Saturday, June 28, 2008

True Emotions

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It was years ago.  I was a resident on an inpatient unit and the patient was floridly manic.  I don't remember the details, what I do remember was that she was running on empty, high as a kite, going 99 revolutions per minute, you name the cliche.  There was a reason why she was on an inpatient unit and not being seen by an out patient doc.  She wasn't getting better and, as is often the case with people suffering from mania, she had no insight that she was ill, she was feeling good-- really good-- and oh so energetic, and even louder than that, and so what's the problem here? Let me outta this joint!  We're talking, I'm trying to reason with her, and finally, she screams at me in a way that stays clear long after her name and the details of her life have oozed from my memory,  "You're problem is you're not Italian!  You don't understand TRUE EMOTION!!"  She had a point.

I'm not Italian, by the way.  And who defines what emotional response is true, what is valid, what is right to have?  

So once patients get the label of Bipolar Disorder, they come under an added scrutiny that makes them, and those who know they suffer from this disorder, subject to both added analysis of their reactions.  It often leaves them feeling invalidated, or questioning themselves in a way that adds an entirely new dimension, if not burden, to life.  I can have a feeling--- it's just my feeling.  I may question if it's valid for me to have that feeling-- come on, we all check out our feelings.  How often do you ask Was it Him or Me?  Or comment that everyone thinks he's a jerk, just to be sure you're not the one being overly sensitive.  People with Bipolar Disorder take this a bit farther.  If they're angry, irritable, have a great idea, in a good mood, in a bad mood, have trouble sleeping...and the list goes on....then they're ill.  No bad hair days for the labeled labile.  They, and everyone around them, are constantly questioning their sanity.  

There are other labels, though, and they aren't all about mental illness.  Perhaps you're a worrier, you want people to be considerate of the fact that you care about them, but they don't like to check in (--this particular example is for us moms).  Maybe they check in so you won't worry, or maybe they label you Neurotic, or Over-protective, or something that lets them blame you for your concern, that frees them from responsibility.  Or maybe you're very sensitive-- a trait that can be a very positive thing, especially if you're sensitive to the needs of others.  But once you're labeled as such, then the someone who says something that upsets you isn't held so accountable.  No biggie that I made Georgie cry, he's too sensitive, you know.

Emotions are a funny thing.  Sometimes I wish they could just be what they are and taken for face value.  And even if I'm not Italian, let it be known on the record that I'll eat pasta and gelato with glee and enthusiasm.


Anonymous said...

Despite not being bipolar, I still relate to your example. I know that I have emotional responses to things that are based on skewed perceptions and are most always out of proportion to what the cause might merit.

Yet I find that not only do I have to hold on to feelings lest they be off base, but I also have to constantly monitor my thoughts in case they end up being negative, skewed, based on false assumptions, or even if they just look at me funny.

As someone who already suffers from too much thinking, this all makes for a nice little feedback loop of self doubt and I seem to spend most of my time and energy thinking about what I'm feeling and thinking about what I'm thinking than anything else.

Granted it's true that both my emotions and thoughts are skewed but once the seed of doubt is planted how the hell do you keep it from stop it?

I met with a brand new therapist recently and I could tell he was directing the session, and thus future sessions, towards a CBT approach, I tried bringing this up. I'm not sure he understood what the hell I was trying to tell him. I'm returning him to the pound next week.

Anonymous said...

It was once thought I was bipolar but my psychiatrist who I have seen for over a year disagrees. Still my friends are hung-up on the original diagnosis. Occasionally I will be excited about something or in a hurry to rush off somewhere and I will immediately get jumped on by my friends for "talking fast". I find this VERY annoying. I listen to the general public for speed of delivery of words and people I assume to be normal will speak rapidly from time to time. My friends worry when I do though, and then start urging me to slow down as though a real mania (if I were in it) would go away just by slowing the speed of my speech.

Anonymous said...

Okay so your grandmother called biscotti by a different name. You got the cookie, you got the high EE in the genes, you might as well be Italian. Go have a slice.

Aqua said...

What a great post. Two pdocs have given me the label "bipolar", but the one I see every week says I have MDD and a hyperthymic temperment. This I believe, but I can't help but worry everytime my mood skyrockets. I am so scared I am going to go manic.

Even before someone tried to label me my friends would make fun of the hyper energy I have when I am well; my million ideas, my rapid speech, how loud I get (very loud...because I get so excited with all the ideas), how excited I get, how wild I get.

I almost bought into the labels until I went to my Great Uncle's funeral and met my Grandma's side of the family...every single one of them was like that...So "On" it was absolutely amazing. It was like being in a room with twenty people just like the well me.

