The Book Crazy Doctor: Mixing Drugs and Mental Illness (Triple A Press, 2012)
By Peter J. Dorsen, M.D., LADC
Here’s the propaganda I have sent out to encourage anyone with their own notions about bipolar disorder to learn about my struggle and some of the ingredients to achieve happiness and stability.
A dear friend when I admitted that writing a book about my fall from grace and the struggle to resurrect from the ashes was maybe narcissistic. “Hey, ALL autobiographies are narcissistic!”
Uh, oh….here’s where the self-focusing leaps out to you our readers:
Here’s what I say about myself (in the third person, no less):
Dr Dorsen certainly has his share of war stories. Growing up in New Jersey as the son of a mother, a physician, and a successful yet disabled father, brought their share of sometimes bitter sweet events into his life. He has tried on many hats: a classics degree from Dartmouth, a sometimes struggling medical student, a stint at “The John,” (Johns Hopkins) for medical residency, accomplished creative nonfiction writer, a latter day cross country ski racer, father, physician. And a blogger with Tim Kuss so we can put out the word…..
Maybe you too can relate to the struggle for life bipolar disorder can bring.
His process, an often painful personal struggle with bipolar disorder and co-occurring self-medicating substance abuse, has made Dr Dorsen’s journey a roller coaster of abysmal failures and walloping successes.
So hop on board and explore my story as it may make yours more understandable.
Crazy Doctor: Mixing Drugs and Mental Illness is ultimately a reassuring guided tour by Dr. Dorsen of how bipolar illness impacted his life from childhood to only recently when he finally experienced the right medications and surrendered to a simple program of recovery.
Now this really is beginning to sound narcissistic isn’t it?
Dorsen is the author of over 150 freelance and peer-reviewed articles as well as the Vikings Change the Play Against Alcohol and Other Dangerous Drugs (Deaconess Press), and Dr D’s Handbook For Men Over 40: A Guide to Health, Fitness, Living, and Loving in the Prime of Life (Wylie and Sons). He lives in Minneapolis with his Kenyan-born wife Dinah and their Labrador, Candy.
Dr. Dorsen aka “Crazy Doctor,” is currently a satisfied addiction counselor, motivational speaker, writer, husband and proud father of three beautiful young women.
Oh, my mother, Lydia would be so proud!
Contact Information: Obtain my book as a paperback or on Kindle through LULU Press or Triple A Press directly.
I hope you will find some more information on your exploration of this painful yet passionate saga of life.
Monday, March 19, 2012
Wednesday, February 8, 2012
Using CBT with Bipolar Disorder
Cognitive Behavioral therapy is an evidence based practice for bipolar disorder as well as for unipolar depression. One way to access the skills of CBT is to go to therapy with a CBT practitioner. It is my belief, however, that the goal of a CBT therapist is to help one's clients understand and use CBT skills on their own. Those of us experiencing episodes of depression, whether mild or severe may benefit from the same kind of cognitive restructuring that folks with unipolar depression find helpful. In low moods we need to recognize pessimistic thinking and exaggerated self-criticism.
Clients with higher levels of mania are often helped to adjust their thinking to accept the need for medications and professional help. I am thinking that a more challenging area is for those of us experiencing milder mania. Hypomania can be very seductive, because it feels so damn good. The addictive voice of hypomania tells us to disregard feedback and criticism from others. Consequences of mild mania are less severe for the short term, but have the potential to affect our careers, our relationships with partners, parents, children and friends.
In my early recovery I was fortunate to get a strong dose of challenges to my "normal" way of thinking. When one is put in a position of getting a great deal of feedback from others, including peers and counselors, one may learn to consider alternative avenues of thought seriously. Also, treatment can provide the opportunity to identify priorities in life, such as a career, a committed relationship, parenting children and positive connections with family and friends. Mania, whether mild or severe tends to be self-focused, hedonistic and isolative, interfering with many of these priority values.
With mild mania, change may require time projection. It may be easier for those of us who have already experienced destructive consequences in our lives. For example, I can ask myself if I really want to lose ANOTHER job or relationship or if I like drifting from friendship to friendship without any permanence? I can notice old patterns of thinking and behavior that have cause me problems in the past. When others challenge me, I can listen and consider options and experiment with small changes that can lead to more and more significant changes.
Some examples. Racing thoughts have had a history of interfering with sleep. I have learned that progressive muscle relaxation and imagery can help me disperse these thoughts and relax my body to promote sleep. I have also learned to change what i am doing about every 30 minutes to try different approaches to the problem. Right now, I am writing this to divert the excess mental energy into a positive form. In a minute I will try lying in bed for a while. more examples will be coming.
