Everything In Between

I recently discovered TEDTalks, a fantastic web site that shares the lectures and presentations at the Technology Entertainment and Design conference in Monterey, California. I just watched Helen Fisher’s talk, which the TED web site describes like this:

Helen Fisher is an anthropologist with Rutgers University, specializing in gender differences and the evolution of human emotions. Her most recent book is “Why We Love: The Nature and Chemistry of Romantic Love.” In this wide-ranging talk, she outlines the bio-chemical foundations of love (and lust), and discusses the natural talents of women, and their new significance in the modern world. (Recorded February 2006 in Monterey, CA. Duration: 24:13)

However, listen carefully, and you’ll hear her also make a case for polyamory, something I’ve written about before. Helen says:

However…these three brain systems, lust, romantic love, and attachment…aren’t always connected to each other. You can feel deep attachment to a long term partner, while you feel intense romantic love for somebody else, while you feel the sex drive for people unrelated to these other partners. In short, we’re capable of loving more than one person at a time.

It’s a good talk, and definitely worth a listen.

Humans are amazing creatures. We have such powers of adaptability and such incredible forces of will that we are able to make the impossible possible.

As my friendly, neighborhood Spiderman is fond of recalling, With great power comes great responsibility. What is missing from this statement is the fact that everyone has great power and thus everyone has an enormous responsibility to use that power wisely. For better and for worse, you can make the impossible possible.

Owning the Theory

I recall a conversation I had long ago with my father. I was either fourteen or fifteen, I think, and the two of us were sitting on my mother’s bed in her bedroom where I used to live. It had been a rough day caused by the turbulence of many mood swings and anger over schooling.

It was after noon. My father had come uptown (he made a special trip to see me that day) so we could talk about things. The conversation was probably long, but I only remember two bits of it right now.

At one point, we spoke about the medications and how much I detested them. We bainstormed on what could be done, and after a while we concluded that there was only one way that I would be able to free myself of them: do what they do for me physiologically by myself.

Bipolar Disorder Has a Physical Root

Bipolar disorder is a mental illness which has physical roots. The brain of a bipolar person is literally physically different than the brain of someone who is not. One of the differences is in the mixture of the chemicals that the brain swims in.

A bipolar person’s brain is swimming in a bath of chemicals that have various different levels of neurotransmitters which cause the symptoms bipolar disorder is so known for. In other words, our brain’s chemical makeup is literally different from a “healthy” person’s brain. Since these neurotransmitters (chemicals) are actually physical molecules, bipolar disorder can be said to have a physical root.

My Personal Bipolar Brain

I was taking lithium and depakote at the time. Depakote is a medication which increases production of the neurotransmitter dopamine, if I remember correctly. Dopamine is one neurotransmitter which makes people feel happy and content. (In fact, surges of dopamine are exactly what taking drugs such as heroin cause in the brain.) Lithium is a mood stabilizer and, I think, it causes increases in seratonin levels. Seratonin is another neurotransmitter with a similar effect as dopamine.

Long story short, my brain was literally missing physical components it needed in order to function well. The only way to ensure that I would function properly and ultimately be happy and healthy was to give it these physical things that I did not have on my own. That is why I needed medication.

The Bipolar’s Catch-22

When I recognized that I am bipolar, I naturally started thinking in circular logic. Since I couldn’t trust my own emotions to be accurate representations of and responses to incoming stimuli, every time I was confronted with a choice of any sort I started asking myself “Is this really based on what happened or is it based on my bipolar disorder’s mutation of it?”

The nasty problem with bipolar disorder is that it is an illness which creates a self-fulfilling prophecy. Once I’d asked myself that question, I had to ask myself the same question about the answer I had just provided as an answer to the first question. “Was my evaluation really based on what I felt or was it based on my bipolar disorder’s permutations of my feelings?” This is a never-ending cycle that causes one to second-guess oneself all the time (and for good reason).

At its root, this second-guessing is caused by the fact that my brain doesn’t have a working set of the physical stuff it needs to make an emotionally aware and informed choice. There is no way around this except to give my brain these things, but the only way to do this is through medication. Since I didn’t want to take medication, there seemed, at first, to be no solution to this problem.

Moods Change the Brain’s Chemical Balance

Then it occured to us that since moods were caused by physical things (changes in the levels of neurotransmitters and chemicals in one’s head), changes in mood also changed the physical makeup (the balance of chemicals) in the brain. This means that when I was sad there was literally something different in my head than when I was happy twenty minutes later.

