Trauma And Bipolar Disorder: Chicken Or Egg?

Photo by haik ourfal on Unsplash

Content Note: This post mentions trauma. It does not include specific details.

It’s a little acknowledged truth that sometimes bipolar disorder does not spring from a history of trauma. On my first admission to hospital and every admission since, I have been asked whether trauma smoulders in my past, and keeps the fire of my bipolar disorder burning.

Up until relatively recently parents were still automatically blamed for their children’s mental illnesses, particularly schizophrenia and bipolar disorder. And while abusive parenting can be a contributing factor to these illnesses, and parents can pass on a genetic predisposition to a highly heritable mental illness such as bipolar disorder, beyond that, a parent isn’t responsible. As for my upbringing – my parents were not perfect. But they were loving and supportive. They were not a source of trauma.

I searched for years for some of the more common culprits of a trauma history (such as physical, sexual, or emotional abuse) hiding in the shadows. I ran a fine-toothed comb through my entire living memory for evidence. For something to explain the existence and severity of my bipolar 1 disorder.

After the second time I got sick, I began to wonder if I was missing something. If I had blocked out something horrible? I spent close to a year working with both my psychologist and psychiatrist to try and unearth a tangible cause for the god awfulness that had descended on me. And I came across a lot of things in this archaeological dig through my psyche.

Among many happy memories. I found sadness, exclusion, some bullying. I found burnout and disappointment. I found ambition and perfectionism. I found drive. I found questionable decisions. I found some experiences that my psychiatrist raised his eyebrows at, but when my psychologist worked through them with me, we found no symptoms of PTSD, no persistent feelings of powerlessness. I found experiences that were difficult and unpleasant and challenging.

But I did not find trauma.

Ironically, the only trauma I have ever experienced came with this illness in the form of psychosis, especially the first episode. Nothing I have experienced before or since that first time comes close to the hell of psychosis.

For me, the sudden onset of this severe psychiatric symptom contributed to its traumatic footprint. One week I was due to give birth to my first baby, with no history of mental illness. The following week I inhabited a terrifying alternate reality that no one else could see, in a psychiatric hospital Special Care Unit, tipping highly medicated breastmilk down the sink, while my husband looked after our new baby at home. For me, the experience of psychosis is the definition of terror and powerlessness.

The trauma of psychosis left its mark. After my second episode I started having panic attacks. I had never had them before. They were linked to the fear of psychosis recurring.

It took a long time to process what happened to me and to learn to live with the ongoing implications of this illness. But I am fortunate it was an acute trauma, not chronic or complex, and not of childhood onset. It didn’t happen at a time when my brain was still developing and more vulnerable to this kind of assault.

I have worked towards having excellent insight, which means I now recognise the precursor symptoms of mania, which can lead to psychosis. The early detection of symptoms and acting on them immediately have meant it’s been six years now since I’ve experienced true symptoms of psychosis. The deep sense of powerlessness has eased. In my case the trauma was a side effect of my bipolar disorder, not a causal factor.

But I sense I am in the minority. Of the people I know who also live with bipolar disorder many carry a history of trauma and/ or complex PTSD with them which, occurred before the emergence of their bipolar disorder.

I do not have the complication of a contributing trauma to re-trigger episodes of illness and to work through. These days, I don’t have a knotted web of psychological issues to untangle before my medication can get to work. I also think letting go of my resentful feelings at being landed with this illness has been somewhat easier because I can’t lay blame or direct my anger at anyone or anything  specific for causing this sickness.

And I am grateful for all of that.

If this post has brought up difficult feelings or symptoms for you and you are struggling, please contact your mental health professional. If you are in crisis (and in Australia) please phone LIFELINE on 13 11 14

Further reading:

Insight: The Essential Ingredient

My First Time

Misunderstood Mania

Vulnerability And The Exploitation Of Kanye West

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Kanye West is unwell again. Hurtling through a manic Bipolar episode while the world laughs. And as someone who lives with Bipolar 1 Disorder, I feel for him.

