Warring Worlds Within

I wrote in my last blog about the interaction that I had with my insurance carrier that manages my disability claim regarding being suspended, pending the submission of  some requested reports from my physician.  In the end, the reports were submitted, and for the time being, all is good.

It was an experience.  The irony of this ongoing process of evaluation by the insurance company (Liberty Mutual) to determine if I remain eligible for the disability benefits is that the process alone aggravates the disease.  Every time the evaluative process comes up I experience a spike in symptoms.  I imagine my physician telling the case manager, "He might be able to work, except every time you ask the question, the stress makes it impossible for him to work."

One of the symptoms that I experience is partial complex seizures, epileptic activity, which causes involuntary tremors centered in my right arm.  These tremors may last a few minutes, a few hours, or be off and on for a few days.  Stress factors apparently cause them to break through, in spite of being on anti-seizure medication.  I first experienced them early on as I was concluding my time in the ministry.  It was actually the seizure activity that was a major factor in my being hospitalized for a week and placed on disability to begin with.  Then, it was being in church that provoked them, that lasted for three months or so.  Now, they return when I get highly stressed.

Saturday, following the news that my benefits had been suspended, I experienced slight tremors.  On Monday, after I received the news that my doctor had submitted the reports and that my benefits were no longer suspended, the seizure activity intensified and peaked that evening.  But that wasn't the most interesting aspect of my experience.

What started to unfold during those days I would describe as a warring madness between the manic thoughts and depressed thoughts.  It was like simultaneously both trains of thought were racing wildly, and my stream of consciousness would randomly shift back and forth between the two.

They focused our house, and whether we'd be able to keep this as our home if the disability benefits were terminated.

I could sell my CNC router to a leasing company, lease it back, and in so doing raise enough capital to make the house payment for a few years.  No, maybe a home equity loan could sustain us for a while.  We could move into a less costly rental, and rent out the house until we retired and have the income to afford the payments.  I'll double down my efforts on the business, expand, and raise my income level.  If I'm denied disability I'll return to the ministry, regardless of whether that would be a wise decision.  I'll buy a lottery ticket.  One way or another, my manic brain was scheming to figure out a way to leverage what I have to preserve what I have.  (For the record, my rational brain recognizes that as a whole these thoughts do not represent sound and realistic financial decisions.)

And then breaking up this thought pattern was the depressed side of my thought pattern.  Bankruptcy is inevitable.  Loosing the house and the equity we have in it is just a matter of time.  I'm just fooling myself to think anything will work.  I lay down in a fetal position and try to go to sleep.  And in spite of the exhaustion that all this causes, I cannot sleep -- and then another wave of scheming or despair would set in.  "I know, the Bishop will retire in the next few years, I could do that!"  (I'm still debating whether that was a depressed thought or a manic thought.)

Eventually, some calm returns.  The warring worlds within are silenced, if for no other reason, shear exhaustion.  This takes a lot of energy.

Mental Illness: Shooters, Care giving, and "The System"

As one with a mental illness, I cringe every time I hear of yet another heinous crime being blamed on somebody being "mentally ill".  It adds to the stigma of mental illness. There is a built in prejudice in such a statement, not dissimilar to  saying "The murderer was black."  The murderer may have been black, but being black does not in anyway predispose one to being a murderer.  Or to put it in other words, imagine a news reporter saying, "This is yet another case of a blond person murdering someone."

Having said that there are some basic facts to acknowledge.  Anyone -- truly anyone-- who commits murder can be diagnosed with a mental illness.  Of course, mentally healthy people simply don't go to school armed to the max and start shooting.  Mentally healthy people do not do things like murdering their family and taking their own life.  There is a diagnosis in DSM for absolutely everyone that would engage in murderous activity.

Mentally healthy people don't murder other people.  But neither do the vast majority of people who struggle with mental illness.

