When Life is Good

There is hope.  Not just the hopy/changy kind of thing politicians promise but are unable to deliver,  but genuine hope in the face of a potentially disabling disease.

I have not always experienced this hope.  Early on in my treatment for bipolar disorder I was sceptical about the prospects of leading a 'normal' life, whatever that is.  I feared that any 'normalcy' would only be the inbetween phase during the transition from manic highs to depressed lows, or vica versa.  Even that was an improvement.  Sometimes as I cycled from highs to lows, the transition was abrupt and almost violent, like falling off a cliff.  Along with major shifts that might take months to cycle I experienced a daily cycle.  I'd feel tolerably well early in the day, only to descend into a deep depression around mid afternoon.  I described it as being like the San Francisco fog that rolled in each day at a predictable time.

Lately, that cycling has been gone.  I'm not sure why, nor do I care why.  It just is.

It's hard to describe the experience.  Just normal, stable, consistent.  I don't cycle.  I thank God for the medications that are a major help in that regard.  I have energy to be productive.  I'm currently working on a side project in my shop, in addition to my normal work.  This is a good sign. 

Two major issues remain, and they are somewhat interrelated.  Insomnia and nicotine. 

It has been two months now since I've had a cigarette.  This would be a great achievement except for the fact that I've only succeeded at that by using nicotine replacement therapy, either with the patch or more recently, with vaping.  My current goal is to put enough time in free from cigarettes, that when I address the issue of cutting down and quitting nicotine entirely, I will not be tempted to buy that pack.  This has been difficult, to say the least.

The most difficult thing about quitting nicotine is that it destabilizes my moods.  Withdrawal brings with it irritability, anger, depression.  I genuinely don't like myself at those times.  And the trap is that I am quick to seek relief.  And because using doesn't carry with it the catastrophic consequences that, for example, having a drink might, it is easy to indulge and to alleviate the moods.  Because I'm bipolar, there is probably no greater fear than that associated with uncontrollable mood shifts.  This intensifies the issues concerning withdrawal and quitting.

My hopes remain.  My game plan at this point is that I will probably use lozenges to ease the transition from the vaping.  Either that or just attempt to gradually reduce the amount of time spent vaping.  Vaping has some advantages over smoking.  In that it is just water vapor that carries the nicotine, much of the negative issues around smoking are eliminated.  Yet it also has the same habitual behavioral issues.  I go out and take a break.

One of the differences is that when smoking one tends to commit to at least one whole cigarette.  At least I did.  With vaping you can take a few puffs and be done with it.  Or you can vape for an extended period of time.  That's the down side.

My main motivation for breaking free is the impact on the rest of my health.  When I first went on the patch my sleep patterns improved drastically.  Now with vaping, I'm back to my old patterns. 

Insomnia.  I first struggled with this during my teenage years.  I always had a hard time falling to sleep, though early on, once asleep I could sleep.  As I aged, and as the bipolar disorder became more pronounced, remaining asleep became a problem. 

Added to this is that these middle of the night times have become a part of my spiritual experience.  I crave the time for reflection and meditation.  The peaceful silence is golden. 

Also, in that sleep is a struggle I often feel relieved to wake up.  One of the things I experience is frustrating and repetitive dreams.  Not nightmares, just repetitive and irritating.  Getting up for a while interrupts this.

These two issues aside, life is good.  Much improved over what it has been and for that I'm grateful.

One of the best things is the confidence with which I can live these days.

One of the fears I had when I was first diagnosed is that I might experience highly undesirable symptoms which might have devastating consequences.  Mania can manifest itself in inappropriate sexual drives and behaviors.  My concern regarding this was related to, among other things, my profession.  In fact, during the time of my being on disability I questioned whether the Church could ever allow one such as me to function as a pastor again.  It is prudent for the Church to allow a bipolar person to be a pastor when one of the defining symptoms of mania is sexual indiscretions?  I thought not.

As I've stabilized on medications, this fear has subsided.  Just take your meds, dude!

That's something one has to remember.  I'm feeling the way I'm feeling in large part due to the medications I am on.  It's easy to convince oneself that 'I'm better now, and don't need the medications anymore.'  Nope.  Don't believe it.  Not for a minute.

Actually, the last time I determined that I didn't need meds, I replaced them with Scotch.  That did not have a good result.

