For the month of May, Defying Shadows will be joining the Mental Health Awareness Month by sharing a post daily on a different type of Mental Illness or “Shadow” that people commonly struggle with. Join us in creating awareness and working to end the stigma that goes with these topics! Today we have Julie Whitehead sharing her perspectives on Bipolar Disorder. ~ Defying Shadows Team
Bipolar symptoms are hard to describe. The medical establishment has lists of symptoms they use to diagnose this disorder; they are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Mania is characterized by a period of mood disturbance where the person experiences an abnormally and persistently elevated, expansive, or irritable mood for at least a week. Three or more symptoms from the following list should be present before the mood disturbance can be called manic: elevated self-esteem (grandiosity), less need for sleep, more talkative than usual (pressured speech), the feeling that thoughts are racing (flight of ideas), abnormally low attention span (distractibility), increase in goal-oriented activity (psychomotor agitation), and risk-taking behavior (such as buying sprees, sexual experimentation, or poor business decisions.).
Depression is characterized by loss of interest or pleasure in life activities for at least two weeks. Five or more symptoms from the following list should be present and cause severe disruptions of a person’s life before the mood disturbance can be called depressed: low mood (depressed mood), low interest or pleasure in all or most activities (anhedonia), significant unintentional weight loss or gain, sleeping too much (hypersomnia) or too little (insomnia), slowing of activity (psychomotor retardation), loss of energy (fatigue), feelings of worthlessness or excessive guilt, unable to think, concentrate, or be decisive, and recurrent thoughts of death (suicidality).
The bipolar person can switch from one pole to another very quickly or very slowly and can have periods of normal functioning in between them. Mania can be fun. Depression is never fun. In my personal experience, mania is scary. I have had periods of high functioning that you could call hypomanic, which is when the symptoms are less severe than in full-blown mania. I think most of my time between the birth of my middle child and my youngest child was spent in hypomania, in that I had the goal-oriented behavior and the drive to accomplish my goals without the excesses of true mania. But my truly manic episodes feature a high level of irritation, a low need for sleep, pressured speech, and grandiosity, where I have big dreams and plans that had no basis in reality.
Many of my episodes have been what are called mixed episodes, where I had both manic and depressed symptoms going on. I would have the irritation, grandiosity, and pressured speech of mania with the sleepiness, suicidality, weight gain, anhedonia, and feelings of worthlessness of depression. Often my episodes featured psychosis, which is a loss of touch with reality in some area of your life. Most of my psychotic episodes were rooted in fear delusions (false beliefs)—fear that my husband was going to leave me, fear of some unspecified danger, or fear that something was going to happen to my children because God was angry with me for not taking care of them like I thought I should.
Thankfully, I have never had hallucinations, where I was seeing, hearing, or feeling sensations that were not real. I don’t hear voices, I don’t see dead people, and I don’t feel insects crawling on my skin.
Another one of my symptoms falls outside the definitions and involves self-harm that does not rise to the level of suicidality. When I am extremely stressed, I have the urge to scratch my nails into the skin of my arms. A more extreme form of this impulse is known as “cutting”, where people cut on their arms with scissors or razor blades.
Other symptoms I’m more or less able to control on a daily basis. I sometimes get the urge to spend money. However, since I grew up in a stone-broke household, I know the value of a dollar and know that saving is a much better proposition than spending. So I resist it, unless it is for Christmas and birthdays. And even then I am so cheap that I don’t buy anything that isn’t discounted or that I don’t have a coupon for. My current weakness is purses—designer ones when I can find a good sale. I only have three so far, so I have kept that impulse in check very well.
I can obsess over small details. I am by nature a neat freak. I like to organize closets, cabinets, bookshelves, files, and collections. However, I was so tortured over neatness by my mom when I was a young child that I swore I would never inflict my obsessions on my kids. So I haven’t. My house is generally neat but has pockets of chaos in it, and I refuse to stress over it. I let the kids manage their own rooms and refuse to freak out over their messes.
I have a cleaning service come once a week to do the cleaning so I am free to spend my time doing the organizing that I enjoy and am capable of. I have taught my girls how to clean but know they have to make the decision to use that training when they get out into the world. My middle daughter loves neatness, while the other two like more clutter in their lives. But that is who they are, and I will not make my condition worse worrying over it.
When I get anxious, I often pace around the house. It’s aimless, directionless, and uncomfortable. I try to do it after I’ve spent a long time sitting at the computer so that I am getting at least some motion into my otherwise sedentary life. But sometimes I do it simply to fill the time. When I feel the anxiety spinning out of control, I do have a medication I can take on an as-needed basis to calm me down.