So since my moods change the physical makeup of my bain, it was logical that controlling these moods would mean that I could control the balance of neurotransmitter levels inside my head. By controlling moods well enough as to orchestrate the same levels of neurotransmitters which the medications gave me, I would be able to effect the same change as I had been getting with the medication without actually taking the medication.

Of course, this brings us back to the problem of the chicken-and-the-egg, to our catch-22. In order for this to work, I needed to create the proper chemical balance in my head without having the proper chemical balance in there to start with and without having the physical chemicals I needed to give myself said balance. What to do?

Journey Towards Self-Awareness and Control

Like I said at the start of this entry, humans are amazing creatures. We can make the impossible possible. The only way out of the dilemma of my bipolar disorder versus its need for medications that I had was to make the impossible possible.

Fighting Internal Demons

At the end of the talk with my father, he stood up and walked towards the doorway. He sighed heavily. Then he stopped and turned around, with both a genuinely sympathetic and understanding expression on his face. He said, Oi, vey, vey, my boy is fighting with his internal demons.

Fighting, or perhaps taming, my internal demons has been what my entire life has always been about. In fact, I think that most people’s lives focus around this issue, but I was lucky enough to have a parent who correctly addressed this issue directly and made it the top priority in my formative years. The process is long, hard, bloody, cruel, depressing, but ultimately rewarding. It’s also not even close to being over.

This battle with my own demons is the process of making the impossible possible. It’s what has enabled me to stay largely self-aware a good deal of the time, which is necessary to maintain a semblance of control over my moods so I can control, more or less, what kinds of chemicals are in there at any given moment. It’s literally the impossible fight for me to win.

Hope Everywhere

But I do have hope. Today, after my squash game with my uncle, I came home and was reading Greg’s blog, when I came upon this entry of his linking to several video clips of mind tricks.

One of the clips addresses the issue of the power and danger of the human being’s ability to believe things head-on, and that was what inspired me to write this entry. In fact, dangit, I meant to be working on my site and now I’m late for a party. See what you did, Greg? ;)

Stuff like this always reminds me of the incredible power we hold over our own lives. That makes me happy. Stuff like this also always reminds me about how many people give that power up so easily, often without even knowing they had it in the first place. That makes me sad.

People are often surprised when I tell them that I no longer take any medications for my bipolar disorder. Sometimes this is because they’ve heard me advocate the importance of medications. Other times it’s because they don’t understand how I can be bipolar and still be okay without them.

The Obligatory Disclaimer

Before I explain why I no loner take medications, I need to make a few things crystal clear:

• Medications saved my life. Without them, I literally might not be here today. They are an invaluable part of treatment for bipolar disorder and if you have been prescribed medications by your psychiatrist, you must take them. (I did.)

• There is absolutely nothing wrong with taking medications prescribed by a mental health professional. In spite of what you may be hearing elsewhere, taking medications does not make you “less good” of a person in any way. Taking medications doesn’t make you weak, it actually strengthens you in many ways. They certainly strengthened me.

• Regardless of personal feelings, you must involve your doctor in your decisions to change the dosage or kind of medication you are taking, or else you are just asking for trouble. It took me several tries to find a doctor with whom I could feel comfortable speaking freely with and who would respect my input in my treatment. This was a vital first step for me before starting to experiment with my medication’s dosage because there is no substitute for a professional’s advice.

• During this entire process, I was seeing a licensed psychologist who I trusted implicitly. No matter what anyone else says, I strongly believe that having a therapist is the single most important support mechanism you can have. Friends and family are wonderfully helpful and nothing short of necessary, but a professional therapist can provide objectivity and insight that no one else can, and which bipolar disorder patients need. (At least, I did.)

• Just in case it isn’t obvious yet, I am not a mental health professional and nothing I say should be interpreted as medical advice. I speak solely from personal experience, and I have no doubt that you are different from me. Everything I say is about me and only me.

My Simplistic Logic

Now that that’s out of the way, allow me to share my own reasoning. Like many other people with bipolar disorder, I was told that I would need to take medications for the rest of my life. In fact, I took them for about six years, from the ages of twelve to eighteen.

The short answer to the question “How come you’re no longer taking medications,” is because I no longer need them to function. I think that medications, like every other form of treatment, are a tool and nothing more. You can use them to modify your base mood and decrease the standard deviation of your mood swings and episodes.

For many people, like they were for me at one time, they are an absolutely critical tool and need to be used constantly, much like a stove-top range or refridgerator or pen and paper. There is absolutely nothing wrong with that. Lots of people I know don’t even want to think about going off their medications because it is such an important tool for keeping them stable and in a good state of mind.