The only downside to the meds is that my insurance company is not pleased that I'm on a lifetime regiment.  And my meds exceed my monthly premium, substantially.  They lose money on me.

On this matter I'm humored.  Portico Benefits is our church's insurance.  They use Express Scripts to manage the prescription drug plan.  Express Scripts has a pharmacy.  What I'm humored by is that when I was using a local pharmacy, Express Scripts, on behalf of Portico, was continually asking that my doctors justify the medications they were prescribing.  This was irritating as these are 'lifetime' meds.  I'll never get off them.  But when I started buying the meds from Express Scripts, they no longer question them.  I wonder if Portico knows that.

Well, its time to lay down again.  Sleep is good, when I can get it.

The Knock at the Door

Just don't answer the door.

Yet the knocking continues.  Persistent.  Recognizable.  Ominous.

It's a familiar caller, been  here before.  But its been a while.

The signs are there.  A heaviness--as though my skull was made of lead.  The weight bearing down from above.  Sleep disturbances.  A growing discontent.  Irritability.

Depression, that lifelong companion, has come calling once again.

And you just don't know why.  Take the irritability.  The strawberries are coming on now.  Last night we had strawberry shortcake.  The other night we had it at the kids, with a pound cake that I loved.  Karla in recent years has been making biscuits of sorts for shortcake.  And she did last night.  Not the pound cake.  "Didn't she hear how much I loved the other?  Doesn't she care?  And now I'm not happy.  I ask so little."  I know its a little thing, and the shortcake was fine, and there is no reason to get irritable.  Except I was not happy.  Depression.  That's not Karla's fault.

There truly is no reason to be depressed.  As days went, yesterday was a good enough day.  We'd had a wonderful night at the kids, Friday night.  Tri-tip BBQ.  Our grandson.  On Saturday I got some honey-do projects done.  Nothing major: fix a light, rewire a lamp, hang a blind, and varnish the oars.  Accomplishments.  Something to feel good about, yet I didn't.

Diversion is a good tool.  Dream.  Live in hope.

Jens and Ker are buying a home in Sagle, out of town.  A nice place with a view.  And enough land for a shop, which one day Jens would love.  My mind schemes.  Perhaps I could take out a home equity loan and finance one.  Move the tools out of my garage.  Have space to work.  It makes sense.  In town I can only run a business out of my home.  A detached garage shop isn't allowed.  If I built a shop at Jens' place maybe one day Olson's WoodWorks would be viable again.  Hope.

Nope.  Not enough.  The weight descends as the day goes on.  No reason.  There's never a reason.  Depression just happens.

I check my calendar.  Thursday I see my therapist.  Not scheduled to see my psychiatrist until August.  Might have to change that.

It's been quite a few years since I've had to change meds.  I was hopeful that these would continue working.  Perhaps an adjustment is necessary.  Though with Lamictal there is not generally any adjustment in dose.  Perhaps a change to to Lithium, that old standby.  Or other more contemporary options.  Don't want to think about it, though, and changing meds can be a crap shoot.  Trial and error.  Some work.  Others don't.  The ones I have been on have been working.

What I hope is that the depression I'm feeling is short lived.  Maybe it was just a bad day.  Oh, but it wasn't a bad day at all.

Part of the difficulty is that depression itself is depressing.  Its a vicious cycle.  The thought alone that life's little pleasures may escape me for a while is a downer.  Knowing that in the past cycles of depression have lasted for extended periods of time weighs on one.

Wait.  Do not answer the door.  I feel better this early morning.  Never mind that I woke at 12:30 am and am not sleeping.  Denial has been one way I've fought off depression.  I take humor in some small things.  "Its all just in your head."  Well of course its in my head.  That's the problem.  I also humor myself with the thought that maybe this will help with my weight.  I've noticed my belly becoming more prominent, lately.  Anymore and I might need to name it.  I lose weight when depressed.  Though I don't recommend it as a weight loss program.

Work through it, forcibly if necessary.  I've done that alot.  And with the two jobs I have, losing myself in my work is not hard.  I could use more people contact at church, though.  My little band is a low maintenance group.  A woman lost her husband recently.  She's fine.  He was ready.  Her husband was not part of the church and so no funeral was scheduled.  What might have been a few weeks of intense ministry was greatly reduced.  Ministry is about responding to their needs, though, not mine.  But it would do my soul good if I felt more needed.