In the early years after my diagnosis, during one manic episode (while hospitalised) I started discussing my sex life with strangers. My friend who was visiting me steered me gently away.

Kanye doesn’t seem to have anyone to steer him away, gently or otherwise.

Kanye is a wealthy, influential man, who probably has access to the best mental health care available. But I don’t believe his problem is accessing top quality care.

His problem is that he lacks insight and no one around him is game to have the difficult conversations with him. The conversations that point out that while he may be a brilliant artist when he is relatively stable, when he develops manic symptoms his brain needs a break from the world, and the world is not entitled to its contents.

Instead, when Kanye becomes unwell his mania is left to run free.

He has been open about his choice not to take medication to help manage his Bipolar Disorder. That is his right. Medication doesn’t work for or agree with everyone.

But he seems to be unaware that to successfully manage this illness without medication, you need to employ other strategies. You need to hone your insight. And if your insight when you are unwell is shaky, you need a mental health directive.

This means sitting down with your doctors and people closest to you when you are well and discussing how you would like to manage your symptoms when you are unwell. And if you experience manic episodes, one of the most basic requests may be to not have access to the media – social or otherwise – while symptomatic. Why?

Because mania can gobble up your inhibitions, make you see the world through a paranoid lens, and sprout delusions of grandeur.

Kanye recently gave an interview to Forbes magazine during which he rambled for four hours, to this effect:

‘…They want to put chips inside of us, they want to do all kinds of things, to make it where we can’t cross the gates of heaven. I’m sorry when I say they, the humans that have the Devil inside them. And the sad thing is that, the saddest thing is that we all won’t make it to heaven, that there’ll be some of us that do not make it.”

“Clean up the chemicals. In our deodorant, in our toothpaste, there are chemicals that affect our ability to be of service to God.”

If Kanye were a homeless man on a street corner sharing these ideas with the world, the interviewer from Forbes magazine would probably have walked past quickly, maybe shuddering at such overt insanity.

Instead that interviewer sat and listened to him for four hours. Noted down delusional quote after quote and then published an article in which they even describe Kanye’s lack of awareness:

‘If it all sounds like a parody, or a particularly surreal episode of Keeping Up With The Kardashians, West doesn’t seem to be in on it.’

Of course West isn’t in on it! He is walled off from reality by illness.

Did that interviewer ever pause to consider why much of what Kanye was saying made no sense? I suspect (with disgust) that they were fully aware their high profile subject was mentally unwell, but chose to exploit him while he was most vulnerable.

I have written thousands of words I thought were brilliant, while in the grip of mania. But once my symptoms recede, I am relieved no one else has read these largely nonsensical word vomits. Because if they had, that would invalidate the quality of my writing when I am healthy.

But Kanye’s word vomits are out there for all the world to snidely pick at, to brand him a rambling idiot and someone to be sniggered at.

At the time of publishing this post, headlines announcing Kanye’s withdrawal from the presidential race are emerging.

I understand stress and sleep deprivation are a president’s companions for most of their time in office, that pushing through is a corner stone of juggling the demands of the job.

Stress and sleep deprivation are the perfect fertiliser for Bipolar episodes to flourish. Bipolar episodes, once active, can’t simply be pushed through. They have no respect for deadlines or work demands – let alone international or national emergencies.

Whether Kanye recognised the risks of pursuing the presidency himself or whether someone in his circle came forward to have the hard conversations and steered him gently away, I am relieved for him.

 

You may also be interested in:

Misunderstood Mania

Psychiatric Medication And Stigma

If I Were Kanye Westwritten two years ago with a different angle to this post

 

 

 

When Covid-19 And Bipolar Recovery Collide With Unexpected Results

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I have spent the last five weeks in a psychiatric hospital for management of a Bipolar 1 Disorder episode.