A psychopath is a person with an antisocial personality disorder, manifested in aggressive, perverted, criminal, or amoral behavior without empathy or remorse.  I might react more favorably to a reporter saying that the "murderer was a psychopath", than to the more generic "mentally ill".

Having said all of that, I appreciate the sentiment behind calls for better care for the mentally ill in our society that often come up following a shooting.  Although, lets be honest.  Not a lot of psychopaths are going to seek out the care of a mental health professional.  You will never find a "Psychopaths Anonymous" group.  For the sake of every one who struggles with mental illness, it would be nice if the general level of knowledge and awareness was increased across our society, and especially within the "system" that is designed to support and care for those with a mental illness.

Case in point.  Yesterday I got a call from Liberty Mutual, that manages my disability claim on behalf of the Evangelical Lutheran Church in America.  "I'm calling to inform you that your benefits have been suspended.  The reason why we are suspending your benefits is because your doctor has failed to submit the report we requested on time."  This came on a Friday afternoon.  My doctor doesn't work Fridays.  Frantically, I tried to get a message through to her.  If I can get her to submit the requested report by Tuesday everything will be alright.  If I don't get ahold of her until Monday, she'll have to drop everything to do the report (six months of treatment notes is what's being requested).

The point?  One of my diagnoses is an anxiety disorder.  The single most difficult thing to cope with during this time, given my diagnosis, has been the disability plan that is supposed to be helping at this time.  In the aftermath of the call I began having "partial complex seizures".  Great.  They're trying to determine whether I should remain on disability, and their methods of determining this are such that they aggravate the disease, and it could land me back in the hospital.  Which of course might answer their question.

Its things like this, difficult to cope with, that can cause deep seated anxieties and, yes, a rage.

Second case in point:  The message implied in much of the communication from the disablity claims department is 'prove to us you cannot work'.  On the other side of the equation, for me to be considered eligible for call, there would be the demand to 'prove to us you can work'.  It is at one and the same time in the best interests of the Church to get me off of disability, yet also, to not allow me to re-enter parish ministry.  The disability plan feels like a severance package and a disposal system.

Then twinges of rage start stirring deep within.

Then I step back, reflect on it, and wonder if such experiences that are common for a person with a mental health diagnosis, are the breeding ground for the type of rage that can lead to horrific behaviors?  For those who are Sesame Street fans, I find myself wondering if there is a monster at the end of this book, and if the monster could be me. . .

Scotch Double, Please.

I drank normally for most of my adult life.  Really.

Two beers was a typical limit.  And even that was occasional.  My typical pattern was to have beer in the refrigerator during the summer months and into the fall during football season, but often there would be no alcohol at all in the house, not by any intentional choice, but simply because I didn't bother to pick any up.  I mean really, 30 below zero, with a thirty mile an hour wind does not stimulate a desire to have a cold one.  I might have a glass of wine when we went out for dinner.  Pizza and beer was a good combination.  And when I would go to the pastor's convocation, I would sit with colleagues till closing, sharing a few pitcher's of beer.  This was the only time I would regularly become intoxicated, and that was only once a year.

When I was first diagnosed with depression, my psychiatrist told me I'd have to refrain from alcohol or else the treatments he could offer would be ineffective.  Alcohol is a depressant.  Taking both anti-depressant medications and drinking alcohol simultaneously simple doesn't work.  They counteract each other.  So I didn't drink.  No big deal.

What ended  up being a big deal was that the psychiatrist put me on an anti-anxiety drug called Ativan, or lorazapam, both for anxiety and to aid my sleep.  It is highly addictive.  A number of years later, feeling better, I decided it was time to go off my medications.  This was before I was diagnosed as being bipolar.  I was being treated for dysthymia at the time, a long term moderate depression, and so it was not untypical to come to a point where discontinuing medication was an option.  When I went off the Ativan, my doctor weaned me by putting me on half a dose for a few weeks, and then off.  I think he may have warned me about alcohol use, but I'm not sure about that.