Focus on those things that you know give you pleasure.  Jasper is certainly one of them.  "Opa!"  Who can be depressed hearing such a greeting and feeling that embrace?  Well, a depressed person can still feel depressed.  At best such pleasures suspend the mood for a bit.  And then it returns.

I must admit that the one thing that gives me the most hope is simply the knowledge that "this too shall pass."  The merciful side of bipolar disorder is that there are two sides to bipolar disorder.  The depression will not last indefinitely.  And a manic phase is not inevitable.  Though, quite frankly, mania can be preferable, to say the least.  At least one 'feels' good, even if there are pitfalls.

Trust.  Medications and therapy seek to limit the extremes and provide a safety net.  Depression may not be as deep, mania not as out of control.  Even though they continue to be experienced, they likely will not be as intense.  Hope.

And then the dark side.  It doesn't help that prominent people fall prey to such a disease.  Anthony Bourdain, dead.  A reminder of the seriousness of mental health disorders.

And the world doesn't help.  Knowing that Trump is in power is not good for my soul.  Most depressing is that some support his erratic behavior.  I shudder as I remember the statement of a friend that "he voted for Trump because our nation has become so divided and something needed to change."  As though Trump would be the great uniter.  Depressing.

I do feel better this morning.  Writing does my soul good.  A couple of hours on my blog is as good as a session of psychotherapy.  But I say that with caution.  My cycle when depressed is that as the day goes on the depression worsens.  I have written in the past about the wave of depression that overwhelms me in the late afternoon, rolling in like the San Francisco fog.  That could be where I'm at, feeling good in the morning, overwhelmed by night.

The knocking at the door persists.  This is not a welcome guest.

I formulate a list in my head of things that would make me happy.  Unfortunately, many of those things are on another list, symptoms of mania.  I wonder how much study has been done about that relationship.  The high risk adrenaline pumping adventures of mania are an antidote to the weight and burden of depression.

And so I listen to the knocking at the door.  Part of the solution is to open the door and face the demon.  Call it by name.  Recognize it for what it is.  My own thought is that depression is more likely to be catastrophic when it is not recognized.  It is helpful to recognize that I only 'feel' depressed.  In truth, life is not that bad.  Emotions are real, but they do not define reality.

I will sleep some more.  And then face a new day.  Worship this morning.  Recognizing Jesus.  One of my themes in the sermon today is that we see through a mirror dimly, meaning that our human nature is to see a reflection of ourselves even as we seek to see Jesus.  We cannot see the real Jesus in the mirror, though.  We look to the cross.  And in the breaking of the bread their eyes were opened.

This is my body, this is my blood, given, shed, for you.  Comforting words.  Words that speak of redemption.  Faith sustains during the dark night of the soul.

One of the ministries of the people of God is to believe on behalf of the besieged.  When we, in our weakness are overwhelmed to the point that faith and hope evade us, others maintain that faith and hope on our behalf.  And that is sufficient.

One Day at a Time

One day at a time sweet Jesus that's all I'm asking from you
Give me the strength to do everyday what I have to do
Yesterday's gone sweet Jesus and tomorrow may never be mine
So for my sake teach me to take one day at a time.

In twelve days I will have 2,000 days of sobriety.  I remember that first day.  Not a good day.  My friends who had helped Karla take care of me the night before had also cleaned out the house of all alcohol.  And there was a flurry of activity, calls to the bishop, consultation with my psychiatrist, arrangements made for inpatient treatment.  Then the long drive down to Kootenai Medical Center.  I took a deep breath.  "I guess I'll  not have a drink tonight."  Day one.

The staff in the psych ward mentioned that I was headed to the chemical dependency unit.  This was news to me.  I had consented to inpatient treatment because I was concerned about my depression and wanted to be treated for that.  Now it felt like a 'bait and switch' situation.  I was angry.  The rage I had been consumed with during my last night of drinking now had a new focus.  I called my psychiatrist and complained.  They were doing nothing about my depression.  I was being forced to play board games with the other patients.  And what about this whole chemical dependency thing.

