I said I was feeling fragile yesterday. I had a brief crying spell before I got online today. It's true Kathleen and I had a rare argument last night, but I was already slipping yesterday. So when I rose this morning, I thought about whether that incident had slightly derailed me then looked down at my sample packs of Lamictal to notice I hadn't taken them for several days. Why?
Because they are 25 mg. samples in blister pouches on thick cardboard, and I have to push really hard to get out eight, and several often fall on the floor, and it's a hassle. More importantly I have a medication dispensing box, and I remember when I filled it up earlier this week that I didn't have the oomph to push out 56 little tablets until my fingertips hurt. I told myself I’d faithfully take them out each day.
In my last dip I realized I hadn't taken Prozac for two days; this bump in the road to recovery is attributable to my screwing up my Lamictal dosage.
These are both great illustrations of the disconnect between mood and experience in bipolar disease. A bipolar II friend of mine (truth be told, my second ex-wife) couldn't help singing and dancing on the city planters in Long Beach after I told her my mother had just been diagnosed with a fatal brain tumor. She couldn't help herself, she said, and being bipolar I understood. It wasn't personal.
When patients came to me complaining of intestinal symptoms, they almost always blamed the symptoms on the last thing they ate the night before, which is almost never true. In the same way, the mood-disordered wants to blame his latest shift in mood on a minor argument, a near accident, an unexpected bill, anything to get the brain itself off the hook.
Your brain in this disease is not your ally, it’s your enemy. The brain can’t handle the concept that it is diseased. The diseased brain will lie to you baldly, trying to shift the blame to anything but itself. In depression it keeps searching for a cause outside itself for the problem; in mania it persuades itself that its perception and thought processes are natural, just a little above the Bell curve. If the organ of perception is diseased you cannot trust its perceptions.
The last thing a manic-depressive should do is to trust his own brain when symptomatic; the brain will go to great lengths to convince you it’s not diseased. In depression it becomes a guilt-inducing, lying sack of shit.
Here is the most difficult part of a serious mood disorder: You must realize that your illness is primarily physiochemical. The flu will put me into a depression; antihistamines and NSAIDs have done it as well, along with blood pressure medication. If there is a psychodynamic trigger for those predisposed to depression, I agree with Andrew Solomon: humiliation is uppermost. But never mind that detail. The point is, if you have a major mood disorder ALWAYS SUSPECT A PHYSIOCHEMICAL BASIS FOR ANY CHANGE IN STATUS.
A few days ago, I sunk because I had forgotten my Prozac. Yesterday I began to sink because of missing my Lamictal. Keep it simple, stupid.
As Dr. Ghosheh used to tell me, "The disease is always going on. That's why we need to change the medications to adjust to it." He was right. I'm always deranged; somewhere underneath my poker-faced exterior is a sine wave looping up and down for the course of my life. I have been ecstatic in the worst of circumstances and suicidal in the best. Right now my circumstances are as good as they've ever been in my life.
One complicating factor is that due to the circumstances of the last two years, I also have symptoms of PTSD (Post-Traumatic Stress Disorder). Whenever you have to deal with pressing, unpredictable and dangerous circumstances for a protracted period of time, you may develop PTSD—when you’re inappropriately and always prepared for danger; you may look calm in a hammock but what they don’t know is that you're also ready if Charlie should jump out of the jungle with a draw bayonet. The adrenaline burnout of PTSD can also bring on a full-blown depression in those at risk.
Still, to be parsimonious in the analysis of my own case, the stresses of the last two years have more activated the anxiety portion of depression, which resembles PTSD, than to deserve a new diagnosis.
I've found two things and two things only that are helpful in treating severe depression (manic depressions are the most resistant to treatment):
1) Be sick. Accept your depression. Endure it because you have no choice but don't overthink it; after all, you've been there before. Your only job is to be sick and...
2) Take your medications! Take them regularly and stay in close touch with your doctor for recommended adjustments.
3) There is no three, stupid. Your job is to be sick and take your effin’ meds!
Now for today's poem, which I recently discovered in sifting through my files. It is not from Sine Wave, but if I had remembered it it might have been in the depressive portion of the ms.
I wish I were ice water
poured on your sleeping genitals
or blood dripping
from your sliced thumb
so you might notice me.
My being is in doubt
so I drape you with words
like papier mache'
that when you withdraw
I have a hollow to inhabit—
everyone is Jesus to me,
everyone who leaves
a space to occupy.
Notice how many hollows
letters contain, and the spaces
between words—a city
with a million rooms.
I could be happy there.
At 1.5 kilorats,