I am no longer sick. But still fragile. Like an egg without its shell. I always reach a point on the return to wellness where I can get no better in the controlled bubble world of the hospital. A point where staying longer is of no benefit and can even become detrimental.

I ventured back out into the world at the end of last week. A world that hasn’t grown any softer in my absence. It is the same hustling harsh, bruising, breaking place it always has been, but perhaps more so. No one was fighting over toilet paper five weeks ago.

That said, after any admission for a Bipolar episode, jumping back into my life can feel like steel wool on newborn skin in the early days.

No one can tell by looking at me when I leave the hospital that I need rehab and resilience building before I am ok again. For me, on average that takes the same amount of time I was hospitalised for. So, in this case – another five weeks.

People tend to be congratulatory about me being well enough to come home. I don’t want to be a downer. I am grateful to be home. But just because I’m out of hospital it doesn’t necessarily mean it’s over. It can look like it is slinking away not to be seen again for a couple of years. But appearances can be deceiving.

Once, this illness spent a whole year of my life bouncing me in and out of hospital so often, I got dizzy. By the end of that year, in which most months had held a hospital admission for me, it had nearly killed me. So, that’s why I don’t think about exhaling as soon as I am home.

Today is my fourth day at home. I am still acclimatising. But I also recognise something unexpectedly positive borne of the last five weeks.

Being in hospital with Bipolar symptoms has prepared me for the Covid-19 headlines very nicely.

I get a sense from these headlines and the empty toilet paper and pasta aisles in the supermarket that many people are panicking, or at least are very worried by the uncertainty they are being force fed right now.

I am still in the mindset it took to get through my last five weeks. I lived that time (and do every time I go into hospital) in two-day increments. Why? because it is pointless to look or plan any further ahead. Neither I nor my psychiatrist could fortune tell what would happen. Five weeks of observing, tweaking medication or not, and then waiting another two days before assessing again.

To be clear, there is a difference between not taking something seriously, and choosing to engage only in what is in front of you. I take my Bipolar Disorder seriously, especially when it flares. But does that mean it would be helpful to spend my entire admission panicking that this is the time I become a permanent inpatient (they exist)?

Or should I break it into chunks the size of a couple of days and hit repeat, until at some unknown time in the future I am out the other side?

I’ve spent early admissions, years ago, engaging in the first option but have learnt that the way through with the least energy wasted is the second one.

In the same way, I take the Covid-19 pandemic seriously. But you won’t find me panic buying or worrying about whether or when it will end. Breaking this issue down into two-day increments feels helpful to me right now. Every two days (or sooner if the headlines change dramatically) I reassess the basics: Do I and my immediate family have enough food, water, medication and accommodation for the next two days? I am fortunate. So, far the answer has been yes.

Is there any point in trying to predict what might happen next month or even next week, and worrying about it?

None!

Because no one knows where we will be then. You can only act on the information you have at the time.  And if right now your basic needs are met and you are well, don’t buy more and more and more food or toilet paper (unless you are doing it for the vulnerable members of our population).

Breaking the overwhelm of a difficult situation with no known endpoint into smaller portions lessens the strain on our mental health and preserves our energy for more productive tasks.

And if we do it often enough that’s what will get us to the other side of this situation too.

 

You may also be interested in:

What a mental illness can teach you about your mental health

Where’s Your Comfort Zone?

Interruption To Regular Programming

Update 27.2.2020

 

Interruption To Regular Programming

red white and yellow medication pills
Photo by Anna Shvets on Pexels.com

I am in hospital, compromised by my standard symptoms that precede a manic or depressive episode. Looking more manic at this point though. The three symptoms are: lack of concentration, loss of short term memory, and pathological irritability.

If you have never been ravaged by them, then listing these symptoms can make it sound as though I am just a bit ditzy and cranky.

So wrong.

It’s going to take it out of me but let me see if I can paint a more accurate portrait of this beast. I am not yet so sick that it has silenced me.

