Taking Step 1 with Bipolar Disorder

Timothy Kuss, LADC, LMFT
I am in recovery from bipolar disorder and chemical dependency. I also currently work as a CD counselor and family therapist in outpatient and residential CD treatment. I believe that taking step 1 for Bipolar Disorder is a lot like taking step 1 for our addiction. Many of us go through a period of denial. People in our family also go through a period of denial about our bipolar disorder.

Mental illness carries quite a stigma and is often seen as untreatable. Sometimes it is seen as a permanent disability, especially if we’ve seen family members or acquaintances suffering long hospitalizations and recurring tragedy related to episodes over the course of decades. Most people don’t understand that with today’s medications and therapy, hospitalizations can be avoided fewer, or at least briefer. Tragedies can be averted and clients can lead relatively normal lives and have careers and families.

My own Step 1 with bipolar disorder was delayed due to a series of misdiagnoses of Schizophrenia. Bipolar disorder, unfortunately, shares a typical age of onset with schizophrenia of 20 as well as the potential for psychosis during manic episodes. My experience with delusional thoughts was probably heightened by the fact that I had used LSD and other hallucinogens frequently. I was hospitalized and treated for an incorrect diagnosis with anti-psychotics such as Thorazine and Haldol, which made me feel and look like a zombie. Such an error in diagnosis served to make me deny my mental illness. However, fortunately this resulted in volunteering myself for long-term chemical dependency treatment.

Twenty-five years later while continuing my sobriety I had a series of manic episodes resulting in short hospital stays and finally got the diagnosis of bipolar disorder. My reaction was one of relief. They finally got it right! As I learned more about the symptoms of bipolar disorder, I was finally able to understand what had been happening to me. As a professional I have encountered many clients with the same reaction of gratitude after finally getting the right diagnosis. Many have had co-occurring addiction and mental illness.

Unfortunately, many of us struggle with the need to take medications to treat our Bipolar Disorder. I tried to wean myself off them at first, just as I had done with those incorrectly prescribed antipsychotics. Today, I understand that my mood-stabilizing meds do not have any negative side effects. They are my insurance policy. They keep me out of the psych wards and out of potentially life-threatening situations that seem to predictably occur when I get psychotic. During my last psychiatric hospitalization I spent 3 days in intensive care due to high blood pressure that resisted medical efforts to bring it down. I have also put myself in dangerous situations when manic, like when I wandered outside in the dead of winter with no clothing and only a sleeping bag and tennis shoes for cover. Another time, I became paranoid of aliens trying to kill my daughter and almost put her in grave danger.

OUR step 1 includes recognition of some “crazy” behavior and thinking. Others also with bipolar disorder can laugh with us about these old episodes just like other drunks can laugh with us about our crazy earlier drinking episodes. Accepting unmanageability comes with accepting that reality is different from our delusions. We were powerless as individuals to cope with our illness. But together and with help we can be in recovery. Step 2!

In summary, Step 1 of our dual recovery includes recognition that our chemical use increased our mental health dysfunction(symptoms). This is different than saying that the chemical use caused the symptoms. I proved after 25 years of sobriety that I can STILL have symptoms WITHOUT using. I can see, however, a constant stream of clients entering the doors of our MI-CD program because their chemical use led to repeated hospitalizations for psychosis. I’m pretty sure that I wouldn’t have struggled with 5 years of psychiatric admissions if someone had helped me understand that I had to stop using chemicals.

As a family therapist I have seen many co-dependents struggle with accepting the reality of the dual diagnosis of a loved one. To help them with their fears I have done my best to help them understand how addiction and mental illness coexist. Besides referring them to Alanon or Naranon I also refer them to NAMI, the National Alliance for the Mentally Ill, which has both education and support groups for clients and family members. In dual recovery just as with following the twelve steps of alcoholism or other addictions, we all need to practice recovery one day at a time.

I do.

Here's a Heads Up on Bipolar Options

Categorization of Bipolar Illness: DSM IV Resources: For Health Professionals
Mood Disorders
Major Depressive Episode: 2-weeks See Beck Inventory, Appendix A
Manic Episode: 1 week, elevated, expansive or irritable mood
Mixed Episode: Both manic and Major depressive Episode: 1-week
Hypomanic Episode: At least 4 days/No hospitalization required
Major Depressive Disorder(MDD). Single or Recurrent(2 Mo Int)
Dysthymic Disorder: Depressed Mood, at least 2 years
Depressive Disorder NOS, Not Otherwise Specified
Bipolar Disorders
Bipolar I Disorder
Single Manic: Presence of only one Manic Episode, no past MDE
Most Recent Episode Hypomanic*: At least one Manic Episode or
Mixed Episode
Most recent Episode Manic*( at least 1 Maj Dep Ep, Manic Ep, or
Mixed Ep
Most Recent Episode Mixed*
Most Recent Episode Depresssed*
Most Recent Episode Unspecified*
*Note: Any of these entities can be associated with rapid cycling