What happened was that I immediately, as in overnight, began having a couple of scotch doubles per night to ease the anxiety and help with sleep.  Prior to this time, I had resumed drinking once a week, or so, rarely more.  A friend would come over on Wednesday nights, and we'd share a couple of drinks of scotch.  That's it.  Once a week.  Then, I stopped the Ativan and it was every night.

Having a couple of drinks per night is generally, socially acceptable.  And in the beginning it was not much of a problem.  At least I didn't think it was a problem.  In the beginning I didn't realize the extent to which I was dependent.  What I discovered later was that I had become chemically dependent on the Ativan, and then when I went off the Ativan, I experienced a "cross addiction" to alcohol.

I realized at one point that if I didn't drink, I couldn't sleep.  So I went to my physician an shared that I felt that I had become dependent on alcohol for sleep.  He put me on Ambien, which produced horrific nightmares.  Then Lunesta. When I went to fill the Lunesta prescription, my pharmacist informed me that Lunesta should not be taken nightly, because it is potentially addictive, habituating, and in the end, could cause significant liver damage.  "I wouldn't recommend using it anymore than once every three nights."  My solution was to alternate between the scotch and the Lunesta.  I preferred the scotch.

The thing was, it worked.  It did what I wanted it to do.  When my wife would raise concerns about my drinking, I would defend it by pointing out that whether it was scotch or Lunesta, the fact was that without help I could not sleep.  It was simply a matter of choice which drug I would use.

The problem is that alcohol is not only addictive, but habituating.  As time went on I needed more to achieve the desired effect.  My two scotch doubles (specifically 6 to 7 fluid ounces per night) became 3, (over 10 fluid  ounces) per night.  And that was the average.  I know this because I have a record of all my purchases of scotch.  I did my finances on Quicken and could look back and itemize every purchase at the Idaho Liquor Store.

What I now realize is that when I would cycle between hypomanic highs, and depression, my consumption would increase at both ends of the spectrum.  As my drinking increased, my tolerance level did as well.  I used to joke that it took two doubles just to feel sober.  It actually did.  There were three phases in my drinking.  First I drank because I liked the taste.  Then I drank for the effect, I liked the buzz.  And finally, I drank to feel normal -- that is to alleviate the symptoms of withdrawal.

Toward the end of my drinking this became quite pronounced.  I had decided I would not drink on Saturday nights because I didn't want my congregation to smell alcohol on me Sunday mornings.  On Sunday mornings I would shake to the point that I could not pour the wine from the pouring chalice anymore.  I thought it was stress.  Turns out that to avoid smelling of alcohol, I was actually detoxing in front of  my congregation each Sunday.

I reentered psychiatric care in 2012 and the psychiatrist put me back on Ativan, hoping I wouldn't need to drink as much.  It didn't work.  On my last night drinking, I was in a rage over some issues at work, trying to 'drink it away', and I decided I'd need the Ativan as well.  Not a good choice.  It nearly killed me.

Alcohol worked until it didn't.  Now it never will again.

Post Script on "Into Your Hands"

Quotable Quote from my first psychiatrist:
"The likelihood of your dying of a self-inflicted gunshot wound is much greater if you actually have a gun. . ."

Into Your Hands. . .

I am in a good place.  Don't call my doctor.  Don't worry.  But I write to share my experiences, now past, but which are a very real part of this disease.

"Into your hands I commend my spirit."

These words which Jesus spoke from the cross just prior to his death spoke to me on numerous occasions.  I contemplated speaking them myself, and with them, breathing my last as he had.  I didn't.

Its interesting to hear people talk about suicide and the judgments that are often rendered.  "Suicide is an unforgivable sin for there is never any chance for repentance."  "Suicide is such a selfish act."  "Suicide is the ultimate lack of faith."

All I can say to those who say, have said, and perhaps continue to say things like this, is that this has not been my experience.

