Under Pressure

My apologies for talking about myself so much, but it was probably inevitable (& if that kind of groveling annoys you, please keep in mind that I'm a Minnesotan, & we apologize like we drink: far too much, far too often).

That said, the saddest thing about bipolar disorder, from my experience, is the loss of a consistent ability to cope with stress.

It hasn’t been a total loss for me, but I used to be much better at it. That was a big part of the reason I started out as a newspaper reporter: the thrill of a deadline, the pressure of talking a reluctant source into telling you what he knows, the daily anxiety over what your readers & sources & editors will think of what you wrote.

But the stress eventually got to be too much, & I left journalism for law school. I knew that carried its own stresses (ridiculously competitive first-year classes, for one; ludicrously competitive second-year summer-job hunts, for another), but I also knew I could study at 4 a.m. & pull all-nighters before exams. I found that harder to manage with a day job.

Now I find it hard even to remember being as ambitious as I was when I graduated from college, or when I started studying law. I usually do what I can to avoid stress now, & I rarely look forward to it. I feel guilty about that once in a while – like I should contribute something to the world but never quite get around to it.

I suspect I’ll be that ambitious again, during one upswing or the next. I also know it won’t last.

'Tis Not the Season for Me

The most pathetic, miserable time of year starts tomorrow. Goddamn the holidays, & goddamn all the puke for which they stand.

Really, is there anything more painful than ignoring every dysfunction in our lives -- & doing it for a month and a half out of every flippin' year?

I do love my family & friends, I swear. But I love them because they're flawed, like me (though usually they're more subtle about their shortcomings). The last thing I want to do is sit around & pretend we were all invented by Norman Rockwell, complete with the fat uncle who smells like rum punch & Chesterfields yet retains his jolly sentiment when he plays Santa Claus every year.

Such families -- such people -- do not exist. Never have, never will. I've done enough genealogy over the last five years to know this.

'Tis the season, for those of us with seasonal mood patterns anyway, to get depressed, sleep until noon every day (claiming we "worked from home" in the morning), & gorge on pure starch constantly. I always make sure to keep a bag of flour, a soup ladle & a spare bucket of insulin handy this time of year.

Besides which, turkey sucks ass. Yes, I said it. Did these flightless freaks of nature never learn to drink water? No matter who cooks them, no matter how lovingly & carefully they do it, no matter how freely the damn things range before someone whacks their heads off, turkeys always taste like tree bark, only drier and stringier. Trytophan helps with depression, apparently, but only if you're willing to eat a U-Haul full of Butterballs. Goose I can stand, but who the hell actually cooks geese anymore?

One thing exists to make the holidays survivable: rich, yolky eggnog, by the half gallon. Also, lefse.

My Medical History & Me, Part 1

On average, manic depressives wait eight years, & four doctors, from the time symptoms show up to the time the psychiatric world makes an accurate diagnosis. I got there in nine & six, but count me lucky anyway: I spent only 24 hours under hospital lock-&-key, received some relatively effective treatment for the depressive end of things, & got a chance to see the sausage factory that is American mental-health-care up close.

At the risk of becoming permanently self-referential, here's a bit of my experience with the insanity industry.

As I've noted before, my crazies struck early, but they waited until I was 23 before they started breaking to the surface (in the form of drunken antics unusual even for a drunk). They waited another four years to make their formal appearance.

When they did, they showed up first as insomnia: I went at least one night a week, sometimes two, sometimes two in a row, without a wink of sleep. Some nights I got in my car & drove around for hours; other nights I watched TV in bed (I firmly believe Homicide: Life on the Street reruns staved off insanity), gave up around 3 a.m. & brewed a pot of coffee; others I drove to my office at 4 a.m. & worked all night through the next day.

Next came the anxiety attacks. These weren't full-blown panic attacks, with all the physical symptoms, but they weren't far off. I typically ended up hyperventilating & dysfunctional, or pounding the holy living Christ out of my dashboard at every red light; driving during these things usually ended with my throat raw from screaming through the windshield at anything that moved.

My first stop: the endocrinologist who treated my diabetes at the time. He had nothing to offer for the sleeplessness, not even a psych referral.

