My new book: Up from the Ashes: One Doc’s Struggle with Drugs and Mental Illness

Up from the Ashes: One Doc’s Struggle with Drugs and Mental Illness

(ebook, Amazon, July 2017)

I write about the bad times in my life. But as my story confirms, there is hope for anyone struggling with bipolar disorder with chemical abuse thrown into the equation.

“Dr. Dorsen’s personal and poignant life story is a risky self-disclosure that mirrors hope to anyone, regardless of profession, who may suffer from co-occurring illnesses.” – Bill Manahan, M.D., author of Eat for Health: Fast and Simple Ways of Eliminating Disease Without Medical Assistance

I was a professional, I was over 50, had a mood disorder that my treating doctors had neglected for decades even back to my childhood. Certainly, my illness was impacted by intermittent pot smoking over all those years. Now, I had relapsed. I was not sure the Board would ever really see how my dual illnesses impacted on my deterioration as a physician, father, husband, and member of a greater community. As my 16-year-old's guardian, I was able to temporarily obtain a medical subsidized housing for me and a shared food card for her and me.
            My recovery was emerging from the shame of failure. Yet the sharp reality of my current destiny let me look clearly at the then and now. Was hard manual labor punishment for my errant ways, or was my sentence an opportunity, at 62, to take a break from my profession — the process Joseph Slater describes in Self Renewal? In every sense, I have had to think out of the box and rediscover who I really am, to find my soul. I remember that I felt a kinship with the physician in Milos Kandahar's wonderful book, The Incredible Lightness of Being. Our protagonist has been banished from medicine for political reasons but enjoys the perks of his new profession traveling from apartment to apartment washing windows. He also gets an opportunity to intimately know the women who live there.
            I now believe I have become closer to the Zen of my life. I feel once again. How did I do it? At first, I attended about three AA meetings a week. By day, as I toiled, my body became harder. I endured an existence that was a trial of hot and cold, wet and dry, clean or dirty unlike the sterility of an unexamined life. My mental health was due to my sobriety and the right medical treatment. I no longer chose to self-medicate with pot and then enter a painful world of anxiety, panic, and depression.
            I went from day-to-day appreciating a new freedom. My life had been self-imposed chaos. I no longer wore the mantle of the medical profession. Sometimes even, I felt good in a new life of honesty and acceptance. I worked trustfully with a sponsor who was a supporter and confidant. I stuck doggedly with a psychiatrist I had known since 1983 and trusted. I now worked to define myself from a different perspective. I was a worker in the earth in search of a stronger, renewed persona; as Plato spoke for Socrates, "The unexamined life is not worth living."

No matter where we are coming from, a doctor like myself, or artist, we fear we will lose creativity by taking the medications. This is my testimony how anyone with bipolar disorder can be creative and functional again. My story is about the relief from suffering from mercurial emotional fluctuations with the right meds.

Popalos and Popalos in the seminal Bipolar Child confirm that bipolar disorder may well have started in kindergarten when I was described as a “Very active little boy.” My life would continue as a seasonal depression. But no one figured it out. Society punishes behavior while paying lip service to a brain disorder like mine.

“Telling this story lays out my guts for the world to see. In so doing, I have surrendered resentments over what I had no control over. Finally, I see, through pain and denial, the devastation my own illness. I am writing about a private personal journey of pain.”

Things Are Looking Up

By Peter J. Dorsen, M.D., LADC

It is so important to take what comes your way as not necessarily bad. In my last post, I confessed I was in the poverty corner.  I told how much I appreciated my sponsor even if he was pessimistic that sometimes in recovery and working back up, we take some hits.

I suggest keeping as active as possible and--if you are about to retire--make some plans.  Retirement and too much time on your hands can be a set up for depression or just saying, "What the hell, I'm not under any stress any longer, so I'll just start dropping my dosage.

Bad move. Maybe less or no stress but our brains still just aren't wired like most of those other critters out on those mean streets.  Let me reiterate by reemphasizing that any life stress can kick off cycling either starting as depression or as hypomania/mania.

