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bipolar diagnosis

“Mania Days” – Movie about Bipolar Disorder

“Mania Days,” Debuts at South by Southwest Film Festival in Austin

Mania Days” is a movie by Paul Dalio, features Katie Holmes and Luke Kirby as two New Yorkers suffering in the various stages of Bipolar DisorderMovie About Bipolar DisorderDalio, who in actual bipolar mode, wrote, directed, produced, edited and unbelievably – “scored” his own movie which is based on his own discovery of his bipolar disorder.

In an interview with the Huffington Post, Dalio describes the Holmes character as what he was like when he had his first episode “really scared and ashamed of it”.  The other character, played by Luke Kirby is based on a period of when he “started to romanticize bipolar disorder” and “embraced lunacy”.

Dalio himself endured three years of bipolar misery but eventually adhered to treatment when he recognized the pain he was causing his family.  Now he credits much of his inner peace to meditation (in addition to medication) and adherence to a routine schedule – including sleep.

The film debuts at the 2015 South by Southwest (SXSW) Music, Film, and Interactive Festival in Austin, Texas which runs a number of independent films.  The film festival coincides with the world famous music festival and an “interactive” conference which includes “gaming” and interactive media.

Katie HolmesKatie Holmes’ presence in the film shows potential for commercial success, but whether it achieves stardom – it is a good thing for bipolar disorder.  Basically, any attention for bipolar disorder is good – even the “bad” of bipolar disorder – as awareness can only reduce bipolar stigma.

I know that in my own journey over 20 plus years, I have gone through many stages.  I don’t much remember being “scared” of the diagnosis – or even of my behavior.  I have chosen to steel myself with “it is what it is”.

I did, however, maintain a long romance with the idea of “crazy” is good.  I spent many years believing (and many hours arguing with my therapist) that being “normal” was boring.  The last thing I wanted to be was “normal”.

I would like to say I was young and stupid – which I was but maybe part of the truth was that I had been crazy for so long that it was “normal”.  Eventually, crazy is exhausting – and you can’t do it anymore.

In most cases – you are eventually stopped from being crazy – up against a wall, sometimes caught by family members but sometimes a lot worse.  You get normal – only to get bored and do it all again.

As much as I would like to say that there is a real way to stop this cycle – in many cases there is not.  Even with medication, the cycle will continue – for a while.  Eventually, hopefully, you just get too tired of doing crazy.  Lost relationships, lost jobs… lost stuff.  It is exhausting.

Today – I am stable on medication.  Like an alcoholic – I say today.  Tomorrow and likely next week I will be stable on medication.  I would like to say forever – but I remember (at least what I do remember) that someday I may not.  The best I can do is to be open and forthright about my disorder so that those around me may know the signs if I decide to do “crazy” again.

Even though, I live near the festival and have many friends who are attendees, musicians, event planners, and sponsors – I won’t be seeing the film in Austin… crowds, excitement, and all that are no longer my thing – but I will see it, and I hope it is good.  Even if it isn’t great, it is another step in the right direction for the disease.

The Movie about Bipolar Disorder, “Mania Days”, Debuts at Film Festival in Austin

Melissa Lind

Bipolar Disorder and Facebook – To Tell or Not to Tell

To Tell or Not to Tell – Bipolar Disorder on social media

I am an avid Facebook user.  Mostly I use it to amuse myself, keep up with old friends, get to know people who should be old friends but weren’t, update family on my kids and such… But, I also enjoy reading “pages” … pages about funny things and pages about serious things that only “we” understand are funny.  I am talking about bipolar” pages.

Facebook - Like PagesBecause Facebook lists updates of what pages you have “liked”, my relatives, who know I am bipolar, have been able to see that I am not keeping my disorder as a big secret from my social group.  Most everyone who is on my Facebook page already knows (or would guess) that I have bipolar disorder.  To them, it is not a big deal, it is just part of who I am, and in some ways actually explains part of who I am – manic-depressive, why I am the way that I am.

I bring this up because one of my “relatives” actually sent me an email “warning” me that I should “be careful” about what pages I frequent, referring to the bipolar pages.

That was one bit of unwelcome advice.  Another bit of advice might be to “unfriend” him or hide my activity from him.  I am NOT Bipolar - I have Bipolar DisorderHe is a close relative so “unfriending” him might cause problems.  I could hide my activity but have made a personal policy that if you are my “friend” then you can see my page.  I haven’t taken advantage of the “close friends”, “friends”, “acquaintances” – feature of Facebook – but then I don’t let anyone on my page unless they are actually someone I know.