Remember, You CAN change the way you think and feel!
Clients with higher levels of mania are often helped to adjust their thinking to accept the need for medications and professional help. I am thinking that a more challenging area is for those of us experiencing milder mania. Hypomania can be very seductive, because it feels so damn good. The addictive voice of hypomania tells us to disregard feedback and criticism from others. Consequences of mild mania are less severe for the short term, but have the potential to affect our careers, our relationships with partners, parents, children and friends.
In my early recovery I was fortunate to get a strong dose of challenges to my "normal" way of thinking. When one is put in a position of getting a great deal of feedback from others, including peers and counselors, one may learn to consider alternative avenues of thought seriously. Also, treatment can provide the opportunity to identify priorities in life, such as a career, a committed relationship, parenting children and positive connections with family and friends. Mania, whether mild or severe tends to be self-focused, hedonistic and isolative, interfering with many of these priority values.
With mild mania, change may require time projection. It may be easier for those of us who have already experienced destructive consequences in our lives. For example, I can ask myself if I really want to lose ANOTHER job or relationship or if I like drifting from friendship to friendship without any permanence? I can notice old patterns of thinking and behavior that have cause me problems in the past. When others challenge me, I can listen and consider options and experiment with small changes that can lead to more and more significant changes.
Some examples. Racing thoughts have had a history of interfering with sleep. I have learned that progressive muscle relaxation and imagery can help me disperse these thoughts and relax my body to promote sleep. I have also learned to change what i am doing about every 30 minutes to try different approaches to the problem. Right now, I am writing this to divert the excess mental energy into a positive form. In a minute I will try lying in bed for a while. more examples will be coming.
Remember, You CAN change the way you think and feel!
Wednesday, December 21, 2011
Having Bipolar Disorder versus being bipolar
Bipolar Disorder is a disease. It is not who I am. I am so much more. To say that I AM bipolar may imply that there is no hope of transcending the worst symptoms. The term bipolar itself shows attention only to the extreme moods of mania and depression. Moods do not exist only as these extremes. There is rather a continuum of moods marked by at least 6 divisions. Starting with low mood, there is not only major depression, but also minor depression. People with Bipolar Disorder can also go through long periods of euthymic , or "normal" mood. Then there is mild mania, known as hypomania and full-blown mania. Another point on the continuum would be mixed states, where symptoms of mania and depression are combined,
It may be best also to distinguish between being an addict and having addiction. I am more than my addiction. Even when I was using i had positive qualities and potential. Our self-esteem may be damaged by identifying ourselves with this scourge on humanity. We are learning that there are various markers or "stages" of abstinence and recovery. Our unifying factor is that we are all somewhere on the journey. Also, I believe that those of us with bipolar disorder can be at different places in our recovery.
So what is recovery as applied to bipolar disorder? it seems that medication compliance has been the standard of recovery for many mental illnesses, This seems to assume that the disorder has been properly diagnosed and that the optimal medication is not only currently in existence, but has been correctly prescribed, Unfortunately, it has unfolded that different people with the same disorder respond better to different medications or combinations of medications.
Research has shown that non-medicine approaches to the treatment of bipolar disorder are also effective. To be fair, the best results were achieved with pharmacotherapy (use of medication plus the therapy). One example of this is Interpersonal Social and Rhythm Therapy (IPSRT) developed by Ellen Frank and others. They developed a 5 item social metric which advocates for regularity with 5 behaviors: getting out of bed, first contact with another person, Starting work, school, volunteering or family care, dinner and bed-time. They found that clients gained more mood stability as they got closer to performing theses function about the same time every day. There is also a 17 item version of the social metric. Attention to the consistency of sleep may be another factor in mood stability. Frank and associates seem to have begun the work of helping clients to change their daily routines.
Other empirically supported psychosocial treatments include Cognitive Behavioral Therapy and Marital and Family Therapy. A specific form of family therapy, known as Family Focused Therapy has been shown to be effective for clients with bipolar disorder and their families. A growing body of evidence-based practices implies new parameters for being in recovery from bipolar disorder. My own experience is that different people are attracted to and therefor more likely to practice different behaviors that contribute to mood stability, Perhaps we can see recovery tools as a buffet. As more of the tools are selected and used we can become healthier and healthier. After all, isn't it all about balance?