Make up a safety plan as I have attempted to do. I can never figure why anyone would just be counting the days until retirement. Another fantasy for many is imagining never ending tee off time will be like heaven.  Unless you play like a pro, forget it. I am told that golf is not for those with weak egos or low self-esteem.  Retirement is of itself often the surrender of all those hats and cloaks of fame and position that made us who we were.  My mother, a retired physician bemoaned how, in her retirement years  she became a nobody

So this is to emphasize that we must be forever on the vigil so that we do not slip back into a dangerous predisposition for feeling worthless hence depressed, angry, stop our meds and then swirl into a vortex of our illness that may be most unsettling or debilitating.

I have to confess, I am having considerable trouble retiring and a significant cause of that is..I need the money.  My bank account continually reminds me that I am not a nonprofit company. I exercise every day (sometimes too much--and risk moodiness).  Eating frequently and avoiding simple sugars, and I avoid self-medicating (pot, alcohol, too much coffee).

Just as addiction is an equal opportunity destroyer, we all have both genetic and environmental (multifactorial) reasons to know we have propensity to relapse anytime. So too, we have also a genetically and environmental reason we can slip and slide back into dysfunctional patterns especially as we age and in fact have new stressors of aging and loss.

I still want very much to get  Kay Redfield Jamison's secret. Is she like the rest of us with bipolar 1 or 2? She must always assess the state of her illness. She deserves her privacy as much as any of us. I try to not take personally that I sent her my book, Crazy Doctor, but, alas, no response. I suspect though that all of us deserve a little mystery but that should probably exclude our loved ones.  Many of them we have hurt by using illicit(pot, meth etc) or licit Vicodin, Oxycontin) drugs.   Others of us have abused our relationships with explosive anger, inconsistent behavior (cycling), infidelity, excessive spending, or failure.

I remember my bottom and don't intend to go there again.

"I'm Peter and I will always have co-occurring illnesses."

Until next time,

Peter J. Dorsen, M.D., LADC

Life With Bipolar Is Possible and Can Be Fun With Proper Treatment

Peter J. Dorsen, M.D., LADC

Hey, Everyone. As Aaaanold says, "I'm back." AS long as I'm not sounding like Clint, I'm gonna be OK.

I apologize that so much time has elapsed since my last blog. One learns to live with success and failure. As that goes, I am about to hear that my license to practice alcohol and drug counseling (LADC) no longer has Rules and Stipulations. Most of what all that was about was The Board watching me for 5 years and confirming I was stable with my bipolar disorder.

Frankly, no one but myself was ever worked up about co-occurring illness, in my case something just as simple as throwing my illness haywire with mood altering substances.

Whew! This a good thing and things just seem to be fitting into place. I am able to deal with pressures that include instances like that with the Board that I find humiliating.My sponsor, John B, tells me he was never poorer than when he entered recovery. Boy, that's great to hear.  Does that men that I have to take a vow of poverty. No. It tells me and indirectly you who will read my blog that moving forward with a stable bipolar life can still have some bumps.  My point in writing is that proper medication and sobriety, as in my case, can--as I explained some time back-- mean a level playing field.
I attribute an improved life as one in which I am constantly doing personal checks and sometimes asking my therapist or psychiatrist if they are comfortable with where I am, my moods, my behavior as they observe it.

I try as best I can to be honest. I have had to report that Trileptal made me dizzy. Heck, I kept on flying off the track last year at cross country ski races. We moved on to lamotrigine but I must confess after I went the wrong way on a course I knew I had to convince my prescriber I was on too much.  Hell, I'm 69 next month (which is very hard to believe), if my coronaries clogged 7 years ago, it doesn't come as a surprise that some of my brain blood vessels have also narrowed some.

My point: Stand up to your provider and don't just stop your meds but challenge, ask questions, and refuse until you get what you deserve.  There are actually psychiatrists I believe fear the mental illnesses that they claim to be qualified to treat. Find a new shrink or therapist who you may feel does not respect you. Hey team, we bipolars are the ones who besides being dysfunctional also are the most creative, the most driven.

I'm welcoming myself back and encourage all of you who gravitate to our blog to tell us what you think about living with a treatable condition.  We're right up there as the most likely to quit taking our meds.  I know, I need them and that my life has taken a beautiful direction with caring professional who listen, are not on the defensive, who do not fear their own mental heath issues that we mirror.

No one said this would be easy. There are plenty of those who have known us who would judge.  That is why impartial opinion and professional expertise mean so much.

Tell us your journey.  We are here to listen and respond. Blessings,

Peter J. Dorsen, M.D., LADC

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!

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?

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

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.