The last bit of advice would be to ignore him.  Luckily, he is such a close relative that I have made a practice of ignoring his advice, as a child would ignore a parent.  I did just that – ignore him.

This situation was easy for me to solve under these particular circumstances but can be a lot of trickier.  I also belong to bipolar pages on LinkedIn, Google+ and other sites, and I sometimes wonder about the impact.  Fortunately, I happen to be a writer, and I am not in a situation where an employer (or potential employer) can make an objection to my diagnosis.

For others that are not the case – and it was not always the case for me.  There is still a huge stigma against bipolar disorder.  Technically, making an employment decision based on a mental diagnosis is illegal – it is against the ADA.

Technically, the employer could be in trouble for violation of federal law, but how many times do employers say outright” “I am not hiring you because…(insert problem here)”?  Likely they will not say anything – they just won’t hire you.  In some states, they can fire you for no reason (“at-will” employment states) or “not-for-cause”.

Technically, they should not hold this against you – if you are stable, and if you remain stable.  The question is – will you?  Hopefully, I will, but I can’t guarantee that.

Bipolar BearsIf I were looking for a job – a “real” job, I would seriously consider curtailing my social media and public announcements of “I am bipolar“.  As a writer – I shouldn’t do that, and I don’t.

You have to evaluate your particular situation.  Know that it is against the law to be discriminated against.  Know your history and likelihood that you will remain stable in your bipolar disorder and be able to do your job.  Decide whether a legal fight is worth it to you.  It may be; it might not be.  Decide whether you really want to work for someone who will hunt you down and discriminate against you based on the information they find.

For me, I am happy not being in a “real job “.  The same relative, full of warnings, is not happy about my lack of “real” employment – but I can just ignore him.  Either way, I am still Bipolar.

Melissa Lind

Living with Someone Who is Bipolar

Living with someone who has Bipolar Disorder can be difficult

Living with Bipolar DisorderI try (like many others I am sure) to keep Bipolar Disorder from wrecking my family.  I don’t always succeed.  In a lot of cases, it comes down to taking my medication on a regular basis (which historically I have not always done).  Even at the best of times, living with someone who has Bipolar Disorder can be difficult.  In some ways, it is probably harder to live with someone who is Bipolar than it is to be Bipolar yourself.

Having Bipolar disorder is just part of who I am.  It isn’t “good”, it isn’t “bad”, – it just “is”.  There are good days and bad days, but I expect that.  Just because someone else thinks I am having a “bad day” doesn’t mean that I experience it that way.  I don’t really know what it is like to live with someone who is Bipolar.  I only know what they say and how they seem to react.

InsaneLong before I was diagnosed, a roommate said to me, “living with you is like walking on eggshells”.  That kind of made me mad – and my response was something like “Well at least I wash my clothes”.  This had nothing to do with anything – except that she didn’t wash her clothes.

My husband once said, “Living with you is like waking up with a rabid animal.”  My thought was, “Then don’t talk to me when I wake up”.  In either case, I still believe that I wasn’t doing anything particularly wrong – unpleasant for them maybe – but normal for me.
There are some things that you can do to help yourself deal with a household member that is Bipolar.  Know these hints will not solve the problem, but they may make things better.

•    Don’t say things like, “I am not putting up with this Bipolar shit!”  First you will make them angrier than they already are. Second, you obviously are putting up with it, and they may feel compelled to remind you that you both live there, which will make you angry.
•    Do keep an eye on whether they are taking their medicationNormal and MiserableIf you can check on it in a prominent manner – do so, but likely you will have to sneak around them.  You can’t easily force them to take their meds, and subtle reminders will probably create an explosion. But you have to decide if the explosion is worth it – or just be prepared in case it is not.
•    Educate yourself so that you can see what “the disease” is, and what the person is.  Know that the disease is also a significant part of a person. Also, know that a lot of what you like about them is because they are bipolar.  While Bipolar Disorder makes things difficult, it also makes things interesting.
•    If you can watch for disruptions, try to be there to compensate.  Meaning; make sure children and other responsibilities are taken care of.  It does not mean that you must do all the work but remember you aren’t necessarily doing it for “them” but for the others that depend on them.
•    Try not to be angry at them for being who they are.  Again, part of what makes them interesting is the disorder and for a lot of use – we like who we are most of the time.  If you don’t like us, then leave.
•    Lastly, and most importantly – if you can, be there to pick up the pieces when it breaks – because with most of us, it usually will.

Whether it is a spouse, child, a sibling or roommate, you will have to make a decision.  If you can put up with the mental disorder, that’s great.  You can help them, but you can’t change them.  They can’t change being Bipolar, and criticism never helps.

