another person, or to let them love you. Once that agreement has been struck, it also takes magnificent strength to tear the heart asunder, and to be separated from your love. That kind of injury is at first raw, leaving nerves exposed to the elements. Depending on the size of the gape, it will take a little or a lot of time to close. Slowly the pain will transform from searing to throbbing, and then to aching. Eventually a scar develops where the gaping wound once was, and you realize that you will never be the same. Forward movement must resume, however. The world around you depends on your continuity and seems to ignore your grief. It might help to be aware that the world around you has suffered grief as well.

The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing... not healing, not curing... that is a friend who cares. 

- Henri Nouwen

The groundbreaking book published by Elisabeth Kübler-Ross, titled "On Death and Dying" was a compilation of her experiences caring for the terminally ill. She noted a common collection of stages experienced by those who were facing their own death, and later she acknowledged that these stages might also be experienced by someone who was facing the death of a loved one. Neither necessary nor specifically ordered, the Kübler-Ross model provides a helpful table at which to sit and observe the movements of the mind as it processes the unthinkable horror of death. Someone facing the reality of their impending death, or the death of a loved one, may experience any of these states of mind:

1. Denial - trying desperately to ignore reality.
2. Anger - picking a target, any target, and unleashing their fury.
3. Bargaining - hoping to make a change that will alter reality.
4. Depression - relinquishing all hope for any sort of redemption. 
5. Acceptance - making peace with the loss and finding hope again.  

 

Denial helps us to pace our feelings of grief. There is a grace in denial. It is nature's way of letting in only as much as we can handle.

- Elisabeth Kübler-Ross

As you ponder your own or another's grief, paint one more layer of color onto the tapestry: the color of hope. This life is wrought with painful loss, but our tears are counted and recorded. Our pain is safely kept and not forgotten. "You’ve kept track of my every toss and turn through the sleepless nights, each tear entered in your ledger, each ache written in your book." (Psalm 56:8) There is a "one day" in each of our stories. One day the grief will end and the scar will no longer ache. One day all love lost will be returned. One day this will all be made well. Hold loosely to the lovely things of this world, but hold firmly to the hope of the joy in eternity. 

He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away.

- Revelation 21:4

 

 

Pathology of Life (part 2 of 2)

well·ness

noun \ˈwel-nəs\

: the quality or state of being healthy

"Wellness." Merriam-Webster.com. http://www.merriam-webster.com/dictionary/wellness

The lifelong pursuit of wellness can feel futile under the wrong expectations. Without the proper understanding of your own faults, the needs of your community, and the surest plan of deliverance, you will feel crushed under the weight. In this introductory discussion of mental health and wellness, let us explore its relevancy in your daily life. 

1. Explain Yourself

One stage in the process of better understanding your goals for mental health is to acknowledge your needs. Choosing a relatively private platform (avoid the trappings of drama) - such as a confidant, counselor, or in prayer - write out an exhaustive list of your needs. This is not a list of demands, and this is not to be handed to someone with expectations of fulfillment. This exercise is for the sole purpose of you getting to know yourself. You are needy. If you do this right, you will walk away with a better understanding of the weight of your burdens. It is too much for any one person to bear. Relief from your needs will be accomplished eventually (more on that in a few minutes), but help in the meantime is always an option. Do not cease your efforts to make peace, to forgive, and to build up.

2. Walk a Mile

If you find yourself in conflict with another person - a spouse, sibling, parent, friend - take an evening to think about them. Only them, and their story. You may not know much about them, or you may know everything. Whatever you do know, use that knowledge to imagine yourself in their place and relive their story. Once you've spent some time walking the proverbial mile in their shoes, try to write a list of needs for them. What do they need? Do not suppose that these are needs that you or any other person can fulfill, but this list begins the process of necessary empathy - the ability to share someone else's feelings. To share a joy or sorrow is to invest in a partnership, to commit to sharpening and being sharpened by another. This is often the first step to conflict resolution.

3. The Meaning of Life

Once upon a time there was a man, and then a woman, and they lived in the land of fearless love and endless time. They chose to go a separate way and we have been suffering the consequences ever since. God describes sin as both choices we make (or have made), and choices that others have made which now rain their consequences down on us. The reason it is futile to argue against the accusation of sin in your life is because it is woven into the thread of our history, our present, and our future. From our ancestors to our progeny, the effects of sin are as inescapable as are the molecules of air that we share and recycle. Errors, choices, and mischievous ways work their way through the lives of not only ourselves, but our neighbors, our children, our children's children, ad infinitum. Stop spending your time finding blame for your sorrows or the sorrows of those you love, acknowledge the pain they cause, and focus your attention on the only saving hope this world knows. The God of the Bible has written a story and instructed us to share it with each other. It begins with a man and a woman, living in perfect health. It moves through their decline, their heartache, their needs, and their story - intertwined through generations - and ends with a dramatic rescue. A feat which requires superhuman strength, consummated by an otherworldly being, able to heal all of mankind (past and present) and satisfy the deepest longings for love without fear and death.

As my children have been taught to say, when they are working together after a day's worth of messes, spills, and creativity gone awry, "many hands make light work!" We use each other to shoulder burdens, to share the weight of sorrows and joy, and to be reminded of our need. How will you put your hands (needy as they may be) to work today?

Letter to My Six Year-Old Self

Dear Mandi,

Today is Saturday September 6, 1984. It is 10 o’clock at night but you’re probably still awake, because your home is alive with baby noises. Your brother and sister are almost four months old. Don’t worry, they won’t always cry this much…

Life has been busy this year! You have moved from your hometown to a new town in a new state. The language seems altogether foreign, although your new teachers are extra nice. You have already made a new friend, and you will make many more. Remember that each new friend needs kindness and so do you. Give it freely.