Specific Reasons

For me, however, there were several reasons why I wanted very badly to no longer take medications. For instance, they had a load of side effects that I simply could not tolerate. These inclued but were not limited to:

Side Effects I Experienced

• Photosensitivity (pain in my eyes caused by light).
• Lethargy, apathy, and sleepiness.
• Frequent urination.
• Difficulty focusing and intense trouble comprehending written text.
• Weight gain.

Lack of Emotional Self-Awareness

The most prominent reason however, was the fact that they were simply too effective at quelling my emotional self. In other words, the medications doctors prescribed for me worked so well at quieting emotional uprisings that handling my emotional wants and needs, outbursts and swings, could have been completely relegated to the medications.

All I’d need to do is a pop a pill and I’d be an emotional zombie for the rest of the day. That’s not how I saw myself growing up. Remember, I was a young teenager at the time.

In order to grow up and increase my emotional intelligence, I knew I had to actually deal with feeling emotions on my own and not with a pill that abolished all of my feelings for me. So I started slowly reducing the dosage I was given. The net effect was that I could slowly turn up the amount of emotional “volume” I wanted to handle by myself and still let the medications mitigate a portion of it for me.

Getting to the point where I was completely free of medications was an extremely slow process. It took me four years of being stable on medications just to be able to safely cut my dosage in half. I expected the other half to be no easier, but thankfully, with all that I had learned during the first four years, it was.

All of those dosage experiments, of course, (except the last bit) were done in conjunction with supervision from my psychiatrists and while I was seeing a psychologist (a therapist). That was important: a psychiatrist can help you with your medications but only a psychologist, and only one that you really like, is qualified to help you deal without the medications. No friend, no family member, and no stranger with a kind heart can help you as much as a therapist, in my humble opinion. (Though it is important to seek out other forms of support too.)

Life Without Medications

Now that I am off medications, don’t think for a moment that my life has suddenly become easily manageable. If anything, it’s far harder; I have mood swings all the time, I am constantly fighting a battle against irritability and a lack of motivation, and I still experience majorly disturbing bipolar symptoms like racing thoughts, hypersexuality, and hypomania. Nevertheless, despite all of that, I have learned how to handle myself well enough so that I can still (at least for the most part) function in day-to-day life.

You won’t find me going on a spending spree during a manic episode. You won’t find me sitting in a corner of my apartment with a kitchen knife pressed into my wrists. You won’t find me blowing up at friends or family at the slightest provocation (though this one is really hard not to do).

You will find me taking deep breaths to combat a mood swing. You will find me working on personal hobbies during a hypomanic phase. And you will certainly find me biting my tongue when I get into pointless arguments.

The bottom line in all this is that, while the emotional impetus to do all sorts of things that would be harmful to me exist all the time, I no longer respond to them in the same way that I used to. This is nothing short of a minor miracle for me, since at one point in my life I was completely under the control of my mood’s whims. Changing that has not been easy, but it has been unbelievably rewarding.

Finally, it should also be noted that all of this is possible while still on medications, and much of it indeed happened like that for me. No form of treatment is exclusive of another, and most of the time different treatment regiments actually spill over and benefit one another. Everything I used (and still use) to help me, from medications to therapy to support from family and friends, contributed major benefits that I don’t think I could have gone without.

In the end, I’m still learning how to handle myself in more effective and efficient ways. It is a never-ending journey of self-reflection, challenges and successes (and failures), and just growing up. Even after all this I realize I have a long way to go. That’s life.

As a general warning, those of you who are sick of the blogosphere’s typical unadulterated flow of personal outcryings will probably want to stop reading my blog for the next…well for a while, anyway. With that out of the way, we now return to our regularly scheduled programming.

Sleep Woes

The last thing I wanted to do tonight was be awake. Unfortunately, I can’t sleep. Since I’m not one to drown out my sorrows with booze or drugs that leaves me with very little alternative except to be awake right now. I managed to sleep for a few hours, from about 9 o’clock or so ’til almost 2 in the morning, but I was really hoping not to rise before the sun today.

Last night, before I went to bed, Danica called the home line. She asked if it was okay if she would sleep here tonight. I told her that I couldn’t kick her out like that, so of course it was all right if she slept here tonight. She offered to sleep on the couch, instead of in the bed with me, which I gratefully accepted.

During the very short conversation, I told her that she has “two months” to find another place to stay. I really meant until the end of next month, but I was tired and my brain seems to have developed this nasty habit of generalizing things when I’m tired. She’s paid her February rent already, for instance, and I can’t very well just kick her out on the street. (Even though she’d end up at Randy’s instead of on the street, but whatever.) I told her that if she finds a place before the end of the month, I’ll refund some of her rent money this month. If she doesn’t, but she finds a place before the end of next month, I’ll refund some of her rent money that month.