Melissa

Living With Someone Who’s Living With Bipolar Disorder:

Living with someone who is living with bipolar disorderA Practical Guide for Family, Friends, and Coworkers is an essential resource for anyone who has a close relationship with a person who has Bipolar disorder.
This book provides a much-needed resource for family and friends of the more than 5 million American adults suffering from bipolar disorder. From psychotic behavior that requires medication to milder mood swings with disturbing ups and down, this book offers a warm and often humorous user-friend guide for coping with bipolar loved ones, colleagues, and friends.

The book includes Guidance for identifying bipolar disorder symptoms and how to get the diagnosis confirmed Strategies for dealing with rants, attacks, blame, depression, mania and other behaviors. The book includes crucial information on medication and its effectiveness, potential side-effects and techniques for dealing with attempts to self-medicate with drugs and alcohol.

How many people with bipolar disorders can care for themselves, get help, feel supported and go on with their own lives? This important book contains real-life illustrative examples and a wealth of helpful strategies and coping mechanisms that can be put into action immediately.

Bipolar II – Really?

Is it Bipolar II – or just plain Bipolar Disorder not yet recognized?

Google “Bipolar” on the “news” tab and see what you find.  It is astounding how many semi-celebrities have come out and said “I have Bipolar Disorder”.  Unfortunately, the story is often about Bipolar II, which somehow makes it “better”.

Bipolar Disorder is still a serious stigma – prevents people from getting jobs and such.  Technically, as Bipolar Disorder is considered a disability, an employer who did not hire or fired an admitted bipolar patient based only on that fact would be in violation of the American Disabilities Act, but few people are willing to go to the carpet on that.  Plus there is the little issue of being “able” to perform one’s job.  I can perform a job if I am taking meds.  If I am off of meds, I become highly unreliable with a lot of other liabilities – risky behavior that I have decided not to discuss.

Only a couple of years ago, I was warned by a well-meaning family member against posting too much on social media about Bipolar Disorder – and this in his mind included “liking” too many Bipolar pages.  He was concerned about my ability to obtain a decent job.  I don’t know if I have a “decent “job today – I have made my own way which works out better for me – no boss to annoy, no dress code, nobody else’s time clock.  For the most part, I don’t worry about social media – I don’t think I will ever have a “real” job again – no more frequent flyer miles for me.

Bipolar 2I was once diagnosed as Bipolar II – but really, both the doctor and the therapist thought differently – they both knew that I had regular Bipolar Disorder but wasn’t ready to accept it.  Actually, I am pretty sure my doctor tricked me into taking Lithium for the first time by telling me that it would help boost my antidepressant activity.

In retrospect, I am astounded that I believed him since I know so much about medication – but I took the medication.  How many of these people really have Bipolar I Disorder and just don’t say so.

It is much easier for people to say and accept that they have Bipolar II.  In my opinion (which is obviously vast and knowledgeable – just kidding, no really), Bipolar II is a way of sliding by the real diagnosis.  As in “I have Bipolar Disorder but not really”.  “I have Bipolar Disorder but I am not crazy”.  “I have Bipolar Disorder but I am not dangerous”.  “I have Bipolar Disorder but I won’t embarrass you”.
When it gets down to it…wasn’t that true for all of us at one time?  Or at least didn’t we believe it at one time?  I still fit some of the criteria – I am “functional”, “productive”, “hypomanic” – except when I am not.

I often confuse my doctor when he asks how it is going by saying “good enough”.  What I mean is that I am not manic exactly, I am not depressed.  Actually it works better for me if I am teetering on the edge of mania.  If I am just crazy enough that I know that I am crazy – then I will keep taking my meds.  Because I forget.

I originally sought treatment for severe depressiondepression bad enough that I had to decide whether to kill myself or study (I had a big exam the next day).  In retrospect, I was actually in a mixed episode with plenty of energy but in a really bad mood.  Oh, and then there was the slight issue of the hypnogogic hallucinations which I denied at the time.  See, even if I know that I have Bipolar DisorderManic Depression – I still forget.

It would be easier for me to say that I have Bipolar Disorder but it is “just” Bipolar II.  I thought that too.

Melissa

Bipolar Disorder – Euphoria vs. Dysphoria or Mixed Episode

Most symptoms of Manic Episodes appear to be positive

Manic-depression or Bipolar disorder is usually perceived on of two ways – a person who alternates between depression and euphoria – or a person who alternates between depression and craziness.