A couple years later, during my first year of law school, I met with the student-health-service "shrink." She was a real psychiatrist (as far as I know), but student health-care in this country is an oxymoron. Campus clinics tend to attract bottom-of-the-barrel medical talent, & student-patients are treated as whiny spoiled annoyances. The urban legend at my undergrad college (& most others, I assume) held that male students routinely had to undergo pregnancy tests before they could get any medical help. The school where I met the shrink has a top-notch teaching hospital, but ironclad rules prevent university students from using it without a referral from the student clinic (which almost no one could get) -- whether or not their insurance would pay for hospital treatment.

So not surprisingly, this psychiatrist was a touch out of her depth. She agreed I probably suffered some degree of depression, but didn't think it was worth doing anything about it. She even suggested my insomnia (which by this point was chronic & repetitive) was a good thing because sleep deprivation is sometimes used to treat depression. It is, but typically only in severe cases, & even then only by psychiatrists who know what they're talking about.

My next try for help was in Manhattan, where I was a summer intern between my first & second years of law school. I happened to be there for the rainiest June in the city's history, & by the end of it I was loopy. I drank for the first time in three and a half years, and strong suicidal ideation crept in.

This time I decided to go with the nearest emergency room. Big mistake. The place turned out to be an assembly line for the sick poor who live around Columbia University. The triage nurse sent me for an interview in the psych ward, which could obviously handle only severe cases of mental illness -- the kind of cases that require cops, restraints & massive amounts of drugs. I could still walk & basically function, so they told me I'd have to wait at least a month or two for an outpatient appointment with a shrink. I didn't really expect to live that long.

And best of all: The "social worker" who interviewed me in place of the on-duty shrink actually asked how often I masturbate, in a way that suggested I should do it as often as possible because that would make me feel better. I don't know about you, pal, but a good wank isn't quite enough to get me down from the window ledge.

There's more to come in a later post . . .

Gleevec, Sutent & Me

From Reuters today:

"CHICAGO (Reuters) - Two popular leukemia drugs, Gleevec and Sutent, kept lab mice from developing type 1 diabetes and put 80 percent of diabetic mice in remission, an international team said on Monday."

I'm always skeptical of claims that Type 1 diabetes is about to be cured. I've had this shit for almost 17 years, & news of a possible cure has come along at least once in every one of those years. I don't want to get my hopes up, but this one sounds a little more promising.

Given the choice between losing diabetes & losing the crazies, I'd choose diabetes in a heartbeat. They both suck, obviously, but my mental health problems come & go. A touch o' the sugar is constant. I worry about it when I wake up, when I shower, when I brush my teeth, when I get to work, when I buy coffee, when I eat lunch, & on & on & on. I can't even daydream freely: Whenever I fantasize about life on an uninhabited island, à la Cast Away (though usually with some hot woman who otherwise wouldn't acknowledge my existence), I quickly give up because I know I wouldn't last a month without insulin (which doesn't exactly grow on coconut trees).

Mental illness, at least, offers some unpredictability. When you're diabetic (& pessimistic) you basically know how it's going to end: blind, footless & on dialysis.

So here's keeping my fingers crossed, if only so I can live to see Eli Lilly take it in the ass.

My Crazy Family & Me

I'm way too fascinated by the crazies in my family history. Whenever I read about the debate over heredity vs. environment, I instictively jump to the genetic side of the argument. No doubt that's in part because I'm no fan of self-blame, but it's also because the statistics support the hereditary position.

And damnit, it just makes sense. Does it really seem likely that bipolar disorder appears repeatedly in the same families solely because of environmental quirks? Mood disorders generally, maybe: Your childhood & family life are fucked up, odds are good that you will be too, someday, & odds are good that your kids' childhoods will be fucked up, etc., etc. But something as specific as manic depression? That's kind of like chalking cystic fibrosis up to shitty luck.

My family's bipolar branches include a grandfather who drank himself to death years before lithium hit the scene; probably a grandmother, who's undergone electroconvulsive therapy (ECT); probably a sibling; an aunt; at least one first cousin; at least four first cousins once removed (first cousins of my parents on both sides); and probably a great-great-grandfather, who killed himself 26 years after he fought in the Civil War (his family covered up the suicide, so I can't be positive, but it's the only explanation that fits).