It may be best also to distinguish between being an addict and having addiction. I am more than my addiction. Even when I was using i had positive qualities and potential. Our self-esteem may be damaged by identifying ourselves with this scourge on humanity. We are learning that there are various markers or "stages" of abstinence and recovery. Our unifying factor is that we are all somewhere on the journey. Also, I believe that those of us with bipolar disorder can be at different places in our recovery.
So what is recovery as applied to bipolar disorder? it seems that medication compliance has been the standard of recovery for many mental illnesses, This seems to assume that the disorder has been properly diagnosed and that the optimal medication is not only currently in existence, but has been correctly prescribed, Unfortunately, it has unfolded that different people with the same disorder respond better to different medications or combinations of medications.
Research has shown that non-medicine approaches to the treatment of bipolar disorder are also effective. To be fair, the best results were achieved with pharmacotherapy (use of medication plus the therapy). One example of this is Interpersonal Social and Rhythm Therapy (IPSRT) developed by Ellen Frank and others. They developed a 5 item social metric which advocates for regularity with 5 behaviors: getting out of bed, first contact with another person, Starting work, school, volunteering or family care, dinner and bed-time. They found that clients gained more mood stability as they got closer to performing theses function about the same time every day. There is also a 17 item version of the social metric. Attention to the consistency of sleep may be another factor in mood stability. Frank and associates seem to have begun the work of helping clients to change their daily routines.
Other empirically supported psychosocial treatments include Cognitive Behavioral Therapy and Marital and Family Therapy. A specific form of family therapy, known as Family Focused Therapy has been shown to be effective for clients with bipolar disorder and their families. A growing body of evidence-based practices implies new parameters for being in recovery from bipolar disorder. My own experience is that different people are attracted to and therefor more likely to practice different behaviors that contribute to mood stability, Perhaps we can see recovery tools as a buffet. As more of the tools are selected and used we can become healthier and healthier. After all, isn't it all about balance?
Tuesday, October 25, 2011
Who Does Best on Lithium?
Genetic clues could help fine-tune treatment for bipolar disorder
By Marjorie Centofanti
The amygdala is hit hard in bipolar disorder. The small almond-shaped structure that nestles in each temporal lobe assumes a major role in quality of life. It’s a crossroads for fear, anger,and emotional learning. It also affects mental state. But something happens to the organ in bipolar disease. Blood flow increases and MRIs don’t look the same; there’s a clear loss of volume.
Enter lithium. Although the mood-stabilizing mineral doesn’t help everyone with bipolar disorder, for many, results are remarkable. Functionally, the amygdala acts healed.
But what happens to it physically? Can lithium actually reverse the organ’s structural damage? Pamela Mahon, whose specialty combines neuroimaging and genetics, aims to find out. AS part of Project Match, a broad effort to help people with bipolar disorder find the best medication as quickly as possible, Mahon is surveying brain MRIs from each new patient who joins the study. “We’ll be comparing the images of those who respond well to lithium with those who don’t,” she says. The hypothesis is that the amygdala will plump out to normal size in people helped by the drug.
At the same time, Mahon’s colleagues are doing animal studies and analyzing patients’ DNA sequences, combing for genetic clues that signal who will be a lithium responder.
The next step, she says, will be to match the genetic variations with any physical differences the images reveal. “If things work out, that will let us connect the genes, ultimately, to the mechanisms of bipolar disorder itself. You’re linking gene to brain understanding disease.”
But a clinical benefit could come sooner. With positive results—admittedly a leap, at this point—and more medications tested, comes a prize: a set of genetic markers packaged as a routine lab test. A blood sample could tell physicians if lithium or Depakote is better to even out a patient moods. More studies could tailor antidepressants—Prozac? Effexor? Wellbutrin?—to a person’s brain chemistry. Hitting that goal would change the face of mental illness worldwide.
Hopkins Medicine Fall 2011 (used by permission)
As someone who himself has thrashed about with and from plenty of antidepressants, lithium, Depakote, and now stabilized on Trileptal, wouldn’t it have been preferable to have utilized genetic techniques to or away from lithium, often regarded as the “gold standard” of mood stabilizers. Likewise, down the pike, such investigators may find a superior route to the right antidepressant for those with unipolar mood challenges. We are all hopeful for a smoother journey to peace and tranquility, perhaps going first class rather than coach.
Peter J. Dorsen, MD, LADC
By Marjorie Centofanti
The amygdala is hit hard in bipolar disorder. The small almond-shaped structure that nestles in each temporal lobe assumes a major role in quality of life. It’s a crossroads for fear, anger,and emotional learning. It also affects mental state. But something happens to the organ in bipolar disease. Blood flow increases and MRIs don’t look the same; there’s a clear loss of volume.