I wish I were only being really nice, but the full truth is that I’m trying to provide incentive. As if the fact that the tension in the air isn’t enough incentive already. Or would be, if she were here.

Home Alone. Again.

I went online briefly before bed to delete junk mail and try to thank the kind people in #polyamory on UnderNet (the IRC polyamory chatroom) for helping me out the other day. Much of what they said provided either helpful reminders or wise insights. My router was acting up in a strange way, however, and wouldn’t easily connect to my laptop via Wi-Fi.

Expecting Danica to arrive home and probably want to check her email and the like, I wrote her a short note on a sheet of printing paper and laid it on her laptop. I’ll read it now:

Danica,

Wi-Fi is finicky. If the Internet won’t work that way, use an ethernet cord. You can take the one from my laptop. Thank you for giving me my space tonight.

—Meitar

I sat looking at it for a few moments. I got up to munch on some nuts. I drank a bit of carrot juice. Then I came back and added to it on the opposite side:

Also, there is mixed fried meats from a Spanish restaurant in the ‘fridge. I will likely toss it, so feel free to enjoy it.

I held the pen in my hand. For some reason, I didn’t want to put it down. So, I continued writing:

I would like to ask some logistical questions, too, (e.g. electric bill), so if you leave before I awake, please leave a note letting me know when I can speak with you about these important things.

I considered signing, “Love,” but after a moment, I ended it with, “Thank you, —Meitar.” Then, I went to bed, and mercifully drifted off to sleep very quickly.

Seeking Support

I awoke needing to pee. I got out of bed and peered into our living room. I didn’t see anything and everything seemed to have been placed where I left it. When I turned on the light, I saw that, indeed, everything was untouched and that Danica was not here.

I went to the bathroom, went back to bed, and tried to fall back asleep. However, despite not wanting to be awake and alone tonight, I eventually got out of bed and went online. Thankfully, I got an IM from a friend almost instantly, and I’ve been speaking with people since then. It’s not quite like being in the same room as somebody else, but at least, in effect, I’m not totally alone.

When I spoke with my father earlier today (er, yesterday), he mentioned that it might be wise to consider taking the medications for Bipolar Disorder again. I told my father that I did not plan on taking medications if I could help it. However, I do not know how bad this will be, and I am prepared to accept the help of a tool like medications to help myself get out of a rough spot should I need it.

I don’t want to be numbed. But, then again, maybe I do. Lithium can be like emotional morphine, and right now, I am wounded….

Joining discussion groups about bipolar disorder has really inspired a lot of thoughts on the matter. Frankly, I don’t know why I didn’t bother to do it sooner. And on that note, here are some more thoughts. This time they’re about working with doctors when the desire to experiment with meds strikes. Of course, the standard disclaimer applies: these are just my own musings, they shouldn’t be taken as a prescription of any kind, etcetera, etcetera, etcetera.

I Do Know Thyself

Doctors who think they always know best are crap doctors. Doctors who ask you what you think and don’t assume that they are all-knowing are the ones I want.

In my opinion, there are very few cases where I would be willing to believe that my doctor knows me better than I know myself. However, I must concede (without a second thought!) that I would be getting in way over my head if I try to pretend that I know enough about medications to start tuning my dosage by myself or believe that I have a better understanding about which medications will work better, or worse, for me.

Fact of the matter is only a professional in the field of psychopharmacology could possibly have the knowledge required to make fully informed decisions about those sorts of matters. Any confidence that I may have on the matter is purely delusional. Put a little more graciously, the best I could hope for was a coincidental success.

Trust Thy Treater

The point here is that doctors are there as guides, as confidants, as advice-givers. They are to be consulted because of their expertise in the field, but their advice is not to be taken independant of my own intuition and/or knowledge of myself. If I feel strongly about something, there’s got to be a reason for that; even if that reason is ultimately inconsequential or inaccurate insofar as reality goes the feeling deserves expression. Naturally, that’s true across the board, but it is of particular relevance here because these sorts of feelings frequently come up as the subject of doctor-patient disputes.

So here’s where building a relationship with one’s doctor, psychologist, and/or psychologist is one of the most important things one can do to improve your treatment. Never forget that you are the one in treatment, and always remember to think twice about everything you feel.

The Bottom Line

There’s some between-the-lines advice there, of course, but the bottom line is worth repeating: ask for your doctor’s advice because their advice is always worth considering. Trust that they know more than you do. The final choice, however, (if you have the necessary faculties to make a final choice, and are a legal adult, and those are issues which will not be touched upon here) is yours and yours alone. The gravity of that responsibility must not be lost on you.