Personally, I think the fact that the debate continues has a lot to do with magical thinking: If we wish really, really hard, we'll make the world a place where we're all individually responsible for every aspect of our circumstances in life, or at least a place where we can blame specific people for their misfortunes. The only alternative is to believe that our lives are almost entirely outside of our control -- & that thought scares a lot of people shitless.

Obviously some number of fruitbaskets stand out as the only crazies in their families. But those could be families where the disease just lay dormant, genetically speaking, for enough generations that its presence is lost to memory. They could also be families where the illness is especially hard to trigger. Or they could be families where bipolar disorder expresses itself mildly in most cases -- too mildly to land anyone else a diagnosis or even suspicion.

And clearly environment plays some role in bipolar disorder, but is it anything more than a trigger that sets off sleeping manic depression?

My personal theory of life (for what little it's worth) is that far more shit happens to us than we make happen. Call it the Moby-Dick school of thought: The harder we try to shove fate into the boxes of human philosophy, the more slippery fate becomes. Life does whatever the fuck it wants -- not what we think it should. And that includes sticking us with hereditary ass-pains that mock our need to believe we live in a meritocratic world.

Barack & Me

I'm gonna milk this shit for all it's worth:

Back in 1999-2000, I worked as a metro reporter at a newspaper on the South Side of Chicago, & in June 2000 I wrote a half-ass story about the christening of a new commuter-rail station in a poor South Side neighborhood. Congressman Jesse Jackson Jr. led the thing, breaking a bottle of sparkling grape juice against the edge of the station platform (& joking, after the TV cameras left, that some of it was "for the homies"). He was joined by a really, really tall state senator (who laughed at Jackson's lame joke).

I'd forgotten that Obama was at the ceremony until an ex-colleague reminded me about the story last night, & the fact that I quoted Obama.

If I were still a journalist, I wouldn't be able to pawn this anecdote off on the janitor. But as a) I'm not still a journalist, b) I gave up on professional dignity long ago, & c) I dropped my marbles down a storm drain, I don't give a goddamn. I knew the dude back when.

My Problem with CBT

Saw a new shrink today. He was very good, very empathetic, very sharp, & he made his diagnosis based on my narrative history & recollections rather than on the standard bipolar checklist. This helps, since I tend to answer "no" to most of the classic bipolar trigger questions (did you ever believe you were King Henry VIII? Did you ever drop $50,000 on lawn ornaments? Did you ever try to break your way into the porn industry?).

He seemed to peg my diagnosis as bipolar not otherwise specified (NOS), that funky-ass catchall category that acknowledges you can be manic-depressive without drawing up plans to build a nuclear power plant in your backyard. This reading certainly makes sense. Like I said in an earlier post, I worry that I see manic depression where it doesn't exist. But this shrink pointed out specific symptoms that do suggest a bipolar-spectrum disorder: My depressive episodes often involve some sort of high-stress trigger (Kerry losing in 2004, for example); my mood changes tend to be seasonal, at least when they're relatively stable (OK in the summer, up a tick early in the fall, then noticeably down around January, & back up again in early spring); and my sleep patterns fit, at least at their worst (staying up later & later every night until I'm sleeping during the day, then crashing & snapping back to a pseudo-normal-human schedule).

I switched to this guy mainly because I was getting tired of the behavioral dreck I was getting from my therapist. It helped for a while, but I keep seeing cognitive behavioral therapy (CBT) as a kind of modern-day blame-the-patient approach: It's not your fault that you never learned to behave properly, but we'll fix that. As much as I appreciate the need for personal responsibility, you won't get very far telling me the reason I'm crazy is that I failed to grow up. My therapist never went so far as saying he didn't consider bipolar disorder a real disease, but he always seemed to lean in that direction -- taking medicine is a good idea, & you shouldn't stop, but our biggest concern is making sure you learn how to behave like a responsible adult. More than a little condescending, frankly -- I doubt many therapists who've actually lived with mental illness would feel that way.

Vote Early, Vote Late -- But Vote Often

In response to a questionnaire from the National Alliance on Mental Illness, Obama answered "Strongly Support" to every question asked. Note especially Nos. 22-24, dealing with incarceration of the mentally ill.