Enter lithium. Although the mood-stabilizing mineral doesn’t help everyone with bipolar disorder, for many, results are remarkable. Functionally, the amygdala acts healed.
But what happens to it physically? Can lithium actually reverse the organ’s structural damage? Pamela Mahon, whose specialty combines neuroimaging and genetics, aims to find out. AS part of Project Match, a broad effort to help people with bipolar disorder find the best medication as quickly as possible, Mahon is surveying brain MRIs from each new patient who joins the study. “We’ll be comparing the images of those who respond well to lithium with those who don’t,” she says. The hypothesis is that the amygdala will plump out to normal size in people helped by the drug.
At the same time, Mahon’s colleagues are doing animal studies and analyzing patients’ DNA sequences, combing for genetic clues that signal who will be a lithium responder.
The next step, she says, will be to match the genetic variations with any physical differences the images reveal. “If things work out, that will let us connect the genes, ultimately, to the mechanisms of bipolar disorder itself. You’re linking gene to brain understanding disease.”
But a clinical benefit could come sooner. With positive results—admittedly a leap, at this point—and more medications tested, comes a prize: a set of genetic markers packaged as a routine lab test. A blood sample could tell physicians if lithium or Depakote is better to even out a patient moods. More studies could tailor antidepressants—Prozac? Effexor? Wellbutrin?—to a person’s brain chemistry. Hitting that goal would change the face of mental illness worldwide.
Hopkins Medicine Fall 2011 (used by permission)
As someone who himself has thrashed about with and from plenty of antidepressants, lithium, Depakote, and now stabilized on Trileptal, wouldn’t it have been preferable to have utilized genetic techniques to or away from lithium, often regarded as the “gold standard” of mood stabilizers. Likewise, down the pike, such investigators may find a superior route to the right antidepressant for those with unipolar mood challenges. We are all hopeful for a smoother journey to peace and tranquility, perhaps going first class rather than coach.
Peter J. Dorsen, MD, LADC
Friday, August 26, 2011
Hypomania
By Tim Kuss, LFMT, LADC
Hypomania is sometimes hard to distinguish from true mania. Rather than clear lines between mild mania(hypomania) and “full-blown mania, it seems that there is a continuum of symptoms, thinking and behavior that stretches across from euthymia (normal) to psychosis. I think of psychosis and milder delusional states as belonging to mania. Having said this, some degree of delusional thought seems to exist across such a continuum of mood states. Because of such a spectrum of dysfunction, hypomania although certainly enjoyable to sa person with bipolar disorder, has definitely resulted in self-defeating behavior for me.
I cannot be sure when hypomania first appeared in my life, but it was there before any of my psychotic episodes. Following the start of my recovery from chemicals, I did not have psychotic episodes for almost 10 years. I managed to stay out of psych wards, but experienced other negative consequences from my mood disorder.
Some of the symptom of hypomania can be grandiosity, irritability, rapid thinking, insomnia, loss of appetite, and hyper sexuality. On the positive side I tend to be very motivated and energetic and can get a lot of work done when I get hypomanic. Like many others with bipolar disorder, I frequently can use these positive mood swings while filtering out the negatives.
Hypomania, or mild mania is one of at least 6 mood states of bipolar disorder. By my own personal experience and through observation, I have learned that hypomania can last for months and perhaps years. Hypomania is very seductive, as it feels so damn good! It tends to have benefits such as perceived clarity of thought and decision-making. I have more creativity and psychic energy and use that creativity in an artistic form, which for me is writing and expansiveness which promotes relationships and connections with others. In hypomania, there is unfortunately also a high risk that a person may get into self-defeating behavior that is self-destructive. Three aspects of hypomania have been particularly self-defeating for me.
The first is grandiosity. I have made poor decisions when hypomanic, since I have not had the necessary mental filter to consider that I may be wrong. I have not had the necessary humility to ask others for feedback (or to hear their feedback). Grandiosity combined with expansiveness went into the equation of deciding to use drugs in my early 20’s, which precipitated deeper and deeper mania until I became psychotic and had to be institutionalized. I now have a firm rule about not using any amount of alcohol or other drugs and also limit my caffeine intake. This rule helps my mood to stay more stable.
