My Mental Disorders

My diagnosis, which I would not get until I turned 53, is Bipolar Type I with Psychotic Features. This is a convenient little pigeon-hole for doctors to use to classify people like me. I don't like it. I consider myself to be manic/depressive and to also be psychotic, two distinctly different mental disorders. Bipolar means two different “poles” of behavior, one manic and the other depressive. But it does not capture the essence of the transition between these states, which sometimes overlap. Psychoanalysts don’t usually see this disorder in children younger than fifteen. In my case I believe my disorder manifested itself when I was ten. 

One “pole” of bipolar behavior in me is mania during which I have long periods of hyper-activity and impulsiveness and heightened sexuality. I feel animated, capable of accomplishing anything, driven to the exclusion of everything else to do whatever is in the moment, whether at work or in social settings or in bed. I excel at work and in social settings. I am always a voracious lover. I am intoxicated by my manias. People love my company. They enjoy my compliments and are willing to do as I wish. I was very successful as a manager. But at times my manias are characterized by anger, hatefulness, maliciousness and paranoia. I withdraw and withhold my love and compassion. 

Most of the time I am in hypomania, a lesser degree of pure mania during which I am relatively lucid. But this is punctuated by real full-blown mania sometimes. I am generous to a fault. I can become impulsive, like buying things I don't need and wrecking my finances in doing so. I live in San Francisco in a small two-bedroom apartment and I made thirty earthquake preparedness kits which I had trouble finding places for. I am loved while in hypomania and I have no compunctions about using that love to my advantage.

I also have depressions, which I guess is my other “pole” of emotion and behavior. A depression is a blackness of the spirit so overwhelming that a person can be driven to suicide. Usually I curl up in a ball under the blankets shivering in fear as I wait for the depression to end. Depressions make me withdraw from the world. I was always tardy or absent from work when I was employed. My movements are wooden. I have trouble eating or even watching television. I am frozen in time.

During bipolar in its episodic form, that is to say, when the transitions between mania and depression occur daily for a week or more, for me detachment from reality is nearly total. I feel grandiose and superhuman, thinking things like I can open doors by the sheer will of my mind. I have had one manic episode.

A person with psychotic features or, as I prefer to call it, psychosis, like me, detaches completely from reality unrelated to an episode or bipolar itself. In my case these detachments are called disassociations. Pretty much anything can happen during a disassociation; in my case my mind wanders off in flights of fancy, oblivious to its surroundings (for example, traffic), I see my body from outside of itself, or I cut myself brutally with a kitchen knife. 

Most bipolar people are at risk of suicide during their depressive phase. This is not my case. During disassociations, not depressions, I have tried to commit suicide three times in my life, ending up each time in a psychiatric hospital. I hallucinate intensely; I see things, I smell things, I hear voices and I get the tactile sensation of someone grabbing me from behind. I typically see blood dripping from surfaces and welling up from the floor. Evil and demonic voices taunt me while their strong unyielding arms hold me in place. Windows go dark and from behind them I hear the sad soft wail of ghosts. The onset of psychosis is unpredictable, as are bipolar symptoms. My type one bipolar is given to long periods of mania interrupted by very brief depressions. I consider my “psychotic features” to be a different phenomenon.

Bipolar is genetic—it is inherited from a parent. In my case, reconstructing the behavior of my mother and her mother, I probably inherited my bipolar disorder from my mother and she from her mother. Because my brother displays no bipolar symptoms and I have no children the long chain of bipolar disorder in my family will end with me.

There is no cure for bipolar disorder or psychosis. Various drug therapies exist that help some and other therapies that help others. Drugs are hit-and-miss. Different drugs have different effects on different people, as we who have mental disorders like to say. I take a very strong anti-psychotic drug that suppresses my psychosis and bipolar symptoms somewhat. Drugs are adjuncts to psychological and psychiatric therapy. It is the combination of these—drugs and psychotherapy—that enable some bipolar and psychotic people to function in society. In my case, my bipolar and psychosis are disabling. I cannot hold down a job or function in any meaningful way in society.

I also suffer from Panic/Anxiety disorder. The symptoms are (from WebMD.com):

• Feelings of panic, fear, and uneasiness
• Problems sleeping
• Cold or sweaty hands and/or feet
• Shortness of breath
• Heart palpitations
• An inability to be still and calm
• Dry mouth
• Numbness or tingling in the hands or feet
• Nausea
• Muscle tension
• Dizziness

I have all of these symptoms during a Panic/Anxiety attack. In my case, the onset of this is caused by a fear of public places. I think that people on a bus are secretly glancing at me and averting their eyes before I can confirm this. I think they are laughing silently at me. I feel like I will be rejected if I try to reach out to people. I have difficulty leaving my apartment because of this. I cannot be in places where there are a lot people. I find it almost impossible to attend meetings in which I might be asked to participate.

Post Traumatic Stress Disorder (PTSD)  is my last diagnosis. An overview of this is provided by WebMD.com):

Post traumatic stress disorder (PTSD) is an anxiety disorder that is triggered by an event such as violence, a car accident, a natural disaster, and more. It can affect one person or a group of people. In soldiers, it has sometimes been called "shell shock." Symptoms include flashbacks, emotional detachment, jumpiness, and more. PTSD can make working and maintaining relationships very difficult. 

In my case the traumatic event of my life was the inexplicable beatings by my father and the psychological control by my mother during which she used the threat of withholding her love for me if I did something that displeased her. These events started when I was seven and onward into my late teens by my mother. My father stopped caring about me and locked himself in his study so the beatings slowly tapered off. My PTSD has made it very difficult for me to maintain friendships and succeed at love relationships. I have made countless friends throughout my life and discarded them as I grew up. I have had four relationships in my life and failed at each.

So what do I do about these disorders?

To begin with I take powerful drugs that for the most part help me. Daily I take 200mg of Geodon, an atypical antipsychotic drug, for my bipolar and psychosis. I take 400mg of Lamictal to address my bipolar depressions. I take 2400mg of Neurontin to address my panic/anxiety disorder. I take 10mg of Valium as needed for my Panic/Anxiety and PTSD problems. I go to bed with 10mg of Prososin in me to quell the nightmares that plague me because of my PTSD. I also take 1mg of Klonopin as needed to help with everyday tension and nervousness.

Then there's psychotherapy. I have been in psychoanalysis since 2003 (it is 2014 at the time of this writing.) I began with once-a-week 50-minute sessions with a therapist and graduated to twice-a-week 55-minute sessions with my psychologist. I have had an army of psychiatrists over the years to prescribe me medication. My current psychiatrist is the best I have ever had (and not very expensive, either.) He talks about my mental health and how things are going with me besides simply prescribing medication.

After a lot of grueling uncertainty I began attending meetings of the Depressive Bipolar Support Alliance (DBSA). I almost started hallucinating the first time there. I now take a Valium before attending a meeting. The group is a safe haven for people with mental disorders. DBSA meetings are organized a lot like group therapy, with which I am familiar from my stays in psychiatric hospitals. I have slowly become adjusted to this and no longer need a solitary life cut off from the world. Tonight (Thursday, November 20th, 2014) I am going to force myself to go to an informal social gathering of DBSA people at a cafe in the Mission. Maybe if I keep attending I will achieve facial recognition and maybe make some friends. I don't want to live alone anymore.

So. These are my mental disorders as of 2014 going into 2015. It is a relief to blog about them. So much of my personality is driven by them. All of my past has been characterized by them. Consider this as you read my Dreams and Things.