intro....

FORWARD

For those of you who opened this book expecting something about Christianity, please close the book immediately and put it quietly back on the shelf. It’s not that there isn’t some degree of spirituality, here. My friends have helped me to see that I am a spiritual person, no matter what I profess about my religious beliefs or my lack of them. My best friend is a Born-Again Christian and knows me very well. He has taught me a lot about forgiveness and kindness, humility and humbleness, for which I am eternally grateful. Rather, this is going to be an autobiography concerning my coping with Bipolar Affective Disorder. This is fiction. I’ve changed the names of some of the people and the names of some of the places. The times are probably quite accurate.

Coming out of every depression, every 6 months or so, I’ve had the feeling of rebirth. It’s definitely joyful. It’s the joy of feeling alive again, of being optimistic, of having energy, of liking the company of other people, of having genuine creativity, of talking easily, of having forgiveness in my heart, of feeling at one with nature, of bicycling on a warm spring day, of conversing naturally, of responding appropriately, of liking myself, of feeling self-confident, of being unafraid to try new things, of having strength and agility, of enjoying jokes, of learning, of reading, of going to movies. of loving and of being loved. It’s the joy of crawling successfully out of a mud hole, of peeking over the edge at the real world, of standing up and taking one’s place in the world and of standing back-to-back and shoulder-to-shoulder and belly-to-belly with friends and family.

My mother and many other family members had and have cyclic mood disorders: Manic-Depressive Disease, Bipolar Affective Disorder, Unipolar Affective Disorder, Post-partum Depression, Cyclothymia and Seasonal Affective Disorder. Believe me, it is not the day to day minor mood swings of hard working and hard playing folks. And, it is not the severe depression of the bereaved, whether it be loss of a loved one, or loss of loved object or loss of an important idea. It is the life-altering and life-threatening mood changes that make those of us with these disorders feel genuinely crazy. We have thoughts that are not real. We make decisions that are very unhealthy. We have false memories that confuse us. We look forward to being happy and yet we fear the happiness that leads to the next crash. I am the classic patient who feels anxious because I am not anxious. On the occasion of my recent 70th birthday, I just recovered from a depression that lasted more than 18 months. I was happy to be talking again and happy to be able to enjoy the birthday meals made by people important to me who stood by me. And yet, I am shaken by the thought that my happiness is short-lived, that it may convert to a state of denial that allows dangerous behaviour and thought processes, that the happier I get, the more likely am I to have a severe depression, and that it may be false because of a chemical abnormality, over which I seem to have not control, that fosters illogical thinking and impulsive behaviour.

I was shaken by recent studies that showed that Tegretal, a drug that I was taking for 10 years, is associated with increased rates and increased intensities of suicidal ideation and with increased rates of suicidal gestures and successful suicides. It explains some things to me, in a sad retrospective way. Moreover, the drug is part of a class of drugs, anti-convulsants, all of which cause this serious difficulty. The side-effects of lithium therapy were bad enough. The propensity for anti-depressants of all kinds to cause rapid mood swings, suicidal ideation and sometimes serious physical side-effects led to the almost complete withdrawal of the antidepressants in patients with serious mood swings. Moreover, the most recent, outcome-oriented results published suggest that antidepressants are not much better than placebos.

Believe it or not, the most current research modality for serious, unrelenting depression is direct, chronic stimulation of certain areas of the brain using implanted electrodes. One of my good friends wants me to sign up for the research trials. The results of such studies may not be available for 5 to 10 years. By that time, I will be 75 or 80, much too old to consider having holes drilled in my head. Also, a surprising side effect of Tamoxafin, an anti-cancer drug, mainly for breast cancer, has been improvement in mood swings, mainly in women. In a sense, that frees me from such a recommendation in the future. The prospects of taking any more of any of the anti-psychotics, anti-convulsants, anti-cancer or anti-depressants seems dismal to me. I’d rather not.

Happily, there has been a favourable shift to more logical thinking in this disease where logical thinking is at a premium, by the patients and their doctors. Recently studies have shown that family and community support, cognitive psychotherapy, behavioural modification and just listening have a very positive, long-term, safe effect on patients with serious mood swings. When I was 40, when the prevailing idea was that there was a chemical imbalance that was untouched by conventional “kindness” psychotherapy, the idea of my being treated without lithium seemed to be untenable. There seemed to be a dogma. Bipolar Affective Disorder is strongly linked to Paranoid Psychophrenia, genetically and psychologically. The psychiatric community seemed to agree that a Bipolar patient is psychotic, has defective thinking patterns and must be on an antipsychotic medication or certainly lithium or an anti-convulsant. I can attest to the idea that supportive therapy and cognitive therapy helped a great deal. I seem to have more insight and I seem to be able to better recognize defective thought patterns and unhealthy behavioural patterns. I seem to know when to ask for help from the folks that love me and the folks that monitor me.

Besides, I’ve made it to 70. Not only have I successfully been able to withstand two very severe Major Depressions lasting over a year, each, in the past 8 years, but also I’ve been able to do it without medications. I could not have done it without the support, and continued vigilance, of my sister and brother-in-law, my sons, a few very good friends, a cognitive psychotherapist, a psychiatrist and a few others, some of whom, it is possible, I am not aware. I believe my own efforts and insights have been very important. I believe I will continue to need feed-back and support for the rest of my life. I believe, the first step that made a difference was the acceptance of my condition as serious and as requiring help. It was not a sudden revelation or epiphany. The ideas were hard-fought and resisted by me at many levels. As my sons and I laugh about it, when I’m able to do so, I sometimes needed to be hit over the head by a 2 by 4 to turn my thinking around to a healthier direction. Who knows how many other false or self-destructive ideas I still harbour? Going by my past experience of the last 60 or more years, there’s still a lot of work to be done.

So, here I am. My brother-in-law and a very good friend of mine have encouraged me, for years, to try and write things down in the form of a book which may help others with similar problems. Until today, I’ve resisted doing it for many reasons, not the least of which is that it would bring up some very uncomfortable memories. I guess it’s time. I’ll need more support from my already tired supporters. I hope this effort pays them some dividends as I think it’ll pay me a lot of dividends. I’m hoping it’ll sharpen my memories and make them more comfortable. “There’s nothing like a good catharsis!” This misquote of a common adage about simple pleasures, may do us all some good. With that charitable idea, I will push ahead. I hope I’m not too wordy, not too mundane, not too boring, not too lost in details and not too heavy with cliches. I have an idea it will not be a chronology. In fact, I’ve already said something about my state of mind at the time of my 70th birthday. If anything it may be a “reverse” chronology. Frankly, I don’t know. Maybe that’s a good place to start: “I don’t know!” There! I said it and I’m glad!

I do know that my moods are bound to be unstable, sometimes rapidly and disturbingly so, and sometimes so intensely up or down that I will become dysfunctional and will not be able to write. I hope that I can write down enough in my “lucid periods,” to make some sense and provoke some interest by readers. I hope that my own interest is sustained. Sometimes just being able to concentrate and remember things is very difficult. Besides, now that I’m 70, I’m getting more senior moments. I feel that most of my forgetfulness can also be due to distraction, and that may be a continuing problem. I know that other folks with serious mood disorders have written autobiographies and “self-help” books. I also know that bright, talented, successful writers can have, nevertheless, serious manic-depressive disorders and disturbances.