Often a person who is told that they are bipolar will identify one of those two states – and will object based on the fact that they have never been “euphoric“, and they have never been actually psychotic or “crazy”.

Bipolar disorder or Manic-Depression is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) – “the Bible” of psychiatric disorders – as “…clinical course that is characterized by the occurrence of one or more Manic Episodes…”

7 “points” retrieved from: DSM IV Criteria for Manic Episode – Food and Drug Administration

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week. With three or more of:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only three hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas, or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school or sexually) or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

There is another specifier – “The symptoms do not meet criteria for a Mixed Episode” which is left out in a lot of thought processes.

Bipolar - EuphoricOne problem that is often encountered when diagnosing Bipolar disorder – or when trying to convince someone who has Bipolar disorder that they do, indeed have the illness – is that most of the “symptoms” of a Manic Episode appear to be “positive” or “happy.”  If you examine the wording – it looks on the surface and is often described as periods of “Euphoria” or extreme happiness.

In truth, many people with Bipolar disorder don’t have periods of “euphoria,” they don’t have what is perceived as “inflated self-esteem or grandiosity“, and they don’t seek out “excessive involvement in pleasurable activities.”  They may have “dysphoria,” they may believe that they have to do everything themselves, they may experience psychomotor agitation…they may be in a really active bad mood.

This is a state of “dysphoria.”  It is also called a “mixed state” where the Manic Episode and the Depressive Episode occur at the same time.  Features may include the racing thoughts, irritability, lack of sleep, psychomotor agitation of a Manic Episode but also include anhedonia or lack of enjoyment, inappropriate guilt, or suicidal thoughts which are symptoms of depression.

Unfortunately, this disconnects in presentation, and lack of awareness of mixed states (in both the patient and some professionals) often gives the bipolar patient an “easy out” in acceptance of the diagnosis.

Melissa Lind

Mixed Episode or Manic Episode with Mixed Features is given too little attention!

Diagnosis and Symptoms of Bipolar Disorder

Bipolar disorder is difficult to diagnose.

The average bipolar patient will see three mental health professionals before getting the right diagnosis. In fact, one-third of bipolar patients will not be diagnosed with the disorder until more than 10 years after they first seek treatment.

There is a lot of similarity between the symptoms of bipolar disorder and other psychiatric conditions, but that isn’t the only reason why it is so difficult to diagnose. Here are some of the complicating factors:

Bipolar Disorder PatientThe patient only talks about depression – as bipolar disorder is a condition that has periods of depression alternating with manic episodes, many patients present when they are depressed. This is particularly true when a patient seeks treatment for themselves. Manic patients feel good or at least energized and are unlikely to believe that anything is wrong. Either they feel terrific, or they are in a heightened “bad” mood – and likely to blame that on other people or life circumstances. Consequently when they first seek treatment – they only profess to the depression as that is most bothersome.

Bipolar disorder looks like anxiety – in actuality, many, if not most bipolar patients also have some type of anxiety disorder. Consequently it may be very difficult for mental health professional to root out bipolar disorder. If patients are seen as agitated, hyperactive or fidgety, they may be only asked about anxiety or given a self-rating scale for anxiety. This would immediately lead the practitioner to diagnose an anxiety disorder – unless careful investigations were done.

Substance abuse can be complicating the issue – many bipolar patients spend years self-treating with substances of abuse. This includes prescription medications, recreational drugs and alcohol. There is not any particular drug that is more often abused by bipolar people as a whole – some will choose alcohol, some will prefer stimulants, some will choose pain medications – all of which will mask the symptoms to some extent. In some cases, the substance abuse appears to be more problematic than anything else and in cases of addiction; the substance abuse must be treated before an accurate evaluation can occur.

Denial is very common – Denial is a nice way of saying dishonesty. That would be lying. This sounds very harsh but in many cases, bipolar patients will not be honest about difficulties that they have had. It may be subconscious dishonesty in that they, themselves do not really know what the problem is. Lack of awareness is common but outright denial is also common. Many bipolar patients absolutely refuse to accept the diagnosis when it is first presented – even after years of not being treated properly. Oddly, this may make it more likely that the practitioner believes that the patient has bipolar disorder but such outright denial delays treatment.

These are just a few of the reasons why bipolar disorder is so difficult to pin down and, unfortunately, delayed treatment can have huge life implicationsBipolar disorder is one of the riskiest psychiatric illnesses to have and can have severe consequences for the patient who is not properly diagnosed and medicated – including job losses, family disturbance, institutionalization, jail and even death.

Bipolar disorder affects not only the patient himself – but family and loved ones as well.

Why is it so difficult to diagnose bipolar disorder?