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Sleep.

“Sleep Hygiene” the experts call it. Paying attention to my sleep cycle is an important part of keeping well. My pattern of sleep can be a strong indicator of my current mood state. Restoring a healthy pattern can be key to restoring a balanced position.

When I’m hypomanic I have little need for sleep. I might go to bed at the usual time and toss and turn for hours, my mind hyperactive, precious sleep evading me. When finally I turn off my brain, I sleep restlessly only to wake again within a few hours. I am compelled to rise and often sit before my computer in the early hours of the morning completing needless tasks in an effort to be occupied. I become impatient and frustrated as nothing seems to match my furious thoughts. It easily becomes draining and energy sapping. Within days, I feel exhausted.

I am finely tuned to this disturbance in my sleep. A speedy consultation with my psychiatrist and prudent manipulation of my medications ensures that these anomalies of sleep don’t last too long. I know the dose is right when the amount of time spent sleeping increases and the compunction to get up early recedes. Ultimately, I am able to take a nap in the afternoon and recharge the batteries following accumulated hours of sleep deprivation.

Depression can be just as damaging to my sleep cycle. Once more, it can be difficult to find sleep though not as much as during hypomania. I usually wake early but not as early as when I’m elated. Far from being quick to leave the bed, in depression, I must drag myself out to face the day. I have often remained in bed for hours when there was nothing pressing to do. But I never sleep again and the fitful sleep of depression is unsatisfying. I never feel refreshed.

Once more, a meeting with my psychiatrist is indicated and the result is usually a reduction in the sedating, anti-manic medications that I take. Within a short time, my sleep pattern improves until one day I wake at a reasonable time and the fog starts lifting.

But I can do a great deal to help by trying to regulate my sleep habits myself. I try to retire at the same time every evening. I avoid staying out too late and I try not to dwell in bed too long in the morning. Naps in the afternoon can be deleterious to a good nights sleep later. I keep them to a minimum and reserve them for the times I am truly exhausted, most often following a period of hypomania.

My sleep patterns oscillate frequently and are harbingers of imminent mood states. My prescribed medication fluctuates in accordance, and observation of my sleep prompts me when to look for help. Caring for my sleep reduces the severity and duration of mood swings. Ultimately, restoration of balanced sleep patterns rejuvenate physically and mentally and prepare me for the next battle. Sleep is a very powerful ally.

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Psychotherapy.

In common with medication, psychotherapy is essential to my wellbeing. Psychotherapy allows me to observe and study myself. It allows me to adapt. It brings cohesion to my life.

I’ve met with a number of psychotherapists over the years. I was introduced to the first a little over twenty years ago. He was a good man and he tried to help me but I was too young and arrogant. My mind was closed and I derived slight benefit from our time together. Later, I tried my hand with a man in Cork. I didn’t get on well with him and stormed out of his office, never to return. A lady kept me company for a few years when I moved to Dublin but she then retired and the search continued. A short trial with a hypnotherapist followed but it wasn’t for me.

Finding the right psychotherapist, not unlike medication, involves a degree of trial and error. For the relationship to work there must be compatible personalities. The work requires trust on both sides. And there is no quick fix. You will be together for a long while.

Three years ago I found the psychotherapist that I continue to meet to this day. I think I was finally mature enough and sufficiently open-minded to start getting well. We have achieved more in the last three years than all the previous years of therapy put together. He knows me better than anyone, except perhaps my wife. Together we have examined the hidden corners of my mind, the deepest recesses of my soul.

I have read a little recently about the concept of making friends with your demons, embracing them and thus coming to understand them. Ultimately to accept them. I don’t know how that works yet but I can assure you it’s not easy. Allowing yourself to sit with your deepest emotions is terrifying and draining. But when you have the right pilot leading and you have the courage to explore, it can be done safely and successfully. Moreover, there is great satisfaction and even relief awaiting you.

Sometimes I don’t have the energy to delve into my various woes. Then my therapist and i just chat and we usually make time for a laugh. We discuss simple things, my wife, my sons, my work. With him, I have learned a greater understanding of my relationships and my journey through life. Most prized of all, I have learned gratitude.

When entering this most recent phase of psychotherapy, I wanted to focus on managing my anger. Whether hereditary, learned behaviour or a manifestation of my mood disorder, my temper was causing me to hurt the ones who loved me the most. To say I was difficult to live with doesn’t really come close to describing it. But I quickly learned it wasn’t going to be that simple. To get to the core I had to peel back all the layers around it. Guilt, fear, grief and loneliness were in the way. But I wasn’t alone. My guide was beside me all the time. And it was worth it. I am certainly less tempestuous now and everyone in my life reaps the rewards. Especially me.