"I haven't been suicidal," I have told my doctors, "but I can see it from here".  I know the feelings of despair and hopelessness that give rise to such thoughts.  The weariness.  Oh, the weariness.  How many times can you hope that a new medication, or counseling, or life changes will bring about healing, only to have those hopes shattered as the day to day grind of depression resumes?  How much of life can be endured during the dark lonely nights of despair before it is finally too much?

To those who would talk about "unforgivable sins" I'd suggest that it is more helpful to recognize the struggles of living with "incurable diseases".  To those who consider that suicide is a "selfish act" I would suggest that for one so burdened with mental illness there comes a point where the "self" is simply lost, destroyed by the disease, with no capacity for consideration of others.  And to those who would suggest that suicide is the ultimate lack of faith, I can only say that as I have contemplated those words "Into your hands I commend my spirit" it was not for lack of faith.

Sometimes the simplest things might be the most important things to remember as one struggles with suicide.  "Take two aspirin and call me in the morning."  Actually, to be serious, dead serious, (pun intended) the most helpful thing of all for me, and I believe many struggling with suicide is to have a reference in the future (hence 'call me in the morning').  Something concrete.  If I were living with someone who was struggling the way I have struggled I would try this simple thing.  Get out a daily planner.  Tomorrow we will go to dinner.  Friday, lets walk to the beach.  Lets talk to the doctor on Monday.  We're going to have eggs benedict in the morning. Next week we will spend some time with the kids.  You don't have to plan a trip around the world, but simply help to build a vision of tomorrow.

During those times when I have been borderline suicidal, it was because a massive curtain was being drawn that closed off all vision of a future.  People commit suicide not because they want to end their life, but because in their perception, their life has already ended. They simply cannot see the future. That is the tragedy.  Its just a perception.

There has got to be something, perhaps simple, but significant nevertheless that is coming, that can be anticipated, that will give reason to pause.  Today is not a good day to die.  The trick you see, is not dying now.  If somehow there is something, no matter how simple, to focus on then the thoughts of 'no tomorrow' will pass.  That's what I believe.

Today, I'm in a good place.  I do have hopes which sustain me.  There are frustrations.  I'm on yet another medication to aid sleep, and the results are mixed.  I've had some good night's sleep, and some nights where it was just more of the same.  But the depression is in check.

And I hope that it is never by my own choice that I utter those words "into your hands I commend my spirit" and then die.  But if you know someone, have loved someone, and grieve the loss of someone who "died by suicide" after a long battle with mental illness -- know that it was the disease that finally killed them.  Their life was taken from them, just as it would have been had they died of cancer.

Responding. . .

So a loved one has a mental illness diagnosis.  How do you respond?  What is helpful?  What response will be welcomed by those of us with a mental illness?

As one with a Bipolar II diagnosis, I wish I knew the answer to these questions.  Its not a simple matter.  At this moment, three things stand out.  Empathy, understanding, and perspective.

"I know how you are feeling."  Well, no, you probably don't.  But I'd sure like for you to try.  Empathy is the ability to understand and appreciate the feelings of another.  This is possible because we are not unique.  We have much in common.  No, in all likelihood you are not Bipolar, nor have you had those experiences and feelings.  That said, even 'normal' people experience the ups and downs of life, We've all experience times of feeling depressed, or experiencing an emotional high.  Its just that with someone who is Bipolar, those cycles are much more pronounced, uncontrollable, and frightening.  Imagine, for example, what it is like to be feeling quite normal, life is good, everything is manageable, and then to be thrown off a cliff.  All it takes is a few words, a bad experience, or nothing at all, and then over the cliff and into the abyss I go.  The frightening thing, is I never know where the bottom is.  Or imagine living each day, knowing that as evening approaches, depression will roll in like the San Francisco fog.  Or imagine what it feels like to believe that life is full of opportunities, everything is achievable, and great things are possible.  There is something exhilarating about being on the top of the mountain.  Can you imagine that?  And then imagine being locked on a roller coaster, and being subject to these ups and downs, uncontrollably, and you can't get off.  If you're normal, you won't experience to totality of life the way one who is Bipolar experiences it, and yet you do experience, at some level, the individual pieces of that.  Draw from that experience and seek on that basis to empathize with what we are experiencing.