"They have to sober you up before they can treat your depression, Dave."  To my way of thinking, I hadn't had a drink in over a day, now, by this time two days.  "I'm sober!"  "It takes longer than that." was the response. The next day I met with the doctor. "You are an alcoholic."  These were the words of my new psychiatrist.  Hard to take.  Day three.

Then my family came to visit.  And my dear Bishop Martin.  Somehow I managed to say the words for the first time.  "I am an alcoholic."  But I wanted out.  I'll attend a few AA meetings.  Maybe.  I can't stay here.  I have a job.  I have responsibilities.  The Bishop was ready to leave.  "I'll let you be alone with your family, you've decisions to make."  I wanted his advice, which initially he was hesitant to offer.  "Dave, you've come so far, don't turn back now."  Day four.  I think.

I told the Bishop that First Lutheran was now his responsibility.  He accepted.  The psych ward staff recorded a 180 degree turn around in my attitude.  There was hope.  A transfer to the chem dep unit.  Day five.  

I would spend 21 days in the Chemical Dependency Unit.  Twenty six days of sobriety seemed like forever.  There was a big change.  I was committed to returning home and not having a drink.  There were things I would have to do though.

It was hard.  When I returned home I was ready to jump right back into my responsibilities at the Church.  "I'm back!"  My council president and vice-president said "No."  They demanded I take more time.  Another month off.  

During that time there was a negotiation about accommodations.  I would no longer set up communion or buy the wine.  I requested that only grape juice be on the altar, and that I not have to handle the wine, at all.  Numerous bottles of wine were stored at church, I asked that they be locked up to remove the temptation.  My psychiatrist wrote a letter to the bishop.  In the end, the arrangements for these accommodations were made.  

I had gone into the hospital on October 15th.  Following the congregation's annual meeting in January I reentered the psych ward for another week.  Turns out alcoholism wasn't the only problem, and sobriety alone was not the cure.  Two years on disability followed.  When I attended church, I would have seizures, partial complex seizures.  By Easter I resigned my call.  And decided to spend a whole lot of money on woodworking equipment.  Olson's WoodWorks was born again.  This was my last manic episode, prior to the diagnosis of Bipolar Disorder.

So, I'm approaching 2,000 days now.  Life has changed.

I'm serving a congregation again.  A small church.  A part time call.  And I work at a cabinet shop in Hayden.  We're getting by.  There have been financial challenges, but every bill has been paid.  

The biggest issue remains the vocational question.  Part of me, now sober, wants some new great challenge so that I can finish off my career with a bang.  I'm far more qualified now that I'm clean and sober than I ever was before.  And yet.  And yet.  There's something to be said for self care.

I'm coming to a resolution.  If my congregation is willing, I have resolved that the best option for me is to commit to serving where I am at, and being at peace, at Peace.  Part of that resolution is to to think just 'one day at a time'.  It's hard to imagine ten years of leaving for work at 4:45 am and sometimes not returning home until nearly 10 pm.  But on a given day, I can do that.  One day.  That's all I'm asking from you, sweet Jesus.  One day.

I realize that grand aspirations regarding the rest of my career may not be realistic.  Just be a faithful pastor today.  Do your best cabinet work, today.  Let tomorrow take care of itself.  

And then there is retirement to plan for.  Some of the pressure I've been feeling has been alleviated somewhat by the realization that next year we can begin moving into retirement.  The first step may be Karla receiving her Social Security benefits.  It will also be an option for me to start receiving my pension, even if I wait till seventy to go on Social Security.  With some additional income, we'll be fine.

But there is a catch.  An asterisk marking it.  All these plans are subject to review by a qualified professional.  For some reason Karla is not comfortable with my making grand plans anymore.  It's a problem for one who is bipolar.  So we'll check with a financial planner.  We'll be careful.  

Day 2,000 is coming.  And after that, maybe 10,000 more.  God willing. 

Then, now, and always an alcoholic

I wasn't always an alcoholic, but I always shall be.  Not everyone will be an alcoholic, but anyone can be. These statements I believe to be true.

It's been over five years now, since I had my last drink.  Time to remember, reflect, and share.