I very rarely have crying spells. One thing that makes discussing depression so confusing is that people use the word depression as a synonym for sadness. When I’m sad, I cry. When I’m depressed, I can’t muster up enough energy to cry. I have very little to be actually sad about. That is why I was diagnosed with clinical depression; depression that has a reason is called situational depression—it is in response to life circumstances. Situational depression can turn into clinical depression if it lasts long enough with the variety of symptoms listed earlier.
One belief I ran into very early on when I was suffering a depression after Hurricane Katrina was expressed by a young woman in a preschool mothers’ group I attended shortly after the hurricane. A woman had come and talked to our group about her experience with depression. We were having small group discussions afterwards, and I had poured out my story about my experiences with depression, particularly postpartum, in the past and after Katrina.
I finished my tale, and the young woman next to me looked at the group leader and said these words: “I just don’t see how you can have Jesus in your heart and be depressed.”
Her words hit me like a wrecking ball. I simply shut up and did not contribute any more to the discussion. Again, depression is not always an issue of the emotions or circumstances. It can be an issue of an imbalance of chemicals in your brain.
Another common belief is that mental illness has its roots in the demonic. People who hear voices are hearing evil spirits that have somehow inserted themselves in their lives. I’ve heard about a “spirit of suicide” and a “spirit of bipolar”. The Bible does speak to people being possessed by unclean spirits being mentally ill; witness the story of the Gadarene demoniac, whom Jesus healed by casing his unclean spirits into a herd of pigs.
However, the only problem with that belief is that voices, suicidal impulses, and bipolar symptoms do respond to medication. The right medicine can make the voices go away. I’ve read this experience in testimony after testimony about the efficacy of drugs in helping paranoid schizophrenics silence their voices with anti-psychotics. Evil spirits don’t respond to drugs. The brain does. That being said, I don’t deny that miraculous healing can happen. I’ve seen it over and over throughout my church experience. And since bipolar disorder is a disorder of the brain, I don’t doubt you can be healed of it miraculously.
However, that is not to say that you should not pursue every medical avenue possible to aid in your healing. That leads to another prevalent belief—that taking psychotropic drugs is a crutch, sign of unbelief, or lack of reliance on God to bring you through a depression. I wondered if people who believe this one would tell a Type I diabetic to stop taking insulin. Insulin is produced by the pancreas and is necessary for life. The Type I diabetic does not produce any insulin and so has to take it in shots or pumps or risk death. If bipolar disorder is a shortage of chemicals in the brain, and medication can stimulate their production, who in their right mind wouldn’t take the medication? But suspicion of psychotropic medications is deeply ingrained in some belief systems.
Another belief found in some circles is a suspicion of psychiatry and psychotherapy themselves. They often cite the stereotype of the doctor steeped in Freudian theories who obsessively questions your thoughts about sex and about your father.
Nothing could be further from the therapy offered by today’s modern practitioners. Modern talk therapy concentrates on giving a person coping skills to handle their symptoms in all facets of their lives. Various therapies exist, but cognitive behavioral therapy and interpersonal therapy are the most common therapies that social workers and therapists are trained in.
Cognitive behavioral therapy focuses on how a person’s thoughts and feelings affect their behaviors. Establishing the feelings and thoughts behind disruptive behaviors is seen as critical to understanding why a person behaves a certain way and aids that person in finding new behaviors that do not depend on faulty thinking and believing.
Interpersonal therapy concentrates on the relationships a person has with others with an eye to improving those relationships through specific strategies and self-awareness. It is particularly helpful with bipolar disorder in that it helps the sufferer understand self-isolation and difficulties getting along with others by educating them on how to better interact with the people in that person’s life. People with bipolar disorder tend to have disordered relationships because their manic and depressed behaviors can wreak havoc on relationships that are formed on a basis of trust because the bipolar person’s emotions are often distorted by the disorder.
How do you support someone suffering from bipolar disorder? That’s a difficult question. Often simply being able to offer an objective counter to the bipolar person’s emotions can be an effective way of helping the person see the truth of their situation. Someone who acknowledges their difficulties can be easier to help than someone who denies their symptoms or the effects of their actions. The impulse is often to try to protect the bipolar person from the consequences of their actions, saying the person doesn’t know any better. That attitude can lead the way to manipulation and exploitation of the situation by the bipolar person, ultimately hindering recovery. I know my best support comes from knowing that those who love me love me regardless of my condition. That knowledge keeps me from hurting them unnecessarily by keeping me vigilant about my symptoms and keeping my moods in check.
Practical support can include help with areas the bipolar person is weak in. My husband keeps up with our checking account and credit cards, and knowing that any overspending I do will be noticed helps me keep the impulse under control. Other situations may call for other support measures, depending on the bipolar person’s needs.