Irritability is the second aspect of hypomania that has caused me a lot of trouble. I had role-models in my life that were irritable and became aggressive with others. I learned to blame others for “making” me angry and to act out my anger by yelling, throwing things, and, I must admit, on occasion hitting or hurting others. I have been fortunate in restraining my physical acting out to a few isolated incidents that did not hurt others excessively, but I did break valuable things early in my first marriage and I did scream at the top of my lungs at several partners and my oldest daughter. This behavior scared others and most likely created more distance in our relationships. I may have “won the battle, but lost the war”. Sometimes, my earlier behavior sometimes colors my present efforts to connect with those I have always loved.
I have had a long struggle sharing the third aspect of hypomania that caused me a lot of problems. It makes it easier that I speak of it from the perspective of a man in an 18 year committed relationship, with zero acting out with others during that time.
Some of my earlier partners had to deal with a series of affairs I had with other women. I have now learned that hyper sexuality can be a warning sign of growing mania that can lead to psychosis. I used to think that guilt was the main factor in contributing to psychosis after the first of these affairs, Later, I learned that my alcohol use was contributing to a kindling effect to increasing mania, Now, I know that hyper sexuality is a symptom of increasing mania, which could end in psychosis with or without chemical use.
Today, my perspective is that hyper sexuality does not need to be a negative thing as long as one makes positive choices about one’s behavior. These choices could include more sexual activity with my partner or simply pleasuring myself.
Wild thoughts can continue like adrenaline that doesn’t go away. I can’t sleep, have enhancement of my senses, feel irritable and euphoric, am incapable of continuing attention, neglect employment, have accelerated thoughts and speech, flight of ideas, unrealistic self-esteem with grandiosity, delusions, and increased activity. This all can lead to exhaustion, spending sprees, increased sexual activity, increased alcohol and drug use, and, for the unfortunate, death. These are notes from readings on hypomania. As I write many of these words, I am experiencing them. I have so much mental activity that I have been unable to sleep for hours. Luckily, I slept for at least 4 hours before this wakefulness. Fortunately, I was teaching my group about sleep management last night.
I do notice that it is hard to focus and concentrate. I have learned over time to keep redirecting myself to a task. No delusions today. I have my wife, friends, and co-workers to validate or challenge my perception of reality. I am over the buying sprees, the increased sexual activity, the my impulses of increased drug or alcohol use. I’m, planning on not going there again and am practicing my recovery program with help of my support network. Learning and writing about bipolar disorder is part of my recovery with not from bipolar disorder.
I am expecting soon to enter into my daily routine, which helps me stay grounded. It is 5:48 AM and I only need to survive until 6:15 when my wife wakes up. Meanwhile I am using this journaling as a grounding force. Later, I have 3 friends with bipolar disorder to talk with about my hypomania. They will “get it”. They will support me to continue with my routine, attend my support group tomorrow, keep taking my meds, and keep practicing my coping skills. I’m taking a break now to practice progressive muscle relaxation.
So I’m through another episode. My wife is up and we talk. I leave for work. Work keeps me grounded in reality. For 8 hours I will be held responsible by more objective measurements utilizing coherent thoughts and behavior. It is a place where I can apply my mental energy in a positive way. If I have too many days of continued hypomania I know I will need to talk to my doctor about adjusting my meds, as one of my supportive friends has suggested.
Hypomania is sometimes hard to distinguish from true mania. Rather than clear lines between mild mania(hypomania) and “full-blown mania, it seems that there is a continuum of symptoms, thinking and behavior that stretches across from euthymia (normal) to psychosis. I think of psychosis and milder delusional states as belonging to mania. Having said this, some degree of delusional thought seems to exist across such a continuum of mood states. Because of such a spectrum of dysfunction, hypomania although certainly enjoyable to sa person with bipolar disorder, has definitely resulted in self-defeating behavior for me.
I cannot be sure when hypomania first appeared in my life, but it was there before any of my psychotic episodes. Following the start of my recovery from chemicals, I did not have psychotic episodes for almost 10 years. I managed to stay out of psych wards, but experienced other negative consequences from my mood disorder.
Some of the symptom of hypomania can be grandiosity, irritability, rapid thinking, insomnia, loss of appetite, and hyper sexuality. On the positive side I tend to be very motivated and energetic and can get a lot of work done when I get hypomanic. Like many others with bipolar disorder, I frequently can use these positive mood swings while filtering out the negatives.
Hypomania, or mild mania is one of at least 6 mood states of bipolar disorder. By my own personal experience and through observation, I have learned that hypomania can last for months and perhaps years. Hypomania is very seductive, as it feels so damn good! It tends to have benefits such as perceived clarity of thought and decision-making. I have more creativity and psychic energy and use that creativity in an artistic form, which for me is writing and expansiveness which promotes relationships and connections with others. In hypomania, there is unfortunately also a high risk that a person may get into self-defeating behavior that is self-destructive. Three aspects of hypomania have been particularly self-defeating for me.