Do This

To end on a more practical note, everytime I was thinking of tinkering with my meds I asked my doctor what he thought about my experiment. If he responded favorably, I told him I’d like to give it a shot and was seeking advice on how to go about the trial safely and effectively. I actually learned some important things about pharmacology that way.

If he indicated that it was a bad idea, I asked him as many questions as I could think of about why he thinks that way. Usually, I was be able to tell immediately if he was just blowing me hot air or was sincerely considering my questions. I suspect most bipolar people will be sharp enough to pick up on this. We’re known for being super slick at times, after all.

Finally, if he responded indifferently, it was time to go get another doctor.

I was lucky; my first prescriptions for treating bipolar disorder was a mix of Depakote and Zyprexa (whose clinical name is actually Olanzapine, but is marketed in a variety of different ways). That didn’t work for me. I gained over 60 pounds in 60 days, and ended up ballooning from 110 pounds to 177 pounds with no sign of slowing down.

I was taken off the Zyprexa and put on Lithium. So my cocktail was 1250mg of Depakote, plus 900mg of Lithium daily. That worked pretty well for me. Over time I have been able to reduce that dosage down dramatically, but that was only possible due to (literally) years of actively, consciously, teaching myself how to handle my own emotions and swings.

Still, I know that I was lucky. I have corresponded with folks who have been looking for medications that will work for them for more than three years and have still not found anything suitable. They are still looking.

I would say, however, that how “religiously” one takes one’s medications could have a really big impact on how well they work. That is to say that if you don’t take them exactly as prescribed, you’re going to find it a lot harder to get a working cocktail. I’ve got no proof, though, just an impression from speaking with many people about it.

That said, I think it’s important not to put up with side effects that are too negatively impacting your quality of life. What constitutes too negative an impact on your quality of life is, of course, subjective. The basic idea, though, is that something that works for you is supposed to increase your quality of life. It’s like if you stub your toe. You’re not going to stub your other toe just to make you forget about the first one.

Another important point to make is that medications are in fact limited to increasing quality of life. In that sense, they are just as effective (and sometimes far less so) than various simple things you can do every day. Whatever makes you feel better is, for all intents and purposes, a medication or treatment for bipolar disorder. And that’s not even a far-fetched thought, considering bipolar disorder is something we have to live with and deal with every second of every waking moment of our entire lives. Writing, computing, and getting some fresh air can very often have just as profund an effect on me as taking a pill might. That’s actually been the key to being able to reduce my reliance on medications while not relapsing. Modern medical science has very little to do with cures and a lot to do with quality of life. Afterall, we still can’t cure viruses.

(Somewhat tangetially, antibiotics and other medicines you may be given do nothing more than help your immune system fight off the infection and symptoms of viruses. But once you are infected with a virus, you will have it for the rest of your life. And on a even further tangential topic, that’s precisely the point most people seem to miss when they scoff at safe sex practices.)

I have a visceral dislike of Prozac when employed to treat bipolar disorder.

Not once can I recall a single time when I corresponded with someone who has said that it has worked for them. The only situations where it did not cause extraneous problems is when it was used as part of a massive drug cocktail in order to nullify or soften the side effects of another drug in that cocktail.

My (non-professional) medical advice: if you need to take drug B to counteract the effect of drug A, then drug A is not for you.

Before I was diagnosed with bipolar disorder, I was diagnosed as “clinically depressed” and prescribed prozac. In the one week I took it, I did not sleep a wink and was literally running into walls due to a huge manic episode it spun me into. My mother pulled me off the medication after trying to reach the doctor who prescribed it to me for 4 days without an answer. Bastard. Sometime later, I bought a pin with a smiley face on it and the words “I took my prozac today.”

But hey, I’m no Ph.D. Has anyone else ever had positive experiences with Prozac when used to treat bipolar disorder?

So just the other day I was asked about my experiences with litium. Lithium is a mood stabilizer.

That’s precisely what my experience has been. For me, it was frighteningly effective. “Numb” was a mild word to use what I felt after taking a high dose. More luke, “dead,” imho.

That’s one reason why I worked so hard at reducing my dose. For me, lithium didn’t just cut out the highs and lows, but effectively killed any ambition and motivation to do anything. Turned me into a living zombie for a while.

But that’s before the dose was really worked out well enough. So while that sounds horrific, it’s really just a sign that I was taking too much of it. Lowering the dose did help, and the effect of that action was a lot more turbulent moods. Which, in my case, was “normal.”

So the key is really using lithium, and other medications, as tools to help you control your reactions to your moods on your own.