Understanding.  It is helpful for those who deal with someone who is Bipolar to make the effort to understand the condition.  For example, the mood swings are both physiological and psychological in nature, or so my counselor says.  And the two are interrelated.  Sometimes I feel the way I feel because, and only because, of the particularities of my brain chemistry on that day.  "Is something wrong?"  Well, yes, and no.  Yes, I'm feeling deeply depressed today, but no, nothing has happened out of the ordinary.  I just feel depressed.  Another day it is quite possible that an event, a comment, a personal interaction, a positive or negative development, has resulted in the mood shift.  Understanding.  I don't feel the way I feel because of what I've done.  I do what I do because of the way I feel.  Understanding.

And then there is a wonderful gift that you can offer to someone who is Bipolar, especially during the manic phases of the disease, and that is perspective.  And yet tread lightly here, it is extremely angering to be dismissed categorically, because "its the mania talking."  Having said that though, it is often helpful to have the perspective of a normal person guiding me.  The more I understand the peculiarities of this disease, the less confidence I have in my own judgement.  "I used to really enjoy fishing.  Maybe I'd feel better if I started fishing again.  Yes, that is it.  Now I'm excited.  I think that to make the most of it, I'll buy a new fishing boat.  Yes, it's more than we can afford, but I'll make it work.  It'll be money well spent, if it makes me feel better, and I know it will, because the thought of it already is making me excited!"  At this point, perspective is indeed helpful.  It's not that a new boat is necessarily a bad thing.  But it would be a better thing if the decision is made based on something a little more grounded than the mood we are experiencing.

But tread lightly here.  The last thing I want to be told is that I'll never be able to buy a boat.  I don't want every 'great idea' I have vetoed because I'm Bipolar.  The gift of perspective though, is to offer assistance making a few judgments.  Is this a reasonable choice given the realities of our life?  Or is this just a mood driven desire?  Perspective is to assist one to make life choices with one's feet firmly grounded in reality, not mood.  This is a gift that can be given.

Savior's a Nuisance. . .

A savior's a nuisance to live with at home,

Stars often fall, heros go unsung,

And martyrs most certainly die too young.

(Joan Baez, "Winds of the Old Days")

What's the narrative of your life?  This was the question my counselor asked yesterday.  What's the narrative?  How do you make sense of it all?  What's the story line.  I recoiled at the question.

"That somehow, through all the suffering, through all the ups and downs, there might be some redemptive value to it all."  "No matter how far down the scale we have gone, we will see how our experience can benefit others."  (AA promises)  Wounded healer.  That others might somehow be helped by my sharing my story.

There is a significant burden to the compulsion to be a 'savior'.  And the quest for meaning and purpose in a life riddled with ups and downs is illusive.  "At least there was a redemptive purpose to Jesus suffering."  Its the search for a redemptive purpose that drives the hypo-manic phases of my life.  In spite of the "nuisance", there is this desire deep within me to change the world.  Perhaps it is born out of a sense of helplessness to change myself.  At least if some good comes out of it, then I can live with it.  A star is born, headlining my own drama.  A hero arises out of life's long suffering battles.  

But stars often fall, heros go unsung.  During times of depression I find myself overwhelmed by the meaninglessness of it all.  There is no purpose.  A life wasted.  It didn't have to be like this.  "Would it spoil some vast eternal plan, if I were a wealthy healthy man!"

Ah, but contentment takes the edge off of creativity.  "Were it not for depression we would never have had a Hemingway.  Of course, were it not for depression we might have had Hemingway a bit longer."  (comments of a colleague)  Perhaps its that tension between being a savior and meaningless suffering that is the catalyst for movement and purpose.  That I suppose is the narrative of my life.