A Bipolar Doctor

I’m glad to say that my mood has improved. If anything I’ve been a bit high. I’m finding it hard to get to sleep at night and I’m up early in the morning. But it is manageable. I’m taking a little extra medication and I’m functioning well. I fell a bit restless but I’m not irritable. I’m minding myself.

I’ve bought a new car. A Tesla. It will be delivered next week. Spending money is a sign of my hypomania and explains why I change my car so frequently. It’s not a big deal but I am excited about it and looking forward to collecting it.

We are skiing in France at the moment. It’s lovely. The scenery is beautiful and skiing conditions are good. I haven’t actually done any skiing yet. I’m not much good and I’ve chosen to lounge about the chalet and amble about town. It’s very relaxing and I’m really recharging the batteries. It’s a welcome break from work.

I have a few things on my mind.

One of my son’s was diagnosed with depression last year. It has been slow progress and he is still struggling. It’s hard to watch. He is taking medication and seeing a psychiatrist. He sees a psychotherapist and our family is doing everything we can to support him. But it is hard going and sometimes upsetting. I know he will get better. I trust in that but it is going to take time.

I feel guilty that I am partly to blame. I wonder is it because of my genes that my son suffers? Is this the beginning of bipolar disorder? The only consolation is knowing that we are doing everything we can for him. We are giving him every chance for a speedy recovery. At least I understand what he is going through. There have been many tears and very few smiles. I wait for the day when that is reversed.

In recent weeks we have begun a fostering process of a teenage boy. He is a friend of my youngest son and he had been spending a lot of time in our house. It transpired that his home circumstances were desperate and he was being neglected. After discussing it with the family, we offered to foster him and now he is living with us.

The assessment of our suitability to foster is ongoing. It involves numerous meetings with social workers and detailed and probing discussions. But in the end it will be worth it. It’s a good thing to do and we can offer this young man a much better life. Hopefully it works out.

There are a few challenges facing us at the moment but my family are addressing them and we are strong. We will survive this. Since my mood has been elated recently, I can expect an episode of depression in the near future. We will survive that too. And in the future we will look back at this time and realise it was just another hurdle in life we had to overcome. We will not only survive, we will thrive as well.

Depression is an isolating illness. It is lonely and miserable. Amnesia sets in. I become so engrossed in the struggle to keep my head above water that I ignore all the good things in my life. They haven’t gone away, I just can’t see them anymore. Life goes out of focus and everything looks negative.

I read an interesting article recently on how to manage negative thoughts. The author asserted that, in origin, thoughts are neither positive nor negative and it is only the value we add to them after they occur that colours our perception. A whole system of psychotherapy, Cognitive Behavioural Therapy or CBT has been developed with this in mind. CBT is deemed to be very useful in the management of depression. In essence, if I can persuade myself to be more positive about my thoughts I can expect to feel better and this in turn will reflect in my behaviour. Unfortunately it is easier said than done.

I’ve dappled in CBT over the years but it has never been the primary aim of my therapy. I differentiate depression into mild, moderate and severe. During mild depression I can function well. With moderate depression it is difficult to maintain normal daily activities and when severely depressed I have no option but to withdraw from the world. Work and social engagements become impossible.

When I am mildly depressed, I can expect to have some clarity of thought. I can expect to be able to logically recognise when my thinking is unhelpful and guide it in a more positive direction. Alternatively, I can distract myself and disrupt the “stinking thinking”. This is not true of moderate or severe depression. My thoughts become progressively darker and even paranoid in a cycle that is near impossible to interrupt. I imagine all sorts of catastrophes befalling my family and to a lesser extent myself. I ruminate and amplify the disaster stories until I believe that they are definitely bound to occur. It is very distressing and I’m not sure that CBT has anything to offer when I’m feeling so low.

But the good news is that the depression I wrote about in my last post has lifted. I’ve been feeling good for the last fortnight. I’ve been feeling grateful. Forgotten is the pain and misery. A new amnesia unfolds. Behind me are the dark days and a new appreciation of all I have develops. Life is easy again. The sun feels warm and I revel in the wind on my arms as I cycle. I can smell the scent of my wife’s hair again. I’ve started to remember how to laugh.

