Monday, December 30, 2013

Why I Resolve to Make No New Year Resolutions

I will not make any New Year resolutions for 2014 because resolutions can be set-ups for bipolar lows and highs:

  • If I make resolutions and break even one, I will become depressed.
  • If I break more than one, I will become more depressed.
  • If I keep even one resolution for at least six months, I may become hypomanic with pride.
  • If I keep all my resolutions, or even most of them, all year, I may become manic with self-congratulations.

·       By not making resolutions, I can feel good about myself without the pressure of how I decided in 2013 to behave in 2014.

But whether or not you make New Year resolutions, have a fine 2014.

Monday, December 23, 2013

Bipolar Holidays

If you have been diagnosed and treated for bipolar disorder long enough to have a routine worked out for minimizing stress and maximizing calm pleasure during the holidays, then you have a head start on surviving this season without trauma.

But if you are bipolar and uneasy or uncertain about dealing with the holidays, here are a few tips for you to consider.

Alcohol. You bipolar meds may require you to stay away from alcohol, but in any case, one drink makes a second drink seem more harmless than it may be for you. You can take alcohol-free wine or beer with you to parties, and if you don't, you can stick to water or club soda.

Parties. Eat with restraint and watch out for sugar overload. If crowds make you nervous, arrange to go to parties with a friend or your spouse or a date.

Sleep. Even if you are the first one to leave a party or if you are not going to get everything done you think you should, be consistent about getting enough sleep. You may miss some of the fun, but you're likely to miss a lot more if exhaustion triggers bipolar symptoms that sleep can keep dormant.

Long-Distance Travel. Changing time zones is too risky for those bipolar people who find the adjustment unsettling. And even if that doesn't bother you, the stress and unreliability of plane delays and weather disruptions are a challenge to just about everyone. Consider conservatively any travel plans.

Stress. If crowds give you the creeps, do your holiday shopping earlier in the year or online. A New York friend and I once discovered that both of us avoided Bloomingdale's in December, because trying to shop there during the holidays triggered panic attacks bad enough to drive us right back out the door.

Money. Many of us lose our grip on money when in a manic or hypomanic state. All of us who share this risk need to keep a reasonable, sensible control on holiday spending. I find it helps to write down my spending limits on gifts and then to consulting this guide if I'm tempted to go overboard.

Medications. During the holidays, be hyper-aware of keeping to your prescribed meds schedule and of not forgetting a dose. Keep your meds with you if you don't want to leave a social event to take them at home.

Family. Dealing with family may require extra resolve, but if large gatherings unhinge you, say so. If not attending a family holiday party is your best option, try to explain without passive aggression, i.e., don't try to make them feel guilty about a long guest list. Ideally, of course, your family will adjust their celebrations to include you.

Therapy. Stick to your usual schedule if you are seeing a therapist. And if your therapist is going away for the holidays, ask for a recommendation of another therapist you can call if necessary.

Self-care. A gift to give yourself for the holidays is to set limits to the social events you might attend or host and the gifts you make or buy. Being kind to yourself enhances your ability to be kind to others.

Sunday, December 15, 2013

Book Review of "Haldol and Hyacinths: A Bipolar Life" by Melody Moezzi

Melody Moezzi is a bipolar Iranian-American Muslim born in Iran whose academically and professionally distinguished family fled political turmoil there and settled in the United States where they became citizens.

Now a lawyer in her thirties, Moezzi writes that in Iran there is no recognition of bipolar disorder (or, as it was originally called, manic depression), and so she has no way of knowing for sure of bipolar relatives, although the disorder tends to run in families.

Because Muslims don't drink alcohol, however, Moezzi was able to bypass the common mistake many bipolar people make of trying to self-medicate by getting drunk. But beginning when she was fourteen, she did have the familiar bipolar urge to kill herself, and it was her suicidal attempt as an adult that led to her first legally mandated stay in a hospital psychiatric ward. Even there, she was not correctly identified and medicated as bipolar but instead was simply labeled as, and treated for, severe depression.

Throughout the nightmare of undiagnosed, untreated bipolar disorder, Moezzi's husband supported and helped her. Her parents also did what they could, although the concept of their daughter's mental illness was difficult to grasp and accept despite that fact that the World Health Organization ranked bipolar disorder as "the sixth leading cause of disability in the world."

After 9-11, Moezzi admits that her bipolar "delusions, hallucinations, melancholia, hair-pulling and nail-biting… have grown significantly worse, leading to three separate psychiatric hospitalizations and an ever-expanding personal pharmacy."

At least she is now correctly diagnosed as bipolar and is grateful to have had Haldol prescribed, because it significantly relieves bipolar symptoms. She takes other drugs as well and has spent some time in a residential half-way house with an effective recovery program.

Her husband has become an expert in recognizing early warning signs that bipolar mania is setting in. He gets her to a medical facility quickly but he can't expect her to go meekly. Once, she insisted that they had won the lottery and that he should quit his job so they could move to Italy. He convinced her to stop at the hospital first.

On another occasion, she protested so dramatically against hospitalization that she and her husband ended up with a police escort making sure they got to the facility that admitted her.
Her delusions have been extreme enough to land Moezzi in five-point restraints while she screamed and struggled to free herself. An ongoing fear is that that because her mania has transformed from "expansive, grandiose and euphoric" to "restless, agitated and hostile," the illness is getting worse. But as of the writing of the book, she had not had a break with reality since she started taking Haldol.

Yet even now, she does not always recognize and own up to the fact that she has a chronic mental illness, which does not prevent her from being grateful finally to have found a psychotherapist who meets her needs.

In addition to being a lawyer, Moezzi has become a journalist and social activist on behalf of a free Iran. She also speaks up for people with mental disorders, pointing out the lack of public sympathy and support. No pastel, looped ribbons to show support for the mentally ill.

Concluding her memoir on a note of hope and happiness, she describes celebrating a traditional Muslim ceremony welcoming spring. A hyacinth plant is key, and at first she can't find one. Then she and her husband go to Trader Joe's, and TJ's comes through, selling her a beautiful lavender hyacinth plant.

Monday, December 9, 2013

Bipolar Twins

If genes were the only source of bipolar disorder, then whenever one identical twin is bipolar, the other, raised in the same family, would always be bipolar, too. But that doesn't happen. If one twin is bipolar, an identical twin is only 60 to 85 times as likely to be bipolar. Experts differ on the percentage, with the extremes being 25 to 96 percent.

Identical twins do not, of course, have identical lives, and if they are bipolar, they may or may not be in manic, depressed, or normal states at the same time. While stress can trigger a bipolar episode, such episodes also can occur with no discernible trigger, whether or not the bipolar person is a twin.

Not only do identical twins not have identical lives but also families vary greatly, and what triggers bipolar disorder in one family may not trigger it in another family, even when both families carry genes for bipolar disorder.

In fraternal (non-identical) twins, half of their genes are the same, just as half are the same in their other siblings and in each parent. As a result, when one fraternal twin is bipolar, the odds that the other will be bipolar are about 5 to 20 percent, the same odds as for other siblings.

Genetic members of a family in which one member is bipolar are more likely to be bipolar than are individuals in a family in which no one else is bipolar. And adopted members in a family where bipolar disorder is present are less likely to be bipolar than are genetically related members of the family.

The number of genes related to bipolar disorder may be as few as one or two, but genetics are the focus in some studies of twins who grow up in the same home, and we still have much to learn

The more I read about bipolar disorder, the more it fascinates me and the more I hope professionals will increase research on the causes and treatments. At the same time, a top priority should be treating the disorder without in any way muting the unusual creativity that many bipolar people capitalize on.