Recently, I proposed a new voyage with my therapist. I want to set sail in a different direction. The destination is far away and I don’t have a map but it is the most worthy of goals. I asked my friend to teach me how to love myself. I’m looking forward to getting there.

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Psychiatry and medication.

In my opinion, the two most important things you can do to stay well (when you have a mental illness) is attend a Psychiatrist and meet with a Psychotherapist. Medication can help you control Bipolar Disorder, Psychotherapy can help you live with it.

I first attended a Psychiatrist in 1994. I was psychotic and he started me on antipsychotics. It was exactly what I needed. I spent a short time in hospital but would remain on medication for about two years. I don’t remember exactly how long but I got my life back and recommenced my medical career. In retrospect, this episode probably signified the clinical onset of Bipolar Disorder but it would be a few years before I was diagnosed for certain.

I had a severe attack of depression in 1998. My first son was just born and I had begun training in Anaesthesia in Cork. I didn’t want to see a Psychiatrist. I was convinced that if it became known that I had a psychiatric illness, my medical career would be over. Instead, I was prescribed antidepressants by my G.P. and I improved. I took a maintenance dose for years after but I never felt quite right. Life was a constant struggle, my relationship with my wife was strained and I was drinking heavily at weekends.

My current Psychiatrist first saw me in 2003. I was coming off the rails and had become very destructive. My wife persuaded me to meet with him and I reluctantly agreed. It was one of the best decisions of my life. I was admitted to hospital for nearly two months and diagnosed with Bipolar Disorder.

I remember crying when I was told. I knew enough to know that Bipolar Disorder isn’t easy to treat but there was also a great sense of relief. Now we had a focus and could plan to improve things.

Antiepiletics and atypical antipsychotics formed the backbone of my medication. The effect wasn’t immediate but life got easier eventually. I continued to have frequent mood swings and, with reservations, I started Lithium. That’s when the worm turned. Lithium is the key to my well-being. By taking Lithium, I finally admitted that I was Bipolar. Acceptance took much longer.

Over the ensuing years, my Psychiatrist and I tried a number of medication combinations with varying degrees of success and failure. We finally landed on my current regime about three years ago and life is definitely much easier. It takes a long time to get the recipe right. I still have mood swings but they are not as severe nor last as long as previously.

My Psychiatrist has supported me through some of the darkest days of my illness. He listens to me, he believes me and he includes me in the choices we make. That element of self-control is important to me. It empowers me and helps me to believe that I am greater than my illness. It is not the whole.

Through the depressions and the hypomanias, through the hospitalisations my Psychiatrist has guided me. He has also seen me when I’m well and done his best to keep me there.

I would be lost without him.

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Why a doctor?

I started to learn about science when I was twelve years old. I enjoyed chemistry and physics but it was biology that really fired my imagination. It seemed to me that medicine was the logical way to learn more about it and have a career immersed in subjects that I liked and for which I had an aptitude. I decided then to become a doctor and I never changed my mind.

It was not an easy path. There was no history of medicine in my family and I was repeatedly told of how difficult it is to gain entry to medical school. I was advised to consider alternatives. But my mother in particular, and my then biology teacher, encouraged me to stick to my guns and I began to believe I could do it.

I can still remember the day, after my Leaving Certificate results had been decided, when the offers of college places were published in the news paper and I was given a position in UCC. I barely made the grade but it was enough. I had my foot in the door and that was all I needed. I ran all the way home from the shop where I bought the paper, full of excitement and delight. I think my parents were very proud.

The next six years had their ups and downs but I started work as an Intern in 1994. I had a psychotic breakdown within the first four months of starting work and I was to be out of action for a year. I repeated my Internship in 1996 and after a brief spell as a Medical Senior House Officer, I commenced specialist training in Anaesthesia in 1998. It was the same year my first son was born.

While I was training, I was diagnosed with Bipolar Disorder. In truth, I think it was with me all the way. Bipolar slowed and altered my career path but I was able to continue. I passed my postgraduate examinations and completed my training in 2006. I have been working as a Consultant Anaesthetist ever since.

