My Chaos Narrative: 67 Years of Bipolar Disorder: Part 2

Discussion in 'Mental Health Disorders' started by RonPrice, Dec 10, 2010.

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  1. RonPrice

    RonPrice Member

    After posting the first part of my story here over six months ago, and after some responses I post below part 2. For those who find long posts difficult to read, I suggest they just skim and/or scan the paragraphs below.-Ron Price Tasmania
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    1.6 The goal of what is sometimes called ‘personalized medicine’ is to utilize a person's genetic makeup for appropriate disease diagnosis and treatment, an idea conceptualized initially in the recent years of the Human Genome Project. The current conceptualisation of MD/BPD can be traced back, as I indicated briefly above, to the 1850s, although its history can be traced as far back as ancient history in Turkey. Both terms, MD and psychosis, were coined in 1875 by Jules Falret, a French psychiatrist and he recognized its genetic link. German psychiatrist Emil Kraepelin (1856–1926), the founder of modern psychopharmacology, also made a major contribution to the early understanding of MD/BPD, only one of the many disorders in the general mood disorder category, but a cyclical mood disorder associated with a circularity between D and euphoria.

    1.7 About 37,000 years ago Neanderthals arguably intermingled with modern humans and thus a new gene entered the human genome, the DRD4 7R gene. This gene arguably originated from Neanderthals. This gene is associated with risk-taking, sensation-seeking and novelty-seeking, and correlated with openness to new experiences, intolerance to monotony, and exploratory behavior, features of Neanderthal behaviour. About 10% of the population have the activated DRD4 7R gene. So goes yet another theory on the genetic predisposition to BPD.

    1.8 All manifestations of BPD share uncertain etiologies, with often opaque, obscure, relationships between genes and environment. Some medical experts and theorists in the field of such studies posit latent changes in the expression of specific genes initially primed at the developmental stage of life. Some studies and some experts emphasize that certain environmental agents disturb gene regulation in a long-term manner, beginning at early developmental stages in the lifespan perhaps even in utero.

    1.8.1 These disturbances, these perturbations, as they are sometimes called, might not have pathological results until significantly later in life. In retrospect, as I look back from these middle years(65-75) of late adulthood, the years 60 to 80 as some developmental psychologists call these years of the lifespan, these perturbations and pathological results were clearly manifested at the age of 18. I could easily theorize an earlier onset on the basis of behavioural perturbations manifested in early childhood and into adolescence and I do such theorizing later in this account(see sections 2.7.1 and 2.7.2 below). The change from psychodynamic models of psychiatry to neurobiologic models that dominate the discipline today has been a critical determinant in both my story and its treatment by the psychiatric profession.

    1.9 I received two or three diagnoses between 1963 and 1980 from psychiatrists, friends, family, GPs and concerned others. The diagnosis that was made in 1980, namely, BPD, is a diagnosis that is standardized according The Diagnostic and Statistical Manual of Mental Disorders (DSMMD-IV) which provides diagnostic criteria for mental disorders. I use the term BPD not MD throughout this document and I use that acronym. In the DSM-IV MD is a 5 axis/level system of diagnosis that is used.

    1.9.1 In my case, axis/level 1 is for clinical disorders that are mood disorders. Axis 3 in this system is for what they refer to as acute medical concerns that relate to BPD; axis-4 is for psycho-social and environmental problems that contribute to BPD and axis-5 is an overall caregiver’s assessment of my functioning on a scale 1 to 100. Most of the successful diagnoses and treatment of my BPD have come from psychopharmacology and its roots in physiological assumptions. In the last decade, say, 2000 to 2010, talking cures and behaviour modification techniques like cognitive behaviour therapy with their roots, their emphasis on assumptions in the domain of intrapsychic experience have also been successful as adjuncts to medications or separate from them.