We weren't Italian, and certainly, statistically, we cannot all have been manic at the same time: we just are a family of people whose personalities are exhuberant, jovial, high, full of ideas, like to do a million projects at once, can fly from one idea to another and understand the connections between all these ideas with ease. Maybe everyone else was just "slow"?

The experience of being surrounded by so many people just like me was breathtaking and eye opening.

pemdas said...

I wrote this in a short blog post in 2007:

When do people ever let you off the hook? Do I ever get to be "blue" again without someone sounding the alarms? Can I have a crankypants day without my mother asking me if I took my meds? As if not taking your meds one day would make a damn bit of difference (since it takes almost 3 fu#king weeks to kick in). Will I ever get to do something stupid and let the reason for it be "just because I was stupid" and not because I'm bipolar?

Thanks for your post.

-- pemdas
(because order matters)

Anonymous said...


I once said something to my therapist about feeling something about her and I commented "How inappropriate." She said "No feelings are inappropriate. It's about what you do with it and whether you act on it."

I thought that was a pretty sensible perspective... it enables you not to invalidate yourself but also not to endorse yourself to do whatever you feel like...

Kim said...

What a fantastic post. I have a niece who is both borderline and bipolar. But...before she was either of those she was vivacious, passionate, caring, energetic,young and excited about life.

Her illness seemed to come on fast, and without going into the horrible details, it came on strong.

But under those diagnoses? She is still all those wonderful things.

Battle Weary said...

I think about feelings often. I wonder sometimes (alright...all the time) if I will ever have a feeling and know what it the same time would be good, too. However, that is a different issue!

My best friend is bipolar and I often hear from her that such and such is "because of being bipolar"...this makes me sad. I believe that a lot of her "moods" is simply being human. Yes, she is bipolar, but that is not the sole explanation for having rough/depressed mornings...I'm pretty sure that waking up this past Christmas eve and finding her husband had passed away in the living room while she slept, has a lot to do with that...and is completely "normal". I also believe that feeling an upsurge in mood right after hearing her toddler granddaughter say "gramma" for the first time is completely "normal" too!

Anonymous said...

I'm bipolar and I frequent bipolar websites. Sometimes the fur starts flying and then people start asking who's well and who's ill. It seems you can't win. If people think you've got heated about something because you're ill, you're resented for playing the ill card, but if people think you're not ill, you'll find that suddenly whoever is on the other side gets the sympathy vote. All terribly messy.

Dragonfly said...

And if mascarpone, mozzarella and risotto consumption is anything to go by...I'm Italian through and throuh.

Sarebear said...
This comment has been removed by the author.
Anonymous said...

I felt for certain that someone was going to challenge my comment above. Now I'm disappointed...

Sarebear said...
This comment has been removed by the author.
Butterfly said...

Having bipolar this hit home with me. I am doing well right now, but every time I start to get weepy, or irritable, or over-emotional I get worried. Just the other day I had an interview and was really nervous and the way it came out my friend asked if I was manic. I'll be asked constantly if I'm taking my meds when things go wrong. Recently I've been the classical bipolar person who believes she isn't bipolar because she feels good, therefore, she doesn't need meds. It was a misdiagnosis. Or I was just immature. Or it was a result of PTSD. Whatever. I can rationalize anything away. But people have to remember I'm not bipolar, I have bipolar.

Anonymous said...