Bipolar II Disorder (recurrent major depressive Episodes With Hypomanic Episodes)*
One or more MDE, at least one hypomanic episode(no manic)
May be in partial or full remission
Note: May occur as rapid cycling
Cyclothymic Disorder
At least 2 years, hypomania, depressive symptoms(not
MDE). One year in children
Can see superimposed bipolar 1 or 2 after 2 years
Bipolar Disorder Not Otherwise Specified
Very rapid alternation (over days) between manic and depressive symptoms meeting symptom threshold criteria but not minimal duration criteria manic, hypomanic, or MDE. Also, the clinician may be unable to determine primary, medical, or substance induced.
Substance-Induced Mood Disorder
The problem developed within a month of substance use or withdrawal

The Latest Info On Life As I Know It

It’s been a few years since my last entry to Crazy Doctor. I am no longer a practicing medical doctor. I surrendered my medical license in 2005. While I was in the transitional process, I became a licensed drug and alcohol counselor (LADC) and tried my hand albeit perhaps less than successfully at two drug treatment jobs. The first offered minimal opportunity to function as an actual bone fide CD counselor and the second left me unhappy both with my new milieu and I encountered insufficient help to unravel the mysteries of the new technology of charting.

So what’s a professional gonna do? I never considered some of the alternative potential of my degrees only recently discovering a teaching opportunity at a Twin Cities acupuncture and Oriental medicine academy teaching Western medicine. Way back then, at the demise of my career as I had known it for thirty years, my ever so tolerant wife had off handedly suggested Sam’s Club which, on a lark, I joined first as a greeter until later moving to their gas station where I quickly discovered how to write, read, and even grade papers on the sly.

My sojourn with “big box” retail has had its heads and tails but a steady paycheck has definitely helped supplement my meager Social Security check. Now too, my teaching stipend has also helped crawling out of credit card debt. Oh, the woes of bankruptcy, divorce, and professional demise.
I have been relatively as clear as anyone can be of problems at Sam’s and have persevered for over four years through heat, rain, snow, and cold. None of the potential problems or issues have arisen as my multiple psychometric testing suggested could. But we were warned, of course, of more intellectual or stressful situations I was told rather glibly. I have shown good judgment, been responsible with work assignments and almost always been timely and never had an unexcused absence ( although I continue to pursue personal diversionary opportunities at a brainless job).

I and a fellow CD counselor who is bipolar 1 also with an addiction history have taken a shot at speaking about bipolar disorder and co-occurring addiction, Tim on bipolar 1 and I on bipolar 2. His journey has been scarred with several hospitalizations for psychosis. Mine has been marked with failures personally and professionally. Together, we have established and manage the blog, Bipolarvisions.blogspot.com and mutually try to report on our experiences with the co-occurring challenges of addiction and mental disorder.

It is extremely comforting receiving consistent feedback from intimate friends of a positive transformation to a euthymic state show compared with an earlier emotional lability. People with bipolar disorder are known to wreak havoc with marriage. I know, I’m on my second and so is Tim. Although neither of us are ready to report a bliss state, gone are the impossible psychotic episodes or, in my case, explosive anger.

Those of us with this challenge, are known to change jobs frequently sometimes with the frequency “normies” change underwear. I have been at Sam’s over four years and am engaged in a monogamous relationship and marriage I must work at continually. Sure, I still make my share of mistakes, have my emotional ups and downs, trials and tribulations. I still cherish that I can be there to give what I can to this relatively new relationship. I often must struggle just to offer another adult presence for my wife’s four now-adult children. Sometimes, it is hard for me not to judge her children or to adjust to the lack of space in my new family environment.
It has been readily clear from the outset that my moods can certainly reflect conflicts or challenges dealing with stepchildren but only rarely with my new primary relationship. I show impatience dealing with stubborn post adolescents who very much deserve a mind of their own.

My medications, the anti seizure mood stabilizer, Depakote has no side effects other than lowering my platelet count. I have none of the tardive dyskinesia (TD) I experienced on Zyprexa with or without Abilify ( in my mind falsely advertised as an antidepressant). I am readying my two classes for next trimester and feeling comfortable with these challenges. My biggest challenge in one will be how to enliven the presentation to keep students awake.

Those in the Mankind Project (New Warriors), where I derive so much peer support, respect my “gold,” as we call our strengths or accomplishments for which we must take credit. My fellow “I” or “Integration” group partners with whom I meet for three hours biweekly, encourage me to risk change and seek greener pastures. I have grown increasingly disillusioned with cognitive behavioral therapy(CBT) and received recent strokes from a practicing octogenarian psychiatrist that I demonstrated an impressive gift for dynamic interactive therapy. He has offered to supervise me with any clients I should undertake to counsel. I am heartily prepared to go that direction. There are some delightful opportunities awaiting me just by opening up the myriad of possibilities that await me