    1.9.2 In my case, my caregiver, namely my wife, evaluated me at 61-70 on the numeric scale. This place on the scale reads as follows: “this adult has some mild symptoms as well as some difficulty in social and occupational functioning. Generally, though, he functions pretty well. He also has some meaningful interpersonal relationships." The bar is set quite high by government departments in order for my wife to get a Caregiver’s Allowance and so it is that she and I have not seriously considered applying for such an allowance. My symptoms are not sufficiently extreme for her to qualify as my Caregiver. Readers wanting access to this diagnostic tool can easily find it on the internet. I have appended it to this statement in appendix 2.

    1.10 The literature now available to those wanting to explore the subject, the field of BPD, is massive both on the internet and off and much of it should be considered by readers wanting to become more familiar with BPD. My story is only one of thousands, if not 100s of thousands, now available. Readers wanting what to me is the best resource to help them deal with BPD should go to Sarah Freeman, The Bipolar Toolkit, 2009. It is far better than this personal, idiosyncratic and non-systematic account.

    1.11 BPD is not medically curable but it is possible through psychiatry, medicine, some types of talk therapy and nutritional supplements or adjuncts, as I say above, to achieve varying degrees/periods of long-term stability. I feel I have achieved this stability by degrees since the 1960s. This is not to say that I have never had any more episodes since those 1960s, that I have not become hypomanic again nor exhibited other symptoms of BPD. I have had five, and arguably as many as seven, decades of experience of BPD symptoms and some of these symptoms are still in my day-to-day life. This lengthy 70,000 word statement is an account of my experience in achieving varying degrees of stability at various periods of my life.

    1.11.1 I should emphasize at the outset of this statement that any research showing that some form of psychotherapy or talk therapy is an effective substitute for medication is not something I entertain seriously after 30 years of dependence(1980-2010) on mood stabilizers and anti-depressant medications. I may seriously consider engaging in talk therapy in the years ahead. Time will tell. I have taken medication in some form as far back as June 1968. Although I acknowledge the research showing that health food and nutritional supplements like fish oil, for example and/or vitamins and minerals and/or amino acid(s) are effective for BPD, and although I in fact take these supplements, I am still not prepared now after all these years to ‘go-it-alone’ without the medication. Both my GP and my psychiatrist concur with this decision.

    I could go to see a counsellor, psychologist or a clinical psychologist for this talk therapy, perhaps CBT. My psychiatrist is a specialist in pharmacology and in treating BPD. Psychiatrists are more trained in pharmacology than psychologists. Some critics of psychiatry and psychiatrists go so far as to say pharmacology is their "weapon" against mental illness. I do not see my shrink, my psychiatrist, as using chemotherapy as a weapon in his arsenal. I only see him now every two or three years because my needs are chemical and I have been taking the same 2 meds for three years(2007-2010). I did discuss my memory and OCD issues with him but he felt they were not serious enough for me to concern myself. Often my regular doctor, my GP, nails my problems and takes away any need I have to see my psychiatrist.

    1.11.2 There is a world of language associated with an attempt like this to describe a lifetime of BPD. I only try to define some of the terms. For me the words short term apply to: today, this week and this month; medium term applies to a period of two months to a year and the two words long term applies to all the time after one year in my personal medical history, retrospectively or prospectively. I try, as far as it is logically possible to use the term mental health or mental distress and not mental illness. This has been a recent emphasis in mental health discussions and in the literature. Apologies at the outset of this statement for the occasional use of complex language. The field of mental health is replete with complex terminology. It is helpful for those with different types of mental health problems to become as familiar as they can with this language. I try for the most part to use simple language—but I do not always achieve this aim.