The first is grandiosity. I have made poor decisions when hypomanic, since I have not had the necessary mental filter to consider that I may be wrong. I have not had the necessary humility to ask others for feedback (or to hear their feedback). Grandiosity combined with expansiveness went into the equation of deciding to use drugs in my early 20’s, which precipitated deeper and deeper mania until I became psychotic and had to be institutionalized. I now have a firm rule about not using any amount of alcohol or other drugs and also limit my caffeine intake. This rule helps my mood to stay more stable.
Irritability is the second aspect of hypomania that has caused me a lot of trouble. I had role-models in my life that were irritable and became aggressive with others. I learned to blame others for “making” me angry and to act out my anger by yelling, throwing things, and, I must admit, on occasion hitting or hurting others. I have been fortunate in restraining my physical acting out to a few isolated incidents that did not hurt others excessively, but I did break valuable things early in my first marriage and I did scream at the top of my lungs at several partners and my oldest daughter. This behavior scared others and most likely created more distance in our relationships. I may have “won the battle, but lost the war”. Sometimes, my earlier behavior sometimes colors my present efforts to connect with those I have always loved.
I have had a long struggle sharing the third aspect of hypomania that caused me a lot of problems. It makes it easier that I speak of it from the perspective of a man in an 18 year committed relationship, with zero acting out with others during that time.
Some of my earlier partners had to deal with a series of affairs I had with other women. I have now learned that hyper sexuality can be a warning sign of growing mania that can lead to psychosis. I used to think that guilt was the main factor in contributing to psychosis after the first of these affairs, Later, I learned that my alcohol use was contributing to a kindling effect to increasing mania, Now, I know that hyper sexuality is a symptom of increasing mania, which could end in psychosis with or without chemical use.
Today, my perspective is that hyper sexuality does not need to be a negative thing as long as one makes positive choices about one’s behavior. These choices could include more sexual activity with my partner or simply pleasuring myself.
Wild thoughts can continue like adrenaline that doesn’t go away. I can’t sleep, have enhancement of my senses, feel irritable and euphoric, am incapable of continuing attention, neglect employment, have accelerated thoughts and speech, flight of ideas, unrealistic self-esteem with grandiosity, delusions, and increased activity. This all can lead to exhaustion, spending sprees, increased sexual activity, increased alcohol and drug use, and, for the unfortunate, death. These are notes from readings on hypomania. As I write many of these words, I am experiencing them. I have so much mental activity that I have been unable to sleep for hours. Luckily, I slept for at least 4 hours before this wakefulness. Fortunately, I was teaching my group about sleep management last night.
I do notice that it is hard to focus and concentrate. I have learned over time to keep redirecting myself to a task. No delusions today. I have my wife, friends, and co-workers to validate or challenge my perception of reality. I am over the buying sprees, the increased sexual activity, the my impulses of increased drug or alcohol use. I’m, planning on not going there again and am practicing my recovery program with help of my support network. Learning and writing about bipolar disorder is part of my recovery with not from bipolar disorder.
I am expecting soon to enter into my daily routine, which helps me stay grounded. It is 5:48 AM and I only need to survive until 6:15 when my wife wakes up. Meanwhile I am using this journaling as a grounding force. Later, I have 3 friends with bipolar disorder to talk with about my hypomania. They will “get it”. They will support me to continue with my routine, attend my support group tomorrow, keep taking my meds, and keep practicing my coping skills. I’m taking a break now to practice progressive muscle relaxation.
So I’m through another episode. My wife is up and we talk. I leave for work. Work keeps me grounded in reality. For 8 hours I will be held responsible by more objective measurements utilizing coherent thoughts and behavior. It is a place where I can apply my mental energy in a positive way. If I have too many days of continued hypomania I know I will need to talk to my doctor about adjusting my meds, as one of my supportive friends has suggested.
Saturday, August 13, 2011
Jail Cells
By Tim Kuss, LMFT, LADC
I’ve had several experiences with arrest and incarceration. With two of them I showed manic behavior. The first of these happened when I was about 21 years old. I had been using hallucinogens like LSD and mescaline experiencing hallucinations and delusions when high. I also had a series of what I considered to be “flashbacks” in which I experienced mostly pleasant delusions when not using. I understand now that my chemical use had triggered my bipolar disorder, serving as “kindling” contributing to increased symptoms.
