My readers, you asked brilliant questions the other day when I
begged invited you to do so—when I asked what you’d like to know about mental illness and/or my experience of it. You inquired about everything from definitions and diagnosis to issues of stigma and medication management. You even asked if maybe I missed the illness, at least the manic highs, and if taking medication made me feel less authentically myself.
I can’t thank you enough. Your questions did exactly what I hoped they would—they got me thinking about my illness in new ways, allowed me new insights. You’ve provided a great list of issues for me to cover in future posts.
However, the clear place to start, in answering these brilliant queries, is with Lisa’s request for background information on bipolar disorder—issues of definition and diagnosis. (To check out Lisa’s blog, “Notes from Africa,” click here.)
Perhaps, one way to approach this background is to personalize it—to explain how my diagnosis came to be—a long story, but at least the first part will help define a few important terms.
I was hospitalized two times in the summer of 1989—very brief stays of less than a week each. At the time I was teaching English at Oral Roberts University and was an inpatient at the university hospital. Each stay was, unfortunately, a waste of time and money, as nothing was accomplished diagnostically.
In the spring of 1990, I was again hospitalized, this time twice in close succession, amounting to a total of 6 weeks or so in an in-patient psychiatric facility.
At this hospital I received the diagnosis that has stuck for the better part of 20 years. I have had other diagnoses along the way, as accurate diagnosis is a complicated process, especially for someone like me who has an illness that can mimic other disorders.
At any rate, in the spring of 1990, I was officially diagnosed with schizoaffective disorder—what was later determined to be a bipolar type of that illness. I don’t use the term “schizoaffective” very often, as it’s one most folks don’t know—though they understand “bipolar” fairly well. But, since we’re talking definitions and diagnosis today, this is an opportunity for me to clarify.
I like to think of mental illness the same way many clinicians do, as existing on a kind of continuum, with schizophrenia on one end, bipolar disorder (followed by major depression) on the other, and schizoaffective disorder in the middle. Basically, “schizoaffective disorder-bipolar type” means that I have symptoms of both schizophrenia and bipolar disorder (what some know as manic-depressive illness).
Schizophrenia, considered the most extreme psychiatric illness, usually begins in early adulthood and is characterized by symptoms such as confused thinking, delusions, and hallucinations. Technically there are 5 kinds of schizophrenia, two of which are well known—the catatonic and paranoid types.
Bipolar disorder, an illness that is marked by dramatic and unpredictable mood swings, is usually diagnosed in women in the mid to late twenties, though slightly earlier in men. Like schizophrenia, there are 5 kinds of bipolar disorder:
Bipolar I—usually considered the most extreme, as the patient has at least one full-blown manic episode.
Bipolar II—similar to but less debilitating that type I, this type never experiences a full-blown manic episode—only hypomania, a mania that does not include psychotic delusions.
Rapid Cycling—unlike types I and II, whose episodes of mania and depression can last months or even years, someone with this form of the disorder can swing between mania and depression several times in one week or even a day.
Mixed—a patient with this form of the illness can experience both manic and depressed symptoms at the same time—for example, the agitation of mania with a mood that is depressed.
Cyclothymia—a milder form of bipolar disorder than any of the others, it is marked with mood swings that are much less severe.
Patients with schizoaffective disorder have the symptoms of both schizophrenia and a mood (affective) disorder and will usually be diagnosed with one of two types—the depressive or bipolar kind. While the depressive form of schizoaffective disorder has symptoms of both depression and schizophrenia, the bipolar type is marked by the symptoms of both schizophrenia and bipolar I.
The bipolar type of schizoaffective disorder is more difficult than many other mental illnesses to both diagnose and treat, since it has symptoms that overlap with those of other psychiatric disorders. It can look like (depending where a patient is cycling at the time) schizophrenia, bipolar disorder, major depression, borderline personality disorder, even multiple personality, disorder when the patient is cycling both rapidly and extremely.
For many this illness can take a long time to diagnose accurately and even longer to correctly medicate, since doctors have to treat a number of different problems. For me this has meant a cocktail of medications that can manage 4 sets of symptoms:
Disordered Thinking (schizophrenic part): as manifest in delusions or hallucinations. These are treated with antipsychotic medications. I take a low dose of Risperal.
Mood Imbalance: as treated with lithium or an anticonvulsant such as Depakote or Neurontin. I actually take a high dose of Neurontin.
Depression: I take two antidepressants—Welbutrin and Prozac—that target two different neurotransmitters. Neurotransmitters are chemicals that help to carry electrical impulses across synapses (space between cells) in the brain.
Mania: There are no specific drugs to treat mania, but in someone with a form of bipolar disorder, doses of antidepressants have to be managed and adjusted, so as not to trigger a manic episode. Doses have to be high enough to alleviate depression but not so high as to trigger mania.
Certainly, I could provide much more background information, but I also don’t want to burden you with more information than might interest you. However, in addition to defining various forms of mental illness, I should also mention that my illness, though symptomatically well-managed, is not curable.
I experience what are called “breakthrough symptoms” quite regularly. These are ones that do exactly what you might think—they penetrate the defenses erected by my medications. They spill over. And even though this might be happening to me, you likely wouldn’t recognize it, unless you knew me quite well. I’ve learned to ignore these periodic hallucinations. They irritate; they can make it difficult to concentrate. But they don’t prevent me from leading a fairly ordinary and productive life.
My biggest and best defense against these kinds of symptoms, however, is stress management. The more stress, the more breakthrough symptoms. This means eating healthy meals, getting plenty of exercise, maintaining a regular sleep schedule, and managing conflict successfully. It also means knowing what stresses me most, what triggers my symptoms and trying to manage that stress with extra vigilance.
I specifically require an unusual degree of predictability in my life. I don’t do well with sudden change, change that I’m not able to anticipate.
However, as many of you know, my partner Sara works in disaster response. (Because of that we’ve spent the last two years living outside the US and have only in the last month come home to Kentucky after a year in Vietnam and more recently another in Haiti.) Well, the thing about disasters is—not only are they, well, disastrous, but they also, for whatever reason, refuse to schedule themselves well enough in advance to suit my sensitive brain chemistry. Damn disasters!
But that’s probably the topic for another post, on another day.
In another couple of months, when Sara’s well-deserved break has ended, she’ll be reassigned to another disaster, and we’ll find ourselves somewhere else in the world. But given my brain’s place on the continuum of crazy, let’s pray we know where well enough in advance to avoid a psychiatric disaster of the Kathy kind!