    1.11.2.1 A good example of the language difficulties is the following part of this paragraph discussing the neurobiological bases of behavioural differences. The language used by specialists is often way over one’s head, both the head of the sufferer from BPD and the heads of others wanting to understand the disability. (See Erik Kandel, “A Biology of Mental Disorder,” Newsweek, June 27, 2009; and C. Langan & C McDonald, “Neurobiological Trait Abnormalities in BPD,” Molecular Psychiatry, Vol. 14, pp. 833–846, published online on 19 May 2009)

    These two sources provide many excellent examples of this language complexity. The abstract of this article with this complex language is as follows: “Dissecting trait neurobiological abnormalities in BPD from those characterizing episodes of mood disturbance will help elucidate the aetiopathogenesis of the illness. This selective review highlights the immunological, neuroendocrinological, molecular biological and neuroimaging abnormalities characteristic of BD, with a focus on those likely to reflect trait abnormalities by virtue of their presence in euthymic/normal patients or in unaffected relatives of patients at high genetic liability for illness. Trait neurobiological abnormalities of BPD include heightened pro-inflammatory function and hypothalamic–pituitary–adrenal axis dysfunction.”

    1.12 My wife, Chris, has suffered from different disorders all of our married life as well as in the years before our marriage in 1975. Her story is long with invasive surgery for two mastectomies and a hysterectomy as well as post-natal depression following two pregnancies and major psycho-social-family problems. I have not included her story here in any detail except in a tangential sense when it seems relevant to my own experience of BPD. The references in this account to the three major families in my life: my consanguineal family(birth), my two affinal families(marriages) and their many extensions(children and cousins, aunts and uncles, etc.), my work experience and my values are emphasised in this account, but only briefly and only en passant. My religion, the Baha’i Faith, which provides the major base for my values, beliefs and attitudes, is also important--but I do not focus on this Faith here, except in an indirect way. However important this religion has been to me in the past and in the present I do not refer to it except, as I say, en passant in my elaboration of my experience of BPD.

    1.13 The new diagnostic term, BPD, is now found in the Diagnostic and Statistical Manual of Mental Disorders-IV published by the American Psychiatric Association in 1994. DSM-III had 300 disorders twice as many as in the DSM-II. DSM-V is due for publication in 2013. The DSM is considered the bible by specialists and by the various professions and other interest groups. It is considered by many as a core/basic information source, a major scientific instrument in the field of mental health. In the DSM-IV the term maniac was deleted and the one-size-fits-all classification system for MD and BPD was more finely tuned by the 4th edition published in 1994. The exact discourse that has come to have jurisdiction in this labelling process, the circumstances that have come to result in a person given some mental illness label are due to: (a) norms and expectations as well as (b) medical, psychological, physiological and (c) most recently, neurochemical and electrical brain activity as seen in brain imaging.

    1.14 This account also provides a statement of my most recent experiences with BPD in the last three years, 2007-2010. Some prospective analysis of my illness is also included with the view to assessing: potential short term, medium term and long-term strategies, appropriate lifestyle choices and activities in which to engage in the years ahead in these middle years(65-75) of late adulthood(60-80) and old age(80++), if I last that long. For the most part, though, this account, this statement I have written here in some 70,000 words, is an outline, a description, of this partially genetically predisposing family-based illness and of my experience with it throughout my life. I would, though, discourage others from blaming their parents for their genetic contribution to the disorders. I would also discourage them from blaming other family members for their contributions in the form of stress and conflict and failure to understand. Rather than wasting time and energy in finger-pointing or bemoaning the fact that one has BPD, I would encourage sufferers to learn how to best use available treatment programs, or modalities as they are sometimes called in the literature, to minimize their symptoms and to find success and satisfaction in their lives despite their disorder.
    -PART 3 TO COME AFTER SOME RELEVANT FEEDBACK--------
     
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  2. In Limbo

    In Limbo Forum Buddy

    "I would also discourage them from blaming other family members for their contributions in the form of stress and conflict and failure to understand"

    I don't know if your article pertains solely to BPD or mental health problems in general, but I'd add that while I agree that discouraging such feelings is the right way, that this is in some cases impossible to do. Perhaps a better way of dealing with it, (and I have no experience thank goodness of any traumas from my family upbringing), would be to say that it's OK to apportion blame as long as one can from that point move on and find ways to cope with that blame?

    Just my initial two penn'orth
     
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