I had been thinking that billboards and other signs were sending me personal messages and was ”following” these messages to a special place. I believed that my “true love” and good friends would be waiting for me at the end of the message trail, where we would be together. I began thinking that they had arranged a surprise party for me.
At one point my delusions led me to being hospitalized in a psychiatric ward. Later, I was following yet another “sign trail” which included barging through the back yards of some expensive homes on Summit avenue in St Paul. I imagine someone must have called the police. When they caught up with me, I had taken my shirt off and discarded it because I believed that I was supposed to do that. The police arrested me on Vagrancy charges, and put me in a jail cell.
They had taken my belt and shoes, asked me where I lived and my phone number. I began to think of myself as an oppressed man suffering from discrimination. I had been an anti-war protester in college and had spent a month marching with Father Grappi’s people in Milwaukee. i started singing the songs we had sung while marching:
“Oh Freedom, oh freedom over me...and before I’ll be a slave, I’ll be buried in my grave...and go home to my lord and be free” then on with several verses, including a few that I made up to go with the situation.
Then “We shall overcome” and several other songs. I had attended Buddhist temples while out in California, I went next to chanting “Nam myoho rengae kyo” and “Om” for my second hour of vocal renditions. The police did not attempt to put others in my cell. I spent some time attempting to lie on the spring on the lower bunk, as they had not provided a mattress. I think I was into my third hour of singing and chanting when my father showed up. He had gathered the few belongings taken from me and had paid my bail. We drove home quietly.
A similar occurrence happened about 19 years later. I had 15 years of sobriety and had been functioning as a chemical dependency counselor for 11 of those years. I was working the evening shift at a halfway house and went over the center line while making a left turn. It was a difficult turn and I imagine that I was tired. It was July 2nd, just before a three day weekend. One officer followed me into the parking lot behind my apartment building. For some reason, I commented that he had taken quite a risk by following me into this dark, isolated spot. He ran my driver’s license and found that I had a warrant, which turned out to be for a parking ticket I had forgotten about.
I wound up cuffed and put in the back of a squad car, despite protesting that my two daughters, ages 1fourteen and ten, were waiting for me to come home. In the jail cell, I had a deja vu experience of thinking that I had been discriminated against and began my routine of singing freedom songs alternating with chanting. This time I heard fellow prisoners yelling at me to shut up. It was a long 2 hours before my girlfriend arrived to pay the parking ticket and court fees.
Friday, July 8, 2011
Nida Takes on Co-occurring Illness
Peter J. Dorsen, M.D., LADC
Nora Volkow, M.D., Director of the National Institute of Drug Abuse(NIDA), in a recent research report, notes: “ Drug addiction is a mental illness.” She also emphasizes that with addiction, drug-induced changes in brain structure and function occur in some of the same brain areas (as) mental disorders…” Wow! Like we didn’t know this already? Unfortunately, society at large fails to put two and two together (if you will excuse the pun here) and believe that collaborative treatment is a must.
Major populations seem to be slipping through the cracks when it comes to treating those saddled unfortunately with the duality of drug dependence and maybe a preexisting mental challenge: schizophrenia, PTSD, bipolar disorder, you name it. Our prisons are teaming with co-morbidity ( 75% of offenders at the state or local level have co-morbidity yet “ services are greatly lacking within these settings.”
What about all those brave men and women returning from Afganistan or Iraq with PTSD ( maybe even 38,000 in the past five years!). You’re damned if you do and damned if you don’t. It’s a case of the lumpers and splitters once again: PTSD programs that don’t accept individuals with active substance problems versus traditional substance abuse clinics(SUDs) clinics who defer treatment of trauma-related issues (combat or noncombat).
When it comes down to discrepancies of treatment there is even an implicit paradox that physicians run the mental health facilities and WILL treat with antipsychotics and anxiolytics while substance abuse venues are skewed to treating just that and may not even have personnel who can or will prescribe despite the predominance of co-morbidity.
Volkow and her team from NIDA emphasize that there is a 40-60% vulnerability to addiction attributable to multiple genes, genetic interactions, and environmental influences. One can joke as one way of relieving angst how mental illness and substance abuse co-mingle by wondering if such predilections start with the drinking water. The study correlates psychosis and marijuana use, how nicotine may lessen symptoms of schizophrenia( a 90% rate of smokers). They note a significant association between mental illness and smoking: “schizophrenics have higher rates of alcohol tobacco, and other drug use.”
They remind us how the neurotransmitter dopamine is pivotal; that it is affected by addicted substances as well as depression, schizophrenia, and other psychiatric disorders.