I haven’t found the solution to my mood swings. I try to manage them simply. I take my medication, I try to exercise and I try to meditate daily. Meditation has had a dramatic effect on me. For thirty minutes a day I find peace. My body relaxes and the black ball in the pit of my stomach gets lighter and easier to carry. I like to think that, thanks to meditation, I am more in tune with my body during the day and more aware of its needs. If nothing else, it’s certainly doing no harm.

I muddle through my periods of depression. Sometimes the best therapy to hand is to tell my wife that I’m feeling like shit. That simple admission brings forgiveness and permission. Forgiveness for not wanting to talk. Acceptance that I will be cranky and ill-tempered. Permission to wallow on the couch for hours on end listening to music. She sometimes enquires if there is anything she can do and I simply ask her to reassure me that it will be alright. Then she smiles and hugs me. Sometimes I cry. But that’s okay, I have permission for that as well.

From a certain perspective, depression is a blessing. It brings me down only to allow me rise above it again. In rising I get the opportunity to see the wonderful gifts bestowed on me by life. Only due to the lows do I appreciate the highs. But it is short lived. I soon take things for granted and forget the excitement of feeling well again. It’s just as well. If I continued to marvel at all around me I would be hypomanic in no time.

Just when everything seems banal, depression will return to level the playing field. It’s a predictable visitor. If only I could remember that is will undoubtedly come to an end and reveal that wonderful enthusiastic feeling when it passes. Depression is the cost of experiencing true gratitude and contentment. It’s a heavy price but I think it’s one I’m willing to pay.

I was still minding myself. My medication prescription was the same for months, a sign of stability. I was meditating almost daily and visiting the Buddhist Centre regularly. I have a number of new friends that I met there and we meet up for coffee and a chat frequently. This social outlet has proven very important to me.

I’ve stopped seeing my therapist. We mutually agreed that I was no longer getting any benefit from our sessions. All the work had been done for now. I can return to him at any stage but breaking contact with him was an indicator of how well I was doing.

I’ve been working more lately. The extra income is welcome but I have to be careful not to overdo it. At times I have been very tired and I have to wonder what effect that is having on my mood. I try to get out on my bike for a bit of exercise but in truth, I haven’t been out as much as I should.

In the last month, things have been tough. At the start of May I started to feel down. It was unexpected. The days were getting brighter and longer and typically I would feel hypomanic at this time of the year. It wasn’t bad. Life was just a little bit of a struggle. The exception was when I was alone on a day off work. My mood sinks quite low when I’m inactive. The solution was simple. to get up and do something improved how I was feeling.

I think a certain amount of this is psychological. I’ve written about loneliness before and it is a real problem for me. But there is a certain amount of biological depression there too. My sleep is disturbed, I’m waking up early and tired. My appetite is reduced and I have little interest in daily activities.

It has become worse in the last week or so. My head is heavy and I’m isolating myself. I hardly talk to my wife and I’m irritable all the time. Irritability can be associated with depression but it can also be a sign of a mixed state. I don’t think I’m mixed at the moment but I’m monitoring myself for racing thoughts and signs of elation.

I get a sense of tension and aching in my stomach when I’m depressed. I call it “The Black Ball”. It holds a life time of anger and fear, guilt and shame. Sometimes I’m very aware of it. Sometimes it unbearable.

Yesterday was on of those times. I felt really low so I drank a glass of wine and then a second. I must admit that I felt better but there is no lasting relief. I know that alcohol will only make things worse and yet I drank. Luckily I stopped before I caused any lasting damage. The last time I drank was two years ago just before I attempted suicide. My wife was very worried when she found me drinking and understandably so. It was very selfish of me.

Two Irish Anaesthetist’s have committed suicide recently and people are rightly shocked and upset. It isn’t hard to change thoughts of committing suicide into action. All you need is the belief that life would be better without you and a bottle of wine. It’s all too easy.

Today is another day. The black ball is there but it’s bearable. The sun is out and my wife is just home from work. Maybe I will go for a cycle later. I won’t drink today. I don’t know about tomorrow but I’ll cross that bridge when I come to it. Alcohol will only make things worse. It’s not worth the risk.

With a little patience, I can get through this episode. Life will improve. It always does. Sometimes I have to fight back but it’s a battle I’ve won before.

This too will pass…….