Being a doctor is a huge part of my life. It is part of my identity. When I am well, I love my work. When I am unwell, it gives me focus and distraction. I have to put the needs of my patients before my own and frequently this takes my mind away from my own thoughts and problems. I am convinced that being Bipolar gives me an advantage. Having lived through fear and anxiety and surfaced at the other side, when an emergency arises, I can cope better with the stress and think clearly and act decisively to rectify the situation. Of course, there have been times when I wasn’t in a position to help others and needed help myself. The trick is to be able to recognise when that is the case and take some time out.

I’ve been fortunate. Some people suffer mental illness so severely that they have to abandon their careers entirely. Some people don’t enjoy the support that I do. For me, I try constantly to remind myself that the debilitating symptoms of being Bipolar have a finite half-life. The bad times pass and it’s possible to live a relatively normal life if you learn to cope with your illness and take care of yourself.

I love being a doctor. I love the contact with people, the challenge and the satisfaction it brings. But most of all, I love it because it’s my chance to give a little back.

 

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What is Bipolar Disorder?

Bipolar Disorder is very difficult to explain to anybody who doesn’t suffer from it. There are excellent descriptions on the websites of the Irish support organisation Aware and the British mental health charity Mind. I’m not a psychiatrist and everybody experiences mental illness differently. I can only tell you what it means to me.

I think Bipolar Disorder is typified by exaggerated mood swings. Everybody feels changes in their mood with the passage of time and changes in circumstance. But when you have Bipolar Disorder the severity of these moods can be extreme and the duration prolonged. Sometimes the change in mood can be so severe that it becomes difficult to function. Occasionally, normal function become impossible.

I have experienced and survived many varied moods. The main ones are depression, elation or hypomania, mixed state or dysphoria, mania and balanced or euthymic.

When I get depressed everything slows down. The simplest of tasks become Herculean labours. I eat little and sleep poorly often waking early and struggling through the long day that follows. Loneliness best describes what I feel. I am filled with fear and anxiety. Often I become quite paranoid and convinced  that something awful will happen. I withdraw from social contact and sit dark and desolate for hours at a time. Work is hard and it is difficult to remember a time when I didn’t feel so terrible and impossible to envisage that the nightmare will ever end. Suicidal thoughts come and go. But I’m fortunate. Depression, for me, only lasts for a month or two and then it lifts. I believe depression represents a state where my soul is low on energy. I just need to try and remember the ways I can recharge it.

I find the early stages of elation or hypomania can be exhilarating. I have immense energy, periods of increased productivity and little need for sleep. I tend to toy with computers when I’m high, sometimes having two or three booted up simultaneously. It’s also a time I might decide to buy a new car and hence I rarely own a car for longer than a year. But the pleasure doesn’t last and I soon become drained. This often leads to a mixed state.

Mixed state or dysphoria is the mood state that I dread the most. It is a mixture of the energy of hypomania and the darkness and misery of depression. I become irritable and severely uncomfortable often rocking in my chair to find release. It is the time when I become angry and I am most likely to hurt and offend the ones I love. I carry great guilt for things I have said and done while dysphoric. For me, depression is more debilitating but dysphoria is the hardest with which to live.

I’ve only been truly manic once and it was the worst experience of my life. I think things just got so bad that my mind took a holiday and I lost touch with reality. I had crippling paranoid delusions and ended up in a psychiatric hospital for the first time. I’ll tell you more another time.

So that’s my opinion of Bipolar disorder and how it affects me. It’s not going away, I have this for life. The key is learning how to understand it, how to cope with it. How to survive.

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Music

IMG_0545I was at a Classical Guitar recital last evening with my wife. The guitarist was talented, the venue was small and intimate and the atmosphere was warm. I sat with my arm draped over my wife’s shoulders, hand in hand, and became lost in the music. It was fabulous.

I love music. Some people love books or theatre, others movies. But I really love music. That’s not to say that I don’t read or go to movies. I do. I like to read fantasy by J.R.R. Tolkien or Terry Pratchett. My favourite actor is Al Pacino and I can think of many great movies and actors. I don’t go to the theatre too often but when i do, I invariably enjoy myself.

But nothing compares to music. I can’t imagine life without it. I am deaf on one side for a long time and it would be the cruellest blow to lose hearing on the opposite side. So I try to mind it. Music speaks to my heart and touches my soul.

