Living Crazy

I live in an area of California where the philosophy of "thought creates" is quite popular. This notion has been one feature of "New Age" thinking that works well for those with normal brains. Unfortunately for the manic-depressive this notion creates but another layer of guilt to apply to previous varnishes. "You become what you imagine." Hmmm... why would anyone want to imagine themselves thrown in jail, as I have been more than once when manic? Why would anyone want to be curled up in a fetal position, unable to speak? The idea that "thought creates" blames the victim and falsely exalts those free of a mood disorder, which by strict criteria might include 90% of the population.

The mistake of ascribing volition to mood is fairly pervasive. In a world of well-balanced folks with normal brain chemistry this might fly; in the real world it is a crock.

Presently I am suffering from a depression of nearly two years' duration, a new personal record. Being depressed is the last thing I want, truly. I didn't create it, wish it, will it, plan it, hope for it, unconsciously crave it, no-it happened to me. It is not my fault that bipolar genes run deep on both sides of my family-both my maternal and paternal grandmothers were hospitalized for it and my father died of it. Not the best of odds.

One of my doctors once told me that bipolar illness continues on, even in the well-medicated subject who is not experiencing current symptoms. It's the background pattern, always present, of a long-term mood disorder. And ultimately the demon will out, no matter how well treated.

Another type of person I've encountered is one who has been "cured" of manic-depression. I met some like this in Alcoholics Anonymous (a group I attended for support when depressed). "If you want to be really clean and sober you will get off that lithium," so I was advised, which advice is even contrary to their "Big Book." What is in fact true is that the person who so advised me was either misdiagnosed or has another episode to look forward to, no matter what kind of spiritual path they pursue.

If you look at the research, both current and historical, there have always been manic-depressives, and they make up 1% of the population across the board, across borders and ethnic distinctions. The word "lunatic" is in fact derived from the behavior of bipolars, back when their extreme mood changes were attributed to cycles of the moon.

The point of my first post? This is a real illness. If twins are separated at birth and raised in different environments and one twin develops the disease, there is a 75% chance that the other twin will, too.

Once one has a valid diagnosis it is fools' gold to pursue alternative treatments recommended by those who don't understand the disease. What undermines this certainty among the affected is first, a desire not to believe one has the disease, and second, the tendency of the disease to allow long periods of normal mood, or "euthymia," between episodes. If one is lucky enough to enter alternative treatment (or no treatment at all) during a period when the illness is quiescent, well, that's dumb luck but it proves nothing. It's also bad luck because it is false, as the wolf will soon be at the door again, either fattened by mania or starved by depression.

The disease is real. The disease is treatable. And for a bipolar I, the standard by which all other mood disorders are measured, the disease becomes the central fact of one's life--more important than marriage, religion, career, you name it. Because none of the things just named are possible for the bipolar if sick. If I am clinically depressed, for example, church can be quite toxic, as all I hear is judgment, not forgiveness.

There is an old debate over whether thought precedes "affect" (the expression of feeling) or whether affect precedes thought. For manic-depressive illness, at least, affect precedes thought. In other words, I am not sad because something sad happens; my mind seeks out sad things and thoughts because I am intrinsically sad for no good reason. (And when it comes to a bipolar depression, "sad" doesn't cover it--it's much worse than that; it's like having your eyeballs painted black and your heart torn out and deflated like a cheap balloon and stomped upon by a band of gypsies.)

It's not that we bipolars can't experience normal emotions. Things can make us sad or happy, just as in other people. It's just that too often our illness dictates how we feel without regard to circumstance.

In my days as a doctor one simple question I developed for diagnosing depression was to ask the patient if he would feel any different if he won the lottery. A clinically depressed person can't imagine feeling better, so the thought of the prize is of no help. A circumstantially depressed person, or someone with a minor case of the blues, is cheered by the idea.

For the bipolar, no amount of good news will make one feel better in a depressed state, just as no amount of bad news will make one feel bad in a manic state (what patients call "feeling bulletproof").

The point of my first missive, here, again? Bipolar disease is real. Untreated, a bipolar I (like myself, the classic and worst case) has a 30% lifetime chance of dying from the disease untreated, whether by accidents due to poor manic judgment or suicide due to depression. (I knew one patient whose father died racing trains in his car.)

p.s. Emily Martin graciously invited me to contribute here. I also have my own blog at http://www.cechaffin.blogspot.com where I struggle with the disease and sometimes speak of other matters, especially literature.