Some people I know were out of control with their drinking from day one.  Not me.  It was probably harder for me to admit I was an alcoholic because I had thirty years or so of normal drinking patterns that seemed like evidence to the contrary.  For most of my adult life I drank an occasional beer, mostly during the summer months, during football season, and with certain meals such as pizza.  There were some occasions where I drank heavily, such as at the pastor's conference.  But most the time I drank no more than a beer or two.  And only occasionally.

Then life happened.

First I was prescribed Ativan for depression, insomnia, and anxiety.  It is a drug that works on the same receptors in the brain as alcohol, with effects so similar that it is also used to manage alcohol withdrawal symptoms in treatment.  I was told point blank at the time that I had to quit drinking.  My psychiatrist put it this way:  "I can't effectively treat your depression if you continue taking a depressant (alcohol).  No problem.  I just didn't drink.

What the doctor didn't tell me is that long-term usage of Ativan can produce "tolerance, dependence, addiction, benzodiazepine withdrawal syndrome, cognitive impairments, etc., which is why it is generally not recommended for use treatment beyond two to four weeks."  However, it is often prescribed for long term use.

After a number of years, a change of employment, a new home, I felt great and decided to cease treatment for depression.  My doctor, Brad, recommended I reduce the dose of Ativan prior to ceasing completely, and also warned that some people develop a drinking problem after going off of Ativan.  I was unphased because I had never had a drinking problem, and was quite confident I never would have.

Prior to ceasing medication I had begun to drink moderately, as in 6 to 7 fluid ounces of Scotch per week.  A couple of Scotch doubles, usually on the night a friend came over for dessert.  In spite of my doctor's warning, that drinking became a nightly affair immediately upon quitting Ativan.  My financial records of purchases confirm that I was now drinking 6 to 7 fluid ounces a day, not a week.

This is what I believe happens in the development of alcoholism.

First of all, a normal person has an adverse reaction to alcohol as a toxin in their body.  That's why it's called 'intoxication'.  Some people such as my wife so dislike this feeling that they will not drink enough to even begin to feel the effect.  Many people like the feeling of early intoxication.  That' why they drink.

When a consistent pattern of drinking develops, the body adapts to the presence of alcohol in the system, called 'habituation', and no longer has as strong a reaction against the alcohol as before.  The drinker who once got a buzz with the first drink now must drink more to feel the same effect.  Which if you are drinking for the effect means you will drink more.

The next stage is that as one drinks more and more to achieve the effect of intoxication the body adapts to the presence of alcohol to the extent that it now has an adverse reaction to the lack of alcohol in the system, that is withdrawal symptoms, not to the presence of alcohol in the system.  During a particularly stressful time in my life I stated to a friend that "It takes two drinks for me to feel sober."  I thought it was a joke but it was actually true.  I had to drink to feel normal.  At that point I had become an alcoholic, beyond a doubt.

Though an alcoholic probably doesn't realize this.  Toward the end, I was concerned that my congregation might smell alcohol on my breath Sunday morning, so I quit drinking Saturday night.  I got the shakes Sunday mornings as a result, though I didn't understand it to have anything to do with my drinking.  I couldn't pour the wine from the pouring chalice.  I didn't know what was happening but blamed it on stress, or something.  Only after treatment did I recognize I was going through detoxification.

If an alcoholic could simply manage by maintaining a base level of alcohol in their system at all times they would.  Anything to avoid withdrawal.  But the problem is with the habituating properties of alcohol.  It takes more and more to achieve the same effect.  But there is only so much of this toxin that the body can tolerate-- before it simply shuts down.  That shut down comes first as 'passing out'.  And then, the body's systems get so depressed they shut down entirely--that's called dying, by the way.

My rock bottom came in part because a doctor had prescribed Ativan again for me.  Circumstances at work sent my into a rage one afternoon, and after consuming a fifth of Scotch that afternoon and evening, I still felt I needed something and so I took Ativan.  The combination of the two almost killed me.

Why does an alcoholic allow this to happen?  One of the reasons is that to the alcoholic it appears that they are in control.  I used alcohol to 'control' my moods, or so I thought.  This is one of the reasons people with mood disorders such as Bipolar Disorder often become addicted.  Alcohol gives them some control.  One drink, two drinks, three drinks, four, I knew what I was drinking for.  "I'm in control" means "I don't need help".  Do you have a drinking problem?  No, I have no problem drinking.