You have heard of God and His everywhere ways. Keep asking your hard questions - do not be afraid. He knows your name, and He will not forget you. God is who he is even when you don’t know everything about Him. Do not worry. He will be guiding you, even when you think you are all alone.

The next bit that I'm going to tell you may not be easy to hear. Don't stop reading... Momma is still sick, and you are told she will get better. She will, sweet child. First, though, she will get worse. She will lose her strength and her hair. She will worry about you and your brother and sister. She does not want to be sick. Do not blame her for your sadness. She is fighting for life, and your hugs and drawings and words of encouragement do help. Do not blame yourself for her sadness. This Christmas she will stare at you often and smile with tears in her eyes. Smile back and hug her every time. She loves you so, and always will. Did you know that love lasts forever? Well, it does! Forever and ever – God says so. When her strength is all gone, your daddy will take her to the hospital, and he will not let you go. Do not blame him for his fear. He is trying to protect you. When he returns home, she will not be with him, and you will have many questions. He will not be able to answer them all. Do not be angry with him. He will sob into your chest and wrap his thick arms around your waist. Yes your daddy will cry, but don’t worry. This is good for him. You don’t need to do anything, but try to hug him back.

When you sit in the pew and stare at the box, let the tears flow, strong girl. Do not be ashamed of your heart. It will be loud, and everyone will know your love and recognize your pain. When you go back home and the silence is unbearable, ask Daddy to play some music for you. Ask him to dance with you. It will be good to smile again. Do not hold it in.

When your heart hurts terribly and the world has passed you by, remember God. He knows your name and he knows your tears. He will keep your love safe, and you will get your love back. He will see you through many seasons.

One last thing… Know this, beautiful girl, that love will not always hurt like this. This hurt you will feel in a short while, it is atomic hurt. It is big person hurt. But you are little, and God’s heart for you is bigger than big. It will cover your hurt and piece you back together. And He will send new love to you. Do not be afraid. Love will not always hurt. Most of the time, love is like music. It makes you smile.

Now, lovely child, go hug Momma. And ask Daddy to dance with you again. Tickle your brother and sister, and then go outside and play. You will be made all right, sweet joy. It will be made all right.

 

 

It is quite the cathartic process to write a letter to yourself as a child. You can write more than one. This exercise points your attention to a particularly emotional, traumatic, or overwhelming time, and allows you to gather perspective on your past. Too often, we experience overwhelming adversity as children without significant help from the adults in our lives at the time. Perhaps the adults were overwhelmed as well, or perhaps they were absent. The wounded part of you remains in your mind... your memory. A common coping mechanism is called "compartmentalization". In a sense, we package up that memory and keep it isolated from the rest of our growing up. When that happens, emotions associated with that memory may remain child-like. What every child needs is adult guidance, input, and explanations to get them through difficult times. Try it. Try writing to the child that you were many years ago, as if they were a child today. Give them advice, forgiveness, hope... whatever you think will help. Your heart will thank you.

Pathology of Life (part 1)

dis·ease

noun \di-ˈzēz\

: an illness that affects a person, animal, or plant : a condition that prevents the body or mind from working normally

: a problem that a person, group, organization, or society has and cannot stop

"Disease." Merriam-Webster.com. Merriam-Webster, n.d. Web. 14 Nov. 2014.

Mental health is a sliding scale. There is no model of perfect health, nor a model of imperfect health (as it pertains to social/emotional/relational/mental health). Psychological disease is evidenced in every human being who chooses to avail themselves to the judgements and mercies of everyday society. Mania, insomnia, depression, bipolar disorder, paranoia, narcissism, nymphomania, kleptomania, etc. Look around you, and you are sure to see a glimpse of disorder...

The presence of mental disease which prohibits supportive relationships, reliable employment, or safekeeping of oneself and others warrants direct intervention. When the progression of life is halted because of emotional or cognitive instability, it is time to take drastic measure and believe in the hope of change.

The definition of mental health (which includes eccentricities) is broad enough to offend the sensitivities of most good folk. A person who can maintain at least one lasting relationship into adulthood, exhibits an absence of homicidal or suicidal tendencies, can sustain menial employment, is able to care for themselves well enough to maintain health - this is a classic example of a mentally healthy person. This list is not exhaustive, of course, but rather it is meant to serve as an example. There is much room for fault, abrasiveness, awkward moments, poor decision-making skills, and overall muck in the model of mental well-being. It is time to scrap this notion that pleasantries and perfectly cooked meals are the hallmark of healthy relationships. It is time to peer into the reality of messy childhoods, awkward marriages, grumpy aging, and relationships that leave room for need.

The better understanding of mental health (and its misnomer) is useful for a variety of reasons. I will mention three of them today.

1.  With it, we can explain our needs. It is why we need each other so desperately, and simultaneously loathe each other so desperately. We crave community, loyalty, partnership, dependability, friends, lovers, dependents, providers. Our most insatiable needs are often rooted in other people, yet one of the most common complaints that marriage counselors hear is "He/she cannot be satisfied".

2. With it, we can empathize. Once we arrive at a better understanding of mental health, our own lack of perfect health, and each other's cries for help, we can see through one another's eyes. We can begin to judge less, help more, and stick around longer.

3. With a better understanding of ourselves comes a better understanding of God. So many people - followers and sojourners - question their need for God. A more accurate understanding of our diseased state can help us see why God intends to heal us (because we are sick!). A firmer appreciation of our struggles can provide a clearer hope for an eternal future, free of maladies.