The chaotic process often begins in adolescence: abusing “gateway” drugs and mental illness. I can relate yet all we had in the sixties was alcohol and nonetheless did a pretty fair job at abusing it. Currently, educators like Dartmouth’s President Kim spend anxious reflective moments disturbed by fears when the next undergraduate will die from alcohol on his campus.
We have on our table promising behavioral therapies that include multisystem therapy (MST) dealing with attitudes, family, and peers; brief family therapy(BSFT) for the oppositional-defiant youngster with a conduct disorder; cognitive behavioral therapy(CBT) helping us change harmful or maladaptive beliefs; therapeutic communities (TC’s) for resocialization, the neglected youth; assertive community treatment(ACT) with an individual approach; dialectical behavioral therapy (DBT) especially for the borderline personality who will self harm; exposure therapy (ET) to create real or simulated reruns and remove fear; and integrated group therapy (IGT) great for bipolar disorder and drug addiction.
The NIDA report is filled with theme and substance offering new ideas for approaching co-occurring illnesses. I heartily recommend obtaining the full report to explore further the direction thinking and treatment must go to better deal with these two illnesses. Not only do they appear to exist in the same part of the brain but should and can be treated better simultaneously often with the right medications and therapy.
Nora Volkow, M.D., Director of the National Institute of Drug Abuse(NIDA), in a recent research report, notes: “ Drug addiction is a mental illness.” She also emphasizes that with addiction, drug-induced changes in brain structure and function occur in some of the same brain areas (as) mental disorders…” Wow! Like we didn’t know this already? Unfortunately, society at large fails to put two and two together (if you will excuse the pun here) and believe that collaborative treatment is a must.
Major populations seem to be slipping through the cracks when it comes to treating those saddled unfortunately with the duality of drug dependence and maybe a preexisting mental challenge: schizophrenia, PTSD, bipolar disorder, you name it. Our prisons are teaming with co-morbidity ( 75% of offenders at the state or local level have co-morbidity yet “ services are greatly lacking within these settings.”
What about all those brave men and women returning from Afganistan or Iraq with PTSD ( maybe even 38,000 in the past five years!). You’re damned if you do and damned if you don’t. It’s a case of the lumpers and splitters once again: PTSD programs that don’t accept individuals with active substance problems versus traditional substance abuse clinics(SUDs) clinics who defer treatment of trauma-related issues (combat or noncombat).
When it comes down to discrepancies of treatment there is even an implicit paradox that physicians run the mental health facilities and WILL treat with antipsychotics and anxiolytics while substance abuse venues are skewed to treating just that and may not even have personnel who can or will prescribe despite the predominance of co-morbidity.
Volkow and her team from NIDA emphasize that there is a 40-60% vulnerability to addiction attributable to multiple genes, genetic interactions, and environmental influences. One can joke as one way of relieving angst how mental illness and substance abuse co-mingle by wondering if such predilections start with the drinking water. The study correlates psychosis and marijuana use, how nicotine may lessen symptoms of schizophrenia( a 90% rate of smokers). They note a significant association between mental illness and smoking: “schizophrenics have higher rates of alcohol tobacco, and other drug use.”
They remind us how the neurotransmitter dopamine is pivotal; that it is affected by addicted substances as well as depression, schizophrenia, and other psychiatric disorders.
The chaotic process often begins in adolescence: abusing “gateway” drugs and mental illness. I can relate yet all we had in the sixties was alcohol and nonetheless did a pretty fair job at abusing it. Currently, educators like Dartmouth’s President Kim spend anxious reflective moments disturbed by fears when the next undergraduate will die from alcohol on his campus.
We have on our table promising behavioral therapies that include multisystem therapy (MST) dealing with attitudes, family, and peers; brief family therapy(BSFT) for the oppositional-defiant youngster with a conduct disorder; cognitive behavioral therapy(CBT) helping us change harmful or maladaptive beliefs; therapeutic communities (TC’s) for resocialization, the neglected youth; assertive community treatment(ACT) with an individual approach; dialectical behavioral therapy (DBT) especially for the borderline personality who will self harm; exposure therapy (ET) to create real or simulated reruns and remove fear; and integrated group therapy (IGT) great for bipolar disorder and drug addiction.
The NIDA report is filled with theme and substance offering new ideas for approaching co-occurring illnesses. I heartily recommend obtaining the full report to explore further the direction thinking and treatment must go to better deal with these two illnesses. Not only do they appear to exist in the same part of the brain but should and can be treated better simultaneously often with the right medications and therapy.
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