I avoided some of the pitfalls of drinking.  I sat out on my deck, drinking myself to sleep at night, but rarely drank out on the town, and did not drive drunk (well, not very often).  My heaviest consumption was when I was alone.  Most of the time I convinced myself that I was only having a couple of drinks, a nightcap, and that was not a problem.  At the end those couple of drinks averaged 9 to 10 fluid ounces a day of Scotch.  Bigger glasses, less ice, kept the 'drink' total at two.  The truth is that 9 to 10 fluid ounces is consider at the minimum, 7 drinks, some would consider it 10.  That sounds like heavy drinking.  And it was an average.

Now I'm free.  I've gone through detoxification, dealt with many of the issues that contributed to the drinking, and no longer experience cravings.  The smell of Scotch is repulsive to me, now.  I can be around people drinking wine or beer, just not Scotch.

I share my story hoping that it will not be your story.  Even a lifetime of drinking normally is no guarantee against developing alcoholism.  Some people are more prone than others, but it is possible, I am convinced, for anyone to become alcoholic.  No one is immune.  Especially vulnerable are those with other issues like bipolar disorder, depression, or other mental illnesses.  Genetics can also play a role.

I don't have a problem with  normal people drinking normally.  Some people drink for the taste, not the effect.  Some people drink occasionally, not consistently.  Some people will enjoy their last drink like they enjoyed their first.  But not all.  Remember that.

The True Self

As one who is bipolar there is an underlying question of identity.  Its not dissimilar to the "I am" of Alcoholics Anonymous. "My name is Dave, and I am an alcoholic."  The honesty of claiming that identity, of stripping oneself of all pretense of denial, is key to healing.  Yet it raises a greater question of identity.  Are we to be defined by our disease.

I am bipolar.  A statement of identity.  To know me, is to know this.

Or not.  Perhaps to know the true me you must see beyond the disease.  

I have been open about my disease.  Part of that is to deny shame a place in my experience.  I should be no more ashamed of being bipolar than I am of having had to have my mitral valve repaired.  It is simply a medical condition that needs to be treated.  It has been.  It continues to be.  But it is not me.

Or maybe it is.  

One take on this condition is to understand being bipolar as being one who is capable of experiencing a broader range of moods from the norm.  We all experience highs and lows.  Its just that one who is bipolar experiences higher highs and lower lows.  Another aspect of being bipolar is that the transition between the highs and lows can be, for lack of a better word, violent.  And uncontrollable.  Not that we don't try to control it.  We do.  I self-medicated with alcohol for a decade or so, and that worked until it didn't.  Alcohol gave me some sense of control.  I knew how I would feel after one, two, and three drinks.  If I were depressed, a Scotch lifted my spirits.  During manic phases, it calmed me.  And then it didn't work anymore.  I was drinking myself to death in a vain effort to find the relief that now alluded me.

Thankfully, the crash that followed created the opportunity for diagnosis and treatment.  Better living through chemicals.  A more stable existence follows.  The goal is to achieve a functional stability. The problem with experiencing the highs and lows of manic and depressed phases is sustainability.  And durability. One could die.  That last point is important to remember.  One could die.  

But there remains the question of identity.  Who is the true self that the "I am" refers to?

My wife would tell you that she is thrilled to have me back again.  When my bipolar disorder was becoming increasingly pronounced life had become a rodeo.  One moment I was riding high on top of the beast, and the next moment at danger of being trampled.  Rodeos are entertaining unless of course you love the rider.  Two thousand pounds of bull crashing down on someone you care for is terrifying, not entertaining.  So it is with being bipolar.  

And yet there remains part of me that feels that with the stabilization of my moods there also came a diminishing of my capacity.

When I explore vocational options with my pastor, who tries very hard to understand my condition, his response is frequently to raise the flag of caution.  "Is this wise?"  Rightfully there is a reason for caution.  Accepting a challenging position could easily trigger a manic episode, and adversity is prone to trigger depression.  How much does one trust the safety net of the psychiatric meds?  

And yet the purpose of those meds is to enhance one's life, not deprive one of life.

Somewhere within the mystery of all this lies the true self.  The person God created me to be.  The person that is both loved, and capable of loving.  

Finally the "I am" is not a reflection of the disease, but of the divine.  And for now, it is best to simply leave it at that.