Bipolar Ability
Bipolar (manic-depressive illness) has been defined as a major affective mood disorder in which one alternates between the mental states of deep and brutal depression and embellished elation- with the depressive episodes occurring more frequently in one who is said to be Bipolar.
Bipolar is believed to affect one’s cognition, emotions, perceptions, and behavior- along with psychosomatic presentations (such as pain with depressive episodes, for example). It is thought to be due to a physiological dysfunctional brain in one affected with bipolar by many. Yet Bipolar allows for exceptional abilities when a bipolar person is in their manic phase at times. So perhaps a brain alteration should be what has happened, or what is happening, instead of a dysfunction
The etiology for bipolar is unknown. As many as half of those suspected as having a bipolar are thought to have at least one parent with some sort of mood disorder similar to bipolar disorder, which suggests a genetic predisposition may be present.
It is also believed that bipolar presents itself with symptoms associated with the definition of bipolar when one is between the ages of 15 and 25 years old. The disorder was entered in the psychiatrists’ bible, the DSM, in 1980, although bipolar disorder is thought to have existed for quite some time.
Also, those with bipolar are thought to be in possession of heightened creativity during their manic phases, as well as they have accelerated growth of their neurons. This is not necessarily a bad thing, it seems.
Research has determined that as many as 15 to over 30 percent of bipolar patients commit suicide if they are left untreated, or undertreated. Also, as many as half of those affected with bipolar also have at times severe substance abuse issues along with their bipolar as well.
Bipolar patients are also often experiencing anxiety issues that vary, and are treated often as a result of these medical issues. The disorder varies as far as severity goes- with some bipolar patients being more severely affected than others. In fact, there are at least 6 classifications of bipolar, according to the DSM.
Bipolar patients are thought to be symptomatic half of their lives. As stated previously, the depressive episodes occur more frequently than manic ones. When symptomatic, bipolar patients are thought to be rather disabled, according to some, when in their depressive state in particular. The diagnosis has become more frequent recently. In one decade, the assigned diagnosis of bipolar rose from being about 25 per 100 thousand people to being 1000 per 100,000 people.
Most diagnosed with bipolar are not diagnosed based on solid, comprehensive, or psychiatric review that is often absent of valid or standard diagnostic methods. Some believe as many as 5 percent of the human population may be affected by bipolar disorder- which may include as many as 12 million people in the United States. This is if the diagnostic criteria developed by others were to be fully utilized.
A subjective questionnaire called the Mental Status Examination is often utilized when diagnosing one suspected has having bipolar disorder. Many believe the diagnosis has increased recently due to the progressive treatment options now available. It is an argument of increased awareness versus over-diagnosis.
Yet the diagnosis is vague, as children and adolescents are often absent in research with bipolar. Also, there is not any objective diagnostic testing to rely upon for bipolar.
Many younger than 18 years of age are prescribed atypical anti-psychotics as first line treatment, which is largely not recommended as treatment options. In fact, close to half a million of those younger than 18 years of age are prescribed the atypical anti-psychotic Risperdal alone, it has been determined. The class of medications overall is thought to be prescribed to about 10 percent of those non-adults thought to have bipolar.
While not recommended, about a half of all those assessed as being bipolar are prescribed antidepressants, such as SSRIs, as first line treatment. It has been suggested that this class of drugs has decreased the risk of suicide attempts compared with other classes of antidepressants for close to 20 years. Yet tricyclic antidepressants have been determined to be efficacious in over half of those diagnosed with bipolar - with a greater amount of research behind this class of drugs.
The most recognized treatments for bipolar long term are lithium (Ekalith or Lamictal- along with an anti-convulsant. Sugar intake is thought to vex the symptoms of one with a bipolar disorder as well.
Atypical anti-psychotics have been prescribed for bipolar, which change some aspects of the brain, physiologically, as does the disease itself. In fact, one may argue the brain becomes more efficient due to both the disorder and the treatment with the atypical anti-psychotics. Yet many recommend the utilization of this class of drugs with bipolar disorder only if psychosis is present as well.
As many as 15 percent of bipolar disorder patients diagnosed as such are prescribed an atypical presently. This class of medications may be particularly beneficial for those women who are diagnosed with bipolar who are pregnant, however.
Lithium, which is essentially a very light metal with low density in which the salts are obtained for medicinal treatment, and an anti-convulsant are believed to be standard bipolar treatment, pharmacologically, studies have shown. This is due to Dr. John Cade and his examination with lithium and its benefits with those who have psychotic excitement close to 60 years ago.
Ekalith is believed to be both neuro-protective as well as having an anti-suicidal affect in those believed to be bipolar- and is viewed as a mainstay as far as treatment for bipolar goes with many who treat the disorder. Lithium is thought to regulate the calcium molecule in the brain, so this and valporate are historically the medicinal treatment options preferred for those with bipolar disorder.
Bipolar is difficult to detect, and is often diagnosed as major depression with many affected by this disorder. There is no objective criteria protocol available to utilize when assessing any patient believed to be suffering from any mental disorder. So such mental disorders that are diagnosed are ambiguous, yet that does not conclude that such disorders do not exist, such as the case with bipolar disorder.
Yet perhaps a health care provider should be very thorough and knowledgeable when assessing a patient believed to have a mental condition such as bipolar. And those who study bipolar should consider calling it Bipolar Ability instead of Bipolar Disorder. A disorder is something considered outside the realms of within normal limits, thus no order exists. An ability is when one has the power to do something utilizing their skills, talent, and expertise.
Both words may or not apply to Bipolar. I’m going with bipolar having atypical abilities.,
Dan Abshear
Author’s note: What has been annotated is based upon information and belief.