Monday, September 23, 2013

Bipolar in Prison

Research into a connection between bipolar disorder and crime is inconclusive. There is no solid evidence that bipolar people are any more inclined toward criminal behavior than those who are not bipolar. But if bipolar people do become violent from time to time, psychiatric care should address the problem. 

Yet according to the National Institute of Mental Health (NIMH), "… People with serious mental illness are frequently arrested for minor offenses, many times as a result of homelessness, and then they are incarcerated in jails where their mental health needs are not met. There are also significant numbers of persons with serious mental illness who come in contact with the police but are not arrested."

Bipolar people are most likely to attract police attention if they are in an extreme manic state, behaving in disruptive or illegal ways. If they do break the law while manic and are arrested, they may be funneled to a psychiatric facility rather than to prison.

Suspects who are manic and irrational despite being on medication are in a more precarious position than those who are off their meds and will cease irrational behavior when they resume medication. Agreeing to take their meds as prescribed may gain them a degree of leniency if they are arrested.

Unfortunately, bipolar prisoners may be misdiagnosed and prescribed meds for a mental disorder they do not have while being denied the meds they need. Prison authorities may continue to deny correct medications and provide the wrong ones even after the prisoner's family and own doctor try to interfere.

Bipolar prisoners who are not appropriately medicated are at risk for becoming violent and irrational even if they were not manic when arrested. On the other hand, if they have been abusing alcohol and drugs, a stay in prison will force them into cold-turkey withdrawal. When they are later released, they may not return to those addictions.

As our society tries to cope with people who have mental disorders and break the law, some police receive training in how to deal nonviolently with irrational suspects. There are even prisons, although not enough of them, that provide therapists for prisoners who need them.

Bipolar prisoners' problems are not necessarily diminished when the prison term ends. Back in the general population, a bipolar ex-prisoner needs a safe, healthy place to stay. Some will go home to people who love them. But others may return to halfway houses or to the streets. Ideally, prisons would provide counseling for recently released prisoners, but let's not hold our breath waiting for that to happen.

Meanwhile, people with bipolar friends and relatives should encourage them to seek and maintain a relationship with a doctor skilled in working with bipolar patients.

Monday, September 16, 2013

Review of Marya Hornbacher's "Madness: A Bipolar Life"

Marya Hornbacher's memoir "Madness: A Bipolar Life" was published in 2008, but her originality, creativity, courage, intelligence, and, yes, wackiness make it compelling today, too.

Hornbacher denied for years that she has rapid cycling bipolar disorder, although her episodes occur at least four times a year, can last for less than a day or for months, have landed her in a hospital psychiatric ward several times, and may again. As if that weren't trouble enough for one life, she has also struggled with (and written about) bulimia and addiction. Her addiction to alcohol was key in her refusal to stick to a treatment regime for bipolar disorder that depends on sobriety.

Despite all her problems, Hornbacher has a tremendous will to keep on keeping on, even when her life seems like a nightmare. After slicing her arm from wrist to elbow, she called 911 and then, fading in and out of consciousness as an ambulance delivers her to the hospital, wonders where she is and why. Eventually sanity returns, but she can never count on it to stay.

I, having lived in Santa Fe, was particularly drawn to Hornbacher's description of wandering in a southwestern desert with her crazy friend Sean. When they find themselves without food, water, or a compass, they know they could die. Through luck alone, their drifting takes them to a roadhouse where they eat and drink.

A particularly striking aspect of her life is the fact that people who love Hornbacher surround and help her. And after her mother and father divorce, they continue to cooperate in meeting Marya's needs for parenting that goes well beyond what is asked of most parents. Marya's friends, who are weird in their own interesting ways, also see her through when she can't take care of herself.

When she marries, Hornbacher and her husband, who suffers from periodic, crippling depression, support each other, although like most couples, they have disagreements and flare ups. The scenes of their cuddling in bed, comforting each other when they both have lost a firm grip on sanity, are touching and life affirming.

Despite the challenges, Hornbacher's husband works full-time, and she freelances as a successful writer.

Hornbacher's psychiatrist of many years continues to see her even when she fails to follow his instructions. At last he must tell her she has been soaking her brain in alcohol for so long that the day may not be far off when there is no way to bring her out of psychosis, and that will mean spending the rest of her life locked in a psychiatric care facility. She is already well known in the locked psychiatric ward of a hospital in Minneapolis, the city near which she grew up and where she now lives.

The appalling prospect of permanently losing connection with consensus reality finally shocks Hornbacher into giving up alcohol. Her bipolar medications and electroconvulsive therapy then work as they should. But no treatment currently available will cure her entirely of the symptoms of rapid cycling bipolar disorder. As a result, the obstacles she overcomes make her talents and accomplishments all the more impressive. On top of that, she is a damn fine storyteller.

Wednesday, September 11, 2013

An Alliterative Alphabet for Bipolar Enjoyment

Before I knew that I am bipolar I composed an alliterative alphabet and posted it on the Open Salon blog I wrote at that time. My cousin Christine said she couldn't read it, because the alliteration became too annoying. Evidently others agreed, because I got no positive responses to the posting, and I and took it down. 

After I was diagnosed as bipolar, I read that bipolar people tend to enjoy alliteration. Since this blog is about bipolar disorder, I am posting the alliterative alphabet here.