From http://www.nami.org/:
1. Support mental health and substance abuse coverage in all plans to provide affordable health care?
2. Support federal parity legislation to provide equivalent coverage of mental health and substance abuse conditions?
3. Ensure that active duty military, veterans and reservists receive the mental health care and disability payments they need to live successfully with mental illness?
4. Support parity of mental health coverage in the Medicare program?
5. Support policies that remove barriers and promote full access to mental health medications in Medicare, Medicaid and other programs?
6. Support renewing Medicare Part D guidance ensuring access to mental health medications?
7. Support Medicaid coverage and reimbursement of effective, recovery-oriented and evidence-based mental health services?
8. Support repealing the Medicaid IMD policy that excludes coverage for inpatient care in certain facilities?
9. Support parity of mental health coverage in the SCHIP program?
10. Support investing new resources in the Mental Health Services Block Grant?
11. Support policies that eliminate the inappropriate use of seclusion and restraint and foster humane alternatives?
12. Support accelerated investment in National Institute of Mental Health research on mental illness, co-occurring disorders, recovery and reintegration into the community?
13. Support incorporating cultural competence standards in requirements for federal mental health funding?
14. Support federal incentives to recruit and train mental health professionals, particularly to increase workforce diversity and serve rural areas?
15. Support the integration of mental health and primary care to achieve better health outcomes, particularly for older adults and communities of color?
16. Support increased funding for the Garrett Lee Smith Memorial Act to expand youth and young adult suicide prevention and early intervention strategies?
17. Support full funding of the Individuals with Disabilities Education Act (IDEA) and passing legislation to fund school-based mental health services?
18. Support passing Keeping Families Together legislation to end unnecessary custody relinquishment by families seeking mental health services for their children?
19. Support increased investment in permanent and supportive housing for people living with serious mental illness?
20. Support programs and policies that result in competitive employment for people living with serious mental illness?
21. Support maintaining health care coverage for people with disabilities who return to work?
22. Support increasing programs to divert people with mental illness from jail into appropriate community treatment?
23. Support increasing programs to identify youth with serious mental disorders at first contact with juvenile justice systems and increase diversion to community treatment?
24. Support access to SSI/SSDI, Medicaid and other federal benefits upon release from jail or prison for people with mental illness?

McCain, meanwhile, refused to answer any of NAMI's questions, responding instead with a one-page statement packed with boilerplate bullshit, including the following:
"Mental health is a necessary complement to physical health in all aspects of our daily lives. Fortunately, the path to greater quality and lower costs is to recognize this fact and where possible provide incentives to treat physical and behavioral health together. Chronic disease is a dominant component of the growth in spending on health care and many of our citizens with chronic illnesses have a behavioral health problem as well. For example, untreated depression raises dramatically the cost of treating the physical ailments of a diabetic. A sensible goal is to design reimbursement for taking care of the whole patient, whatever ails them, and recognize the essential role mental health treatment plays in the overall health of the patient and the reduction in physical health needs.
I have stressed the central role of personal responsibility in leading to lower health care costs. Personal fitness and better lifestyles, especially reduction in addictions of all types – food, narcotics, or cigarettes – can yield dramatic improvements in the cost of chronic illness and high‐cost medical care. We can do a better job of treating addictions, but we also have an obligation to do a better job of teaching our children the benefits of good lifestyles and the perils of addictive activities."

The Arnold Schwarzenegger school of mental health: "Personal fitness & better lifestyles." And this from a guy whose wife is a recovering addict.

I just hope the Obama landslide predictions pan out tonight.

My Election Anxiety

Jesus, does election season put me on edge. I swear to God, my moods seem to cycle according to the political news in the months before a presidential vote.

Back in 2004, I did pretty well most of the year, still recovering from a nasty depression but feeling a hell of a lot better. I even worked as a poll watcher, which I don't think I could've pulled off in a bad state of mind.

Then John Kerry lost, & I couldn't get out of bed for two days straight. It was the start of the third major depressive episode I've been able to pinpoint.

This time around I promised myself I wouldn't get so emotionally attached to the race. That worked until about two days after Barack Obama announced his campaign in 2007.

So vote Democratic tomorrow, or I'll have a nervous breakdown. And it'll be on you.