The memory loss and lack of concentration leave my brain moth eaten. Holding onto thoughts long enough to articulate them takes a lot of effort. It is like using tweezers to try and catch tiny fish darting around in a big aquarium.

And the irritability? Surely as a rational, compassionate human being I should not feel so permanently unreasonable. I always insert the word ‘pathological’ in front of this symptom to try and describe just how out of control the stream of swear words is that run through my head when I am surrounded by people within ten metres of my personal space.

I say ‘pathological’ to describe the feeling of having hundreds of mosquito bites, my hands tied, and someone running a feather over the bites while they make fun of me. Sometimes it feels more like I’ve been sandpapered and then doused in lemon juice.

It is excruciating.

I will eventually get better. I always do. I know in time I will have the reserves to write properly again, and I will eventually go home and continue to rehabilitate. But for now, any spare energy is going towards doing what I need to do to get well, and if anything is left over it is going towards giving some moral support to my husband and children. So there may be some time between posts.

I always hope it won’t be too long but have been here often enough to know that it will take the time it takes and focusing on it won’t speed my recovery.

Stay tuned.

You may also be interested in:

Misunderstood Mania

My First Time

 

 

Misunderstood Mania

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What do you know about mania?

Everyone knows depression is bad. But does this mean mania is good because it supposedly sits at the opposite end of the bipolar spectrum?

Mania is often painted as the cartoonish counterpoint to depression. Perpetually bright, happy, and fun. But it is not fun. It is the character in a horror movie who starts out friendly but then morphs into someone with sinister, glowing eyes.

Mania assaults your senses.

Continue reading “Misunderstood Mania”

Lessons For A Control Freak

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Image courtesy of Flow Magazine

I have a somewhat unhealthy relationship with control. I rely on having it a little too much. Throw me an unexpected traffic jam, and I’ll feel no more or less anxious than the next person. However, when control goes AWOL from the bigger areas of my life my stress levels sky rocket.

I have been seeing my psychologist for years now. Some visits neither of us have to work hard to tweak things. But whenever there’s a larger life issue I’m struggling with, my distress almost always comes down to my lack of control over an undesirable situation. For me one of the worst-case scenarios are sleep deprivation  combined with the stress of a sick child. The reason this combination is so triggering is that it is kryptonite to my defences against a bipolar episode. (Sleep deprivation especially accompanied by stress is a major risk factor for developing manic and psychotic episodes)

This said, I firmly believe the universe sometimes sits back stroking its chin and assesses where I’m at. And then as though giving me a cosmic performance review, it points out areas for improvement, and gives me the opportunities to practice the life skills I lack. Clearly, I still need a lot of practice accepting a lack of control, because I have been sent the following homework:

Continue reading “Lessons For A Control Freak”

Piloting A Jumbo Jet

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The manic symptoms have almost all subsided, probably due to pushing the Lithium dose up. And so far, no signs of Lithium toxicity. I am now waking up every 3-4 hours for more medication instead of every 1-2, which is a huge relief.

So where does that leave me? Fixed? All better? If only it were that simple.

In the first instance it leaves me absolutely exhausted. The energy credit card the manic symptoms racked up with insomnia, over-exercising, not being able to sit still or shut up, and thoughts firing for 23 hours a day, is demanding payment.

Continue reading “Piloting A Jumbo Jet”

Flying Into The Sun

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Manic exercising on an hour’s sleep

I didn’t have to wait long at all after I last posted for further symptoms to develop. Manic symptoms. Neurological symptoms. Some might argue with the ‘neurological’ description for a mental illness. But when you develop the short-term memory of an advanced stage Alzheimer’s patient, the attention span of a toddler, and irritability so pathological it hurts (feels like you’ve been coated in oil, rolled in sand, rubbed down with a towel, and then someone sprays lemon juice all over you.) virtually overnight, it feels neurological.

Continue reading “Flying Into The Sun”