An acrimonious alligator ate Alice's astonished attorney as an appetizer & afterward acted awkward and anxious about ablating an ace asset.
Bold bankers built boomer billionaires’ blessed budgets, but behemoth battering busted balances before beautiful bequests became bountiful.
Clever crooked cops (craftily conferring, creeping cautiously) coolly collected copious cannabis cash covertly, carefully closing cases.
Depression doomed demented Deedee’s darkling dreams during delirious dipsomaniac days delivering dahlias—drifting, distracted, dazed.
Every elegant entertainment elicited enthusiastic, energetic emails earnestly expressing erstwhile Episcopalians’ eerily elemental ecstasy.
Frances's fabulous fractals fried Francis's fractious forebrain, finally fogging forever friendship’s fragile foundation, finishing frostily.
Glimpsing glamorous Gloria’s gorgeous gams gave guileless, gaping geeks greater gumption Googling glamorous guiltless-gilt gal gifts.
Hapless Harlequin hazarded honorable happenstances—hindered horrendously, hopelessly hopeful, hilariously humorous, handily handsome.
Images illustrating influential Indian iconography initiate infinite intellectual interpretive identification including intimate iconology.
Juries jailing junkies jumpstart jackass jokester justice, jabbing Janus, justifying jerks, jackhammering jurisprudence, jamming jails.
Kitty, kindly kissing Kat’s kitten (Kinky Knight), kept knitting keepsakes; keen Kat, kneeling, knifed kindling; Kinky Knight keened.
Luscious lovers leave luster lingering lastingly, lamenting little, lacking loss, letting limits lessen, liltingly luring luck. Lucid.
Many miracles make marginal martyrs meekly melt; meanwhile, mistily morbid men meander meaninglessly; most march mindlessly, missing much.
Naked navigator’s noontime nosh: naan, nachos, napoleons, nasi-goreng, nasturtiums, nectarines, noodles Newberg, Newtons, nougat, ‘n’ nuts.
Optimizing options, oligarchs overlook optimism, offering omnibus opinions on official occurrences, operating ostentatiously or opting out.
Personifying plausibility, prominent people promenaded—passing perilously perceptive pedants pondering preferable paradigms purposefully.
Quite quarrelsome quarterbacks quasi-quit qat* querulously, quipped quintuplet Quentin, quashing queasy, quixotic questioners quickly. (*Cross between opium and cocaine.)
Randy rockers race rapturously riverward relishing random radiant revelations released rarely, realized reluctantly, righteously recorded.
Seven silk scarves swirling, sweet Suzette (sizzling seductively) straddled salacious sailor Samson, saying simply, "So, sugar, shall …?"
Troubleshooting time travel (tantamount to transcendental tourism) takes tedious testing trials, tentative tasks, tribulation, tall tales.
Usually upset, unctuous Uncle Underwood ululates under umbrellas uncannily, utterly usurping ultimate utopias, undercutting understanding.
Voluptuous villains’ vast, venomous victories verify viciously virulent visions vested vexingly. Vindication vanishes. Vodka vaporizes.
What’s with wakeful, warm-blooded wanderers wishing whirling wizards would win while watchful WASPs, whose waistlines wither, wane woefully?
Xanaxy xenophobic xylophonists xerographed Xana’s xenoliths; x-rayed Xerxes's xylem/xerophytes; X-rated Xanadu’s Xmas xebecs.
Yes, yesteryear’s yentas yakkety-yaked; youthful yokels yoked; Yugoslavian yogis yearned; yo-yo yachtsmen yelled; yardbird yeggs yodeled.
Zonked zany zealot zoologists' zaftig zitherist’s zillion zebras zipped, zoomed, zigzagged zestfully. Zowie zoogeography!

Monday, September 2, 2013

Bipolar Kids

While having or being a bipolar child is difficult and can be frightening, there are resources to help deal with the challenge that were not available until recently — resources, at least, for people who can afford them. Some health insurance does not cover childhood bipolar disorder because it isn't yet listed in the "Diagnostic and Statistic Manual of Mental Disorders" (DSM).

All four of the variations on bipolar disorder that appear in adults and are sanctified by the DSM may, some experts believe, also strike children: Bipolar I Disorder, Bipolar II Disorder, Bipolar Disorder Not Otherwise Specified (BP-NOS), and Cyclothymic Disorder (or Cyclothymia). Like an adult, a child may also have hypomania, which has symptoms that are similar to bipolar symptoms but are much less severe.

Complicating the situation further are two childhood disorders that may be confused with bipolar disorder: attention deficit hyperactivity disorder (ADHD) and severe mood dysregulation (SMD). This is one of several good reasons to consult an expert in bipolar disorder for a child who is having extreme and frequent mood swings.

Doctors and their bipolar patients, whatever the patients' ages, try various medications and doses that have been identified as possibly helpful. When something works, or at least works better than anything else, they settle on that. Treatments of childhood bipolar disorder include various medications, but no medication works for all bipolar children or, for that matter, for all bipolar adults. Furthermore, children and adults may react differently to the same medication.

Children typically have high energy and noticeable changes in mood that may be extreme. Unfortunately, experts do not agree on how to distinguish normal moods in children from bipolar mood swings. As a result, there is no way of knowing whether the rapidly increasing number of children being diagnosed with bipolar disorder are really bipolar. Not a comforting situation for parents living with an intensely moody child.

Shocking and sad as it is, young people with bipolar disorder are even more likely than bipolar adults to be suicidal. Parents, teachers, and doctors of bipolar kids should be familiar with signs of suicidal thoughts and fantasies. A failed attempt at suicide should never be dismissed as merely a plea for attention and not a serious attempt to die. Any signs of interest in suicide should be addressed immediately by an expert.

Because bipolar disorder runs in families, the pediatrician of a child with a bipolar parent should be alerted to the risk and sensitive to possible symptoms in the child.

When bipolar symptoms are extremely severe and unmanageable, a child may have to be hospitalized, and the hospital ideally should be one in which experts are experienced in dealing with childhood bipolar disorder. In less severe cases, outpatient talk therapy for child and parents may bring relief.

Whatever the details of the lives of bipolar children and their parents, an expert in the disorder should be able to suggest ways to improve their quality of life.