My Bipolar influences both the music I listen to and how it affects me. My choice of artist sometimes reflects the mood I’m in but it may also have a healing effect, if that’s what I need. I don’t just listen to music, I study it, dissect it and look for meaning in the words, tempo and rhythm. My favourite instrument is the guitar but a good bass line can really get into your bones. Mostly I try to absorb it and feel it move me.

My taste is fairly mainstream and I’m not going to bore you with a list. But, I will mention a few artists that have had a profound effect on me over the years. I listened to Leonard Cohen when I was in college. When I was down, he cheered me up. I felt that he understood. I wasn’t alone. When I needed to relax or found it hard to sleep, I played Enya. When I was high, I liked Mark Knopfler, Eric Clapton and David Bowie. When I was balanced, euthymic, I loved it all.

I’m reading a book at the moment, “Touched with Fire” by Kay Redfield Jamison. She investigates the relationship between Bipolar Disorder and creativity in some of the greatest authors, artists and poets. There may be a link but I haven’t finished reading it yet so I will have to get back to you. I don’t think I am particularly creative but I do have a good imagination. I think when you survive the peaks and troughs of Bipolar Disorder you gain a different perspective. I think that maybe you feel things differently and maybe a little more deeply than many other people do.

I feel music deeply and it helps me to survive. It helps to recharge my soul when it’s running low on energy. It allows me to connect with my emotions and sometimes I cry but mostly I smile. Music always makes me feel alive. And just occasionally, it gives me an excuse to dance with my wife. That’s when music is at it’s very best.

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Early signs.

Looking back, it was clear that I had the signs of Bipolar Disorder long before I was diagnosed.

I started Medical School in University College Cork (UCC) in 1988 at the age of seventeen. It was new and exciting and full of promise. I settled in quickly and made new friends, some I still keep in contact with today. UCC is also where I would begin to drink heavily. That was going to become a problem in later years.

I had long periods of balance and calm in my student life but it would become punctuated with episodes where my mood was more volatile. On one hand, I could be the life and soul of the party. Energetic, hyperactive and full of fun. On the other, there were times when I would curl up in a ball in my flat and avoid all human contact for weeks on end. I would miss college and drink as often as I could afford. That wasn’t too often but then, I wasn’t able to hold my drink anyway. Frequently, I would be carried home on the shoulder of a friend. And then life would settle down again and everything would feel normal. I always pulled myself together and would study furiously before exams. I usually did well.

Medical school lasted six years. The tempestuous mood swings occurred more often and it became increasingly difficult to keep up. I was depressed for most of my final year but managed to pass my exit exams. However, my results didn’t reflect what I think I was capable of and I was disappointed for a long time afterwards. But I survived and now I had my medical degree. I was still a long way from being a doctor but I was headed in the right direction.

I don’t know what kept me going through those early years. I really wanted to be a doctor and maybe my ambition spurred me on. Maybe, I was more resilient than I remember or maybe the mood swings weren’t as severe as they would manifest later. I definitely drank too much and I believe I used it as a form of self-medication.

I’m eternally grateful to the friends I had in college. They tolerated me, they forgave the erratic moods and focussed on the better parts of my personality. They kept me company, supported me and sometimes literally carried me. I am forever in their debt.

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New Ideas.

Hi there.

As you’ve guessed by now, I live with Bipolar Disorder. I’m recovering from an episode of depression and I’m getting better every day. It takes time, you can’t rush it.

I’ve decided to start this blog primarily for myself. It might give me an opportunity to make some sense of my life. And just maybe somebody will read it and find it supportive. They might relate to some of my experiences and it might give them a different perspective. Maybe it will help. That’s enough for me.

I was diagnosed with Bipolar thirteen years ago but I was first hospitalised when I was twenty four. I’ve had quite a few admissions since then and it hasn’t been easy. But I’m still here.

Not only that but I have a wonderful wife, whom I love deeply, and three beautiful sons. I have been able to maintain a professional career as an Anaesthetist despite needing to take time off occasionally. And over the years I have better learned to cope with my illness.

I guess what I’m saying is that I have been lucky. I have managed to survive a debilitating illness and prosper. I needed a lot of help and guidance along the way. Sometimes I was simply carried. But it can be done.

Up to now, I have been very private about my Bipolar Disorder. Very few knew about it except for my family, a few close friends and a few colleagues at work. The silence that surrounds mental illness is lifting and I see it as a change for the better. I’m not going to be so silent anymore.

Over the next while I will share my experience and thoughts with anyone who cares to listen. Bear with me, I’m new to this.