I enjoyed Christmas. It was spent with family and relatives and it went well. There were no dramas. It’s an unusual time of the year for me as I know it is for a lot of people. I have very happy memories of Christmas with my wife and sons but some less pleasant ones from childhood. It’s easy to get distracted by the past but probably best not to study it too closely. At least not without the guiding hand of a therapist. But despite the occasional sorrowful thought, the holiday was a happy occasion.

Since the New Year I’ve had a new lease of life. I feel alive and have a spring in my step. Work has been seamless and my home life has been easy. There is no hassle. I’m taking care of myself. I continue to meditate and I exercise regularly. I am sleeping well and I’m careful to maintain a steady pattern. I continue to meet with my therapist and I’ll be checking in with my psychiatrist next month. All these things contribute to my stability and require a little effort. But it’s worth it. I’m enjoying myself.

I’ve been getting out on the bike a bit more lately. It’s a great past time. This week, I signed up to do a cycle from Dublin to Galway and back over a weekend in April. My wife is already committed to it and we hope to do it together. So I’m in training. I don’t know if I will be ready in time but I’m going to try. It gives me something to focus on. A goal to achieve. I’ll let you know how it goes in future posts.

I had a flute lesson today. It went well. I think I’m progressing. I can play a few tunes now. It gives me something to do. It’s a bit of fun and everybody needs a little of that.

I keep a journal on my phone and recently I’ve been reviewing past entries. It’s two years since I was last so ill that I was admitted to hospital. My entries from that time make for sobering reading. It’s hard to remember that I was that upset, that miserable and that afraid. There was so much fear.

It upset me a little reading them. I could recall some of how I felt when I wrote them. I also started to feel guilty. I felt guilty for things I had said and done while sick that had upset my family. But mostly I felt grateful. Grateful that those days were behind me.

I have had bipolar disorder most of my adult life. It has brought me to dizzying highs and dragged me down to devastating lows. But with the help of my family and friends I have survived and at times found neutral ground where life is just normal. That’s where I am today and that’s where I want to stay.

So things are good. I’ve had a long stretch of feeling well. Paradoxically, it can be a dangerous time. Doubt sets in. Do I have bipolar disorder anymore? Do I need to take my medication at all?

These may seem like ridiculous questions but the mind can play funny tricks on you when you’re feeling good. These doubts also arise in the early stages of hypomania when I feel energetic and full of adrenaline. It’s an addictive state. I don’t want it to end. But there is always a crash after a few weeks and the elation never lasts. The aftermath is never worth it. 

I have never stopped taking my medication. I accept that bipolar disorder is for life. Sometimes that is a bitter pill to swallow. But nonetheless, it is better to make peace with the fact that bipolar disorder is forever rather than fool myself that it will somehow resolve. 

I have seen the results of non-compliance over the years. On every admission to hospital I have met at least one patient who has become unstable and deteriorated because they stopped taking their tablets. They have the unenviable task of starting again from the beginning in an effort to regain stability. It seems like such a waste of time and unnecessary pain. 

I understand why some people do it. I can understand the appeal. Feeling good can be seductive. It’s easy to hope it will never end. But experience has taught me that another mood swing is just around the corner. But I know that medication will reduce the frequency and severity of these events. 

When I have prolonged periods of balanced mood, my psychiatrist will slightly reduce some of my medication but never do I stop completely. Usually, they will just be increased again next time I become unstable. My treatment is tailored to my needs but it is never ceased. 

Taking tablets is part of my daily life. Occasionally I resent it but mostly I recognise the improvements they have brought me. It’s not easy to be compliant all the time. Some of the drugs I take have side effects. Some side effects are obvious while others remain unseen. 

For example, I take Lithium. It gives me a tremor in my hands. It’s not very obvious but I’m conscious of it and it bothers me. Because I have Diabetes Insipidus, I need to pee hourly. It can be a pain on long journeys. And every three to six months I have blood tests to check on damage to my kidneys especially but also my thyroid gland. And that’s just one of the medication I take. 

But for all it’s disadvantages, Lithium has changed my life. I don’t think I would be here writing this blog without it. In short, the benefits far outweigh the side effects. 

So if you’re reading this and you suffer with mental illness, think twice before you stop your medication. Talk to your doctor about it and be sure that it is the right move for you. 

One of the things I have to do to keep well is to take a few pills. It’s easy and I’m going to keep doing it.